II 

118TH CONGRESS 

2D SESSION S. 4773 

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

IN THE SENATE OF THE UNITED STATES 

JULY 25, 2024 

Ms. HIRONO (for herself, Mr. PADILLA, Mr. BOOKER, Ms. WARREN, Ms. 

DUCKWORTH, Mr. WARNOCK, Mr. CARDIN, Mr. WELCH, and Mr. 

BLUMENTHAL) 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 2024’’. 

6 SEC. 2. TABLE OF CONTENTS. 

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

Sec. 1. Short title. 

Sec. 2. Table of contents. 

TITLE I—DATA COLLECTION AND REPORTING 


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Sec. 1001. Strengthening data collection, improving data analysis, and expanding data reporting. 

Sec. 1002. Elimination of prerequisite of direct appropriations for data collection and analysis. 

Sec. 1003. Collection of data for the Medicare program. 

Sec. 1004. Revision of HIPAA claims standards. 

Sec. 1005. National Center for Health Statistics. 

Sec. 1006. Disparities data collected by the Federal Government. 

Sec. 1007. Data collection and analysis grants to minority-serving institutions. 

Sec. 1008. Safety and effectiveness of drugs with respect to racial and ethnic 

background. 

Sec. 1009. Improving health data regarding Native Hawaiians and Pacific Islanders. 

Sec. 1010. Clarification of simplified administrative reporting requirement. 

Sec. 1011. Data collection regarding pandemic preparedness, testing, infections, 

and deaths. 

Sec. 1012. Commission on Ensuring Data for Health Equity. 

Sec. 1013. Task Force on Preventing Bias in AI and Algorithms. 

Sec. 1014. Report on the health of the Middle Eastern and North African population. 

TITLE II—CULTURALLY AND LINGUISTICALLY APPROPRIATE 

HEALTH AND HEALTH CARE 

Sec. 2001. Definitions. 

Sec. 2002. Improving access to services for individuals with limited English 

proficiency. 

Sec. 2003. Ensuring standards for culturally and linguistically appropriate 

services in health care. 

Sec. 2004. Culturally and linguistically appropriate health care in the Public 

Health Service Act. 

Sec. 2005. Pilot program for improvement and development of State medical 

interpreting services. 

Sec. 2006. Training tomorrow’s doctors for culturally and linguistically appropriate care: graduate medical education. 

Sec. 2007. Federal reimbursement for culturally and linguistically appropriate 

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

Health Insurance Programs. 

Sec. 2008. Increasing understanding of and improving health literacy. 

Sec. 2009. Requirements for health programs or activities receiving Federal 

funds. 

Sec. 2010. Report on Federal efforts to provide culturally and linguistically appropriate health care services. 

Sec. 2011. English instruction for individuals with limited English proficiency. 

Sec. 2012. Implementation. 

Sec. 2013. Language access services. 

Sec. 2014. Medically underserved populations. 

TITLE III—HEALTH WORKFORCE DIVERSITY 

Sec. 3001. Amendment to the Public Health Service Act. 

Sec. 3002. Hispanic-serving institutions, historically Black colleges and universities, historically Black professional or graduate institutions, 

Asian American and Native American Pacific Islander-serving 

institutions, Tribal Colleges, regional community-based organizations, and national minority medical associations. 


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Sec. 3003. Loan repayment program of Centers for Disease Control and Prevention. 

Sec. 3004. Cooperative agreements for online degree programs at schools of 

public health and schools of allied health. 

Sec. 3005. National Health Care Workforce Commission. 

Sec. 3006. Scholarship and fellowship programs. 

Sec. 3007. McNair Postbaccalaureate Achievement Program. 

Sec. 3008. Rules for determination of full-time equivalent residents for cost-reporting periods. 

Sec. 3009. Developing and implementing strategies for local health equity. 

Sec. 3010. Health Professions Workforce Fund. 

Sec. 3011. Future advancement of academic nursing. 

Sec. 3012. Sense of Congress relating to graduate medical education. 

Sec. 3013. Career support for skilled, internationally educated health professionals. 

Sec. 3014. Study and report on strategies for increasing diversity. 

Sec. 3015. Conrad State 30 program; physician retention. 

Sec. 3016. Grants for schools of medicine and schools of osteopathic medicine 

in underserved areas. 

TITLE IV—IMPROVING HEALTH CARE ACCESS AND QUALITY 

Sec. 4000. Definition. 

Subtitle A—Reducing Barriers to Accessing Care 

Sec. 4001. Protecting protected areas. 

Sec. 4002. Repeal of requirement for documentation evidencing citizenship or 

nationality under the Medicaid program. 

Sec. 4003. LIFT the BAR Act. 

Sec. 4004. Improve affordability and reduce premium costs of health insurance 

for consumers. 

Sec. 4005. Removing citizenship and immigration barriers to access to affordable health care under the ACA. 

Sec. 4006. HEAL for Immigrant Families Act. 

Sec. 4007. Study on the uninsured. 

Sec. 4008. Medicaid fallback coverage program for low-income adults in nonexpansion States. 

Sec. 4009. Increase and extension of temporary enhanced FMAP for States 

which begin to expend amounts for certain mandatory individuals. 

Subtitle B—Improvement of Coverage 

Sec. 4101. Medicaid in the territories. 

Sec. 4102. Extension of the Supplemental Security Income Program to Puerto 

Rico, the United States Virgin Islands, Guam, and American 

Samoa. 

Sec. 4103. Extension of Medicare secondary payer. 

Sec. 4104. Indian defined in title I of the Patient Protection and Affordable 

Care Act. 

Sec. 4105. Removing Medicare barrier to health care. 

Sec. 4106. Lowering Medicare premiums and prescription drug costs. 

Sec. 4107. Reducing cost-sharing, aligning income and resource eligibility tests, 

simplifying enrollment, and other program improvements for 

low-income beneficiaries. 


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Sec. 4108. 100 percent FMAP for medical assistance provided by urban Indian 

organizations. 

Sec. 4109. 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. 4110. Repeal of requirement for estate recovery under the Medicaid program. 

Sec. 4111. Allow for suspension of Medicare benefits and premium liability for 

individuals who are incarcerated and provide a special enrollment period around the date of release. 

Sec. 4112. Federal employee health benefits plans. 

Sec. 4113. Continuation of Medicaid income eligibility standard for pregnant 

individuals and infants. 

Subtitle C—Expansion of Access 

PART 1—GENERAL PROVISIONS

Sec. 4201. Amendment to the Public Health Service Act. 

Sec. 4202. Border health grants. 

Sec. 4203. Critical access hospital improvements. 

Sec. 4204. Medicare remote monitoring pilot projects. 

Sec. 4205. Community health center collaborative access expansion. 

Sec. 4206. Facilitating the provision of telehealth services across State lines. 

Sec. 4207. Scoring of preventive health savings. 

Sec. 4208. Sense of Congress on maintenance of effort provisions regarding 

children’s health. 

Sec. 4209. Protection of the HHS Offices of Minority Health. 

Sec. 4210. Office of Minority Health in Veterans Health Administration of Department of Veterans Affairs. 

Sec. 4211. Study of DSH payments to ensure hospital access for low-income 

patients. 

Sec. 4212. Reauthorization of programs under the Native Hawaiian Health 

Care Improvement Act. 

PART 2—RURAL

Sec. 4221. Establishment of Rural Community Hospital (RCH) Program. 

Sec. 4222. Rural Health Quality Advisory Commission and demonstration 

projects. 

Sec. 4223. Rural health care services. 

PART 3—INDIAN COMMUNITIES

Sec. 4231. Assistant Secretary of the Indian Health Service. 

Sec. 4232. Extension of full Federal medical assistance percentage to Indian 

health care providers. 

Sec. 4233. Conferring with urban Indian organizations. 

PART 4—PROVIDERS

Sec. 4241. Availability of non-English language speaking providers. 

Sec. 4242. Access to essential community providers. 

Sec. 4243. Provider network adequacy in communities of color. 

PART 5—DENTAL

Sec. 4251. Improving access to dental care. 


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Sec. 4252. Oral health literacy and awareness campaign. 

Sec. 4253. Ensuring Kids Have Access to Medically Necessary Dental Care 

Act. 

Subtitle D—Advancing Health Equity Through Payment and Delivery Reform 

Sec. 4301. Centers for Medicare & Medicaid Services reporting and value-based 

programs. 

Sec. 4302. Development and testing of disparity reducing delivery and payment 

models. 

Sec. 4303. Diversity in Centers for Medicare and Medicaid consultation. 

Sec. 4304. Supporting safety net and community-based providers to compete in 

value-based payment systems. 

Sec. 4305. Improving access to care for Medicare and Medicaid beneficiaries. 

Subtitle E—Health Empowerment Zones 

Sec. 4401. Designation of health empowerment zones. 

Sec. 4402. Assistance to those seeking designation. 

Sec. 4403. Benefits of designation. 

Sec. 4404. Definition of Secretary. 

Sec. 4405. Authorization of appropriations. 

Subtitle F—Equitable Health Care for All 

Sec. 4501. Data collection and reporting. 

Sec. 4502. Requiring equitable health care in the hospital value-based purchasing program. 

Sec. 4503. Provision of inequitable health care as a basis for permissive exclusion from Medicare and State health care programs. 

Sec. 4504. Office for Civil Rights and Health Equity of the Department of 

Health and Human Services. 

Sec. 4505. Prohibiting discrimination in health care. 

Sec. 4506. Federal Health Equity Commission. 

Sec. 4507. Grants for hospitals to promote equitable health care and outcomes. 

Subtitle G—Investing in Equity 

Sec. 4601. Definitions. 

Sec. 4602. Strategy to incentivize health equity. 

Sec. 4603. Pay for Equity Advisory Council. 

TITLE V—IMPROVING HEALTH OUTCOMES FOR WOMEN, 

GENDER-DIVERSE PEOPLE, CHILDREN, AND FAMILIES 

Subtitle A—Underserved Communities 

Sec. 5001. Grants to promote health for underserved communities. 

Subtitle B—Pregnancy Screening 

Sec. 5101. Pregnancy intention screening initiative demonstration program. 

Sec. 5102. Birth defects prevention, risk reduction, and awareness. 

Subtitle C—Pregnancy-Related Care 

Sec. 5201. Community access, resources, and empowerment for moms. 

Sec. 5202. MOMMIES. 

Sec. 5203. Social determinants for moms. 


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Sec. 5204. Kira Johnson Act. 

Sec. 5205. Perinatal workforce. 

Sec. 5206. Data to Save Moms Act. 

Sec. 5207. Moms matter. 

Sec. 5208. Justice for Incarcerated Moms. 

Sec. 5209. Tech to save moms. 

Sec. 5210. IMPACT To Save Moms Act. 

Sec. 5211. Protecting moms and babies against climate change. 

Sec. 5212. Protect moms from domestic violence. 

Sec. 5213. Midwives schools and programs expansion. 

Sec. 5214. Gestational diabetes. 

Sec. 5215. Consumer education campaign. 

Sec. 5216. Bibliographic database of systematic reviews for care of childbearing 

individuals and newborns. 

Sec. 5217. Development of interprofessional maternity care educational models 

and tools. 

Sec. 5218. Dissemination of the quality family planning guidelines. 

Subtitle D—Federal Agency Coordination on Maternal Health 

Sec. 5301. Interagency Coordinating Committee on the Promotion of Optimal 

Maternity Outcomes. 

Sec. 5302. Expansion of CDC Prevention Research Centers Program to include 

Centers on Optimal Maternity Outcomes. 

Sec. 5303. Expanding models to be tested by Center for Medicare and Medicaid 

Innovation to explicitly include maternity care and children’s 

health models. 

Sec. 5304. Interagency update to the quality family planning guidelines. 

Subtitle E—Reproductive and Sexual Health 

Sec. 5401. Sense of Congress on urgent issues concerning barriers to abortion 

access and vital solutions. 

Sec. 5402. Emergency contraception education and information programs. 

Sec. 5403. Duties of pharmacies to ensure provision of FDA-approved contraception. 

Sec. 5404. Real Education and Access for Healthy Youth Act. 

Sec. 5405. Compassionate assistance for rape emergencies. 

Sec. 5406. Menstrual Equity for All Act of 2024. 

Sec. 5407. Additional focus area for the Office on Women’s Health. 

Sec. 5408. Including services furnished by certain students, interns, and residents supervised by certified nurse midwives or certified midwives within inpatient hospital services under Medicare. 

Sec. 5409. Grants to professional organizations and minority-serving institutions to increase diversity in maternal, reproductive, and sexual 

health professionals. 

Subtitle F—Children’s Health 

Sec. 5501. CARING for Kids Act. 

Sec. 5502. End Diaper Need Act of 2024. 

Sec. 5503. Decreasing the risk factors for sudden unexpected infant death and 

sudden unexplained death in childhood. 

Subtitle G—Elder Care 


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Sec. 5601. Expenses for household and elder care services necessary for gainful 

employment. 

Subtitle H—Miscellaneous Provisions 

Sec. 5701. Clarification supporting permissible use of funds for stillbirth prevention activities. 

TITLE VI—MENTAL HEALTH AND SUBSTANCE USE DISORDERS 

Sec. 6001. Sense of Congress. 

Subtitle A—Access to Care and Funding Streams 

Sec. 6101. Coverage of substance use disorder counselor services and peer support specialist services under part B of the Medicare program. 

Sec. 6102. Reauthorization of Minority Fellowship Program. 

Sec. 6103. Additional funds for National Institutes of Health. 

Sec. 6104. Additional funds for National Institute on Minority Health and 

Health Disparities. 

Sec. 6105. Grants for increasing racial and ethnic minority access to high-quality trauma support services and mental health care. 

Subtitle B—Interprofessional Care 

Sec. 6201. Health professions competencies to address racial and ethnic mental 

health inequities. 

Sec. 6202. Interprofessional health care teams for behavioral health care. 

Sec. 6203. Integrated Health Care Demonstration Program. 

Subtitle C—Workforce Development 

Sec. 6301. Building an effective workforce in mental health. 

Sec. 6302. Demonstration program to increase language access at eligible 

health centers. 

Sec. 6303. Health professions competencies to address racial and ethnic minority mental health disparities. 

Subtitle D—Children’s Mental Health 

Sec. 6401. Grant programs to support pediatric behavioral health care. 

Sec. 6402. Increasing Federal investment in pediatric behavioral health services. 

Sec. 6403. Mental health in schools. 

Sec. 6404. Additional support for youth and young adult mental health service 

provision. 

Sec. 6405. Early intervention and prevention programs for transition-age 

youth. 

Sec. 6406. Strategies to increase access to telehealth under Medicaid and Children’s Health Insurance Program. 

Sec. 6407. Youth and young adult mental health promotion, prevention, intervention, and treatment. 

Subtitle E—Community-Based Care 

Sec. 6501. Mental health at the border. 


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Sec. 6502. Asian American, African American, Native Hawaiian, Pacific Islander, Indigenous, Middle Eastern and North African, and 

Hispanic and Latino behavioral health outreach and education 

strategy. 

Subtitle F—Reports 

Sec. 6601. Addressing racial and ethnic minority mental health disparities research gaps. 

Sec. 6602. Research on adverse health effects associated with interactions with 

law enforcement. 

Sec. 6603. GeoAccess study. 

Sec. 6604. Co-occurring conditions. 

Sec. 6605. Study and report on the AANHPI youth mental health crisis. 

Sec. 6606. Study and report on strategies on the AANHPI behavioral health 

workforce shortage. 

Subtitle G—Miscellaneous Provisions 

Sec. 6701. Strengthening mental health supports for BIPOC communities. 

Sec. 6702. STRONG support for children. 

Sec. 6703. Improving access to mental health. 

Sec. 6704. Program to establish public-private contributions to increase the 

available workforce of school-based mental health service providers. 

Sec. 6705. School social workers improving student success. 

Sec. 6706. Opioid grants to support caregivers, kinship care families, and kinship caregivers. 

Sec. 6707. Substance Use and Mental Health Services Administration and subagencies. 

TITLE VII—ADDRESSING HIGH-IMPACT MINORITY DISEASES 

Subtitle A—Cancer 

Sec. 7001. Lung cancer mortality reduction. 

Sec. 7002. Expansion of prostate cancer research, outreach, screening, testing, 

access, and treatment effectiveness. 

Sec. 7003. Prostate research, imaging, and men’s education. 

Sec. 7004. Prostate cancer detection research and education. 

Sec. 7005. National Prostate Cancer Council. 

Sec. 7006. Improved Medicaid coverage for certain breast and cervical cancer 

patients in the territories. 

Sec. 7007. Cancer prevention and treatment demonstration for ethnic and racial minorities. 

Sec. 7008. Reducing cancer disparities within Medicare. 

Subtitle B—Viral Hepatitis and Liver Cancer Control and Prevention 

Sec. 7101. Biennial assessment of HHS hepatitis B and hepatitis C prevention, 

education, research, and medical management plan. 

Sec. 7102. Liver cancer and disease prevention, awareness, and patient tracking grants. 

Subtitle C—Acquired Bone Marrow Failure Diseases 

Sec. 7201. Acquired bone marrow failure diseases. 


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

Disease Issues 

Sec. 7301. Guidelines for disease screening for minority patients. 

Sec. 7302. CDC Wisewoman Screening Program. 

Sec. 7303. Report on cardiovascular care for women and minorities. 

Sec. 7304. GAO report on structural and systemic factors that perpetuate cardiovascular disparities. 

Sec. 7305. Coverage of comprehensive tobacco cessation services in Medicaid, 

CHIP, and private health insurance. 

Sec. 7306. Clinical research funding for oral health. 

Sec. 7307. Guide on evidence-based strategies for public health department obesity prevention programs. 

Sec. 7308. Stephanie Tubbs Jones Uterine Fibroid Research and Education 

Act. 

Subtitle E—HIV/AIDS 

Sec. 7401. Statement of policy. 

Sec. 7402. Additional funding for AIDS drug assistance program treatments. 

Sec. 7403. Enhancing the national HIV surveillance system. 

Sec. 7404. Evidence-based strategies for improving linkage to, and retention in, 

appropriate care. 

Sec. 7405. Improving entry into, and retention in, care and antiretroviral adherence for persons with HIV. 

Sec. 7406. Services to reduce HIV/AIDS in racial and ethnic minority communities. 

Sec. 7407. Minority AIDS initiative. 

Sec. 7408. Health care professionals treating individuals with HIV. 

Sec. 7409. HIV/AIDS provider loan repayment program. 

Sec. 7410. Dental education loan repayment program. 

Sec. 7411. Reducing new HIV infections among injecting drug users. 

Sec. 7412. Report on impact of HIV/AIDS in vulnerable populations. 

Sec. 7413. National HIV/AIDS observance days. 

Sec. 7414. Review of all Federal and State laws, policies, and regulations regarding the criminal prosecution of individuals for HIV-related 

offenses. 

Sec. 7415. Expanding support for condoms in prisons. 

Sec. 7416. Automatic reinstatement or enrollment in Medicaid for people who 

test positive for HIV before reentering communities. 

Sec. 7417. Stop HIV in prison. 

Sec. 7418. Transfer of funds for implementation of Ending the HIV Epidemic: 

A Plan for America. 

Sec. 7419. PrEP access and coverage. 

Subtitle F—Diabetes 

Sec. 7501. Research, treatment, and education. 

Sec. 7502. Research, education, and other activities. 

Sec. 7503. Programs to educate health providers on the causes and effects of 

diabetes in minority populations. 

Sec. 7504. Research, education, and other activities regarding diabetes in 

American Indian populations. 

Sec. 7505. Updated report on health disparities. 

Subtitle G—Lung Disease 


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Sec. 7601. Asthma-related activities of the Centers for Disease Control and 

Prevention. 

Sec. 7602. Influenza and pneumonia vaccination campaign. 

Sec. 7603. Chronic obstructive pulmonary disease. 

Subtitle H—Tuberculosis 

Sec. 7701. United States Government assistance to combat tuberculosis. 

Subtitle I—Osteoarthritis and Musculoskeletal Diseases 

Sec. 7801. Osteoarthritis and other musculoskeletal health-related activities of 

the Centers for Disease Control and Prevention. 

Sec. 7802. Grants for comprehensive osteoarthritis and musculoskeletal disease 

health education within health professions schools. 

Subtitle J—Sleep and Circadian Rhythm Disorders 

Sec. 7901. Sleep and circadian rhythm disorders research activities of the National Institutes of Health. 

Sec. 7902. Sleep and circadian rhythm health disparities-related activities of 

the Centers for Disease Control and Prevention. 

Sec. 7903. Grants for comprehensive sleep and circadian health education within health professions schools. 

Sec. 7904. 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. 7901A. Kidney disease research in minority populations. 

Sec. 7901A–1. Kidney disease action plan. 

Sec. 7901A–2. Providing for staff-assisted home dialysis for certain hemodialysis and peritoneal dialysis patients. 

Sec. 7901A–3. Increasing kidney transplants in minority populations. 

Sec. 7901A–4. Environmental and occupational health programs. 

Sec. 7901A–5. Understanding the treatment patterns associated with providing 

care and treatment of kidney failure in minority populations. 

Sec. 7901A–6. Encouraging kidney care workforce in underserved areas. 

Sec. 7901A–7. The Jack Reynolds Memorial Medigap Expansion Act; Medigap 

coverage for beneficiaries with end-stage renal disease. 

Subtitle L—Diversity in Clinical Trials 

Sec. 7901B. FDA review of clinical trial best practices. 

Sec. 7901B–1. Diversifying Investigations Via Equitable Research Studies for 

Everyone Trials Act. 

Sec. 7901B–2. Clinical trial diversity. 

Sec. 7901B–3. Patient experience data. 

Subtitle M—Additional Provisions Addressing High-Impact Minority Diseases 

Sec. 7901C. Medicare coverage of multi-cancer early detection screening tests. 

Sec. 7901C–1. Amputation Reduction and Compassion Act. 

Sec. 7901C–2. Eliminating the coinsurance requirement for certain colorectal 

cancer screening tests furnished under the Medicare program. 

Sec. 7901C–3. Expanding the availability of medical nutrition therapy services 

under the Medicare program. 


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Sec. 7901C–4. Encouraging the development and use of DISARM antimicrobial 

drugs. 

Sec. 7901C–5. Treat and Reduce Obesity Act. 

Sec. 7901C–6. Incentives, improvements, and outreach to increase diversity in 

Alzheimer’s disease research. 

TITLE VIII—HEALTH INFORMATION TECHNOLOGY 

Sec. 8001. Definitions. 

Subtitle A—Reducing Health Disparities Through Health IT 

Sec. 8101. HRSA assistance to health centers for promotion of Health IT. 

Sec. 8102. Assessment of impact of Health IT on racial and ethnic minority 

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

Sec. 8103. Nondiscrimination and health equity in health information technology. 

Sec. 8104. Language access in health information technology. 

Subtitle B—Modifications To Achieve Parity in Existing Programs 

Sec. 8201. Extending funding to strengthen the Health IT infrastructure in racial and ethnic minority communities. 

Sec. 8202. 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. 8203. Authorization of appropriations. 

Subtitle C—Additional Research and Studies 

Sec. 8301. Data collection and assessments conducted in coordination with minority-serving institutions. 

Sec. 8302. Study of health information technology in medically underserved 

communities. 

Sec. 8303. Assessment of use and misuse of de-identified health data. 

Subtitle D—Closing Gaps in Funding To Adopt Certified EHRs 

Sec. 8401. Extending Medicaid EHR incentive payments to rehabilitation facilities, long-term care facilities, and home health agencies. 

Sec. 8402. Extending physician assistant eligibility for Medicaid electronic 

health record incentive payments. 

Subtitle E—Expanding Access to Telehealth Services 

Sec. 8501. Removing geographic requirements for telehealth services. 

Sec. 8502. Expanding originating sites. 

TITLE IX—ACCOUNTABILITY AND EVALUATION 

Sec. 9001. Prohibition on discrimination in Federal assisted health care services and research on the basis of sex (including sexual orientation, gender identity, and pregnancy, including termination of 

pregnancy), race, color, national origin, marital status, familial 

status, or disability status. 

Sec. 9002. Treatment of Medicare payments under title VI of the Civil Rights 

Act of 1964. 


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Sec. 9003. Accountability and transparency within the Department of Health 

and Human Services. 

Sec. 9004. United States Commission on Civil Rights. 

Sec. 9005. Sense of Congress concerning full funding of activities to eliminate 

racial and ethnic health disparities. 

Sec. 9006. GAO and NIH reports. 

Sec. 9007. Investigative and enforcement actions. 

Sec. 9008. Federal Health Equity Commission. 

TITLE X—ADDRESSING SOCIAL DETERMINANTS AND IMPROVING 

ENVIRONMENTAL JUSTICE 

Subtitle A—In General 

Sec. 10001. Definitions. 

Sec. 10002. Health impact assessments. 

Sec. 10003. Grant program to conduct environmental health improvement activities and to improve social determinants of health. 

Sec. 10004. Additional research on the relationship between the built environment and the health of community residents. 

Sec. 10005. Environment and public health restoration. 

Sec. 10006. GAO report on health effects of Deepwater Horizon oil rig explosion in the Gulf Coast. 

Sec. 10007. Establish an interagency council and grant programs on social determinants of health. 

Sec. 10008. Correcting Hurtful and Alienating Names in Government Expression (CHANGE). 

Sec. 10009. Andrew Kearse Accountability for Denial of Medical Care. 

Sec. 10010. Investing in community healing. 

Sec. 10011. Environmental justice mapping and data collection. 

Sec. 10012. Antiracism in public health. 

Sec. 10013. LGBTQ essential data. 

Sec. 10014. Social determinants accelerator. 

Sec. 10015. Improving social determinants of health. 

Sec. 10016. Notification regarding SNAP for students receiving Federal workstudy assistance. 

Subtitle B—Gun Violence 

Sec. 10101. Reaffirming research authority of the Centers for Disease Control 

and Prevention. 

Sec. 10102. National Violent Death Reporting System. 

Sec. 10103. Report on effects of gun violence on public health. 

Sec. 10104. Report on effects of gun violence on mental health in minority 

communities. 

Subtitle C—Nutrition for Women, Children, Families 

CHAPTER 1—SENIOR HUNGER PREVENTION

Sec. 10201. Short title. 

Sec. 10202. Improving SNAP efficacy. 

Sec. 10203. Streamlining nutrition access for older adults and adults with disabilities. 

Sec. 10204. Enrollment and outreach pilot program for older adults, kinship 

families, and adults with disabilities. 

Sec. 10205. Food delivery under supplemental nutrition assistance program. 


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Sec. 10206. Commodity supplemental food program. 

Sec. 10207. Seniors farmers’ market nutrition program. 

Sec. 10208. Infrastructure funding for farmers’ markets; local procurement 

pilot program. 

CHAPTER 2—CLOSING THE MEAL GAP

Sec. 10211. Elimination of time limit. 

Sec. 10212. Inclusion of Puerto Rico in supplemental nutritional assistance 

program. 

Subtitle D—Universal School Meals 

Sec. 10301. Short title. 

Sec. 10302. Effective date. 

CHAPTER 1—SCHOOL BREAKFAST PROGRAM

Sec. 10311. Free school breakfast program. 

CHAPTER 2—SCHOOL LUNCH PROGRAM

Sec. 10321. Apportionment to States. 

Sec. 10322. Nutritional and other program requirements. 

Sec. 10323. Special assistance program. 

Sec. 10324. Price for paid lunch. 

Sec. 10325. Summer food service program for children. 

Sec. 10326. Summer electronic benefit transfer for children program. 

Sec. 10327. Child and adult care food program. 

Sec. 10328. Meals and supplements for children in afterschool care. 

Sec. 10329. Pilot projects. 

Sec. 10330. Fresh fruit and vegetable program. 

Sec. 10331. Training, technical assistance, and Food Service Management Institute. 

Sec. 10332. Reimbursement of school meal delinquent debt program. 

Sec. 10333. Conforming amendments. 

CHAPTER 3—ELEMENTARY AND SECONDARY EDUCATION DATA

Sec. 10341. Measure of poverty. 

CHAPTER 4—AMENDMENTS TO OTHER PROGRAMS AND LAWS

Sec. 10351. Supplemental nutrition assistance program. 

Sec. 10352. Higher Education Act of 1965. 

Sec. 10353. Elementary and Secondary Education Act of 1965. 

Sec. 10354. America COMPETES Act. 

Sec. 10355. Workforce Innovation and Opportunity Act. 

Sec. 10356. National Science Foundation Authorization Act of 2002. 

Sec. 10357. Child care and development block grant. 

Sec. 10358. Children’s Health Act of 2000. 

Sec. 10359. Juvenile justice and delinquency prevention. 


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1 TITLE I—DATA COLLECTION 

2 AND REPORTING 

3 SEC. 1001. STRENGTHENING DATA COLLECTION, IMPROV4 ING DATA ANALYSIS, AND EXPANDING DATA 

5 REPORTING. 

6 (a) AMENDMENTS TO THE PUBLIC HEALTH SERVICE

7 ACT.— 

8 (1) PURPOSE.—The purpose of the amend9 ments made by this subsection is to promote cul10 turally and linguistically appropriate data collection, 

11 analysis, and reporting by race, ethnicity, sex, pri12 mary language, sexual orientation, disability status, 

13 gender identity, age, and socioeconomic status in 

14 federally supported health programs. 

15 (2) AHRQ GENERAL AUTHORITIES.—Section 

16 902(a) of the Public Health Service Act (42 U.S.C. 

17 299a(a)) is amended— 

18 (A) in paragraph (8), by striking ‘‘and’’ at 

19 the end; 

20 (B) in paragraph (9), by striking the pe21 riod at the end and inserting ‘‘; and’’; and 

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

23 ‘‘(10) cultural and linguistic competence of 

24 health care services and of data collection activities 

25 described under section 3101.’’. 


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1 (3) DEFINITION OF RACIAL AND ETHNIC MI2 NORITY GROUP.— 

3 (A) IN GENERAL.—Section 1707(g)(1) of 

4 the Public Health Service Act (42 U.S.C. 

5 300u–6(g)(1)) is amended to read as follows: 

6 ‘‘(1)(A) The term ‘racial and ethnic minority 

7 group’ means a group of individuals who are any of 

8 the following: 

9 ‘‘(i) American Indian or Alaska Native. 

10 ‘‘(ii) Asian. 

11 ‘‘(iii) Black or African American. 

12 ‘‘(iv) Hispanic or Latino. 

13 ‘‘(v) Middle Eastern or North African. 

14 ‘‘(vi) Native Hawaiian or Pacific Islander. 

15 ‘‘(B) The terms listed in clauses (i) through (vi) 

16 of subparagraph (A) shall have the meanings given 

17 such terms for purposes of the Revisions to OMB’s 

18 Statistical Policy Directive No. 15: Standards for 

19 Maintaining, Collecting, and Presenting Federal 

20 Data on Race and Ethnicity (89 Fed. Reg. 22182; 

21 March 29, 2024).’’. 

22 (B) REFERENCES.—Except as otherwise 

23 specified, any reference to the term ‘‘racial and 

24 ethnic minority group’’ in any Federal regula25 tion, guidance, order, or document for establishVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 00015 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 ment or implementation of any federally con2 ducted or supported health care or public health 

3 program, activity, or survey shall be treated as 

4 having the definition given to such term in sec5 tion 1707(g) of the Public Health Service Act 

6 (42 U.S.C. 300u–6(g)). 

7 (C) SIMILAR TERMINOLOGY.—Not later 

8 than 2 years after the date of enactment of this 

9 Act, the Secretary of Health and Human Serv10 ices shall— 

11 (i) identify all regulations, guidance, 

12 orders, and documents of the Department 

13 of Health and Human Services for estab14 lishment or implementation of a health 

15 care or public health program, activity, or 

16 survey that use, without a definition, ter17 minology that is similar to the term ‘‘racial 

18 and ethnic minority group’’; and 

19 (ii) take such actions as may be nec20 essary to clarify whether the definition of 

21 the term ‘‘racial and ethnic minority 

22 group’’ in section 1707(g)(1) of the Public 

23 Health Service Act (42 U.S.C. 300u– 

24 6(g)(1)), as amended by subparagraph (A), 

25 applies to such terminology. 


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1 (4) OFFICE OF MINORITY HEALTH DUTIES.— 

2 Section 1707(b)(6) of the Public Health Service Act 

3 (42 U.S.C. 300u–6(b)(6)) is amended by inserting 

4 ‘‘and, to the extent practicable, subgroups of racial 

5 and ethnic minority groups’’ after ‘‘the health status 

6 of each minority group’’. 

7 (5) OFFICE OF THE NATIONAL COORDINATOR

8 FOR HEALTH INFORMATION TECHNOLOGY.—Section 

9 3001 of the Public Health Service Act (42 U.S.C. 

10 300jj–11) is amended— 

11 (A) in subsection (b)— 

12 (i) in paragraph (10), by striking 

13 ‘‘and’’ at the end; 

14 (ii) in paragraph (11), by striking the 

15 period at the end and inserting ‘‘; and’’; 

16 and 

17 (iii) by adding at the end the fol18 lowing: 

19 ‘‘(12) ensures the interoperability of health in20 formation systems among federally conducted or 

21 supported health care or public health programs, 

22 State health agencies, and social service agencies.’’; 

23 and 

24 (B) by amending clause (vii) in subsection 

25 (c)(3)(A) to read as follows: 


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1 ‘‘(vii) Strategies to enhance the use of 

2 health information technology in improving 

3 the quality of health care; reducing medical 

4 errors; reducing health disparities and en5 suring the provision of equitable health 

6 services; improving public health; increas7 ing prevention and coordination with com8 munity resources; ensuring interoperability 

9 among federally conducted or supported 

10 health care or public health programs, 

11 State health agencies, and social service 

12 agencies; and improving the continuity of 

13 care among health care settings.’’. 

14 (6) DATA COLLECTION, ANALYSIS, AND QUAL15 ITY.—Section 3101 of the Public Health Service Act 

16 (42 U.S.C. 300kk) is amended— 

17 (A) in subsections (a)(1)(A), (a)(1)(C), 

18 (a)(2)(B), and (a)(2)(E), by striking ‘‘and dis19 ability status’’ and inserting ‘‘sexual orienta20 tion, gender identity, age, disability status, and 

21 socioeconomic status’’; 

22 (B) in subsection (a)(1), by amending sub23 paragraph (D) to read as follows: 

24 ‘‘(D) data for additional population groups 

25 if such groups can be aggregated into the data 


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1 collection standards described under paragraph 

2 (2).’’; 

3 (C) in subsection (a)(2)— 

4 (i) in subparagraph (C)— 

5 (I) in clause (i), by striking 

6 ‘‘and’’ at the end; 

7 (II) in clause (ii)— 

8 (aa) by striking ‘‘is a minor 

9 or legally incapacitated’’ and in10 serting ‘‘is a minor, requires as11 sistance with communication in 

12 speech or writing, or is legally in13 capacitated’’; and 

14 (bb) by striking the semi15 colon at the end and inserting ‘‘; 

16 and’’; and 

17 (III) by adding at the end the 

18 following: 

19 ‘‘(iii) collects data in a manner that is 

20 culturally and linguistically appropriate 

21 and does not include questions unrelated 

22 to, or that could potentially deter, care, 

23 such as questions related to immigration 

24 status;’’; 


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1 (ii) in subparagraph (D)(iii), by strik2 ing ‘‘and’’ at the end; 

3 (iii) in subparagraph (E), by striking 

4 the period at the end and inserting ‘‘; 

5 and’’; and 

6 (iv) by adding at the end the fol7 lowing: 

8 ‘‘(F) use, where practicable, the standards 

9 developed by the Health and Medicine Division 

10 of the National Academies of Sciences, Engi11 neering, and Medicine (formerly known as the 

12 ‘Institute of Medicine’) in the 2009 publication 

13 titled ‘Race, Ethnicity, and Language Data: 

14 Standardization for Health Care Quality Im15 provement’.’’; and 

16 (D) in subsection (a)(3), by amending sub17 paragraph (B) to read as follows: 

18 ‘‘(B) develop interoperability and security 

19 systems for data management among federally 

20 conducted or supported health care or public 

21 health programs, State health agencies, and so22 cial service agencies.’’. 

23 (b) COROLLARY PROVISIONS.— 

24 (1) RECOMMENDATIONS BY THE DATA COUN25 CIL.—The Data Council of the Department of 


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1 Health and Human Services, in consultation with 

2 the Director of the National Center for Health Sta3 tistics, the Deputy Assistant Secretary for Minority 

4 Health, the Deputy Assistant Secretary for Women’s 

5 Health, the Administrator of the Centers for Medi6 care & Medicaid, the National Coordinator for 

7 Health Information Technology, and other appro8 priate public and private entities and officials, shall 

9 make recommendations to the Secretary of Health 

10 and Human Services concerning how to— 

11 (A) implement the amendments made by 

12 this section, while minimizing the cost and ad13 ministrative burdens of data collection and re14 porting on all parties, including patients and 

15 providers; 

16 (B) expand awareness among Federal 

17 agencies, States, territories, Indian Tribes, 

18 counties, municipalities, health providers, health 

19 plans, and the general public that data collec20 tion, analysis, and reporting by race, ethnicity, 

21 sex, primary language, sexual orientation, gen22 der identity, age, socioeconomic status, and dis23 ability status is legal and necessary to ensure 

24 equity and nondiscrimination in the quality of 

25 health care services; 


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1 (C) ensure that future patient record sys2 tems follow Federal standards promulgated 

3 under the HITECH Act (42 U.S.C. 201 note) 

4 for the collection and meaningful use of elec5 tronic health data on race, ethnicity, sex, pri6 mary language, sexual orientation, gender iden7 tity, age, socioeconomic status, and disability 

8 status; 

9 (D) improve health and health care data 

10 collection and analysis for more population 

11 groups if such groups can be aggregated into 

12 minimum race and ethnicity categories, includ13 ing exploring the feasibility of enhancing collec14 tion efforts in States, counties, and municipali15 ties for racial and ethnic groups that comprise 

16 a significant proportion of the population of the 

17 State, county, or municipality; 

18 (E) provide researchers with greater access 

19 to racial, ethnic, primary language, sex, sexual 

20 orientation, gender identity, age, socioeconomic 

21 status, and disability status data, subject to all 

22 applicable privacy and confidentiality require23 ments, including HIPAA privacy and security 

24 law as defined in section 3009(a) of the Public 

25 Health Service Act (42 U.S.C. 300jj–19(a)); 


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1 (F) ensure the cultural and linguistic com2 petence of entities that receive Federal support 

3 to collect and report data pursuant to the 

4 amendments made by subsection (a); and 

5 (G) safeguard and prevent the misuse of 

6 data collected under section 3101 of the Public 

7 Health Service Act (42 U.S.C. 300kk), as 

8 amended by subsection (a)(6). 

9 (2) RULES OF CONSTRUCTION.—Nothing in 

10 this section shall be construed to— 

11 (A) permit the use of information collected 

12 under this section or any provision amended by 

13 this section in a manner that would adversely 

14 affect any individual providing any such infor15 mation; or 

16 (B) diminish any requirements on health 

17 care providers to collect data, including such re18 quirements in effect on or after the date of en19 actment of this Act. 

20 (3) TECHNICAL ASSISTANCE FOR THE ANALYSIS

21 OF HEALTH DISPARITY DATA.—The Secretary of 

22 Health and Human Services, acting through the Di23 rector of the Agency for Healthcare Research and 

24 Quality, and in coordination with the Assistant Sec25 retary for Planning and Evaluation, the AdminisVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 00023 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 trator of the Centers for Medicare & Medicaid Serv2 ices, the Director of the National Center for Health 

3 Statistics, the Director of the National Institutes of 

4 Health, and the National Coordinator for Health In5 formation Technology, shall provide technical assist6 ance to agencies of the Department of Health and 

7 Human Services in meeting Federal standards for 

8 health disparity data collection and for analysis of 

9 racial, ethnic, and other disparities in health and 

10 health care in programs conducted or supported by 

11 such agencies by— 

12 (A) identifying appropriate quality assur13 ance mechanisms to monitor for health dispari14 ties; 

15 (B) specifying the clinical, diagnostic, or 

16 therapeutic measures which should be mon17 itored; 

18 (C) developing new quality measures relat19 ing to racial and ethnic disparities and their 

20 overlap with other disparity factors in health 

21 and health care; 

22 (D) identifying the level at which data 

23 analysis should be conducted; 


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1 (E) sharing data with external organiza2 tions for research and quality improvement pur3 poses; and 

4 (F) identifying and addressing issues relat5 ing to the interoperability of Federal- and 

6 State-level health information systems which 

7 undermine the ability of health-related pro8 grams collecting data under this section to 

9 achieve the purpose described in subsection 

10 (a)(1). 

11 (4) AUTHORIZATION OF APPROPRIATIONS.—To 

12 carry out this subsection, subsection (a), and the 

13 amendments made by subsection (a), there are au14 thorized to be appropriated such sums as may be 

15 necessary for each of fiscal years 2025 through 

16 2029. 

17 (c) ADDITIONAL AMENDMENTS TO THE PUBLIC

18 HEALTH SERVICE ACT.—Title XXXIV of the Public 

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

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

21 following: 


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1 ‘‘Subtitle C—Strengthening Data 

2 Collection, Improving Data 

3 Analysis, and Expanding Data 

4 Reporting 

5 ‘‘SEC. 3431. ESTABLISHING GRANTS FOR DATA COLLECTION 

6 IMPROVEMENT ACTIVITIES. 

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

8 the Director of the Agency for Healthcare Research and 

9 Quality and in consultation with the Deputy Assistant 

10 Secretary for Minority Health, the Director of the Na11 tional Institutes of Health, the Assistant Secretary for 

12 Planning and Evaluation, the National Coordinator for 

13 Health Information Technology, and the Director of the 

14 National Center for Health Statistics, shall establish a 

15 technical assistance program under which the Secretary 

16 provides grants to eligible entities to assist such entities 

17 in complying with section 3101. 

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

19 under this section may be used to— 

20 ‘‘(1) enhance or upgrade computer technology 

21 that will facilitate collection, analysis, and reporting 

22 of racial, ethnic, primary language, sexual orienta23 tion, sex, gender identity, socioeconomic status, and 

24 disability status data; 


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

2 and analysis, including additional population groups 

3 if such groups can be aggregated into the race and 

4 ethnicity categories outlined by standards developed 

5 under section 3101; 

6 ‘‘(3) develop mechanisms for submitting col7 lected data subject to any applicable privacy and 

8 confidentiality regulations; 

9 ‘‘(4) develop educational programs to inform 

10 health plans, health providers, health-related agen11 cies, and the general public that data collection and 

12 reporting by race, ethnicity, primary language, sex13 ual orientation, sex, gender identity, disability sta14 tus, and socioeconomic status are legal and essential 

15 for eliminating health and health care disparities; 

16 and 

17 ‘‘(5) develop educational programs to train 

18 health providers, health care organizations, health 

19 plans, health-related agencies, and frontline health 

20 care workers on how to collect and report 

21 disaggregated data in a culturally and linguistically 

22 appropriate manner. 

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 3101. 

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 2025 through 2029. 

8 ‘‘SEC. 3432. 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, and other officials within the De14 partment of Health and Human Services as the Sec15 retary determines appropriate, shall develop and im16 plement a sustainable national strategy for oversam17 pling underrepresented populations within the cat18 egories of race, ethnicity, sex, primary language, sex19 ual orientation, disability status, gender identity, 

20 and socioeconomic status as determined appropriate 

21 by the Secretary in Federal health surveys and pro22 gram data collections. Such national strategy shall 

23 include a strategy for oversampling of Middle East24 erners and North Africans, Asian Americans, Native 

25 Hawaiians, and Pacific Islanders. 


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1 ‘‘(2) CONSULTATION.—In developing and imple2 menting a national strategy, as described in para3 graph (1), not later than 180 days after the date of 

4 the enactment of this section, the Secretary shall— 

5 ‘‘(A) consult with representatives of com6 munity groups, nonprofit organizations, non7 governmental organizations, and government 

8 agencies working with underrepresented popu9 lations; 

10 ‘‘(B) solicit the participation of representa11 tives from other Federal departments and agen12 cies, including subagencies of the Department 

13 of Health and Human Services; and 

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

15 2014 National Health Interview Survey over16 sample of Native Hawaiian and Pacific Islander 

17 populations, the 2016 Behavioral Risk Factor 

18 Survey of Health Risk Behaviors Among Arab 

19 Adults Within the State of Michigan, and the 

20 2017 Behavioral Risk Factor Surveillance Sys21 tem oversample of American Indian and Alaska 

22 Native communities. 

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

24 after the date of enactment of this section, the Secretary 

25 shall submit to the Congress a progress report, which shall 


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1 include the national strategy required by subsection 

2 (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 each of fiscal 

6 years 2025 through 2029.’’. 

7 (d) REPORT TO CONGRESS.—Not later than 2 years 

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

9 Health and Human Services shall submit a report to Con10 gress on the implementation of this section, including the 

11 amendments made by this section. 

12 SEC. 1002. ELIMINATION OF PREREQUISITE OF DIRECT AP13 PROPRIATIONS FOR DATA COLLECTION AND 

14 ANALYSIS. 

15 Section 3101 of the Public Health Service Act (42 

16 U.S.C. 300kk), as amended by section 1001(a), is further 

17 amended— 

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

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

20 (h). 

21 SEC. 1003. COLLECTION OF DATA FOR THE MEDICARE PRO22 GRAM. 

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

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

25 the following: 


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1 ‘‘COLLECTION OF DATA FOR THE MEDICARE PROGRAM

2 ‘‘SEC. 1150D. 

3 ‘‘(a) REQUIREMENT.— 

4 ‘‘(1) IN GENERAL.—The Commissioner of So5 cial Security (in this section referred to as the ‘Com6 missioner’), in consultation with the Administrator 

7 of the Centers for Medicare & Medicaid Services (in 

8 this section referred to as the ‘Administrator’), shall 

9 collect data on the race, ethnicity, sex, primary lan10 guage, sexual orientation, gender identity, socio11 economic status, and disability status of all appli12 cants for social security benefits under title II or 

13 Medicare benefits under title XVIII. 

14 ‘‘(2) DATA COLLECTION STANDARDS.— 

15 ‘‘(A) IN GENERAL.—In collecting data 

16 under paragraph (1), the Commissioner shall at 

17 least use the standards for data collection devel18 oped under section 3101 of the Public Health 

19 Service Act (42 U.S.C. 300kk) or the standards 

20 developed by the Office of Management and 

21 Budget, whichever is more disaggregated. 

22 ‘‘(B) NO STANDARDS AVAILABLE.—In the 

23 event there are no standards for the demo24 graphic groups listed under paragraph (1), the 

25 Commissioner shall consult with stakeholder 


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1 groups representing the various identities as 

2 well as with the Office of Minority Health with3 in the Centers for Medicare & Medicaid Serv4 ices to develop appropriate standards. 

5 ‘‘(3) DATA FOR ADDITIONAL POPULATION

6 GROUPS.—Where practicable, the data collected by 

7 the Commissioner under paragraph (1) shall include 

8 data for additional population groups if such groups 

9 can be aggregated into the race and ethnicity cat10 egories outlined by the data collection standards de11 scribed in paragraph (2)(A). 

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

13 LEGALLY INCAPACITATED INDIVIDUALS.—With re14 spect to the collection of the data described in para15 graph (1) of applicants who are under 18 years of 

16 age or otherwise legally incapacitated, the Commis17 sioner shall require that— 

18 ‘‘(A) such data be collected from the par19 ent or legal guardian of such an applicant; and 

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

21 or legal guardian of such an applicant or recipi22 ent be used in collecting the data. 

23 ‘‘(5) QUALITY OF DATA.—The Commissioner 

24 shall periodically review the quality and completeVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 00032 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 ness of the data collected under paragraph (1) and 

2 make adjustments as necessary to improve both. 

3 ‘‘(6) TRANSMISSION OF DATA.—Upon enroll4 ment for Medicare benefits under title XVIII, the 

5 Commissioner shall transmit the demographic data 

6 of an individual as collected under paragraph (1) to 

7 the Centers for Medicare & Medicaid Services. 

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

9 With respect to the data transmitted under para10 graph (6), the Administrator, in consultation with 

11 the Commissioner, shall— 

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

13 analyzed and that such analysis be reported at 

14 least annually to Congress; 

15 ‘‘(B) incorporate such data in other anal16 ysis and reporting on health disparities and the 

17 provision of inequitable health care services by 

18 a health care provider, as appropriate; 

19 ‘‘(C) make such data available to research20 ers, under the protections outlined in paragraph 

21 (8); 

22 ‘‘(D) provide opportunities to individuals 

23 enrolled for Medicare benefits under title XVIII 

24 to submit updated data; and 


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1 ‘‘(E) ensure that the provision of assist2 ance or benefits to an applicant is not denied 

3 or otherwise adversely affected because of the 

4 failure of the applicant to provide any of the 

5 data collected under paragraph (1). 

6 ‘‘(8) PROTECTION OF DATA.—The Commis7 sioner shall ensure (through the promulgation of 

8 regulations or otherwise) that all data collected pur9 suant to paragraph (1) is protected— 

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

11 the Secretary applies to health data under the 

12 regulations promulgated under section 264(c) of 

13 the Health Insurance Portability and Account14 ability Act of 1996 (relating to the privacy of 

15 individually identifiable health information and 

16 other protections); and 

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

18 any entity that collects, stores, or receives the 

19 data, including use of such data in determina20 tions of eligibility (or continued eligibility) in 

21 health plans, and from other inappropriate 

22 uses, as defined by the Secretary. 

23 ‘‘(b) RULE OF CONSTRUCTION.—Nothing in this sec24 tion shall be construed to permit the use of information 

25 collected under this section in a manner that would adVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 00034 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 versely affect any individual providing any such informa2 tion. 

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

4 either directly or by grant or contract, provide technical 

5 assistance to enable any entity to comply with the require6 ments of this section or with regulations implementing this 

7 section. 

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

9 are authorized to be appropriated to carry out this section 

10 $500,000,000 for fiscal year 2025 and $100,000,000 for 

11 each fiscal year thereafter.’’. 

12 SEC. 1004. REVISION OF HIPAA CLAIMS STANDARDS. 

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

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

15 Human Services shall revise the regulations promulgated 

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

17 U.S.C. 1320d et seq.) (relating to the collection of data 

18 on demographics in a health-related transaction) to re19 quire— 

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

21 data collection on race, ethnicity, sex, primary lan22 guage, sexual orientation, gender identity, age, dis23 ability status, and socioeconomic status developed 

24 under section 3101 of the Public Health Service Act 


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1 (42 U.S.C. 300kk), as amended by section 

2 1001(a)(6); and 

3 (2) in consultation with the Office of the Na4 tional Coordinator for Health Information Tech5 nology, the designation of the appropriate racial, 

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

7 code sets as required for claims and enrollment data. 

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

9 Human Services shall disseminate the new standards de10 veloped under subsection (a) to all entities that are subject 

11 to the regulations described in such subsection and provide 

12 technical assistance with respect to the collection of the 

13 data involved. 

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

15 Human Services shall require that entities comply with the 

16 new standards developed under subsection (a) not later 

17 than 2 years after the final promulgation of such stand18 ards. 

19 SEC. 1005. NATIONAL CENTER FOR HEALTH STATISTICS. 

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

21 U.S.C. 242k(n)) is amended— 

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

23 inserting ‘‘2025’’; 

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

25 striking ‘‘2003’’ and inserting ‘‘2025’’; and 


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

2 inserting ‘‘2025’’. 

3 SEC. 1006. DISPARITIES DATA COLLECTED BY THE FED4 ERAL GOVERNMENT. 

5 (a) REPOSITORY OF GOVERNMENT DATA.—The Sec6 retary of Health and Human Services, in coordination 

7 with the officials referenced in subsection (b), shall estab8 lish a centralized electronic repository of Federal Govern9 ment data on factors related to the health and well-being 

10 of the population of the United States. 

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

12 days after the date of enactment of this Act, and January 

13 31 of each year thereafter, each department, agency, and 

14 office of the Federal Government that has collected data 

15 on race, ethnicity, sex, primary language, sexual orienta16 tion, gender identity, age, disability status, or socio17 economic status during the preceding calendar year shall 

18 submit such data to the repository of Federal Government 

19 data established under subsection (a). 

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

21 Not later than April 30, 2024, and April 30 of each year 

22 thereafter, the Secretary of Health and Human Services, 

23 acting through the Assistant Secretary for Planning and 

24 Evaluation, the Assistant Secretary for Health, the Direc25 tor of the Agency for Healthcare Research and Quality, 


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1 the Director of the National Center for Health Statistics, 

2 the Administrator of the Centers for Medicare & Medicaid 

3 Services, the Director of the National Institute on Minor4 ity Health and Health Disparities, and the Deputy Assist5 ant Secretary for Minority Health, shall— 

6 (1) prepare and make available datasets for 

7 public use that relate to disparities in health status, 

8 health care access, health care quality, health out9 comes, public health, the provision of equitable 

10 health services, and other areas of health and well11 being by factors that include race, ethnicity, sex, pri12 mary language, sexual orientation, gender identity, 

13 disability status, age, and socioeconomic status; 

14 (2) ensure that these datasets are publicly iden15 tified on the repository established under subsection 

16 (a) as ‘‘disparities’’ data; and 

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

18 availability and use of such data by public stake19 holders. 

20 SEC. 1007. DATA COLLECTION AND ANALYSIS GRANTS TO 

21 MINORITY-SERVING INSTITUTIONS. 

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

23 Human Services, acting through the Director of the Na24 tional Institute on Minority Health and Health Disparities 

25 and the Deputy Assistant Secretary for Minority Health, 


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1 shall award grants to eligible entities to access and analyze 

2 racial and ethnic data on disparities in health and health 

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

4 and health care, to monitor and report on progress to re5 duce and eliminate disparities in health and health care. 

6 (b) ELIGIBLE ENTITY.—In this section, the term ‘‘el7 igible entity’’ means an entity that has an accredited pub8 lic health, health policy, or health services research pro9 gram and is any of the following: 

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

11 322 of the Higher Education Act of 1965 (20 

12 U.S.C. 1061). 

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

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

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

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

17 (4) An Asian American and Native American 

18 Pacific Islander-serving institution, as defined in 

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

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 each of fiscal years 

23 2025 through 2029. 


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1 SEC. 1008. SAFETY AND EFFECTIVENESS OF DRUGS WITH 

2 RESPECT TO RACIAL AND ETHNIC BACK3 GROUND. 

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

5 Drug, and Cosmetic Act (21 U.S.C. 351 et seq.) is amend6 ed by inserting after section 505G (21 U.S.C. 355h) the 

7 following: 

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

9 RESPECT TO RACIAL AND ETHNIC BACK10 GROUND. 

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

12 a racial or ethnic disparity in safety or effectiveness with 

13 respect to a drug or biological product, then— 

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

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

16 adequate and well-controlled investigations of the 

17 disparity; or 

18 ‘‘(B) in the case of a biological product, the evi19 dence required under section 351(a) of the Public 

20 Health Service Act for approval of a biologics license 

21 application for the biological product shall include 

22 adequate and well-controlled investigations of the 

23 disparity; and 

24 ‘‘(2) if the investigations described in subpara25 graph (A) or (B) of paragraph (1) confirm that 

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


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1 biological product shall include appropriate informa2 tion about the disparity. 

3 ‘‘(b) POSTMARKET STUDIES.— 

4 ‘‘(1) IN GENERAL.—If there is evidence of a ra5 cial or ethnic disparity in safety or effectiveness with 

6 respect to a drug for which there is an approved ap7 plication under section 505 of this Act or of a bio8 logical product for which there is an approved li9 cense under section 351 of the Public Health Service 

10 Act, the Secretary may by order require the holder 

11 of the approved application or license to conduct, by 

12 a date specified by the Secretary, postmarket studies 

13 to investigate the disparity. 

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

15 that the postmarket studies confirm that there is a 

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

17 the drug or biological product shall include appro18 priate information about the disparity. 

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

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

21 the design of the postmarket studies required under 

22 such paragraph for a drug or biological product, in23 cluding the number of studies and study partici24 pants, and the other demographic characteristics of 

25 the study participants. 


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

2 Secretary may, by order and as necessary, modify 

3 any aspect of the design of a postmarket study re4 quired in an order under paragraph (1) after issuing 

5 such order. 

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

7 study required under paragraph (1) shall be sub8 mitted to the Secretary as a supplement to the drug 

9 application or biologics license application. 

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

11 ‘‘(1) IN GENERAL.—A drug for which an appli12 cation has been submitted or approved under section 

13 505(j) shall not be considered ineligible for approval 

14 under that section or misbranded under section 502 

15 on the basis that the labeling of the drug omits in16 formation relating to a disparity on the basis of ra17 cial or ethnic background as to the safety or effec18 tiveness of the drug, whether derived from investiga19 tions or studies required under this section or de20 rived from other sources, when the omitted informa21 tion is protected by patent or by exclusivity under 

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

23 ‘‘(2) LABELING.—Notwithstanding paragraph 

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

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1 formation relating to a disparity on the basis of ra2 cial or ethnic background as to the safety or effec3 tiveness of the drug include a statement of any ap4 propriate contraindications, warnings, or precautions 

5 related to the disparity that the Secretary considers 

6 necessary. 

7 ‘‘(d) DEFINITION.—In this section, the term ‘evi8 dence of a racial or ethnic disparity in safety or effective9 ness’, with respect to a drug or biological product, in10 cludes— 

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

12 basis of racial or ethnic background as to safety or 

13 effectiveness of a drug or biological product in the 

14 same chemical class as the drug or biological prod15 uct; 

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

17 basis of racial or ethnic background in the way the 

18 drug or biological product is metabolized; and 

19 ‘‘(3) other evidence as the Secretary may deter20 mine appropriate.’’. 

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

22 Food, Drug, and Cosmetic Act (21 U.S.C. 352) is amend23 ed by adding at the end the following: 

24 ‘‘(hh) If it is a drug and the holder of the approved 

25 application under section 505 or license under section 351 


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

2 to complete the investigations or studies required under 

3 section 505H, or comply with any other requirement of 

4 such section 505H.’’. 

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

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

7 379h(a)(1)(A)(ii)) is amended by inserting after ‘‘are not 

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

9 required under section 505H,’’. 

10 SEC. 1009. IMPROVING HEALTH DATA REGARDING NATIVE 

11 HAWAIIANS AND PACIFIC ISLANDERS. 

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

13 (42 U.S.C. 243 et seq.) is amended by inserting after sec14 tion 317V (42 U.S.C. 247b–24) the following: 

15 ‘‘SEC. 317W. NATIVE HAWAIIAN AND PACIFIC ISLANDER 

16 HEALTH DATA. 

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

18 ‘‘(1) INSULAR AREA.—The term ‘insular area’ 

19 means Guam, the Commonwealth of the Northern 

20 Mariana Islands, American Samoa, the United 

21 States Virgin Islands, the Federated States of Mi22 cronesia, the Republic of Palau, or the Republic of 

23 the Marshall Islands. 

24 ‘‘(2) NATIVE HAWAIIANS AND PACIFIC ISLAND25 ERS (NHPI).—The term ‘Native Hawaiians and PaVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 00044 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 cific Islanders’ or ‘NHPI’ means people having ori2 gins in any of the original peoples of American 

3 Samoa, the Commonwealth of the Northern Mariana 

4 Islands, the Federated States of Micronesia, Guam, 

5 Hawaii, the Republic of the Marshall Islands, the 

6 Republic of Palau, or any other Pacific Island. 

7 ‘‘(3) NHPI STAKEHOLDER GROUPS.—The term 

8 ‘NHPI stakeholder group’ includes each of the fol9 lowing: 

10 ‘‘(A) COMMUNITY GROUP.—A group of 

11 NHPI who are organized at the community 

12 level, and may include a church group, social 

13 service group, national advocacy organization, 

14 or cultural group. 

15 ‘‘(B) NONPROFIT, NONGOVERNMENTAL

16 ORGANIZATION.—A group of NHPI with a dem17 onstrated history of addressing NHPI issues, 

18 including a NHPI coalition. 

19 ‘‘(C) DESIGNATED ORGANIZATION.—An 

20 entity established to represent NHPI popu21 lations and which has statutory responsibilities 

22 to provide, or has community support for pro23 viding, health care. 

24 ‘‘(D) GOVERNMENT REPRESENTATIVES OF

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1 waii, American Samoa, the Commonwealth of 

2 the Northern Mariana Islands, the Federated 

3 States of Micronesia, Guam, the Republic of 

4 Palau, and the Republic of the Marshall Is5 lands. 

6 ‘‘(b) PRELIMINARY HEALTH SURVEY.— 

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

8 through the Director of the National Center for 

9 Health Statistics of the Centers for Disease Control 

10 and Prevention (referred to in this section as 

11 ‘NCHS’), shall conduct a preliminary health survey 

12 in order to identify the major areas and regions in 

13 the continental United States, Hawaii, American 

14 Samoa, the Commonwealth of the Northern Mariana 

15 Islands, the Federated States of Micronesia, Guam, 

16 the Republic of Palau, and the Republic of the Mar17 shall Islands in which NHPI people reside. 

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

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

20 other data the Secretary determines to be— 

21 ‘‘(A) useful in determining health status 

22 and health care needs of NHPI populations; or 

23 ‘‘(B) required for developing or imple24 menting the national strategy under subsection 

25 (c). 


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

2 health survey described in paragraph (1), including 

3 plans for designing questions, implementation, sam4 pling, and analysis, shall be developed in consulta5 tion with NHPI stakeholder groups. 

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

7 this subsection shall be completed not later than 18 

8 months after the date of enactment of the Health 

9 Equity and Accountability Act of 2024. 

10 ‘‘(c) NATIONAL STRATEGY.— 

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

12 through the Director of the NCHS and other agen13 cies within the Department of Health and Human 

14 Services as the Secretary determines appropriate, 

15 shall develop and implement a sustainable national 

16 strategy for identifying and evaluating the health 

17 status and health care needs of NHPI populations 

18 living in the continental United States, Hawaii, 

19 American Samoa, the Commonwealth of the North20 ern Mariana Islands, the Federated States of Micro21 nesia, Guam, the Republic of Palau, and the Repub22 lic of the Marshall Islands. 

23 ‘‘(2) CONSULTATION.—In developing and imple24 menting a national strategy, as described in para25 graph (1), not later than 180 days after the date of 


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1 enactment of the Health Equity and Accountability 

2 Act of 2024, the Secretary— 

3 ‘‘(A) shall consult with representatives of 

4 NHPI stakeholder groups; and 

5 ‘‘(B) may solicit the participation of rep6 resentatives from other Federal agencies. 

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

8 after the date of enactment of the Health Equity and Ac9 countability Act of 2024, the Secretary shall submit to 

10 Congress a progress report, which shall include the na11 tional strategy described in subsection (c)(1). 

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

13 MEDICINE DIVISION.— 

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

15 enter into an agreement with the Health and Medi16 cine Division of the National Academies of Sciences, 

17 Engineering, and Medicine to conduct a study, with 

18 input from stakeholders in insular areas, on each of 

19 the following: 

20 ‘‘(A) The standards and definitions of 

21 health care applied to health care systems in in22 sular areas and the appropriateness of such 

23 standards and definitions. 

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

25 care systems in insular areas, evaluated based 


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1 upon standards and definitions, as the Sec2 retary determines appropriate. 

3 ‘‘(C) The effectiveness of donor aid in ad4 dressing health care needs and priorities in in5 sular areas. 

6 ‘‘(D) The progress toward implementation 

7 of recommendations of the Committee on 

8 Health Care Services in the United States—As9 sociated Pacific Basin that are set forth in the 

10 1998 report entitled ‘Pacific Partnerships for 

11 Health: Charting a New Course’. 

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

13 paragraph (1) shall require the Health and Medicine 

14 Division to submit to the Secretary and to Congress, 

15 not later than 2 years after the date of the enact16 ment of the Health Equity and Accountability Act of 

17 2024, a report containing a description of the results 

18 of the study conducted under paragraph (1), includ19 ing the conclusions and recommendations of the 

20 Health and Medicine Division for each of the items 

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

22 paragraph. 

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

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1 priated such sums as may be necessary for fiscal years 

2 2025 through 2029.’’. 

3 SEC. 1010. CLARIFICATION OF SIMPLIFIED ADMINISTRA4 TIVE REPORTING REQUIREMENT. 

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

6 (7 U.S.C. 2020(a)) is amended by adding at the end the 

7 following: 

8 ‘‘(5) SIMPLIFIED ADMINISTRATIVE REPORTING

9 REQUIREMENT.—With respect to any obligation of a 

10 State agency to comply with the notification require11 ment under paragraph (2) of section 421(e) of the 

12 Personal Responsibility and Work Opportunity Rec13 onciliation Act of 1996 (8 U.S.C. 1631(e)), notwith14 standing the requirement to include in that notifica15 tion the names of the sponsor and the sponsored 

16 alien involved, the State agency shall be considered 

17 to have complied with the notification requirement if 

18 the State agency submits to the Attorney General a 

19 report that includes the aggregate number of excep20 tions granted by the State agency under paragraph 

21 (1) of that section.’’. 


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1 SEC. 1011. DATA COLLECTION REGARDING PANDEMIC PRE2 PAREDNESS, TESTING, INFECTIONS, AND 

3 DEATHS. 

4 (a) SKILLED NURSING FACILITIES QUALITY RE5 PORTING.—Section 1819 of the Social Security Act (42 

6 U.S.C. 1395i–3) is amended by adding at the end the fol7 lowing new subsection: 

8 ‘‘(l) REQUIREMENTS RELATING TO REPORTING DUR9 ING PUBLIC HEALTH EMERGENCIES.—During a public 

10 health emergency declared by the Secretary pursuant to 

11 section 319 of the Public Health Service Act, a skilled 

12 nursing facility shall, not later than 1 year after the first 

13 day of such declaration, and monthly thereafter during the 

14 application of such declaration, submit to the Secretary 

15 the following information, with respect to such facility and 

16 the residents of such facility: 

17 ‘‘(1) Information described in section 

18 483.80(g)(1) of title 42, Code of Federal Regula19 tions. 

20 ‘‘(2) The age, race, ethnicity, sex, sexual ori21 entation, gender identity, socioeconomic status, dis22 ability status, and preferred language of the resi23 dents of such skilled nursing facility.’’. 

24 (b) TRANSPARENCY OF DEMOGRAPHIC INFORMATION

25 IN CERTAIN SETTINGS.— 


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1 (1) DEMOGRAPHIC INFORMATION.—The Sec2 retary of Health and Human Services shall post the 

3 following information with respect to skilled nursing 

4 facilities (as defined in section 1819(a) of the Social 

5 Security Act (42 U.S.C. 1395i–3(a))), congregate 

6 care settings (including skilled nursing facilities, as7 sisted living facilities, prisons and jails, residential 

8 behavioral health care and psychiatric facilities, and 

9 facilities providing services for aging adults and peo10 ple with disabilities), and nursing facilities (as de11 fined in section 1919(a) of such Act (42 U.S.C. 

12 1396r(a))) on the Nursing Home Compare website 

13 (as described in section 1819(i) of such Act (42 

14 U.S.C. 1395i–3(i))), or a successor website, aggre15 gated by State: 

16 (A) The age, race, ethnicity, sex, sexual 

17 orientation, gender identity, socioeconomic sta18 tus, disability status, and preferred language of 

19 the residents of such skilled nursing facilities, 

20 congregate care settings (including skilled nurs21 ing facilities, assisted living facilities, prisons 

22 and jails, residential behavioral health care and 

23 psychiatric facilities, and facilities providing 

24 services for aging adults and people with dis25 abilities), and nursing facilities with suspected 


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1 or confirmed infections, including residents pre2 viously treated for COVID–19. 

3 (B) The age, race, ethnicity, sex, sexual 

4 orientation, gender identity, socioeconomic sta5 tus, disability status, and preferred language 

6 relating to total deaths and public health emer7 gency-related deaths among residents of such 

8 skilled nursing facilities, congregate settings 

9 (including skilled nursing facilities, assisted liv10 ing facilities, prisons and jails, residential be11 havioral health care and psychiatric facilities, 

12 and facilities providing services for aging adults 

13 and people with disabilities), and nursing facili14 ties. 

15 (2) CONFIDENTIALITY.—Any information re16 ported under this subsection that is made available 

17 to the public shall be made so available in a manner 

18 that protects the identity of residents of skilled nurs19 ing facilities, congregate care settings (including 

20 skilled nursing facilities, assisted living facilities, 

21 prisons and jails, residential behavioral health care 

22 and psychiatric facilities, and facilities providing 

23 services for aging adults and people with disabil24 ities), and nursing facilities. 


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1 (3) IMPLEMENTATION.—Notwithstanding any 

2 other provision of law, the Secretary of Health and 

3 Human Services may implement the provisions of 

4 this subsection by program instruction or otherwise. 

5 (c) EQUITABLE DATA COLLECTION AND DISCLOSURE

6 REGARDING PANDEMICS.—Part A of title XI of the Social 

7 Security Act (42 U.S.C. 1301 et seq.) as amended by sec8 tion 1003, is further amended by adding at the end the 

9 following new section: 

10 ‘‘SEC. 1150E. EQUITABLE DATA COLLECTION AND DISCLO11 SURE REGARDING PANDEMICS. 

12 ‘‘(a) IN GENERAL.—Not later than 60 days after the 

13 Secretary submits to Congress written notification of the 

14 determination that a disease or disorder presents a public 

15 health emergency or that a public health emergency other16 wise exists, subject to subsections (b) and (c), the Sec17 retary, acting through the Director of the Centers for Dis18 ease Control and Prevention and the Administrator of the 

19 Centers for Medicare & Medicaid Services and in consulta20 tion with the Director of the Indian Health Service, shall 

21 collect and make publicly available on the website of the 

22 Centers for Disease Control and Prevention and the Cen23 ters for Medicare & Medicaid Services, and update every 

24 day during a pandemic, data collected across all surveil25 lance systems relating to a public health emergency deVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 00054 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 clared under section 319 of the Public Health Service Act 

2 that is caused by a disease (as determined by the Sec3 retary), disaggregated by race, ethnicity, sex, sexual ori4 entation, gender identity, age, preferred language, socio5 economic status, disability status, and county. Such data 

6 shall include the following: 

7 ‘‘(1) Data relating to all testing for the patho8 gen or pathogens causing the pandemic, including 

9 the number of individuals tested and the number of 

10 tests that were positive. 

11 ‘‘(2) Data relating to treatment for the patho12 gen causing the pandemic, including hospitalizations 

13 and intensive care unit admissions. 

14 ‘‘(3) Data relating to pandemic outcomes, in15 cluding total fatalities and case fatality rates (ex16 pressed as the proportion of individuals who were in17 fected with the pathogen causing the pandemic and 

18 died from the pathogen). 

19 ‘‘(4) In the case a vaccine is developed in re20 sponse to a pandemic, data relating to such vaccina21 tion, including— 

22 ‘‘(A) the number of vaccines administered; 

23 ‘‘(B) the number of vaccinations offered, 

24 accepted, and refused; 


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1 ‘‘(C) the most common reasons for refusal; 

2 and 

3 ‘‘(D) the percentage of vaccine doses allo4 cated and administered to each priority group. 

5 ‘‘(b) APPLICATION OF CERTAIN STANDARDS WITH

6 RESPECT TO DATA COLLECTION.—To the extent prac7 ticable, data collected under subsection (a) shall follow 

8 standards developed by the Department of Health and 

9 Human Services Office of Minority Health and be col10 lected, analyzed, and reported in accordance with the 

11 standards promulgated by the Assistant Secretary for 

12 Planning and Evaluation under title XXXI of the Public 

13 Health Service Act. 

14 ‘‘(c) PRIVACY.—In publishing data pursuant to sub15 section (a), the Secretary shall take all necessary steps to 

16 protect the privacy of individuals whose information is in17 cluded in such data, including— 

18 ‘‘(1) complying with privacy protections pro19 vided under the regulations promulgated under sec20 tion 264(c) of the Health Insurance and Account21 ability Act of 1996; and 

22 ‘‘(2) protections from all inappropriate internal 

23 use by an entity that collects, stores, or receives the 

24 data, including use of such data in determinations of 


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1 eligibility (or continued eligibility) in health plans, 

2 and from inappropriate uses.’’. 

3 (d) REPORT REQUIREMENTS FOLLOWING PUBLIC

4 HEALTH EMERGENCIES.— 

5 (1) PUBLICLY AVAILABLE SUMMARY.—Not later 

6 than 60 days after the date on which the Secretary 

7 of Health and Human Services certifies that a public 

8 health emergency declared under section 319 of the 

9 Public Health Service Act has ended, the Secretary 

10 shall make publicly available on the website of the 

11 Department of Health and Human Services a sum12 mary of the final statistics related to such emer13 gency. 

14 (2) REPORT TO CONGRESS.—Not later than 60 

15 days after the date on which the Secretary of Health 

16 and Human Services certifies that a public health 

17 emergency declared under section 319 of the Public 

18 Health Service Act has ended, the Secretary shall 

19 submit to the Committee on Health, Education, 

20 Labor, and Pensions and the Committee on Finance 

21 of the Senate and the Committee on Energy and 

22 Commerce and the Committee on Ways and Means 

23 of the House of Representatives a report— 

24 (A) describing the testing, hospitalization, 

25 mortality rates, vaccination rates, and preferred 


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1 language of patients associated with the pan2 demic by race and ethnicity, rural and urban 

3 areas (as defined in section 1886(d)(2)(D) of 

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

5 1395ww(d)(2)(D))), and congregate care set6 tings (including skilled nursing facilities, as7 sisted living facilities, prisons and jails, residen8 tial behavioral health care and psychiatric facili9 ties, and facilities providing services for aging 

10 adults and people with disabilities) and noncon11 gregate care settings (as such terms are defined 

12 by the Secretary); and 

13 (B) proposing evidenced-based response 

14 strategies to safeguard the health of these com15 munities in future pandemics. 

16 SEC. 1012. COMMISSION ON ENSURING DATA FOR HEALTH 

17 EQUITY. 

18 (a) IN GENERAL.—Not later than 30 days after the 

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

20 Human Services (referred to in this section as the ‘‘Sec21 retary’’) shall establish a commission, to be known as the 

22 ‘‘Commission on Ensuring Data for Health Equity’’ (re23 ferred to in this section as the ‘‘Commission’’) to provide 

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1 ysis, and use of demographic data in responding to future 

2 public health emergencies. 

3 (b) MEMBERSHIP AND CHAIRPERSON.— 

4 (1) MEMBERSHIP.—The Commission shall be 

5 composed of— 

6 (A) the Assistant Secretary for Prepared7 ness and Response; 

8 (B) the Director of the Centers for Disease 

9 Control and Prevention; 

10 (C) the Director of the National Institutes 

11 of Health; 

12 (D) the Commissioner of Food and Drugs; 

13 (E) the Administrator of the Federal 

14 Emergency Management Agency; 

15 (F) the Director of the National Institute 

16 on Minority Health and Health Disparities; 

17 (G) the Director of the Indian Health 

18 Service; 

19 (H) the Administrator of the Centers for 

20 Medicare & Medicaid Services; 

21 (I) the Director of the Agency for 

22 Healthcare Research and Quality; 

23 (J) the Surgeon General; 

24 (K) the Administrator of the Health Re25 sources and Services Administration; 


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1 (L) the Director of the Office of Minority 

2 Health; 

3 (M) the Director of the Office on Women’s 

4 Health; 

5 (N) the Chairperson of the National Coun6 cil on Disability; 

7 (O) at least 4 State, local, territorial, and 

8 Tribal public health officials representing de9 partments of public health, or an Urban Indian 

10 health representative, who shall represent juris11 dictions from different regions of the United 

12 States with relatively high concentrations of 

13 historically marginalized populations and rural 

14 populations, to be appointed by the Secretary; 

15 (P) the National Coordinator for Health 

16 Information Technology; 

17 (Q) at least 3 independent individuals with 

18 expertise on racially and ethnically diverse rep19 resentation with knowledge or field experience 

20 with community-based participatory research on 

21 racial and ethnic disparities in public health, to 

22 be appointed by the Secretary; and 

23 (R) at least 4 individuals with expertise on 

24 health equity and demographic data disparities 

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1 guage, disability status, sex, sexual orientation, 

2 gender identity, or socioeconomic status. 

3 (2) CHAIRPERSON.—The Assistant Secretary 

4 for Preparedness and Response shall serve as the 

5 Chairperson of the Commission. 

6 (c) DUTIES.—The Commission shall— 

7 (1) examine barriers to collecting, analyzing, 

8 and using demographic data in public health; 

9 (2) determine how to best use such data to pro10 mote health equity across the United States and re11 duce racial, Tribal, and other demographic dispari12 ties in health outcomes; 

13 (3)(A) gather available data related to treat14 ment of individuals with disabilities during the 

15 COVID–19 pandemic and other public health emer16 gencies, including access to vaccinations, denial of 

17 treatment for preexisting conditions, removal or de18 nial of disability related equipment (including ven19 tilators and continuous positive airway pressure 

20 (commonly referred to as ‘‘CPAP’’) machines), and 

21 data on completion of do-not-resuscitate orders; and 

22 (B) identify barriers to obtaining accurate and 

23 timely data related to treatment of such individuals; 

24 (4) solicit input from public health officials, 

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1 viders, State and local agency officials, Tribal offi2 cials, and other experts on barriers to, and best 

3 practices for, collecting demographic data; and 

4 (5) recommend policy changes that the data in5 dicates are necessary to reduce demographic dispari6 ties in health outcomes. 

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

8 of the enactment of this Act, the Commission shall submit 

9 to Congress, and publish on the website of the Department 

10 of Health and Human Services, a report containing— 

11 (1) the findings of the Commission pursuant to 

12 subsection (c); 

13 (2) to the extent possible, an analysis of— 

14 (A) racial and other demographic dispari15 ties in COVID–19 mortality, including an anal16 ysis of comorbidities and case fatality rates; 

17 (B) sex, sexual orientation, and gender 

18 identity disparities in COVID–19 treatment and 

19 mortality; and 

20 (C) Federal Government policies that dis21 parately exacerbate the COVID–19 impact, and 

22 recommendations to improve racial and other 

23 demographic disparities in health outcomes; 

24 (3) an analysis of COVID–19 treatment of indi25 viduals with disabilities, including equity of access to 


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1 treatment and equipment and intersections of dis2 ability status with other demographic factors, includ3 ing race; 

4 (4) an analysis of what demographic data is 

5 currently being collected, the accuracy of that data 

6 and any gaps, how this data is currently being used 

7 to inform efforts to combat COVID–19, and what 

8 resources are needed to supplement existing public 

9 health data collection; and 

10 (5) the Commission’s recommendations with re11 spect to— 

12 (A) how to enhance State, local, territorial, 

13 and Tribal capacity to conduct public health re14 search on COVID–19 and in future public 

15 health emergencies, with a focus on expanded 

16 capacity to analyze data on disparities cor17 related with race, ethnicity, income, sex, sexual 

18 orientation, gender identity, age, disability sta19 tus, specific geographic areas, and other rel20 evant demographic characteristics; 

21 (B) how to collect, process, and disclose to 

22 the public the data described in subparagraph 

23 (A) in a way that maintains individual privacy 

24 while helping direct the State, local, and Tribal 

25 response to public health emergencies; 


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1 (C) how to improve demographic data col2 lection related to COVID–19 and other public 

3 health emergencies in the short-term and long4 term, including how to continue to grow and 

5 value the Tribal sovereignty of data and infor6 mation concerning urban and rural Tribal com7 munities; 

8 (D) how to improve transparency and eq9 uity of treatment for individuals with disabil10 ities during the COVID–19 public health emer11 gency and future public health emergencies; and 

12 (E) how to support State, local, and Tribal 

13 capacity to eliminate barriers to vaccinations, 

14 testing, and treatment during the COVID–19 

15 public health emergency and future public 

16 health emergencies. 

17 (e) STAFF OF COMMISSION.— 

18 (1) ADDITIONAL STAFF.—The Chairperson of 

19 the Commission may appoint and fix the pay of ad20 ditional staff to the Commission as the Chairperson 

21 considers appropriate. 

22 (2) APPLICABILITY OF CERTAIN CIVIL SERVICE

23 LAWS.—The staff of the Commission may be ap24 pointed without regard to the provisions of title 5, 

25 United States Code, governing appointments in the 


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1 competitive service, and may be paid without regard 

2 to the provisions of chapter 51 and subchapter III 

3 of chapter 53 of that title relating to classification 

4 and General Schedule pay rates. 

5 (3) DETAILEES.—Any Federal Government em6 ployee may be detailed to the Commission without 

7 reimbursement from the Commission, and the 

8 detailee shall retain the rights, status, and privileges 

9 of his or her regular employment without interrup10 tion. 

11 (f) COORDINATION WITH OTHER EFFORTS.—The 

12 Secretary shall, in establishing the Commission under this 

13 section, take such steps as may be necessary to ensure 

14 that the work of the Commission does not overlap with, 

15 or otherwise duplicate, other Federal Government efforts 

16 with respect to ensuring health equity in data collection 

17 in public health emergencies. 

18 (g) AUTHORIZATION OF APPROPRIATIONS.—There 

19 are authorized to be appropriated such sums as may be 

20 necessary to carry out this section. 

21 SEC. 1013. TASK FORCE ON PREVENTING BIAS IN AI AND 

22 ALGORITHMS. 

23 (a) IN GENERAL.—Not later than 30 days after the 

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

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1 retary’’) shall establish a Task Force to be known as the 

2 ‘‘Task Force on Preventing AI and Algorithmic Bias in 

3 Health Care’’ (referred to in this section as the ‘‘Task 

4 Force’’) to provide clear and robust guidance on how to 

5 ensure that the development and integration of artificial 

6 intelligence and algorithmic technologies within the health 

7 care service delivery process does not exacerbate health 

8 disparities and inequities, expands access to health care 

9 services, and improves health care delivery. 

10 (b) MEMBERSHIP AND CHAIRPERSON.— 

11 (1) MEMBERSHIP.—The Task Force shall be 

12 composed of— 

13 (A) the Chief Information Officer of the 

14 Department of Health and Human Services; 

15 (B) the Director of the Centers for Disease 

16 Control and Prevention; 

17 (C) the Director of the National Institutes 

18 of Health; 

19 (D) the Commissioner of Food and Drugs; 

20 (E) the Administrator of the Federal 

21 Emergency Management Agency; 

22 (F) the Director of the National Institute 

23 on Minority Health and Health Disparities; 

24 (G) the Director of the Indian Health 

25 Service; 


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1 (H) the Administrator of the Centers for 

2 Medicare & Medicaid Services; 

3 (I) the Director of the Agency for 

4 Healthcare Research and Quality; 

5 (J) the Surgeon General; 

6 (K) the Administrator of the Health Re7 sources and Services Administration; 

8 (L) the Director of the Office of Minority 

9 Health; 

10 (M) the Director of the Office on Women’s 

11 Health; 

12 (N) the Chairperson of the National Coun13 cil on Disability; 

14 (O) the National Coordinator for Health 

15 Information Technology; 

16 (P) at least 4 State, local, territorial, and 

17 Tribal public health officials representing de18 partments of public health, or an Urban Indian 

19 health representative, who shall represent juris20 dictions from different regions of the United 

21 States with relatively high concentrations of 

22 historically marginalized populations, to be ap23 pointed by the Secretary; 

24 (Q) at least 3 independent individuals with 

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1 resentation with knowledge or field experience 

2 with community-based participatory research on 

3 racial and ethnic disparities in public health, to 

4 be appointed by the Secretary; and 

5 (R) at least 4 individuals with expertise on 

6 health equity and demographic data disparities 

7 with knowledge of, or field experience in, lan8 guage, disability status, sex, sexual orientation, 

9 gender identity, or socioeconomic status. 

10 (2) CHAIRPERSON.—The Chief Information Of11 ficer of the Department of Health and Human Serv12 ices (or the Chief Information Officer’s designee) 

13 shall serve as the Chairperson of the Task Force. 

14 (c) DUTIES.—The Task Force shall— 

15 (1) examine artificial intelligence and algo16 rithms in the health care service sector, including 

17 the health care delivery process relative to the use 

18 of autonomous human decision makers; 

19 (2) identify the risks of health care system utili20 zation of artificial intelligence and algorithms in 

21 terms of civil rights, civil liberties, and discrimina22 tory bias in health care access, quality, and out23 comes; and 

24 (3) prepare and submit the report under sub25 section (d). 


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

2 of enactment of this Act, the Task Force shall— 

3 (1) submit a written report of the findings of 

4 the examination under subsection (c)(1) and rec5 ommendations to Congress with respect to imple6 mentation of artificial intelligence and algorithms in 

7 health care delivery and mitigation of the risks asso8 ciated with that implementation; and 

9 (2) publish such report on the website of the 

10 Department of Health and Human Services. 

11 (e) PUBLIC COMMENT.—Not later than 60 days after 

12 the date of the enactment of this Act, the Task Force shall 

13 publish in the Federal Register a notice providing for a 

14 public comment period on the duties and activities of the 

15 Task Force of not less than 90 days, beginning on the 

16 date of that publication. 

17 (f) STAFF OF COMMISSION.— 

18 (1) ADDITIONAL STAFF.—The Chairperson of 

19 the Task Force may appoint and fix the pay of addi20 tional staff to the Task Force as the Chairperson 

21 considers appropriate. 

22 (2) APPLICABILITY OF CERTAIN CIVIL SERVICE

23 LAWS.—The staff of the Task Force may be ap24 pointed without regard to the provisions of title 5, 

25 United States Code, governing appointments in the 


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1 competitive service, and may be paid without regard 

2 to the provisions of chapter 51 and subchapter III 

3 of chapter 53 of that title relating to classification 

4 and General Schedule pay rates. 

5 (3) DETAILEES.—Any Federal Government em6 ployee may be detailed to the Task Force without re7 imbursement from the Task Force, and the detailee 

8 shall retain the rights, status, and privileges of his 

9 or her regular employment without interruption. 

10 SEC. 1014. REPORT ON THE HEALTH OF THE MIDDLE EAST11 ERN AND NORTH AFRICAN POPULATION. 

12 (a) STUDY REQUIRED.—The Secretary of Health and 

13 Human Services (referred to in this section as the ‘‘Sec14 retary’’) shall conduct or support a comprehensive study 

15 regarding the unique health patterns and outcomes of 

16 Middle Eastern and North African (referred to in this sec17 tion as ‘‘MENA’’) populations. 

18 (b) REQUIREMENTS FOR STUDY.—The comprehen19 sive study under subsection (a) shall include an enumera20 tion of MENA populations across the United States, 

21 disaggregated by subpopulation, and with respect to each 

22 such population and subpopulation— 

23 (1) the rates of— 

24 (A) obesity, diabetes, sickle cell anemia, 

25 stroke, asthma, pneumonia, lung cancer, HIV/ 


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1 AIDS, HPV, high cholesterol, high blood pres2 sure, and chronic heart, lung, and kidney dis3 ease; 

4 (B) morbidity and mortality, including the 

5 rates of morbidity and mortality associated with 

6 the health conditions listed in subparagraph 

7 (A); 

8 (C) mental health and substance use dis9 orders; and 

10 (D) domestic violence, dating violence, sex11 ual assault, sexual harassment, and stalking; 

12 (2) analysis of— 

13 (A) the rates described in paragraph (1); 

14 (B) the leading causes of pregnancy-associ15 ated morbidity and mortality; and 

16 (C) access to health care facilities and the 

17 associated outcomes of care; 

18 (3) analysis, enumeration, or quantification of 

19 any other health or health-related parameters the 

20 Secretary may determine necessary; and 

21 (4) analysis of the relationship between the 

22 health factors, outcomes, and conditions described in 

23 paragraphs (1) through (3) and the implementation 

24 of Federal health programs. 

25 (c) CONSULTATION.—The Secretary shall— 


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1 (1) carry out this section in consultation, as ap2 propriate, with the Director of the Census Bureau, 

3 the Director of the Centers for Disease Control and 

4 Prevention, the Director of the National Institutes 

5 of Health, the Assistant Secretary for Mental Health 

6 and Substance Use, and other stakeholders (includ7 ing community-based organizations); and 

8 (2) determine through such consultation the 

9 subpopulations to be used for purposes of 

10 disaggregation of data pursuant to subsection (b). 

11 (d) ONLINE PORTAL.—Upon conclusion of the com12 prehensive study under this section, the Secretary shall 

13 establish a public online portal to catalogue the results of 

14 the study, its underlying data, and information in the re15 port submitted pursuant to subsection (e). 

16 (e) REPORTING.— 

17 (1) INTERIM REPORT.—Not later than 2 years 

18 after the date of enactment of this Act, the Sec19 retary shall submit to Congress a report outlining 

20 the challenges associated with, and progress towards 

21 implementing health data collection for MENA pop22 ulations as a distinct category and the plan for com23 pleting a comprehensive study regarding the unique 

24 health patterns and outcomes of MENA populations. 


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1 (2) FINAL REPORT.—Not later than 30 days 

2 after the conclusion of the comprehensive study 

3 under this section, the Secretary shall submit to 

4 Congress a report describing— 

5 (A) the results of the study conducted 

6 under this section; and 

7 (B) the rulemakings and other actions the 

8 agencies described in subsection (c)(1) can un9 dertake to more equitably include MENA indi10 viduals in their programs. 

11 (f) PRIVACY.—The Secretary shall not include any 

12 personally identifiable information on the online portal 

13 under subsection (d) or in a report under subsection (e). 

14 (g) DEFINITION OF MIDDLE EASTERN AND NORTH

15 AFRICAN; MENA.—In this section, the terms ‘‘Middle 

16 Eastern and North African’’ or ‘‘MENA’’, with respect to 

17 individuals or populations, includes individuals and popu18 lations who identify with or belong to one or more nation19 alities or ethnic groups originating in a country (or portion 

20 thereof) in the Middle Eastern and North African region 

21 (such as Lebanese, Iranians, Egyptians, Moroccans, Yem22 enis, Chaldeans, Imazighen, Kurds, Palestinians, and 

23 Yazidis). 


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1 TITLE II—CULTURALLY AND LIN2 GUISTICALLY APPROPRIATE 

3 HEALTH AND HEALTH CARE 

4 SEC. 2001. DEFINITIONS. 

5 In this title, the definitions in section 3400 of the 

6 Public Health Service Act, as added by section 2004, shall 

7 apply. 

8 SEC. 2002. IMPROVING ACCESS TO SERVICES FOR INDIVID9 UALS WITH LIMITED ENGLISH PROFICIENCY. 

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

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

12 to improving access to services for persons with limited 

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

14 (1) to improve Federal agency performance re15 garding access to federally conducted and federally 

16 assisted programs and activities for individuals with 

17 limited English proficiency; 

18 (2) to require each Federal agency to examine 

19 the services it provides and develop and implement 

20 a system by which individuals with limited English 

21 proficiency can obtain culturally competent services 

22 and meaningful access to those services consistent 

23 with, and without substantially burdening, the fun24 damental mission of the agency; 


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1 (3) to require each Federal agency to translate 

2 any English language written material prepared for 

3 the general public into the top 15 non-English lan4 guages in the United States (according to the most 

5 recent data from the American Community Survey 

6 or its replacement) within established timelines de7 scribed in subsection (b)(2)(C)(v); 

8 (4) to require each Federal agency to ensure 

9 that recipients of Federal financial assistance pro10 vide culturally competent services and meaningful 

11 access to applicants and beneficiaries who are indi12 viduals with limited English proficiency; 

13 (5) to ensure that recipients of Federal finan14 cial assistance take reasonable steps, consistent with 

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

16 Financial Assistance Recipients Regarding Title VI 

17 Prohibition Against National Origin Discrimination 

18 Affecting Limited English Proficient Persons’’ (67 

19 Fed. Reg. 41455 (June 18, 2002)), to ensure cul20 turally and linguistically appropriate access to their 

21 programs and activities by individuals with limited 

22 English proficiency; and 

23 (6) to ensure compliance with title VI of the 

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

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1 fordable Care Act (42 U.S.C. 18116) (prohibiting 

2 health care providers and organizations from dis3 criminating in the provision of services). 

4 (b) FEDERALLY CONDUCTED PROGRAMS AND AC5 TIVITIES.— 

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

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

8 agency providing financial assistance to, or admin9 istering, a health program or activity described in 

10 section 2003(a) shall prepare a plan or update a 

11 plan to improve culturally and linguistically appro12 priate access to such program or activity with re13 spect to individuals with limited English proficiency. 

14 Not later than 1 year after the date of enactment 

15 of this Act, each such Federal agency shall ensure 

16 that such plan is fully implemented. 

17 (2) PLAN REQUIREMENT.—Each plan under 

18 paragraph (1) shall include— 

19 (A) the steps the agency will take to en20 sure that individuals with limited English pro21 ficiency have access to each health program or 

22 activity supported or administered by the agen23 cy; 

24 (B) the policies and procedures for identi25 fying, assessing, and meeting the culturally and 


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1 linguistically appropriate language needs of its 

2 beneficiaries that are individuals with limited 

3 English proficiency served by such program or 

4 activity; 

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

6 program or activity to be culturally and linguis7 tically appropriate by— 

8 (i) providing a range of language as9 sistance options; 

10 (ii) giving notice to individuals with 

11 limited English proficiency of the right to 

12 competent language services; 

13 (iii) training staff (at least annually); 

14 (iv) monitoring and assessing the 

15 quality of the language services (at least 

16 annually); and 

17 (v) translating any English language 

18 written material prepared for the general 

19 public into the top 15 non-English lan20 guages in the United States (according to 

21 the most recent data from the American 

22 Community Survey or its replacement) 

23 within established timelines that ensure 

24 that high-quality, culturally competent 

25 translated material is provided promptly 


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1 within not more than 15 calendar days in 

2 general and within not more than 7 cal3 endar days in the case of any national 

4 emergency or State disaster declaration; 

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

6 program or activity to provide reasonable ac7 commodations necessary for individuals with 

8 limited English proficiency, including those in9 dividuals with a communication disability, to 

10 understand communications from the agency; 

11 (E) the steps the agency will take to en12 sure that applications, forms, and other signifi13 cant documents for such program or activity 

14 are competently translated into the primary 

15 language of a client that is an individual with 

16 limited English proficiency where such mate17 rials are needed to improve access of such client 

18 to such program or activity; 

19 (F) the resources the agency will provide 

20 to improve cultural and linguistic appropriate21 ness to assist recipients of Federal funds to im22 prove access to health care-related programs 

23 and activities for individuals with limited 

24 English proficiency; 


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1 (G) the resources the agency will provide 

2 to ensure that competent language assistance is 

3 provided to patients that are individuals with 

4 limited English proficiency by interpreters or 

5 trained bilingual staff; 

6 (H) the resources the agency will provide 

7 to ensure that family, particularly minor chil8 dren, and friends are not used to provide inter9 pretation services, except as permitted under 

10 section 1557 of the Patient Protection and Af11 fordable Care Act (42 U.S.C. 18116); and 

12 (I) the steps the agency will take and re13 sources the agency will provide to ensure that 

14 individuals know their rights, including the abil15 ity to file a complaint. 

16 (3) SUBMISSION OF PLAN TO DOJ.—Each agen17 cy that is required to prepare a plan under para18 graph (1) shall— 

19 (A) consult with populations who are di20 rectly impacted by policies in the plan and their 

21 representatives in the development of the plan; 

22 and 

23 (B) when the plan is finalized, send a copy 

24 of such plan to the Attorney General, to serve 

25 as the central repository of all such plans. 


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1 SEC. 2003. ENSURING STANDARDS FOR CULTURALLY AND 

2 LINGUISTICALLY APPROPRIATE SERVICES IN 

3 HEALTH CARE. 

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

5 health program or activity— 

6 (1) of which any part is receiving Federal fi7 nancial assistance, including credits, subsidies, or 

8 contracts of insurance; or 

9 (2) that is carried out (including indirectly 

10 through contracts, subcontracts, or other support) 

11 by an executive agency or any entity established 

12 under title I of the Patient Protection and Afford13 able Care Act (42 U.S.C. 18001 et seq.) (or amend14 ments made thereby). 

15 (b) STANDARDS.—Each program or activity de16 scribed in subsection (a)— 

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

18 and promote individuals at all levels to maintain a 

19 diverse staff and leadership that can provide cul20 turally and linguistically appropriate health care to 

21 patient populations of the service area of the pro22 gram or activity; 

23 (2) shall educate and train governance, leader24 ship, and workforce at all levels and across all dis25 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 yearly; 

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 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. 1320d–2 note; Public Law 104–191), 

23 data on an individual required to be collected pursu24 ant to section 3101 of the Public Health Service Act 

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1 native format preferences and policy modification 

2 needs, are— 

3 (A) collected in health records; 

4 (B) integrated into the management infor5 mation systems of the program or activity; 

6 (C) reported in such a way as to be inter7 operable with health information systems at the 

8 Federal and State levels; and 

9 (D) periodically updated; 

10 (8) shall maintain a current demographic, cul11 tural, and epidemiological profile of the community, 

12 conduct regular assessments of community health 

13 assets and needs, and use the results of such assess14 ments to accurately plan for and implement services 

15 that respond to the cultural and linguistic character16 istics of the service area of the program or activity; 

17 (9) shall develop participatory, collaborative 

18 partnerships with community-based organizations 

19 and utilize a variety of formal and informal mecha20 nisms to facilitate community and patient involve21 ment in designing, implementing, and evaluating 

22 policies and practices to ensure culturally and lin23 guistically appropriate service-related activities; 

24 (10) shall ensure that conflict and grievance 

25 resolution processes are culturally and linguistically 


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1 appropriate and capable of identifying, preventing, 

2 and resolving cross-cultural conflicts or complaints 

3 by patients; 

4 (11) shall annually— 

5 (A) make available to the public— 

6 (i) information about the progress and 

7 successful innovations of the program or 

8 activity in implementing the standards 

9 under this section; and 

10 (ii) translated materials of such infor11 mation that is culturally and linguistically 

12 appropriate to the communities served 

13 under this section; and 

14 (B) provide public notice in such commu15 nities about the availability of such information; 

16 and 

17 (12) shall, if requested, regularly make avail18 able to the head of each Federal entity from which 

19 Federal funds are provided, information about the 

20 progress and successful innovations of the program 

21 or activity in implementing the standards under this 

22 section as required by the head of such entity. 

23 (c) COMMENTS ACCEPTED THROUGH NOTICE AND

24 COMMENT RULEMAKING.—An executive agency carrying 

25 out a program or activity described in subsection (a)— 


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1 (1) shall ensure that comments with respect to 

2 such program or activity that are accepted through 

3 notice and comment rulemaking are accepted in all 

4 languages; 

5 (2) may not require such comments to be sub6 mitted only in English; and 

7 (3) shall ensure that any such comments that 

8 are not submitted in English are considered, during 

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

10 such comments that are submitted in English. 

11 SEC. 2004. CULTURALLY AND LINGUISTICALLY APPRO12 PRIATE HEALTH CARE IN THE PUBLIC 

13 HEALTH SERVICE ACT. 

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

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

16 ‘‘TITLE XXXIV—CULTURALLY 

17 AND LINGUISTICALLY APPRO18 PRIATE HEALTH CARE 

19 ‘‘SEC. 3400. DEFINITIONS. 

20 ‘‘(a) IN GENERAL.—In this title: 

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

22 respect to an individual, means an individual who 

23 has a sufficient degree of proficiency in 2 languages. 

24 ‘‘(2) COMMUNITY HEALTH WORKER.—The term 

25 ‘community health worker’ means a frontline health 


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1 worker who is a trusted member of the community 

2 in which the worker serves or who has an unusually 

3 close understanding of the community served that 

4 enables the worker to build trusted relationships, 

5 serve as a liaison between health and social services 

6 and the community, facilitate access to services, and 

7 improve the quality and cultural competence of serv8 ice delivery. 

9 ‘‘(3) CULTURAL.—The term ‘cultural’ means 

10 relating to integrated patterns of human behavior 

11 that include the language, thoughts, communica12 tions, actions, customs, beliefs, values, age, and in13 stitutions of racial, ethnic, religious, or social 

14 groups, including lesbian, gay, bisexual, transgender, 

15 queer, and questioning individuals, and individuals 

16 with physical and mental disabilities. 

17 ‘‘(4) CULTURALLY AND LINGUISTICALLY AP18 PROPRIATE.—The term ‘culturally and linguistically 

19 appropriate’ means being respectful of and respon20 sive to the cultural and linguistic needs of all indi21 viduals. 

22 ‘‘(5) EFFECTIVE COMMUNICATION.—The term 

23 ‘effective communication’ means an exchange of in24 formation between the provider of health care or 

25 health care-related services and the recipient of such 


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1 services who is limited in English proficiency, or has 

2 a communication impairment such as a hearing, vi3 sion, speaking, or cognitive disability, that enables 

4 access to, understanding of, and benefit from health 

5 care or health care-related services, and full partici6 pation in the development of the treatment plan of 

7 the recipient. 

8 ‘‘(6) GRIEVANCE RESOLUTION PROCESS.—The 

9 term ‘grievance resolution process’ means all aspects 

10 of dispute resolution including filing complaints, 

11 grievance and appeal procedures, and court action. 

12 ‘‘(7) HEALTH CARE GROUP.—The term ‘health 

13 care group’ means a group of physicians organized, 

14 at least in part, for the purposes of providing physi15 cian services under the Medicaid program under title 

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

17 Health Insurance Program under title XXI of such 

18 Act, or the Medicare program under title XVIII of 

19 such Act, including a provider of services under part 

20 B of such title XVIII, and may include a hospital, 

21 a hospice provider, a palliative care provider, and 

22 any other individual or entity furnishing services 

23 covered under any such program that is affiliated 

24 with the health care group. 


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1 ‘‘(8) HEALTH CARE.—The term ‘health care’ 

2 includes all health care needed throughout the life 

3 cycle and the end of life. 

4 ‘‘(9) HEALTH CARE SERVICES.—The term 

5 ‘health care services’ means services that address 

6 physical and mental health conditions, as well as 

7 conditions impacted by social determinants of health, 

8 in all care settings throughout the life cycle and the 

9 end of life. 

10 ‘‘(10) HEALTH CARE-RELATED SERVICES.—The 

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

12 social services programs or activities that provide ac13 cess, referrals, or links to health care services. 

14 ‘‘(11) HEALTH EDUCATOR.—The term ‘health 

15 educator’ includes a professional with a bacca16 laureate degree who is responsible for designing, im17 plementing, and evaluating individual and population 

18 health promotion, health education (including edu19 cation on end-of-life care options), end-of-life care, 

20 or chronic disease prevention programs. 

21 ‘‘(12) INDIAN; INDIAN TRIBE.—The terms ‘In22 dian’ and ‘Indian Tribe’ have the meanings given 

23 such terms in section 4 of the Indian Self-Deter24 mination and Education Assistance Act. 


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1 ‘‘(13) INDIVIDUAL WITH A DISABILITY.—The 

2 term ‘individual with a disability’ means any indi3 vidual who has a disability as defined for the pur4 pose of section 504 of the Rehabilitation Act of 

5 1973. 

6 ‘‘(14) INDIVIDUAL WITH LIMITED ENGLISH

7 PROFICIENCY.—The term ‘individual with limited 

8 English proficiency’ means an individual who self9 identifies on the Census as speaking English less 

10 than ‘very well’. 

11 ‘‘(15) INTEGRATED HEALTH CARE DELIVERY

12 SYSTEM.—The term ‘integrated health care delivery 

13 system’ means an interdisciplinary system that 

14 brings together providers from the primary health, 

15 mental health, substance use disorder, hospice and 

16 palliative care, and related disciplines to improve the 

17 health outcomes of an individual and the community. 

18 Such providers may include hospitals, health, mental 

19 health, or substance use prevention and treatment 

20 clinics and providers, home health agencies, home21 and community-based services providers, congregate 

22 settings (including any skilled nursing facilities, as23 sisted living facilities, prisons and jails, residential 

24 behavioral health care and psychiatric facilities, and 

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1 viduals with disabilities), ambulatory surgery cen2 ters, rehabilitation centers, employed, independent, 

3 or contracted physicians, and oral health care pro4 viders. 

5 ‘‘(16) INTERPRETING; INTERPRETATION.—The 

6 terms ‘interpreting’ and ‘interpretation’ mean the 

7 transmission of a spoken, written, or signed message 

8 from one language or format into another, faithfully, 

9 accurately, and objectively. 

10 ‘‘(17) LANGUAGE ACCESS.—The term ‘language 

11 access’ means the provision of language services to 

12 an individual with limited English proficiency or an 

13 individual with communication disabilities designed 

14 to enhance that individual’s access to, understanding 

15 of, or benefit from health care services or health 

16 care-related services. 

17 ‘‘(18) LANGUAGE ASSISTANCE SERVICES.—The 

18 term ‘language assistance services’ includes— 

19 ‘‘(A) oral language assistance, including in20 terpretation in non-English languages provided 

21 in person or remotely by a qualified interpreter 

22 for an individual with limited English pro23 ficiency, and the use of qualified bilingual or 

24 multilingual staff to communicate directly with 

25 individuals with limited English proficiency; 


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

2 qualified translator, of written content in paper 

3 or electronic form into languages other than 

4 English; and 

5 ‘‘(C) taglines. 

6 ‘‘(19) MINORITY POPULATIONS.—The term ‘mi7 nority populations’ means individuals of racial and 

8 ethnic minority groups, individuals of sexual and 

9 gender minority groups, and individuals with a dis10 ability. 

11 ‘‘(20) ONSITE INTERPRETATION.—The term 

12 ‘onsite interpretation’ means a method of inter13 preting or interpretation for which the interpreter is 

14 in the physical presence of the provider of health 

15 care services or health care-related services and the 

16 recipient of such services who is limited in English 

17 proficiency or has a communication impairment such 

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

19 ‘‘(21) QUALIFIED INDIVIDUAL WITH A DIS20 ABILITY.—The term ‘qualified individual with a dis21 ability’ means, with respect to a health program or 

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

23 without reasonable modifications to policies, prac24 tices, or procedures, the removal of architectural, 

25 communication, or transportation barriers, or the 


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1 provision of auxiliary aids and services, meets the es2 sential eligibility requirements for the receipt of aids, 

3 benefits, or services offered or provided by the health 

4 program or activity. 

5 ‘‘(22) QUALIFIED INTERPRETER FOR AN INDI6 VIDUAL WITH A DISABILITY.—The term ‘qualified 

7 interpreter for an individual with a disability’, with 

8 respect to an individual with a disability— 

9 ‘‘(A) means an interpreter for such indi10 vidual who by means of a remote interpreting 

11 service or an onsite appearance— 

12 ‘‘(i) adheres to generally accepted in13 terpreter ethics principles, including client 

14 confidentiality; and 

15 ‘‘(ii) is able to interpret effectively, ac16 curately, and impartially, both receptively 

17 and expressively, using any necessary spe18 cialized vocabulary, terminology, and phra19 seology; and 

20 ‘‘(B) may include— 

21 ‘‘(i) sign language interpreters; 

22 ‘‘(ii) oral transliterators, which are in23 dividuals who represent or spell in the 

24 characters of another alphabet; and 


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1 ‘‘(iii) cued language transliterators, 

2 which are individuals who represent or 

3 spell by using a small number of 

4 handshapes. 

5 ‘‘(23) QUALIFIED INTERPRETER FOR AN INDI6 VIDUAL WITH LIMITED ENGLISH PROFICIENCY.— 

7 The term ‘qualified interpreter for an individual with 

8 limited English proficiency’ means an interpreter 

9 who by means of a remote interpreting service or an 

10 onsite appearance— 

11 ‘‘(A) adheres to generally accepted inter12 preter ethics principles, including client con13 fidentiality; 

14 ‘‘(B) has demonstrated proficiency in 

15 speaking and understanding both spoken 

16 English and one or more other spoken lan17 guages; and 

18 ‘‘(C) is able to interpret effectively, accu19 rately, and impartially, both receptively and ex20 pressly, to and from such languages and 

21 English, using any necessary specialized vocab22 ulary, terminology, and phraseology. 

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

24 ‘qualified translator’ means a translator who— 


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1 ‘‘(A) adheres to generally accepted trans2 lator ethics principles, including client confiden3 tiality; 

4 ‘‘(B) has demonstrated proficiency in writ5 ing and understanding both written English 

6 and one or more other written non-English lan7 guages; and 

8 ‘‘(C) is able to translate effectively, accu9 rately, and impartially to and from such lan10 guages and English, using any necessary spe11 cialized vocabulary, terminology, and phrase12 ology. 

13 ‘‘(25) RACIAL AND ETHNIC MINORITY GROUP.— 

14 The term ‘racial and ethnic minority group’ has the 

15 meaning given such term in section 1707(g). 

16 ‘‘(26) SECRETARY.—The term ‘Secretary’ 

17 means the Secretary of Health and Human Services, 

18 acting through the Director of the Agency for 

19 Healthcare Research and Quality. 

20 ‘‘(27) SEXUAL AND GENDER MINORITY

21 GROUP.—The term ‘sexual and gender minority 

22 group’ includes lesbian, gay, bisexual, and 

23 transgender populations, as well as those whose sex24 ual orientation, gender identity and expression, or 


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1 reproductive development varies from traditional, so2 cietal, cultural, or physiological norms. 

3 ‘‘(28) SIGHT TRANSLATION.—The term ‘sight 

4 translation’ means the transmission of a written 

5 message in one language into a spoken or signed 

6 message in another language, or an alternative for7 mat in English or another language. 

8 ‘‘(29) STATE.—Notwithstanding section 2, the 

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

10 District of Columbia, the Commonwealth of Puerto 

11 Rico, the United States Virgin Islands, Guam, 

12 American Samoa, and the Commonwealth of the 

13 Northern Mariana Islands. 

14 ‘‘(30) TELEPHONIC INTERPRETATION.—The 

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

16 the phone interpretation’ or ‘OPI’) means, with re17 spect to interpretation for an individual with limited 

18 English proficiency, a method of interpretation in 

19 which the interpreter is not in the physical presence 

20 of the provider of health care services or health care21 related services and such individual receiving such 

22 services, but the interpreter is connected via tele23 phone. 

24 ‘‘(31) TRANSLATION.—The term ‘translation’ 

25 means the transmission of a written message in one 


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1 language into a written or signed message in an2 other language, and includes translation into an3 other language or alternative format, such as large 

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

5 ‘‘(32) UNDERSERVED COMMUNITIES.—The 

6 term ‘underserved communities’ means populations 

7 sharing particular characteristics, or geographic 

8 communities, who have been systematically denied a 

9 full opportunity to participate in aspects of eco10 nomic, social, and civic life, such as— 

11 ‘‘(A) Black, Latino, Indigenous, and Na12 tive American persons, Asian Americans, Native 

13 Hawaiians and Pacific Islanders, Middle East14 erners and North Africans, and other persons 

15 of color; 

16 ‘‘(B) members of religious minorities; 

17 ‘‘(C) lesbian, gay, bisexual, transgender, 

18 and queer persons; 

19 ‘‘(D) individuals with a disability; 

20 ‘‘(E) persons who live in rural areas; and 

21 ‘‘(F) persons otherwise adversely affected 

22 by persistent poverty or inequality. 

23 ‘‘(33) VIDEO REMOTE INTERPRETING SERV24 ICES.—The term ‘video remote interpreting services’ 

25 means the provision, in health care services or health 


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1 care-related services, through a qualified interpreter 

2 for an individual with limited English proficiency, of 

3 video remote interpreting services that are— 

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

5 audio over a dedicated high-speed, wide-band6 width video connection or wireless connection 

7 that delivers high-quality video images that do 

8 not produce lags, choppy, blurry, or grainy im9 ages, or irregular pauses in communication; and 

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

11 large enough to display. 

12 ‘‘(34) VITAL DOCUMENT.—The term ‘vital doc13 ument’ includes applications for government pro14 grams that provide health care services, medical or 

15 financial consent forms, financial assistance docu16 ments, letters containing important information re17 garding patient instructions (such as prescriptions, 

18 referrals to other providers, and discharge plans) 

19 and participation in a program (such as a Medicaid 

20 managed care program), notices pertaining to the 

21 reduction, denial, or termination of services or bene22 fits, notices of the right to appeal such actions, and 

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1 ability of free language services, alternative formats, 

2 and other outreach materials. 

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

4 a regulatory provision applicable to a ‘handicapped indi5 vidual’, the term ‘handicapped individual’ in such provi6 sion shall have the same meaning as the term ‘individual 

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

8 ‘‘Subtitle A—Resources and Innova9 tion for Culturally and Linguis10 tically Appropriate Health Care 

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

12 AND LINGUISTICALLY APPROPRIATE HEALTH 

13 CARE. 

14 ‘‘(a) ESTABLISHMENT.—The Secretary shall estab15 lish and support a center to be known as the ‘Robert T. 

16 Matsui Center for Culturally and Linguistically Appro17 priate Health Care’ (referred to in this section as the 

18 ‘Center’) to carry out each of the following activities: 

19 ‘‘(1) INTERPRETATION SERVICES.— 

20 ‘‘(A) IN GENERAL.—The Center shall pro21 vide resources via the internet to identify and 

22 link health care providers to competent and 

23 qualified interpreter and translation services. 

24 ‘‘(B) TRAINING.—For purposes of pro25 viding the services described in subparagraph 


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1 (A), the Center shall adopt a language access 

2 plan that includes training requirements for 

3 Center staff to provide such services. 

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

5 ‘‘(A) VITAL DOCUMENTS.—The Center 

6 shall provide, directly or through contract, to 

7 providers of health care services and health 

8 care-related services, at no cost to such pro9 viders and in a timely and reasonable manner, 

10 vital documents— 

11 ‘‘(i) which may be submitted by an 

12 entity described in subparagraph (C) for 

13 translation into non-English languages, or 

14 alternative formats, at a fifth-grade read15 ing level; and 

16 ‘‘(ii) from competent translation serv17 ices, the quality of which shall be mon18 itored and reported publicly. 

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, not later than 45 calendar days of 

24 the Secretary receiving final approval of the 


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1 form from the Office of Management and 

2 Budget— 

3 ‘‘(i) translate the form, at a min4 imum, into the top 15 non-English lan5 guages in the United States according to 

6 the most recent data from the American 

7 Community Survey or its replacement; and 

8 ‘‘(ii) post all translated forms on the 

9 Center’s website. 

10 ‘‘(C) ENTITIES.— 

11 ‘‘(i) IN GENERAL.—An entity de12 scribed in this subparagraph is— 

13 ‘‘(I) an entity that operates a 

14 health program or activity, any part 

15 of which receives Federal financial as16 sistance; 

17 ‘‘(II) an entity established under 

18 title I of the Patient Protection and 

19 Affordable Care Act that administers 

20 a health program or activity; or 

21 ‘‘(III) the Department of Health 

22 and Human Services. 

23 ‘‘(ii) HEALTH PROGRAM OR ACTIV24 ITY.—For purposes of clause (i), the term 

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1 ing given such term in section 92.4 of title 

2 45, Code of Federal Regulations, as in ef3 fect on July 5, 2024. 

4 ‘‘(3) TOLL-FREE CUSTOMER SERVICE TELE5 PHONE NUMBER.—The Center shall provide, 

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

7 for individuals with limited English proficiency that 

8 is linked to the toll-free telephone number 1–800– 

9 MEDICARE and a toll-free telephone hotline pro10 vided for pursuant to section 1311(d)(4)(B) of the 

11 Patient Protection and Affordable Care Act by an 

12 Exchange established under title I of such Act— 

13 ‘‘(A) to obtain information about federally 

14 conducted or funded health programs, including 

15 the Medicare program under title XVIII of the 

16 Social Security Act, the Medicaid program 

17 under title XIX of such Act, and the State Chil18 dren’s Health Insurance Program under title 

19 XXI of such Act, and coverage available 

20 through an Exchange established under title I 

21 of the Patient Protection and Affordable Care 

22 Act, and other sources of free or reduced care 

23 including federally qualified health centers, enti24 ties receiving assistance under title X, and pub25 lic 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, and make available on the 

10 internet and in print, an information clearing11 house that includes the information described in 

12 subparagraphs (B) through (G)— 

13 ‘‘(i) to facilitate the provision of lan14 guage services by providers of health care 

15 services and health care-related services to 

16 reduce medical errors; 

17 ‘‘(ii) to improve medical outcomes, im18 prove cultural competence, reduce health 

19 care costs caused by miscommunication 

20 with individuals with limited English pro21 ficiency; and 

22 ‘‘(iii) to reduce or eliminate the dupli23 cation of efforts to translate materials. 

24 ‘‘(B) DOCUMENT TEMPLATES.—The Cen25 ter shall collect and evaluate for accuracy, deVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 00102 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 velop, and make available templates for stand2 ard documents that are necessary for patients 

3 and consumers to access and make educated de4 cisions about their health care, including tem5 plates for each of the following: 

6 ‘‘(i) Administrative and legal docu7 ments, including— 

8 ‘‘(I) intake forms; 

9 ‘‘(II) forms related to the Medi10 care program under title XVIII of the 

11 Social Security Act, the Medicaid pro12 gram under title XIX of such Act, 

13 and the State Children’s Health In14 surance Program under title XXI of 

15 such Act, including eligibility informa16 tion for such programs; 

17 ‘‘(III) forms informing patients 

18 of the compliance and consent re19 quirements pursuant to the regula20 tions under section 264(c) of the 

21 Health Insurance Portability and Ac22 countability Act of 1996; and 

23 ‘‘(IV) documents concerning in24 formed consent, advanced directives, 

25 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 such 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, at no cost, to all health care providers 

19 and all providers of health care-related services, 

20 information relating to culturally and linguis21 tically appropriate health care for minority pop22 ulations residing in the United States, includ23 ing— 

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 for health care 

11 services and health care-related services; 

12 and 

13 ‘‘(v) culturally and linguistically ap14 propriate information for educators, practi15 tioners, students, and researchers. 

16 ‘‘(F) TRANSLATION GLOSSARIES.—The 

17 Center shall— 

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

19 translation glossaries that provide stand20 ardized translations of commonly used 

21 terms and phrases utilized in documents 

22 translated by the Center; and 

23 ‘‘(ii) make such glossaries available— 

24 ‘‘(I) free of charge; 


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1 ‘‘(II) in each language in which 

2 the Center translates forms under 

3 paragraph (2)(B); 

4 ‘‘(III) in alternative formats in 

5 accordance with the Americans with 

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

7 12101 et seq.); and 

8 ‘‘(IV) in paper format upon re9 quest. 

10 ‘‘(G) INFORMATION ABOUT PROGRESS.— 

11 The Center shall— 

12 ‘‘(i) regularly collect and make pub13 licly available information about the 

14 progress of entities receiving grants under 

15 section 3402 regarding successful innova16 tions in implementing the requirements of 

17 this subsection; and 

18 ‘‘(ii) provide public notice in the enti19 ties’ communities about the availability of 

20 such information. 

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

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

23 to, the Director of the Agency for Healthcare Research 

24 and Quality. 


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1 ‘‘(c) AVAILABILITY OF LANGUAGE ACCESS.—The Di2 rector of the Center shall collaborate with the Deputy As3 sistant Secretary for Minority Health, the Administrator 

4 of the Centers for Medicare & Medicaid Services, and the 

5 Administrator of the Health Resources and Services Ad6 ministration to notify health care providers and health 

7 care organizations about the availability of language ac8 cess services by the Center. 

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

10 through contract, shall undertake a national education 

11 campaign to inform providers, individuals with limited 

12 English proficiency, individuals with hearing or vision im13 pairments, health professionals, graduate schools, commu14 nity health centers, social service providers, and commu15 nity-based organizations about— 

16 ‘‘(1) Federal and State laws and guidelines gov17 erning access to language services; 

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

19 interpreters and the risks associated with using fam20 ily members, friends, minors, and untrained bilin21 gual staff; 

22 ‘‘(3) funding sources for developing and imple23 menting language services; and 

24 ‘‘(4) promising practices to effectively provide 

25 language services. 


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

2 are authorized to be appropriated to carry out this section 

3 $5,000,000 for each of fiscal years 2025 through 2029. 

4 ‘‘SEC. 3402. INNOVATIONS IN CULTURALLY AND LINGUIS5 TICALLY APPROPRIATE HEALTH CARE 

6 GRANTS. 

7 ‘‘(a) IN GENERAL.— 

8 ‘‘(1) GRANTS.—The Secretary shall award 

9 grants to eligible entities to enable such entities to 

10 design, implement, and evaluate innovative, cost-ef11 fective programs to improve culturally and linguis12 tically appropriate access to health care services for 

13 individuals with limited English proficiency and com14 munication disabilities. 

15 ‘‘(2) COORDINATION.—In making grants under 

16 this section, and in the design and implementation 

17 of the program established under this section, the 

18 Secretary shall coordinate with, and ensure the par19 ticipation of, other agencies including the Health Re20 sources and Services Administration, the National 

21 Institute on Minority Health and Health Disparities 

22 at the National Institutes of Health, and the Office 

23 of Minority Health. 

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

25 under subsection (a), an entity shall be— 


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1 ‘‘(1) a city, county, Indian Tribe, State, or sub2 division thereof; 

3 ‘‘(2) an organization described in section 

4 501(c)(3) of the Internal Revenue Code of 1986 and 

5 exempt from tax under section 501(a) of such Code; 

6 ‘‘(3) a community health, mental health, or 

7 substance use disorder center or clinic; 

8 ‘‘(4) a solo or group physician practice; 

9 ‘‘(5) an integrated health care delivery system; 

10 ‘‘(6) a public hospital; 

11 ‘‘(7) a health care group, university, or college; 

12 or 

13 ‘‘(8) any other entity designated by the Sec14 retary. 

15 ‘‘(c) APPLICATION.—An eligible entity seeking a 

16 grant under this section shall prepare and submit to the 

17 Secretary an application, at such time, in such manner, 

18 and containing such additional information as the Sec19 retary may reasonably require. 

20 ‘‘(d) USE OF FUNDS.—An entity shall use funds re21 ceived through a grant under this section to— 

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

23 providing competent interpretation services through 

24 onsite interpretation, telephonic interpretation, or 

25 video remote interpreting services; 


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

2 promote individuals at all levels of the organization 

3 to maintain a diverse staff and leadership that can 

4 promote and provide language services to patient 

5 populations of the service area of the entity; 

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

7 that identifies the current demographic, cultural, 

8 and epidemiological profile of the community to ac9 curately plan for and implement language services 

10 needed in the service area of the entity; 

11 ‘‘(4) develop a strategic plan to implement lan12 guage services; 

13 ‘‘(5) develop participatory, collaborative part14 nerships with communities encompassing the patient 

15 populations of individuals with limited English pro16 ficiency served by the grant to gain input in design17 ing and implementing language services; 

18 ‘‘(6) develop and implement grievance resolu19 tion processes that are culturally and linguistically 

20 appropriate and capable of identifying, preventing, 

21 and resolving complaints by individuals with limited 

22 English proficiency; 

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

24 health interpretation training courses and incentives 


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1 for bilingual health care staff who are asked to pro2 vide interpretation services in the workplace; 

3 ‘‘(8) develop formal training programs, includ4 ing continued professional development and edu5 cation programs as well as supervision, for individ6 uals interested in becoming dedicated health care in7 terpreters and culturally and linguistically appro8 priate providers; 

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

10 which shall include information on the practical limi11 tations of such instruction for nonnative speakers; 

12 ‘‘(10) develop policies that address compensa13 tion in salary for staff who receive training to be14 come either a staff interpreter or bilingual provider; 

15 ‘‘(11) develop other language assistance services 

16 as determined appropriate by the Secretary; 

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

18 of improving cultural competence, including cultural 

19 competence programs for community health workers; 

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

21 protections provided for under the regulations pro22 mulgated under section 264(c) of the Health Insur23 ance Portability and Accountability Act of 1996 and 

24 any applicable State privacy laws, data on the indi25 vidual patient or recipient’s race, ethnicity, and priVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 00112 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 mary language are collected (and periodically up2 dated) in health records and integrated into the or3 ganization’s information management systems or 

4 any similar system used to store and retrieve data; 

5 and 

6 ‘‘(14) ensure that culturally competent care and 

7 language assistance are available to individuals with 

8 limited English proficiency. 

9 ‘‘(e) PRIORITY.—In awarding grants under this sec10 tion, the Secretary shall give priority to entities that pri11 marily engage in providing direct care and that have devel12 oped partnerships with community organizations or with 

13 agencies with experience in improving language access. 

14 ‘‘(f) EVALUATION.— 

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

16 grant under this section shall submit to the Sec17 retary an evaluation that describes, in the manner 

18 and to the extent required by the Secretary, the ac19 tivities carried out with funds received under the 

20 grant, and how such activities improved access to 

21 health care services and health care-related services 

22 and the quality of health care for individuals with 

23 limited English proficiency. Such evaluation shall be 

24 collected and disseminated through the Robert T. 

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1 propriate Health Care established under section 

2 3401. The Director of the Agency for Healthcare 

3 Research and Quality shall notify grantees of the 

4 availability of technical assistance for the evaluation 

5 and provide such assistance upon request. 

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

7 Agency for Healthcare Research and Quality shall 

8 evaluate or arrange with other individuals or organi9 zations to evaluate projects funded under this sec10 tion. 

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

12 is authorized to be appropriated to carry out this section 

13 $5,000,000 for each of fiscal years 2025 through 2029. 

14 ‘‘SEC. 3403. RESEARCH ON CULTURAL AND LANGUAGE COM15 PETENCE. 

16 ‘‘(a) IN GENERAL.—The Secretary shall expand re17 search concerning language access in the provision of 

18 health care services. 

19 ‘‘(b) ELIGIBILITY.—The Secretary may conduct the 

20 research described in subsection (a) or enter into contracts 

21 with other individuals or organizations to conduct such re22 search. 

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

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

25 following: 


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1 ‘‘(1) To identify the barriers to mental and be2 havioral services that are faced by individuals with 

3 limited English proficiency. 

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

5 health administrators’ knowledge and awareness of 

6 the barriers to quality health care services that are 

7 faced by individuals with limited English proficiency 

8 and communication disabilities. 

9 ‘‘(3) To identify optimal approaches for deliv10 ering language access. 

11 ‘‘(4) To identify best practices for data collec12 tion, including— 

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

14 care services and health care-related services of 

15 data on the race, ethnicity, and primary lan16 guage of recipients of such services, taking into 

17 account existing research conducted by the Gov18 ernment or private sector; 

19 ‘‘(B) the development and implementation 

20 of data collection and reporting systems; and 

21 ‘‘(C) effective privacy safeguards for col22 lected data. 

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

24 for primary language. 


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

2 which the Secretary can create or coordinate, and 

3 subsidize or otherwise fund, telephonic interpretation 

4 services for health care providers, taking into consid5 eration, among other factors, the flexibility necessary 

6 for such a system to accommodate variations in— 

7 ‘‘(A) provider type; 

8 ‘‘(B) languages needed and their frequency 

9 of use; 

10 ‘‘(C) type of encounter; 

11 ‘‘(D) time of encounter, including whether 

12 the encounter occurs during regular business 

13 hours and after hours; and 

14 ‘‘(E) location of encounter. 

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

16 are authorized to be appropriated to carry out this section 

17 $5,000,000 for each of fiscal years 2025 through 2029.’’. 

18 SEC. 2005. PILOT PROGRAM FOR IMPROVEMENT AND DE19 VELOPMENT OF STATE MEDICAL INTER20 PRETING SERVICES. 

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

22 and Human Services (referred to in this section as the 

23 ‘‘Secretary’’) shall award 1 grant in accordance with this 

24 section to each of 3 States (to be selected by the Sec25 retary) to assist each such State in designing, impleVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 00116 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 menting, and evaluating a statewide program to provide 

2 onsite interpreter services under the State Medicaid plan. 

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

4 section is authorized for the period of 3 fiscal years begin5 ning on October 1, 2024, and ending on September 30, 

6 2027. 

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

8 section, the Secretary shall give preference to a State— 

9 (1) that has a high proportion of qualified LEP 

10 enrollees, as determined by the Secretary; 

11 (2) that has a large number of qualified LEP 

12 enrollees, as determined by the Secretary; 

13 (3) that has a high growth rate of the popu14 lation of individuals with limited English proficiency, 

15 as determined by the Secretary; and 

16 (4) that has a population of qualified LEP en17 rollees that is linguistically diverse, requiring inter18 preter services in at least 200 non-English lan19 guages. 

20 (d) USE OF FUNDS.—A State receiving a grant under 

21 this section shall use the grant funds to— 

22 (1) ensure that all health care providers in the 

23 State participating in the State Medicaid plan have 

24 access to onsite interpreter services, for the purpose 

25 of enabling effective communication between such 


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1 providers and qualified LEP enrollees during the 

2 furnishing of items and services and administrative 

3 interactions; 

4 (2) establish, expand, procure, or contract for— 

5 (A) a statewide health care information 

6 technology system that is designed to achieve 

7 efficiencies and economies of scale with respect 

8 to onsite interpreter services provided to health 

9 care providers in the State participating in the 

10 State Medicaid plan; and 

11 (B) an entity to administer such system, 

12 the duties of which shall include— 

13 (i) procuring and scheduling inter14 preter services for qualified LEP enrollees; 

15 (ii) procuring and scheduling inter16 preter services for individuals with limited 

17 English proficiency seeking to enroll in the 

18 State Medicaid plan; 

19 (iii) ensuring that interpreters receive 

20 payment for interpreter services rendered 

21 under the system; and 

22 (iv) consulting regularly with organi23 zations representing LEP consumers, in24 terpreters, and health care providers; and 


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1 (3) develop mechanisms to establish, improve, 

2 and strengthen the competency of the medical inter3 pretation workforce that serves qualified LEP enroll4 ees in the State, including a national certification 

5 process that is valid, credible, and vendor-neutral. 

6 (e) APPLICATION.—To receive a grant under this sec7 tion, a State shall submit an application at such time and 

8 containing such information as the Secretary may require, 

9 which shall include the following: 

10 (1) A description of the language access needs 

11 of individuals in the State enrolled in the State Med12 icaid plan. 

13 (2) A description of the extent to which the 

14 program will— 

15 (A) use the grant funds for the purposes 

16 described in subsection (d); 

17 (B) meet the health care needs of rural 

18 populations of the State; and 

19 (C) collect information that accurately 

20 tracks the language services requested by con21 sumers as compared to the language services 

22 provided by health care providers in the State 

23 participating in the State Medicaid plan. 

24 (3) A description of how the program will be 

25 evaluated, including a proposal for collaboration with 


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1 organizations representing interpreters, consumers, 

2 and individuals with limited English proficiency. 

3 (f) DEFINITIONS.—In this section: 

4 (1) QUALIFIED LEP ENROLLEE.—The term 

5 ‘‘qualified LEP enrollee’’ means an individual— 

6 (A) who is limited English proficient; and 

7 (B) who is enrolled in a State Medicaid 

8 plan. 

9 (2) STATE.—The term ‘‘State’’ has the mean10 ing given the term in section 1101(a)(1) of the So11 cial Security Act (42 U.S.C. 1301(a)(1)), for pur12 poses of title XIX of such Act (42 U.S.C. 1396 et 

13 seq.). 

14 (3) STATE MEDICAID PLAN.—The term ‘‘State 

15 Medicaid plan’’ means a State plan under title XIX 

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

17 or a waiver of such a plan. 

18 (4) UNITED STATES.—The term ‘‘United 

19 States’’ has the meaning given the term in section 

20 1101(a)(2) of the Social Security Act (42 U.S.C. 

21 1301(a)(2)), for purposes of title XIX of such Act 

22 (42 U.S.C. 1396 et seq.). 

23 (g) CONTINUATION PAST DEMONSTRATION.—Any 

24 State receiving a grant under this section must agree to 


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1 directly pay for language services in Medicaid for all Med2 icaid providers by the end of the grant period. 

3 (h) FUNDING.— 

4 (1) AUTHORIZATION OF APPROPRIATIONS.— 

5 There is authorized to be appropriated $5,000,000 

6 to carry out this section. 

7 (2) AVAILABILITY OF FUNDS.—Amounts appro8 priated pursuant to the authorization in paragraph 

9 (1) are authorized to remain available without fiscal 

10 year limitation. 

11 (3) INCREASED FEDERAL FINANCIAL PARTICI12 PATION.—Section 1903(a)(2)(E) of the Social Secu13 rity Act (42 U.S.C. 1396b(a)(2)(E)) is amended by 

14 inserting ‘‘(or, in the case of a State that was 

15 awarded a grant under section 2005 of the Health 

16 Equity and Accountability Act of 2024, 100 percent 

17 for each quarter occurring during the grant period 

18 specified in subsection (b) of such section)’’ after 

19 ‘‘75 percent’’. 

20 (i) LIMITATION.—No Federal funds awarded under 

21 this section may be used to provide interpreter services 

22 from a location outside the United States. 


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1 SEC. 2006. TRAINING TOMORROW’S DOCTORS FOR CUL2 TURALLY AND LINGUISTICALLY APPRO3 PRIATE CARE: GRADUATE MEDICAL EDU4 CATION. 

5 (a) DIRECT GRADUATE MEDICAL EDUCATION.—Sec6 tion 1886(h)(4) of the Social Security Act (42 U.S.C. 

7 1395ww(h)(4)) is amended by adding at the end the fol8 lowing new subparagraph: 

9 ‘‘(L) TREATMENT OF CULTURALLY AND

10 LINGUISTICALLY APPROPRIATE TRAINING.—In 

11 determining a hospital’s number of full-time 

12 equivalent residents for purposes of this sub13 section, all the time that is spent by an intern 

14 or resident in an approved medical residency 

15 training program for education and training in 

16 culturally and linguistically appropriate service 

17 delivery, which shall include all medically under18 served populations (as defined in section 

19 330(b)(3) of the Public Health Service Act), 

20 shall be counted toward the determination of 

21 full-time equivalency.’’. 

22 (b) INDIRECT MEDICAL EDUCATION.—Section 

23 1886(d)(5)(B) of the Social Security Act (42 U.S.C. 

24 1395ww(d)(5)(B)) is amended by adding at the end the 

25 following new clause: 


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1 ‘‘(xiv) The provisions of subparagraph (L) of 

2 subsection (h)(4) shall apply under this subpara3 graph in the same manner as they apply under such 

4 subsection.’’. 

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

6 subsections (a) and (b) shall apply with respect to pay7 ments made to hospitals on or after the date that is 1 

8 year after the date of the enactment of this Act. 

9 SEC. 2007. FEDERAL REIMBURSEMENT FOR CULTURALLY 

10 AND LINGUISTICALLY APPROPRIATE SERV11 ICES UNDER THE MEDICARE, MEDICAID, AND 

12 STATE CHILDREN’S HEALTH INSURANCE 

13 PROGRAMS. 

14 (a) LANGUAGE ACCESS GRANTS FOR MEDICARE

15 PROVIDERS.— 

16 (1) ESTABLISHMENT.— 

17 (A) IN GENERAL.—Not later than 6 

18 months after the date of the enactment of this 

19 Act, the Secretary of Health and Human Serv20 ices (in this subsection referred to as the ‘‘Sec21 retary’’), acting through the Centers for Medi22 care & Medicaid Services and in consultation 

23 with the Center for Medicare and Medicaid In24 novation (as referred to in section 1115A of the 

25 Social Security Act (42 U.S.C. 1315a)), shall 


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1 establish a demonstration program under which 

2 the Secretary shall award grants to eligible 

3 Medicare service providers to provide culturally 

4 and linguistically appropriate services to Medi5 care beneficiaries who are limited English pro6 ficient, including beneficiaries who live in di7 verse and underserved communities. 

8 (B) APPLICATION OF INNOVATION

9 RULES.—The demonstration project under sub10 paragraph (A) shall be conducted in a manner 

11 that is consistent with the applicable provisions 

12 of subsections (b), (c), and (d) of section 1115A 

13 of the Social Security Act (42 U.S.C. 1315a). 

14 (C) NUMBER OF GRANTS.—To the extent 

15 practicable, the Secretary shall award not less 

16 than 24 grants under this subsection. 

17 (D) GRANT PERIOD.—Except as provided 

18 in paragraph (2)(D), each grant awarded under 

19 this subsection shall be for a 3-year period. 

20 (2) ELIGIBILITY REQUIREMENTS.—To be eligi21 ble for a grant under this subsection, an entity must 

22 meet the following requirements: 

23 (A) MEDICARE PROVIDER.—The entity 

24 must be— 


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1 (i) a provider of services under part A 

2 of title XVIII of the Social Security Act 

3 (42 U.S.C. 1395c et seq.); 

4 (ii) a provider of services under part 

5 B of such title (42 U.S.C. 1395j et seq.); 

6 (iii) a Medicare Advantage organiza7 tion offering a Medicare Advantage plan 

8 under part C of such title (42 U.S.C. 

9 1395w–21 et seq.); or 

10 (iv) a PDP sponsor offering a pre11 scription drug plan under part D of such 

12 title (42 U.S.C. 1395w–101 et seq.). 

13 (B) UNDERSERVED COMMUNITIES.—The 

14 entity must serve a community that, with re15 spect to necessary language services for improv16 ing access and utilization of health care among 

17 individuals who are limited English proficient, 

18 is disproportionally underserved. 

19 (C) APPLICATION.—The entity must pre20 pare and submit to the Secretary an applica21 tion, at such time, in such manner, and accom22 panied by such additional information as the 

23 Secretary may require. 

24 (D) REPORTING.—In the case of a grantee 

25 that received a grant under this subsection in 


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1 a previous year, such grantee is only eligible for 

2 continued payments under a grant under this 

3 subsection if the grantee met the reporting re4 quirements under paragraph (9) for such year. 

5 If a grantee fails to meet the requirements of 

6 such paragraph for the first year of a grant, the 

7 Secretary may terminate the grant and solicit 

8 applications from new grantees to participate in 

9 the demonstration program. 

10 (3) DISTRIBUTION.—To the extent feasible, the 

11 Secretary shall award— 

12 (A) at least 10 grants to providers of serv13 ices described in paragraph (2)(A)(i); 

14 (B) at least 10 grants to service providers 

15 described in paragraph (2)(A)(ii); 

16 (C) at least 10 grants to organizations de17 scribed in paragraph (2)(A)(iii); and 

18 (D) at least 10 grants to sponsors de19 scribed in paragraph (2)(A)(iv). 

20 (4) CONSIDERATIONS IN AWARDING GRANTS.— 

21 (A) VARIATION AMONG GRANTEES.—In 

22 awarding grants under this subsection, the Sec23 retary shall select grantees to ensure the fol24 lowing: 


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1 (i) The grantees provide many dif2 ferent types of language services. 

3 (ii) The grantees serve Medicare bene4 ficiaries who speak different languages, 

5 and who, as a population, have differing 

6 needs for language services. 

7 (iii) The grantees serve Medicare 

8 beneficiaries in both urban and rural set9 tings. 

10 (iv) The grantees represent each Cen11 ters for Medicare & Medicaid Services re12 gion, as defined by the Secretary. 

13 (v) The grantees serve Medicare bene14 ficiaries in at least 2 large metropolitan 

15 statistical areas with diverse populations, 

16 including diversity in race, ethnicity, sexual 

17 orientation, gender identity, disability sta18 tus, and socioeconomic status. 

19 (B) PRIORITY FOR PARTNERSHIPS WITH

20 COMMUNITY ORGANIZATIONS AND AGENCIES.— 

21 In awarding grants under this subsection, the 

22 Secretary shall give priority to eligible entities 

23 that have a partnership with 1 or more of the 

24 following entities that have experience in pro25 viding language services: 


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1 (i) A community organization. 

2 (ii) A consortium of community orga3 nizations, State agencies, and local agen4 cies. 

5 (5) USE OF FUNDS FOR COMPETENT LANGUAGE

6 SERVICES.— 

7 (A) IN GENERAL.—Subject to subpara8 graph (E), a grantee may only use grant funds 

9 received under this subsection to pay for the 

10 provision of competent language services to 

11 Medicare beneficiaries who are individuals who 

12 are limited English proficient to supplement ex13 isting Medicare requirements. 

14 (B) COMPETENT LANGUAGE SERVICES DE15 FINED.—For purposes of this subsection, the 

16 term ‘‘competent language services’’ means— 

17 (i) interpreter and translation services 

18 that— 

19 (I) subject to the exceptions 

20 under subparagraph (C)— 

21 (aa) if the grantee operates 

22 in a State that has statewide 

23 health care interpreter standards, 

24 meet the State standards cur25 rently in effect; or 


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1 (bb) if the grantee operates 

2 in a State that does not have 

3 statewide health care interpreter 

4 standards, utilize competent in5 terpreters who follow the Na6 tional Council on Interpreting in 

7 Health Care’s Code of Ethics and 

8 Standards of Practice and com9 ply with the requirements of sec10 tion 1557 of the Patient Protec11 tion and Affordable Care Act (42 

12 U.S.C. 18116) as published in 

13 the Federal Register on May 18, 

14 2016, 81 Fed. Reg. 31375; and 

15 (II) in the case of interpreter 

16 services, are provided through— 

17 (aa) onsite interpretation; 

18 (bb) telephonic interpreta19 tion; or 

20 (cc) video interpretation; 

21 and 

22 (ii) the direct provision of health care 

23 or health care-related services by a com24 petent bilingual health care provider. 

25 (C) EXCEPTIONS.— 


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1 (i) IN GENERAL.—The requirements 

2 of subparagraph (B)(i)(I) do not apply, 

3 with respect to interpreter and translation 

4 services and a grantee— 

5 (I) in the case of a Medicare ben6 eficiary who is limited English pro7 ficient, if— 

8 (aa) such beneficiary has 

9 been informed, in the bene10 ficiary’s primary language, of the 

11 availability of free interpreter 

12 and translation services and the 

13 beneficiary instead requests that 

14 a family member, friend, or other 

15 person provide such services; and 

16 (bb) the grantee documents 

17 such request in the beneficiary’s 

18 medical record; or 

19 (II) subject to clause (ii), in the 

20 case of a medical emergency where 

21 the delay directly associated with ob22 taining a competent interpreter or 

23 translation services would jeopardize 

24 the health of the patient. 


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1 (ii) CLARIFICATION.—Clause (i)(II) 

2 shall not be construed to exempt emer3 gency rooms or similar entities that regu4 larly provide health care services in med5 ical emergencies to patients who are indi6 viduals who are limited English proficient 

7 from any applicable legal or regulatory re8 quirements related to providing competent 

9 interpreter and translation services without 

10 undue delay. 

11 (D) MEDICARE ADVANTAGE ORGANIZA12 TIONS AND PDP SPONSORS.—A grantee that is 

13 a Medicare Advantage organization or a pre14 scription drug plan sponsor must provide at 

15 least 50 percent of the grant funds that the 

16 grantee receives under this subsection directly 

17 to the entity’s network providers (including all 

18 health providers and pharmacists) for the pur19 pose of providing support for such providers to 

20 provide competent language services to Medi21 care beneficiaries who are individuals who are 

22 limited English proficient. 

23 (E) ADMINISTRATIVE AND REPORTING

24 COSTS.—A grantee may use up to 10 percent of 

25 the grant funds to pay for administrative costs 


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1 associated with the provision of competent lan2 guage services and for reporting required under 

3 paragraph (9). 

4 (6) DETERMINATION OF AMOUNT OF GRANT

5 PAYMENTS.— 

6 (A) IN GENERAL.—Payments to grantees 

7 under this subsection shall be calculated based 

8 on the estimated numbers of Medicare bene9 ficiaries who are limited English proficient in a 

10 grantee’s service area utilizing— 

11 (i) data on the numbers of English 

12 learners who speak English less than ‘‘very 

13 well’’ from the most recently available data 

14 from the Bureau of the Census or other 

15 State-based study the Secretary determines 

16 is likely to yield accurate data regarding 

17 the number of such individuals in such 

18 service area; or 

19 (ii) data provided by the grantee, if 

20 the grantee routinely collects data on the 

21 primary language of the Medicare bene22 ficiaries that the grantee serves and the 

23 Secretary determines that the data is accu24 rate and shows a greater number of indi25 viduals who are limited English proficient 


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1 than would be estimated using the data 

2 under clause (i). 

3 (B) DISCRETION OF SECRETARY.—Subject 

4 to subparagraph (C), the amount of payment 

5 made to a grantee under this subsection may be 

6 modified annually at the discretion of the Sec7 retary, based on changes in the data under sub8 paragraph (A) with respect to the service area 

9 of a grantee for the year. 

10 (C) LIMITATION ON AMOUNT.—The 

11 amount of a grant made under this subsection 

12 to a grantee may not exceed $500,000 for the 

13 period under paragraph (1)(D). 

14 (7) ASSURANCES.—Grantees under this sub15 section shall, as a condition of receiving a grant 

16 under this subsection— 

17 (A) ensure that clinical and support staff 

18 receive appropriate ongoing education and 

19 training in linguistically appropriate service de20 livery; 

21 (B) ensure the linguistic competence of bi22 lingual providers; 

23 (C) offer and provide appropriate language 

24 services at no additional charge to each patient 

25 who is limited English proficient for all points 


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1 of contact between the patient and the grantee, 

2 in a timely manner during all hours of oper3 ation; 

4 (D) notify Medicare beneficiaries of their 

5 right to receive language services in their pri6 mary language at least annually; 

7 (E) post signage in the primary languages 

8 commonly used by the patient population in the 

9 service area of the organization; and 

10 (F) ensure that— 

11 (i) primary language data are col12 lected for recipients of language services 

13 and such data are consistent with stand14 ards developed under title XXXIV of the 

15 Public Health Service Act, as added by 

16 section 2002 of this Act, to the extent such 

17 standards are available upon the initiation 

18 of the demonstration program; and 

19 (ii) consistent with the privacy protec20 tions provided under the regulations pro21 mulgated pursuant to section 264(c) of the 

22 Health Insurance Portability and Account23 ability Act of 1996 (42 U.S.C. 1320d–2 

24 note), if the recipient of language services 

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1 guage data must also be collected on the 

2 parent or legal guardian of such recipient. 

3 (8) NO COST SHARING.—Medicare beneficiaries 

4 who are limited English proficient shall not have to 

5 pay cost sharing or co-payments for competent lan6 guage services provided under this demonstration 

7 program. 

8 (9) REPORTING REQUIREMENTS FOR GRANT9 EES.—Not later than the end of each calendar year, 

10 a grantee that receives funds under this subsection 

11 in such year shall submit to the Secretary a report 

12 that includes the following information: 

13 (A) The number of Medicare beneficiaries 

14 to whom competent language services are pro15 vided, disaggregated by age and entitlement 

16 basis (on the basis of age, disability, or deter17 mination of end stage renal disease). 

18 (B) The primary languages of those Medi19 care beneficiaries. 

20 (C) The types of language services pro21 vided to such beneficiaries. 

22 (D) Whether such language services were 

23 provided by employees of the grantee or 

24 through a contract with external contractors or 

25 agencies. 


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1 (E) The types of interpretation services 

2 provided to such beneficiaries, and the approxi3 mate length of time such service is provided to 

4 such beneficiaries. 

5 (F) The costs of providing competent lan6 guage services. 

7 (G) An account of the training or accredi8 tation of bilingual staff, interpreters, and trans9 lators providing services funded by the grant 

10 under this subsection. 

11 (10) EVALUATION AND REPORT TO CON12 GRESS.—Not later than 1 year after the completion 

13 of a 3-year grant under this subsection, the Sec14 retary shall conduct an evaluation of the demonstra15 tion program under this subsection and shall submit 

16 to the Congress a report that includes the following: 

17 (A) An analysis of the patient outcomes 

18 and the costs of furnishing care to the Medicare 

19 beneficiaries who are individuals who are lim20 ited English proficient participating in the 

21 project as compared to such outcomes and costs 

22 for such Medicare beneficiaries not partici23 pating, based on the data provided under para24 graph (9) and any other information available 

25 to the Secretary. 


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1 (B) The effect of delivering language serv2 ices on— 

3 (i) Medicare beneficiary access to care 

4 and utilization of services; 

5 (ii) the efficiency and cost-effective6 ness of health care delivery; 

7 (iii) patient satisfaction with respect 

8 to both health service delivery and lan9 guage assistance; 

10 (iv) health outcomes; and 

11 (v) the provision of culturally appro12 priate services provided to such bene13 ficiaries. 

14 (C) The extent to which bilingual staff, in15 terpreters, and translators providing services 

16 under such demonstration were trained or ac17 credited and the nature of accreditation or 

18 training needed by type of provider, service, or 

19 other category as determined by the Secretary 

20 to ensure the provision of high-quality interpre21 tation, translation, or other language services to 

22 Medicare beneficiaries if such services are ex23 panded pursuant to section 1115A(c) of the So24 cial Security Act (42 U.S.C. 1315a(c)). 


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1 (D) Recommendations, if any, regarding 

2 the extension of such project to the entire Medi3 care Program, subject to the provisions of such 

4 section 1115A(c). 

5 (11) APPROPRIATIONS.—There is appropriated 

6 to carry out this subsection, in equal parts from the 

7 Federal Hospital Insurance Trust Fund under sec8 tion 1817 of the Social Security Act (42 U.S.C. 

9 1395i) and the Federal Supplementary Medical In10 surance Trust Fund under section 1841 of such Act 

11 (42 U.S.C. 1395t), $16,000,000 for each fiscal year 

12 of the demonstration program. 

13 (12) LIMITED ENGLISH PROFICIENT DE14 FINED.—In this subsection, the term ‘‘limited 

15 English proficient’’ means individuals who self-iden16 tify on the Census as speaking English less than 

17 ‘‘very well’’. 

18 (b) LANGUAGE ASSISTANCE SERVICES UNDER THE

19 MEDICARE PROGRAM.— 

20 (1) INCLUSION AS RURAL HEALTH CLINIC

21 SERVICES.—Section 1861 of the Social Security Act 

22 (42 U.S.C. 1395x) is amended— 

23 (A) in subsection (aa)(1)— 

24 (i) in subparagraph (C), by striking 

25 ‘‘and’’ at the end; 


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1 (ii) in subparagraph (D), by inserting 

2 ‘‘and’’ after the comma at the end; and 

3 (iii) by inserting after subparagraph 

4 (D) the following new subparagraph: 

5 ‘‘(E) language assistance services as defined in 

6 subsection (nnn),’’; and 

7 (B) by adding at the end the following new 

8 subsection: 

9 ‘‘Language Assistance Services and Related Terms 

10 ‘‘(nnn) The term ‘language assistance services’ means 

11 ‘language access’ or ‘language assistance services’ (as 

12 those terms are defined in section 3400 of the Public 

13 Health Service Act) furnished by a ‘qualified interpreter 

14 for an individual with limited English proficiency’ or a 

15 ‘qualified translator’ (as those terms are defined in such 

16 section 3400) to an ‘individual with limited English pro17 ficiency’ (as defined in such section 3400).’’. 

18 (2) COVERAGE.—Section 1832(a)(2) of the So19 cial Security Act (42 U.S.C. 1395k(a)(2)) is amend20 ed— 

21 (A) in subparagraph (I), by striking ‘‘and’’ 

22 at the end; 

23 (B) in subparagraph (J), by striking the 

24 period at the end and inserting ‘‘; and’’; and 


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1 (C) by adding at the end the following new 

2 subparagraph: 

3 ‘‘(K) language assistance services (as de4 fined in section 1861(nnn)).’’. 

5 (3) PAYMENT.—Section 1833(a) of the Social 

6 Security Act (42 U.S.C. 1395l(a)) is amended— 

7 (A) in paragraph (9), by striking ‘‘and’’ at 

8 the end; 

9 (B) in paragraph (10), by striking the pe10 riod at the end and inserting ‘‘; and’’; and 

11 (C) by inserting after paragraph (10) the 

12 following new paragraph: 

13 ‘‘(11) in the case of language assistance serv14 ices (as defined in section 1861(nnn)), 100 percent 

15 of the reasonable charges for such services, as deter16 mined in consultation with the Medicare Payment 

17 Advisory Commission.’’. 

18 (4) WAIVER OF BUDGET NEUTRALITY.—For 

19 the 3-year period beginning on the date of enact20 ment of this section, the budget neutrality provision 

21 of section 1848(c)(2)(B)(ii) of the Social Security 

22 Act (42 U.S.C. 1395w–4(c)(2)(B)(ii)) shall not 

23 apply with respect to language assistance services 

24 (as defined in section 1861(nnn) of such Act). 


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1 (c) MEDICARE PARTS C AND D; MEDICARE ADVAN2 TAGE PLANS AND PRESCRIPTION DRUG PLANS REPORT3 ING REQUIREMENT.—Section 1857(e) of the Social Secu4 rity Act (42 U.S.C. 1395w–27(e)) is amended by adding 

5 at 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 2024, 

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 2005(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 (30)’’ and inserting ‘‘(30), and (32)’’. 

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 (31), by striking ‘‘and’’ 

11 at the end; 

12 (B) by redesignating paragraph (32) as 

13 paragraph (33); and 

14 (C) by inserting after paragraph (31) the 

15 following new paragraph: 

16 ‘‘(32) language assistance services, as such 

17 term is defined in section 1861(nnn), provided in a 

18 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.—Subsections (a)(2) and (b)(2) of section 1916 

23 of the Social Security Act (42 U.S.C. 1396o) are 

24 each amended— 


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1 (A) in subparagraph (I), by striking ‘‘or’’ 

2 at the end; 

3 (B) in subparagraph (J), by striking ‘‘; 

4 and’’ and inserting ‘‘, or’’; and 

5 (C) by adding at the end the following new 

6 subparagraph: 

7 ‘‘(K) language assistance services described 

8 in section 1905(a)(32); and’’. 

9 (5) CHIP COVERAGE REQUIREMENTS.—Section 

10 2103 of the Social Security Act (42 U.S.C. 1397cc) 

11 is amended— 

12 (A) in subsection (a), in the matter before 

13 paragraph (1), by striking ‘‘(5), (6), (7) and 

14 (8)’’ and inserting ‘‘(5) through (13)’’; 

15 (B) in subsection (c), by adding at the end 

16 the following new paragraph: 

17 ‘‘(13) LANGUAGE ASSISTANCE SERVICES.—The 

18 child health assistance provided to a targeted low-in19 come child shall include coverage of language assist20 ance services, as such term is defined in section 

21 1861(nnn), provided in a timely manner to individ22 uals with limited English proficiency (as defined in 

23 section 3400 of the Public Health Service Act).’’; 

24 and 

25 (C) in subsection (e)(2)— 


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1 (i) in the heading, by striking ‘‘PRE2 VENTIVE’’ and inserting ‘‘CERTAIN’’; and 

3 (ii) by inserting ‘‘language assistance 

4 services described in subsection (c)(12),’’ 

5 before ‘‘or for pregnancy-related assist6 ance’’. 

7 (6) DEFINITION OF CHILD HEALTH ASSIST8 ANCE.—Section 2110(a)(27) of the Social Security 

9 Act (42 U.S.C. 1397jj(a)(27)) is amended by strik10 ing ‘‘transportation, translation, and outreach serv11 ices’’ and inserting ‘‘transportation services, lan12 guage assistance services as described in section 

13 2103(c)(13), and outreach services’’. 

14 (7) STATE DATA COLLECTION.—Pursuant to 

15 the reporting requirement described in section 

16 2107(b)(1) of the Social Security Act (42 U.S.C. 

17 1397gg(b)(1)), the Secretary of Health and Human 

18 Services shall require that States collect data on— 

19 (A) the primary language of individuals re20 ceiving child health assistance under title XXI 

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

22 seq.); and 

23 (B) in the case of such individuals who are 

24 minors or incapacitated, the primary language 

25 of the individual’s parent or guardian. 


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1 (8) CHIP PAYMENTS TO STATES.—Section 

2 2105 of the Social Security Act (42 U.S.C. 1397ee) 

3 is amended— 

4 (A) in subsection (a)(1)— 

5 (i) in the matter preceding subpara6 graph (A), by striking ‘‘75’’ and inserting 

7 ‘‘95’’; and 

8 (ii) in subparagraph (D)(iv), by strik9 ing ‘‘translation or interpretation services’’ 

10 and inserting ‘‘language assistance serv11 ices’’; and 

12 (B) in subsection (c)(2)(A), by inserting 

13 before the period at the end the following: ‘‘, 

14 except that expenditures pursuant to clause (iv) 

15 of subparagraph (D) of such paragraph shall 

16 not count towards this total’’. 

17 (e) FUNDING LANGUAGE ASSISTANCE SERVICES

18 FURNISHED BY PROVIDERS OF HEALTH CARE AND

19 HEALTH CARE-RELATED SERVICES THAT SERVE HIGH

20 RATES OF UNINSURED LEP INDIVIDUALS.— 

21 (1) PAYMENT OF COSTS.— 

22 (A) IN GENERAL.—Subject to subpara23 graph (B), the Secretary of Health and Human 

24 Services (referred to in this subsection as the 

25 ‘‘Secretary’’) shall make payments (on a quarVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 00146 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 terly basis) directly to eligible entities to sup2 port the provision of language assistance serv3 ices to individuals with limited English pro4 ficiency in an amount equal to an eligible enti5 ty’s eligible costs for providing such services for 

6 the quarter. 

7 (B) FUNDING.—Out of any funds in the 

8 Treasury not otherwise appropriated, there are 

9 appropriated to the Secretary such sums as 

10 may be necessary for each of fiscal years 2025 

11 through 2029. 

12 (C) RELATION TO MEDICAID DSH.—Pay13 ments under this subsection shall not offset or 

14 reduce payments under section 1923 of the So15 cial Security Act (42 U.S.C. 1396r–4), nor 

16 shall payments under such section be consid17 ered when determining uncompensated costs as18 sociated with the provision of language assist19 ance services for the purposes of this sub20 section. 

21 (2) METHODOLOGY FOR PAYMENT OF

22 CLAIMS.— 

23 (A) IN GENERAL.—The Secretary shall es24 tablish a methodology to determine the average 

25 per person cost of language assistance services. 


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1 (B) DIFFERENT ENTITIES.—In estab2 lishing such methodology, the Secretary may es3 tablish different methodologies for different 

4 types of eligible entities. 

5 (C) NO INDIVIDUAL CLAIMS.—The Sec6 retary may not require eligible entities to sub7 mit individual claims for language assistance 

8 services for individual patients as a requirement 

9 for payment under this subsection. 

10 (3) DATA COLLECTION INSTRUMENT.—For pur11 poses of this subsection, the Secretary shall create a 

12 standard data collection instrument that is con13 sistent with any existing reporting requirements by 

14 the Secretary or relevant accrediting organizations 

15 regarding the number of individuals to whom lan16 guage access is provided. 

17 (4) GUIDELINES.—Not later than 6 months 

18 after the date of enactment of this Act, the Sec19 retary shall establish and distribute guidelines con20 cerning the implementation of this subsection. 

21 (5) REPORTING REQUIREMENTS.— 

22 (A) REPORT TO SECRETARY.—Entities re23 ceiving payment under this subsection shall pro24 vide the Secretary with a quarterly report on 

25 how the entity used such funds. Such report 


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1 shall contain aggregate (and may not contain 

2 individualized) data collected using the instru3 ment under paragraph (3) and shall otherwise 

4 be in a form and manner determined by the 

5 Secretary. 

6 (B) REPORT TO CONGRESS.—Not later 

7 than 2 years after the date of enactment of this 

8 Act, and every 2 years thereafter, the Secretary 

9 shall submit a report to Congress concerning 

10 the implementation of this subsection. 

11 (6) DEFINITIONS.—In this subsection: 

12 (A) ELIGIBLE COSTS.—The term ‘‘eligible 

13 costs’’ means, with respect to an eligible entity 

14 that provides language assistance services to 

15 limited English proficient individuals, the prod16 uct of— 

17 (i) the average per person cost of lan18 guage assistance services, determined ac19 cording to the methodology devised under 

20 paragraph (2); and 

21 (ii) the number of individuals with 

22 limited English proficiency who are pro23 vided language assistance services by the 

24 entity and for whom no reimbursement is 

25 available for such services under the 


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1 amendments made by subsection (a), (b), 

2 (c), or (d), or by private health insurance. 

3 (B) ELIGIBLE ENTITY.—The term ‘‘eligible 

4 entity’’ means an entity that— 

5 (i) is a Medicaid provider that is— 

6 (I) a physician; 

7 (II) a hospital with a low-income 

8 utilization rate (as defined in section 

9 1923(b)(3) of the Social Security Act 

10 (42 U.S.C. 1396r–4(b)(3))) of greater 

11 than 25 percent; 

12 (III) a Federally qualified health 

13 center (as defined in section 

14 1905(l)(2)(B) of the Social Security 

15 Act (42 U.S.C. 1396d(l)(2)(B))); 

16 (IV) a hospice provider; or 

17 (V) a palliative care provider; 

18 (ii) not later than 6 months after the 

19 date of the enactment of this Act, provides 

20 language assistance services to not less 

21 than 8 percent of the entity’s total number 

22 of patients; and 

23 (iii) prepares and submits an applica24 tion to the Secretary, at such time, in such 

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1 mation as the Secretary may require, to 

2 ascertain the entity’s eligibility for funding 

3 under this subsection. 

4 (C) LANGUAGE ASSISTANCE SERVICES.— 

5 The term ‘‘language assistance services’’ has 

6 the meaning given such term in section 

7 1861(nnn) of the Social Security Act, as added 

8 by subsection (b). 

9 (f) APPLICATION OF CIVIL RIGHTS ACT OF 1964, 

10 SECTION 1557 OF THE AFFORDABLE CARE ACT, AND

11 OTHER LAWS.—Nothing in this section shall be construed 

12 to limit otherwise existing obligations of recipients of Fed13 eral financial assistance under title VI of the Civil Rights 

14 Act of 1964 (42 U.S.C. 2000d et seq.), section 1557 of 

15 the Affordable Care Act (42 U.S.C. 18116), or other laws 

16 that protect the civil rights of individuals. 

17 (g) EFFECTIVE DATE.— 

18 (1) IN GENERAL.—Except as otherwise pro19 vided and subject to paragraph (2), the amendments 

20 made by this section shall take effect on January 1, 

21 2025. 

22 (2) EXCEPTION IF STATE LEGISLATION RE23 QUIRED.—In the case of a State plan for medical as24 sistance under title XIX of the Social Security Act 

25 (42 U.S.C. 1396 et seq.) or a State plan for child 


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1 health assistance under title XXI of such Act (42 

2 U.S.C. 1397aa 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 this section, such 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. 2008. INCREASING UNDERSTANDING OF AND IMPROV19 ING HEALTH LITERACY. 

20 (a) IN GENERAL.—The Secretary, in consultation 

21 with the Director of the National Institute on Minority 

22 Health and Health Disparities and the Deputy Assistant 

23 Secretary for Minority Health, shall award grants to eligi24 ble entities to improve health care for patient populations 

25 that have low health literacy. 


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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 hospital, health center or clinic, health 

4 plan, or other health entity (including a nonprofit 

5 minority health organization or association); and 

6 (2) prepare and submit to the Secretary an ap7 plication at such time, in such manner, and con8 taining such information as the Secretary may rea9 sonably require. 

10 (c) USE OF FUNDS.— 

11 (1) AGENCY FOR HEALTHCARE RESEARCH AND

12 QUALITY.—A grant under subsection (a) that is 

13 awarded through the Director of the Agency for 

14 Healthcare Research and Quality shall be used— 

15 (A) to define and increase the under16 standing of health literacy across all areas of 

17 health care, including end of life care; 

18 (B) to investigate the correlation between 

19 low health literacy and health and health care; 

20 (C) to clarify which aspects of health lit21 eracy have an effect on health outcomes; and 

22 (D) for any other activity determined ap23 propriate by the Director. 

24 (2) HEALTH RESOURCES AND SERVICES ADMIN25 ISTRATION.—A grant under subsection (a) that is 


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1 awarded through the Administrator of the Health 

2 Resources and Services Administration shall be used 

3 to conduct demonstration projects for interventions 

4 for patients with low health literacy that may in5 clude— 

6 (A) the development of new disease man7 agement and end of life care programs for pa8 tients with low health literacy; 

9 (B) the tailoring of disease management 

10 programs and end of life care addressing men11 tal, physical, oral, and behavioral health condi12 tions for patients with low health literacy; 

13 (C) the translation of written health mate14 rials for patients with low health literacy; 

15 (D) the identification, implementation, and 

16 testing of low health literacy screening tools; 

17 (E) the conduct of educational campaigns 

18 for patients and providers about low health lit19 eracy; 

20 (F) the conduct of educational campaigns 

21 concerning health directed specifically at pa22 tients with mental disabilities, including those 

23 with cognitive and intellectual disabilities, de24 signed to reduce the incidence of low health lit25 eracy among these populations, which shall 


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1 have instructional materials in the plain lan2 guage standards promulgated under the Plain 

3 Writing Act of 2010 (5 U.S.C. 301 note) for 

4 Federal agencies; and 

5 (G) other activities determined appropriate 

6 by the Administrator. 

7 (d) DEFINITIONS.—In this section: 

8 (1) LOW HEALTH LITERACY.—The term ‘‘low 

9 health literacy’’ means the inability of an individual 

10 to obtain, process, and understand basic health in11 formation and services needed to make appropriate 

12 health decisions. 

13 (2) SECRETARY.—The term ‘‘Secretary’’ means 

14 the Secretary of Health and Human Services— 

15 (A) acting through the Director of the 

16 Agency for Healthcare Research and Quality, 

17 with respect to grants under subsection (c)(1); 

18 and 

19 (B) acting through the Administrator of 

20 the Health Resources and Services Administra21 tion with respect to grants under subsection 

22 (c)(2). 

23 (e) AUTHORIZATION OF APPROPRIATIONS.—There 

24 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 2025 through 2029. 

3 SEC. 2009. REQUIREMENTS FOR HEALTH PROGRAMS OR 

4 ACTIVITIES RECEIVING FEDERAL FUNDS. 

5 (a) COVERED ENTITY; HEALTH PROGRAM OR ACTIV6 ITY.—In this section: 

7 (1) COVERED ENTITY.—The term ‘‘covered en8 tity’’ means an entity described in clause (i) of sec9 tion 3401(a)(2)(C) of the Public Health Service Act, 

10 as added by section 2004. 

11 (2) HEALTH PROGRAM OR ACTIVITY.—The 

12 term ‘‘health program or activity’’ has the meaning 

13 given such term in clause (ii) of such section 

14 3401(a)(2)(C). 

15 (b) REQUIREMENTS.—A covered entity, in order to 

16 ensure the right of individuals with limited English pro17 ficiency to receive access to high-quality health care 

18 through the health program or activity, shall— 

19 (1) ensure that appropriate clinical and support 

20 staff receive ongoing education and training in cul21 turally and linguistically appropriate service delivery 

22 at least annually; 

23 (2) offer and provide appropriate language as24 sistance services at no additional charge to each pa25 tient that is an individual with limited English proVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 00156 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 ficiency at all points of contact, in a timely manner 

2 during all hours of operation; 

3 (3) notify patients of their right to receive lan4 guage services in their primary language; and 

5 (4) utilize only qualified interpreters for an in6 dividual with limited English proficiency or qualified 

7 translators, except as provided in subsection (c). 

8 (c) EXEMPTIONS.—The requirements of subsection 

9 (b)(4) shall not apply as follows: 

10 (1) When a patient requests the use of family, 

11 friends, or other persons untrained in interpretation 

12 or translation if each of the following conditions are 

13 met: 

14 (A) The interpreter requested by the pa15 tient is over the age of 18. 

16 (B) The covered entity informs the patient 

17 in the primary language of the patient that he 

18 or she has the option of having the entity pro19 vide to the patient an interpreter and trans20 lation services without charge. 

21 (C) The covered entity informs the patient 

22 that the entity may not require an individual 

23 with a limited English proficiency to use a fam24 ily member or friend as an interpreter. 


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1 (D) The covered entity evaluates whether 

2 the person the patient wishes to use as an in3 terpreter is competent. If the covered entity has 

4 reason to believe that such person is not com5 petent as an interpreter, the entity provides its 

6 own interpreter to protect the covered entity 

7 from liability if the patient’s interpreter is later 

8 found not competent. 

9 (E) If the covered entity has reason to be10 lieve that there is a conflict of interest between 

11 the interpreter and patient, the covered entity 

12 may not use the patient’s interpreter. 

13 (F) The covered entity has the patient sign 

14 a waiver, witnessed by at least 1 individual not 

15 related to the patient, that includes the infor16 mation stated in subparagraphs (A) through 

17 (E) and is translated into the patient’s primary 

18 language. 

19 (2) When a medical emergency exists and the 

20 delay directly associated with obtaining competent 

21 interpreter or translation services would jeopardize 

22 the health of the patient, but only until a competent 

23 interpreter or translation service is available. 

24 (d) RULE OF CONSTRUCTION.—Subsection (c)(2) 

25 shall not be construed to mean that emergency rooms or 


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1 similar entities that regularly provide health care services 

2 in medical emergencies are exempt from legal or regu3 latory requirements related to competent interpreter serv4 ices. 

5 SEC. 2010. REPORT ON FEDERAL EFFORTS TO PROVIDE 

6 CULTURALLY AND LINGUISTICALLY APPRO7 PRIATE HEALTH CARE SERVICES. 

8 (a) REPORT.—Not later than 1 year after the date 

9 of enactment of this Act, and annually thereafter, the Sec10 retary of Health and Human Services shall seek to enter 

11 into a contract with the National Academy of Medicine 

12 for the preparation and publication of a report that de13 scribes Federal efforts to ensure that all individuals with 

14 limited English proficiency have meaningful access to 

15 health care services and health care-related services that 

16 are culturally and linguistically appropriate. Such report 

17 shall include— 

18 (1) a description and evaluation of the activities 

19 carried out under this Act; 

20 (2) a description and analysis of best practices, 

21 model programs, guidelines, and other effective 

22 strategies for providing access to culturally and lin23 guistically appropriate health care services; 

24 (3) recommendations on the development and 

25 implementation of policies and practices by providers 


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1 of health care services and health care-related serv2 ices for individuals with limited English proficiency, 

3 including people with cognitive, hearing, vision, or 

4 print impairments; 

5 (4) recommend guidelines or standards for 

6 health literacy and plain language, informed consent, 

7 discharge instructions, and written communications, 

8 and for improvement of health care access; 

9 (5) a description of the effect of providing lan10 guage services on quality of health care and access 

11 to care; and 

12 (6) a description of the costs associated with or 

13 savings related to the provision of language services. 

14 (b) 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 2025 through 2029. 

18 SEC. 2011. ENGLISH INSTRUCTION FOR INDIVIDUALS WITH 

19 LIMITED ENGLISH PROFICIENCY. 

20 (a) GRANTS AUTHORIZED.—The Secretary of Edu21 cation is authorized to provide grants to eligible entities 

22 for the provision of English as a second language (in this 

23 section referred to as ‘‘ESL’’) instruction to individuals 

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1 sultation with appropriate stakeholders, the mechanism 

2 for administering and distributing such grants. 

3 (b) ELIGIBLE ENTITY.—In this section, the term ‘‘el4 igible entity’’ means— 

5 (1) a State; or 

6 (2) a community-based organization that pre7 dominantly employs and serves racial and ethnic mi8 nority groups (as defined in section 1707(g) of the 

9 Public Health Service Act (42 U.S.C. 300u–6(g)). 

10 (c) APPLICATION.—An eligible entity that desires to 

11 receive a grant under this section shall apply by submit12 ting to the Secretary of Education an application at such 

13 time, in such manner, and containing such information as 

14 the Secretary may require. 

15 (d) USE OF GRANT.—An eligible entity shall use 

16 grant funds provided under this section to— 

17 (1) develop and implement a plan for assuring 

18 the availability of ESL instruction, free of charge, to 

19 the community served by the eligible entity, that ef20 fectively integrates information about the nature of 

21 the United States health care system, how to access 

22 care, and any special language skills that may be re23 quired for individuals with limited English pro24 ficiency to access and regularly negotiate the health 

25 care system effectively; 


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1 (2) develop a plan for making ESL instruction 

2 available free to charge to individuals with limited 

3 English proficiency in the community served by the 

4 eligible entity who are seeking instruction, including, 

5 where appropriate, through the use of public-private 

6 partnerships; and 

7 (3) provide ESL instruction to individuals with 

8 limited English proficiency in the community served 

9 by the eligible entity. 

10 (e) SUPPLEMENT, NOT SUPPLANT.—An eligible enti11 ty awarded a grant under this section shall use funds 

12 made available under this section to supplement, and not 

13 supplant, other Federal, State, and local funds that would 

14 otherwise be expended to carry out activities under this 

15 section. 

16 (f) DUTIES OF THE SECRETARY.—The Secretary of 

17 Education shall— 

18 (1) collect and make publicly available annual 

19 data on how much Federal, State, and local govern20 ments spend annually on ESL instruction; 

21 (2) collect data from eligible entities awarded a 

22 grant under this section to identify the unmet needs 

23 of individuals with limited English proficiency for 

24 appropriate ESL instruction, including— 


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1 (A) the preferred written and spoken lan2 guage of such individuals; 

3 (B) the availability of enrollment in ESL 

4 instruction programs in the communities served 

5 by each eligible entity awarded a grant under 

6 this section, including the extent of waiting lists 

7 for ESL instruction, how many programs main8 tain waiting lists, and, for programs that do not 

9 have waiting lists, the reasons why such a list 

10 is unnecessary or otherwise not maintained; 

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 with limited 

17 English proficiency and the number of individ18 uals enrolled in ESL instruction programs in 

19 the communities served by each eligible entity 

20 awarded a grant under this section; 

21 (F) the effectiveness of the ESL instruc22 tion provided through grants awarded under 

23 this section in meeting the needs of individuals 

24 receiving such instruction; and 


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1 (G) an assessment of the need for pro2 grams that integrate job training and ESL in3 struction, to assist individuals with limited 

4 English proficiency in obtaining better jobs; 

5 (3) determine the cost and most appropriate 

6 methods of making ESL instruction available to all 

7 individuals with limited English proficiency in the 

8 United States who are seeking instruction; and 

9 (4) not later than 1 year after the date of en10 actment of this Act, issue a report to Congress 

11 that— 

12 (A) assesses the information collected in 

13 paragraphs (1), (2), and (3) and makes rec14 ommendations on steps that should be taken to 

15 realize the goal of making ESL instruction 

16 available to all individuals with limited English 

17 proficiency in the United States who are seek18 ing instruction; and 

19 (B) evaluates the impact of the grant pro20 gram authorized under this section on the ac21 cessibility of, and ability to effectively negotiate, 

22 the health care system for individuals with lim23 ited English proficiency who have received ESL 

24 instruction funded by a grant under this sec25 tion. 


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1 (g) AUTHORIZATION OF APPROPRIATIONS.—There 

2 are authorized to be appropriated to the Secretary of Edu3 cation $250,000,000 for each of fiscal years 2025 through 

4 2029 to carry out this section. 

5 SEC. 2012. IMPLEMENTATION. 

6 (a) GENERAL PROVISIONS.— 

7 (1) IMMUNITY.—A person injured by a violation 

8 of this title (including an amendment made by this 

9 title) by a State may bring a civil action in the ap10 propriate Federal court for such injury in accord11 ance with this section. 

12 (2) REMEDIES.—In a civil action under this 

13 section for a violation of this title, such remedies 

14 shall be available as would be available in a civil ac15 tion for such violation against any party other than 

16 a State. 

17 (b) RULE OF CONSTRUCTION.—Nothing in this title 

18 may be construed to limit otherwise existing obligations 

19 of recipients of Federal financial assistance under title VI 

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

21 or any other Federal statute. 

22 SEC. 2013. LANGUAGE ACCESS SERVICES. 

23 (a) ESSENTIAL BENEFITS.—Section 1302(b)(1) of 

24 the Patient Protection and Affordable Care Act (42 


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1 U.S.C. 18022(b)(1)) is amended by adding at the end the 

2 following: 

3 ‘‘(K) Language access services, including 

4 oral interpretation and written translations.’’. 

5 (b) EMPLOYER-SPONSORED MINIMUM ESSENTIAL

6 COVERAGE.— 

7 (1) IN GENERAL.—Section 36B(c)(2)(C) of the 

8 Internal Revenue Code of 1986 is amended by redes9 ignating clauses (iii) and (iv) as clauses (iv) and (v), 

10 respectively, and by inserting after clause (ii) the fol11 lowing new clause: 

12 ‘‘(iii) COVERAGE MUST INCLUDE LAN13 GUAGE ACCESS AND SERVICES.—Except as 

14 provided in clause (iv), an employee shall 

15 not be treated as eligible for minimum es16 sential coverage if such coverage consists 

17 of an eligible employer-sponsored plan (as 

18 defined in section 5000A(f)(2)) and the 

19 plan does not provide coverage for lan20 guage access services, including oral inter21 pretation and written translations.’’. 

22 (2) CONFORMING AMENDMENTS.— 

23 (A) Section 36B(c)(2)(C) of such Code is 

24 amended by striking ‘‘clause (iii)’’ each place it 


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1 appears in clauses (i) and (ii) and inserting 

2 ‘‘clause (iv)’’. 

3 (B) Section 36B(c)(2)(C)(iv) of such Code, 

4 as redesignated by this subsection, is amended 

5 by striking ‘‘(i) and (ii)’’ and inserting ‘‘(i), (ii), 

6 and (iii)’’. 

7 (c) QUALITY REPORTING.—Section 2717(a)(1) of the 

8 Public Health Service Act (42 U.S.C. 300gg–17(a)(1)) is 

9 amended— 

10 (1) by striking ‘‘and’’ at the end of subpara11 graph (C); 

12 (2) by striking the period at the end of sub13 paragraph (D) and inserting ‘‘; and’’; and 

14 (3) by adding at the end the following new sub15 paragraph: 

16 ‘‘(E) reduce health disparities through the 

17 provision of language access services, including 

18 oral interpretation and written translations.’’. 

19 (d) REGULATIONS REGARDING INTERNAL CLAIMS

20 AND APPEALS AND EXTERNAL REVIEW PROCESSES FOR

21 HEALTH PLANS AND HEALTH INSURANCE ISSUERS.— 

22 The Secretary of the Treasury, the Secretary of Labor, 

23 and the Secretary of Health and Human Services shall 

24 amend the regulations in section 54.9815–2719(e) of title 

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1 tions), section 2590.715–2719(e) of title 29, Code of Fed2 eral Regulations (or successor regulations), and section 

3 147.136(e) of title 45, Code of Federal Regulations (or 

4 successor regulations), respectively, to require group 

5 health plans and health insurance issuers offering group 

6 or individual health insurance coverage to which such sec7 tions apply— 

8 (1) to provide oral interpretation services with9 out any threshold requirements; 

10 (2) to provide in the English versions of all no11 tices a statement prominently displayed in not less 

12 than 15 non-English languages clearly indicating 

13 how to access the language services provided by the 

14 plan or issuer; and 

15 (3) with respect to the requirements for pro16 viding relevant notices in a culturally and linguis17 tically appropriate manner in the applicable non18 English languages, to apply a threshold that 5 per19 cent of the population, or not less than 500 individ20 uals, in the county is literate only in the same non21 English language in order for the language to be 

22 considered an applicable non-English language. 

23 (e) DATA COLLECTION AND REPORTING.—The Sec24 retary of Health and Human Services shall— 


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1 (1) amend the single streamlined application 

2 form developed pursuant to section 1413 of the Pa3 tient Protection and Affordable Care Act (42 U.S.C. 

4 18083) to collect the preferred spoken and written 

5 language for each household member applying for 

6 coverage under a qualified health plan through an 

7 Exchange under title I of such Act (42 U.S.C. 

8 18001 et seq.); 

9 (2) require navigators, certified application 

10 counselors, and other individuals assisting with en11 rollment to collect and report requests for language 

12 assistance; and 

13 (3) require the toll-free telephone hotlines es14 tablished pursuant to section 1311(d)(4)(B) of the 

15 Patient Protection and Affordable Care Act (42 

16 U.S.C. 18031(d)(4)(B)) to submit an annual report 

17 documenting the number of language assistance re18 quests, the types of languages requested, the range 

19 and average wait time for a consumer to speak with 

20 an interpreter, the number of complaints and any 

21 steps the hotline, and any entity contracting with 

22 the Secretary to provide language services, have 

23 taken to actively address some of the consumer com24 plaints. 


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

2 this section shall not apply to plans beginning prior to the 

3 date of the enactment of this Act. 

4 SEC. 2014. MEDICALLY UNDERSERVED POPULATIONS. 

5 Section 330(b)(3) of the Public Health Service Act 

6 (42 U.S.C. 254b(b)(3)) is amended to read as follows: 

7 ‘‘(3) MEDICALLY UNDERSERVED POPU8 LATION.—The term ‘medically underserved popu9 lation’ means— 

10 ‘‘(A) the population of an urban or rural 

11 area designated by the Secretary as— 

12 ‘‘(i) an area with a shortage of per13 sonal health services; or 

14 ‘‘(ii) a population group having a 

15 shortage of such services; or 

16 ‘‘(B) a population of individuals, not con17 fined to a particular urban or rural area, who 

18 are designated by the Secretary as having a 

19 shortage of personal health services due to a 

20 specific demographic trait.’’. 


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1 TITLE III—HEALTH WORKFORCE 

2 DIVERSITY 

3 SEC. 3001. AMENDMENT TO THE PUBLIC HEALTH SERVICE 

4 ACT. 

5 Title XXXIV of the Public Health Service Act, as 

6 added by section 2004, is amended by adding at the end 

7 the following: 

8 ‘‘Subtitle B—Diversifying the 

9 Health Care Workplace 

10 ‘‘SEC. 3411. NATIONAL WORKING GROUP ON WORKFORCE 

11 DIVERSITY. 

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

13 the Bureau of Health Workforce of the Health Resources 

14 and Services Administration, shall award a grant to an 

15 entity determined appropriate by the Secretary for the es16 tablishment of a national working group on workforce di17 versity. 

18 ‘‘(b) REPRESENTATION.—In establishing the national 

19 working group under subsection (a): 

20 ‘‘(1) The grantee shall ensure that the group 

21 has representatives of each of the following: 

22 ‘‘(A) The Health Resources and Services 

23 Administration. 

24 ‘‘(B) The Department of Health and 

25 Human Services Data Council. 


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1 ‘‘(C) The Office of Minority Health of the 

2 Department of Health and Human Services. 

3 ‘‘(D) The Substance Abuse and Mental 

4 Health Services Administration. 

5 ‘‘(E) The Bureau of Labor Statistics of 

6 the Department of Labor. 

7 ‘‘(F) The National Institute on Minority 

8 Health and Health Disparities. 

9 ‘‘(G) The Agency for Healthcare Research 

10 and Quality. 

11 ‘‘(H) The National Academy of Medicine. 

12 ‘‘(I) The Indian Health Service. 

13 ‘‘(J) The Centers for Medicare & Medicaid 

14 Services. 

15 ‘‘(K) The Department of Education. 

16 ‘‘(L) Institutions described in section 

17 371(a) of the Higher Education Act of 1965. 

18 ‘‘(M) Consumer organizations. 

19 ‘‘(N) Health professional associations, in20 cluding those that represent underrepresented 

21 minority populations. 

22 ‘‘(O) Researchers in the area of health 

23 workforce. 

24 ‘‘(P) Health workforce accreditation enti25 ties. 


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1 ‘‘(Q) Private (including nonprofit) founda2 tions that have sponsored workforce diversity 

3 initiatives. 

4 ‘‘(R) Local and State health departments. 

5 ‘‘(S) Representatives of community mem6 bers to be included on admissions committees 

7 for health profession schools pursuant to sub8 section (c)(9). 

9 ‘‘(T) National community-based organiza10 tions that serve as a national intermediary to 

11 their rural or urban affiliate members and have 

12 demonstrated capacity to train health care pro13 fessionals. 

14 ‘‘(U) The Veterans Health Administration. 

15 ‘‘(V) Other entities determined appropriate 

16 by the Secretary. 

17 ‘‘(2) The grantee shall ensure that, in addition 

18 to the representatives under paragraph (1), the 

19 working group has not less than 5 health professions 

20 students representing various health profession fields 

21 and levels of training. 

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

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

24 to complete the following activities: 


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

2 diversity initiatives. 

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

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

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

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

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

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

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

16 professions programs and programs funded under 

17 this Act. 

18 ‘‘(7) Develop guidelines to train health profes19 sionals to care for a diverse population. 

20 ‘‘(8) Develop a workforce data collection or 

21 tracking system to identify where health profes22 sionals of racial and ethnic minority groups practice. 

23 ‘‘(9) Develop a strategy for the inclusion of 

24 community members on admissions committees for 

25 health profession schools. 


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1 ‘‘(10) Help with monitoring of standards for di2 versity, equity, and inclusion. 

3 ‘‘(11) Other activities determined appropriate 

4 by the Secretary. 

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

6 the establishment of the working group under subsection 

7 (a), and annually thereafter, the working group shall pre8 pare and make available to the general public for com9 ment, an annual report on the activities of the working 

10 group. Such report shall include the recommendations of 

11 the working group for improving health workforce diver12 sity. 

13 ‘‘(e) COORDINATION WITH OTHER EFFORTS.—In 

14 providing for the establishment of the working group 

15 under subsection (a), the Secretary shall take such steps 

16 as may be necessary to ensure that the work of the work17 ing group does not overlap with, or otherwise duplicate, 

18 other Federal Government efforts with respect to ensuring 

19 health equity in data collection in public health emer20 gencies. 

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

22 are authorized to be appropriated to carry out this section 

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

24 2025 through 2029. 


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1 ‘‘SEC. 3412. TECHNICAL CLEARINGHOUSE FOR HEALTH 

2 WORKFORCE DIVERSITY. 

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

4 the Deputy Assistant Secretary for Minority Health, and 

5 in collaboration with the Bureau of Health Workforce 

6 within the Health Resources and Services Administration 

7 and the National Institute on Minority Health and Health 

8 Disparities, shall establish a technical clearinghouse on 

9 health workforce diversity within the Office of Minority 

10 Health and coordinate current and future clearinghouses 

11 related to health workforce diversity. 

12 ‘‘(b) INFORMATION AND SERVICES.—The clearing13 house established under subsection (a) shall offer the fol14 lowing information and services: 

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

16 workforce diversity. 

17 ‘‘(2) Statistical information relating to rep18 resentation of underrepresented minority populations 

19 in health and allied health professions and occupa20 tions. 

21 ‘‘(3) Model health workforce diversity practices 

22 and programs, including integrated models of care. 

23 ‘‘(4) Admissions policies that promote health 

24 workforce diversity and are in compliance with Fed25 eral and State laws. 


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1 ‘‘(5) Retainment policies that promote comple2 tion of health profession degrees for underserved 

3 populations. 

4 ‘‘(6) Lists of scholarship, loan repayment, and 

5 loan cancellation grants as well as fellowship infor6 mation for underserved populations for health pro7 fessions schools. 

8 ‘‘(7) Foundation and other large organizational 

9 initiatives relating to health workforce diversity. 

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

11 the Secretary shall consult with non-Federal entities which 

12 may include health professional associations representing 

13 minority populations and sections of major health profes14 sional associations representing minority populations to 

15 ensure the adequacy and accuracy of information. 

16 ‘‘(d) 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 2025 through 2029. 

20 ‘‘SEC. 3413. SUPPORT FOR INSTITUTIONS COMMITTED TO 

21 WORKFORCE DIVERSITY, EQUITY, AND IN22 CLUSION. 

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

24 the Administrator of the Health Resources and Services 

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1 ease Control and Prevention, shall award grants to eligible 

2 entities that demonstrate a commitment to health work3 force diversity. 

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

5 under subsection (a), an entity shall— 

6 ‘‘(1) be an educational institution or entity that 

7 historically produces or trains meaningful numbers 

8 of underrepresented health professionals of minority 

9 populations, including— 

10 ‘‘(A) part B institutions, as defined in sec11 tion 322 of the Higher Education Act of 1965; 

12 ‘‘(B) historically Black professional or 

13 graduate institutions eligible for grants under 

14 section 326 of such Act; 

15 ‘‘(C) Hispanic-serving health professions 

16 schools; 

17 ‘‘(D) Hispanic-serving institutions, as de18 fined in section 502 of such Act; 

19 ‘‘(E) Tribal Colleges or Universities, as de20 fined in section 316 of such Act; 

21 ‘‘(F) Asian American and Native American 

22 Pacific Islander-serving institutions, as defined 

23 in section 371(c) of such Act; 

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1 sionals of minority populations, in which a sig2 nificant number of the enrolled participants are 

3 from minority populations; 

4 ‘‘(H) health professional associations, 

5 which may include health professional associa6 tions representing underrepresented minority 

7 populations; and 

8 ‘‘(I) institutions, including national and re9 gional community-based organizations with 

10 demonstrated commitment to a diversified 

11 workforce— 

12 ‘‘(i) located in communities with pre13 dominantly underrepresented minority pop14 ulations; 

15 ‘‘(ii) with whom partnerships have 

16 been formed for the purpose of increasing 

17 workforce diversity; and 

18 ‘‘(iii) in which at least 20 percent of 

19 the enrolled participants are from under20 represented minority populations; and 

21 ‘‘(2) submit to the Secretary an application at 

22 such time, in such manner, and containing such in23 formation as the Secretary may require. 

24 ‘‘(c) USE OF FUNDS.—Amounts received under a 

25 grant under subsection (a) shall be used to expand existing 


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1 workforce diversity programs, implement new workforce 

2 diversity programs, or evaluate existing or new workforce 

3 diversity programs, including with respect to mental 

4 health care professions. Such programs shall enhance di5 versity by considering status as a member of a minority 

6 population as part of an individualized consideration of 

7 qualifications. Possible activities may include— 

8 ‘‘(1) educational outreach programs relating to 

9 opportunities in the health professions; 

10 ‘‘(2) scholarship, fellowship, grant, loan repay11 ment, and loan cancellation programs; 

12 ‘‘(3) postbaccalaureate programs; 

13 ‘‘(4) academic enrichment programs, particu14 larly targeting those who would not be competitive 

15 for health professions schools; 

16 ‘‘(5) supporting workforce diversity in kinder17 garten through 12th grade and other health pipeline 

18 programs; 

19 ‘‘(6) mentoring programs; 

20 ‘‘(7) internship or rotation programs involving 

21 hospitals, health systems, health plans, and other 

22 health entities; 

23 ‘‘(8) community partnership development for 

24 purposes relating to workforce diversity; or 

25 ‘‘(9) leadership training. 


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1 ‘‘(d) REPORTS.—Not later than 1 year after receiving 

2 a grant under this section, and annually for the term of 

3 the grant, a grantee shall submit to the Secretary a report 

4 that summarizes and evaluates all activities conducted 

5 under the grant. 

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

7 are authorized to be appropriated to carry out this section 

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

9 2025 through 2029. 

10 ‘‘SEC. 3414. CAREER DEVELOPMENT FOR SCIENTISTS AND 

11 RESEARCHERS. 

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

13 the Director of the National Institutes of Health, the Di14 rector of the Centers for Disease Control and Prevention, 

15 the Commissioner of Food and Drugs, the Director of the 

16 Agency for Healthcare Research and Quality, and the Ad17 ministrator of the Health Resources and Services Admin18 istration, shall award grants that expand existing opportu19 nities for scientists and researchers and promote the inclu20 sion of underrepresented minority populations in the 

21 health professions. 

22 ‘‘(b) RESEARCH FUNDING.—The head of each agency 

23 listed in subsection (a) shall establish or expand existing 

24 programs to provide research funding to scientists and re25 searchers in training. Under such programs, the head of 


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1 each such entity shall give priority in allocating research 

2 funding to support health research in traditionally under3 served communities, including underrepresented minority 

4 populations, and research classified as community or 

5 participatory. 

6 ‘‘(c) DATA COLLECTION.—The head of each agency 

7 listed in subsection (a) shall collect data on the number 

8 (expressed as an absolute number and a percentage) of 

9 underrepresented applicants from minority populations, 

10 and applicants from populations that are not minority 

11 populations, who receive and are denied agency funding 

12 at every stage of review. Such data shall be reported annu13 ally to the Secretary and the appropriate committees of 

14 Congress. 

15 ‘‘(d) STUDENT LOAN REIMBURSEMENT.—The Sec16 retary shall establish a student loan reimbursement pro17 gram to provide student loan reimbursement assistance to 

18 researchers who focus on racial and ethnic disparities in 

19 health. The Secretary shall promulgate regulations to de20 fine the scope and procedures for the program under this 

21 subsection. 

22 ‘‘(e) STUDENT LOAN CANCELLATION.—The Sec23 retary shall establish a student loan cancellation program 

24 to provide student loan cancellation assistance to research25 ers who focus on racial and ethnic disparities in health. 


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1 Students participating in the program shall make a min2 imum 5-year commitment to work at an accredited health 

3 professions school. The Secretary shall promulgate addi4 tional regulations to define the scope and procedures for 

5 the program under this subsection. 

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

7 are authorized to be appropriated to carry out this section 

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

9 2025 through 2029. 

10 ‘‘SEC. 3415. CAREER SUPPORT FOR NONRESEARCH HEALTH 

11 PROFESSIONALS. 

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

13 the Director of the Centers for Disease Control and Pre14 vention, the Assistant Secretary for Mental Health and 

15 Substance Use, the Administrator of the Health Resources 

16 and Services Administration, and the Administrator of the 

17 Centers for Medicare & Medicaid Services, shall establish 

18 a program to award grants to universities and other insti19 tutions to enter into agreements with eligible individuals 

20 under which— 

21 ‘‘(1) the university or institution supports the 

22 eligible individual’s career in a nonresearch-related 

23 health and wellness profession; and 

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1 reer to serve, or to work on health issues affecting, 

2 underserved communities, such as communities of 

3 racial and ethnic minority groups. 

4 ‘‘(b) ELIGIBLE INDIVIDUALS.—To be an eligible indi5 vidual for purposes of subsection (a), an individual shall 

6 be a student in a health professions school, a graduate 

7 of such a school who is working in a health profession, 

8 an individual working in a health or wellness profession 

9 (including mental and behavioral health), or a faculty 

10 member of such a school. 

11 ‘‘(c) APPLICATION.—To seek a grant under this sec12 tion, a university or other institution shall submit to the 

13 Secretary an application at such time, in such manner, 

14 and containing such information as the Secretary may re15 quire. 

16 ‘‘(d) USE OF FUNDS.—A university or other institu17 tion receiving a grant under this section shall use the 

18 grant for agreements described in subsection (a). Such 

19 agreements may— 

20 ‘‘(1) support an eligible individual’s health ac21 tivities or projects that involve underserved commu22 nities, including communities of racial and ethnic 

23 minority groups; 

24 ‘‘(2) support an eligible individual’s health-re25 lated career advancement activities; 


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1 ‘‘(3) pay, or reimburse for payment of, student 

2 loans or training or credentialing costs for eligible 

3 individuals who are health professionals and are fo4 cused on health issues affecting underserved commu5 nities, including communities of racial and ethnic 

6 minority groups; and 

7 ‘‘(4) establish and promote leadership training 

8 programs for eligible individuals to decrease health 

9 disparities and to increase cultural competence with 

10 the goal of increasing diversity in leadership posi11 tions. 

12 ‘‘(e) DEFINITION.—In this section, the term ‘career 

13 in a nonresearch-related health and wellness profession’ 

14 means employment or intended employment in the field 

15 of public health, health policy, health management, health 

16 administration, medicine, nursing, pharmacy, psychology, 

17 social work, psychiatry, other mental and behavioral 

18 health, allied health, community health, social work, or 

19 other fields determined appropriate by the Secretary, 

20 other than in a position that involves research. 

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

22 are authorized to be appropriated to carry out this section 

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

24 2025 through 2029. 


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1 ‘‘SEC. 3416. RESEARCH ON THE EFFECT OF WORKFORCE DI2 VERSITY ON QUALITY. 

3 ‘‘(a) IN GENERAL.—The Director of the Agency for 

4 Healthcare Research and Quality (in this section referred 

5 to as the ‘Director’), in collaboration with the Deputy As6 sistant Secretary for Minority Health and the Director of 

7 the National Institute on Minority Health and Health Dis8 parities, shall award grants to eligible entities to expand 

9 research on the link between health workforce diversity 

10 and quality health care. 

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

12 under subsection (a), an entity shall— 

13 ‘‘(1) be a clinical, public health, or health serv14 ices research entity or other entity determined ap15 propriate by the Director; 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. 

19 ‘‘(c) USE OF FUNDS.—Amounts received under a 

20 grant awarded under subsection (a) shall be used to sup21 port research that investigates the effect of health work22 force diversity on— 

23 ‘‘(1) language access; 

24 ‘‘(2) cultural competence; 

25 ‘‘(3) patient satisfaction; 

26 ‘‘(4) timeliness of care; 


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1 ‘‘(5) safety of care; 

2 ‘‘(6) effectiveness of care; 

3 ‘‘(7) efficiency of care; 

4 ‘‘(8) patient outcomes; 

5 ‘‘(9) community engagement; 

6 ‘‘(10) resource allocation; 

7 ‘‘(11) organizational structure; 

8 ‘‘(12) compliance of care; or 

9 ‘‘(13) other topics determined appropriate by 

10 the Director. 

11 ‘‘(d) PRIORITY.—In awarding grants under sub12 section (a), the Director shall give individualized consider13 ation to all relevant aspects of the applicant’s background. 

14 Consideration of prior research experience involving the 

15 health of underserved communities shall be such a relevant 

16 aspect. 

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 2025 through 2029. 

21 ‘‘SEC. 3417. HEALTH DISPARITIES EDUCATION PROGRAM. 

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

23 through the Office of Minority Health, in collaboration 

24 with the National Institute on Minority Health and Health 

25 Disparities, the Office for Civil Rights, the Centers for 


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1 Disease Control and Prevention, the Centers for Medicare 

2 & Medicaid Services, the Health Resources and Services 

3 Administration, and other appropriate public and private 

4 entities, shall establish and coordinate a health and health 

5 care disparities education program to support, develop, 

6 and implement educational initiatives and outreach strate7 gies that inform health care professionals and the public 

8 about the existence of and methods to reduce racial and 

9 ethnic disparities in health and health care. 

10 ‘‘(b) ACTIVITIES.—The Secretary, through the edu11 cation program established under subsection (a), shall, 

12 through the use of public awareness and outreach cam13 paigns targeting the general public and the medical com14 munity at large— 

15 ‘‘(1) disseminate scientific evidence for the ex16 istence and extent of racial and ethnic disparities in 

17 health care, including disparities that are not other18 wise attributable to known factors such as access to 

19 care, patient preferences, or appropriateness of 

20 intervention, as described in the 2002 report of the 

21 National Academy of Medicine (formerly the ‘Insti22 tute of Medicine’) entitled ‘Unequal Treatment: Con23 fronting Racial and Ethnic Disparities in Health 

24 Care’, as well as the impact of disparities related to 

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1 der identity, and sexual orientation on racial and 

2 ethnic minority groups; 

3 ‘‘(2) disseminate new research findings to 

4 health care providers and patients to assist them in 

5 understanding, reducing, and eliminating health and 

6 health care disparities; 

7 ‘‘(3) disseminate information about the impact 

8 of linguistic and cultural barriers on health care 

9 quality and the obligation of health providers who 

10 receive Federal financial assistance to ensure that 

11 individuals with limited English proficiency have ac12 cess to language access services; 

13 ‘‘(4) disseminate information about the impor14 tance and legality of racial, ethnic, disability status, 

15 socioeconomic status, sex, gender identity, and sex16 ual orientation, and primary language data collec17 tion, analysis, and reporting; 

18 ‘‘(5) design and implement specific educational 

19 initiatives to health care providers relating to health 

20 and health care disparities; 

21 ‘‘(6) assess the impact of the programs estab22 lished under this section in raising awareness of 

23 health and health care disparities and providing in24 formation on available resources; and 


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1 ‘‘(7) design and implement specific educational 

2 initiatives to educate the health care workforce relat3 ing to unconscious bias. 

4 ‘‘(c) 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 2025 through 2029.’’. 

8 SEC. 3002. HISPANIC-SERVING INSTITUTIONS, HISTORI9 CALLY BLACK COLLEGES AND UNIVERSITIES, 

10 HISTORICALLY BLACK PROFESSIONAL OR 

11 GRADUATE INSTITUTIONS, ASIAN AMERICAN 

12 AND NATIVE AMERICAN PACIFIC ISLANDER13 SERVING INSTITUTIONS, TRIBAL COLLEGES, 

14 REGIONAL COMMUNITY-BASED ORGANIZA15 TIONS, AND NATIONAL MINORITY MEDICAL 

16 ASSOCIATIONS. 

17 Part B of title VII of the Public Health Service Act 

18 (42 U.S.C. 293 et seq.) is amended by adding at the end 

19 the following: 


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1 ‘‘SEC. 742. HISPANIC-SERVING INSTITUTIONS, HISTORI2 CALLY BLACK COLLEGES AND UNIVERSITIES, 

3 HISTORICALLY BLACK PROFESSIONAL OR 

4 GRADUATE INSTITUTIONS, ASIAN AMERICAN 

5 AND NATIVE AMERICAN PACIFIC ISLANDER6 SERVING INSTITUTIONS, AND TRIBAL COL7 LEGES. 

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

9 the Administrator of the Health Resources and Services 

10 Administration and in consultation with the Secretary of 

11 Education, shall award grants to Hispanic-serving institu12 tions, historically Black colleges and universities, histori13 cally Black professional or graduate institutions eligible 

14 for grants under section 326 of the Higher Education Act 

15 of 1965, Asian American and Native American Pacific Is16 lander-serving institutions, Tribal Colleges or Universities, 

17 regional community-based organizations, and national mi18 nority medical associations, for counseling, mentoring, and 

19 providing information on financial assistance to prepare 

20 underrepresented minority individuals to enroll in and 

21 graduate from health professional schools and to increase 

22 services for underrepresented minority students includ23 ing— 

24 ‘‘(1) mentoring with underrepresented health 

25 professionals; 


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1 ‘‘(2) providing financial assistance information 

2 for continued education and applications to health 

3 professional schools; and 

4 ‘‘(3) retaining existing enrolled underrep5 resented minority students in a health professions 

6 school. 

7 ‘‘(b) DEFINITIONS.—In this section: 

8 ‘‘(1) ASIAN AMERICAN AND NATIVE AMERICAN

9 PACIFIC ISLANDER-SERVING INSTITUTION.—The 

10 term ‘Asian American and Native American Pacific 

11 Islander-serving institution’ has the meaning given 

12 such term in section 320(b) of the Higher Education 

13 Act of 1965. 

14 ‘‘(2) HISPANIC-SERVING INSTITUTION.—The 

15 term ‘Hispanic-serving institution’ means an entity 

16 that— 

17 ‘‘(A) is a school or program for which 

18 there is a definition under section 799B; 

19 ‘‘(B) has an enrollment of full-time equiva20 lent students that is made up of at least 9 per21 cent Hispanic students; 

22 ‘‘(C) has been effective in carrying out pro23 grams to recruit Hispanic individuals to enroll 

24 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). 

10 ‘‘(3) HISTORICALLY BLACK COLLEGE AND UNI11 VERSITY.—The term ‘historically Black college and 

12 university’ has the meaning given the term ‘part B 

13 institution’ as defined in section 322 of the Higher 

14 Education Act of 1965. 

15 ‘‘(4) TRIBAL COLLEGE OR UNIVERSITY.—The 

16 term ‘Tribal College or University’ has the meaning 

17 given such term in section 316(b) of the Higher 

18 Education Act of 1965. 

19 ‘‘(c) CERTAIN LOAN REPAYMENT PROGRAMS.—In 

20 carrying out the National Health Service Corps Loan Re21 payment Program established under subpart III of part 

22 D of title III and the loan repayment program under sec23 tion 317F, the Secretary shall ensure, notwithstanding 

24 such subpart or section, that loan repayments of not less 

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1 ment of loans incurred for enrollment or participation of 

2 underrepresented minority individuals in health profes3 sional schools and other health programs described in this 

4 section. 

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

6 are authorized to be appropriated to carry out this section 

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

8 2025 through 2029.’’. 

9 SEC. 3003. LOAN REPAYMENT PROGRAM OF CENTERS FOR 

10 DISEASE CONTROL AND PREVENTION. 

11 Section 317F(c)(1) of the Public Health Service Act 

12 (42 U.S.C. 247b–7(c)(1)) is amended by striking 

13 ‘‘$500,000 for fiscal year 1994, and such sums as may 

14 be necessary for each of the fiscal years 1995 through 

15 2002’’ and inserting ‘‘such sums as may be necessary for 

16 each of fiscal years 2025 through 2029’’. 

17 SEC. 3004. COOPERATIVE AGREEMENTS FOR ONLINE DE18 GREE PROGRAMS AT SCHOOLS OF PUBLIC 

19 HEALTH AND SCHOOLS OF ALLIED HEALTH. 

20 Part D of title VII of the Public Health Service Act 

21 (42 U.S.C. 294 et seq.) is amended by inserting after sec22 tion 755 of such Act (42 U.S.C. 294e) the following: 


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1 ‘‘SEC. 755A. 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 2025 through 2029.’’. 

15 SEC. 3005. NATIONAL HEALTH CARE WORKFORCE COMMIS16 SION. 

17 (a) SENSE OF CONGRESS.—It is the sense of Con18 gress that the National Health Care Workforce Commis19 sion established by section 5101 of the Patient Protection 

20 and Affordable Care Act (42 U.S.C. 294q) should, in car21 rying out its assigned duties under that section, give at22 tention to the needs of racial and ethnic minority groups, 

23 individuals with lower socioeconomic status, individuals 

24 with mental, developmental, and physical disabilities, les25 bian, gay, bisexual, transgender, queer, and questioning 


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1 populations, and individuals who are members of multiple 

2 minority or special population groups. 

3 (b) REAUTHORIZATION.—Section 5101(h)(2) of the 

4 Patient Protection and Affordable Care Act (42 U.S.C. 

5 294q(h)(2)) is amended by striking ‘‘such sums as may 

6 be necessary’’ and inserting ‘‘$3,000,000 for each of fiscal 

7 years 2025 through 2027’’. 

8 SEC. 3006. SCHOLARSHIP AND FELLOWSHIP PROGRAMS. 

9 Subtitle B of title XXXIV of the Public Health Serv10 ice Act, as added by section 3001, is further amended by 

11 inserting after section 3417 the following: 

12 ‘‘SEC. 3418. DAVID SATCHER PUBLIC HEALTH AND HEALTH 

13 SERVICES CORPS. 

14 ‘‘(a) IN GENERAL.—The Director of the Centers for 

15 Disease Control and Prevention, in collaboration with the 

16 Administrator of the Health Resources and Services Ad17 ministration and the Deputy Assistant Secretary for Mi18 nority Health, shall award grants to eligible entities to in19 crease awareness among secondary and postsecondary stu20 dents of career opportunities in the health professions. 

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

22 under subsection (a), an entity shall— 

23 ‘‘(1) be a clinical, public health, or health serv24 ices organization, community-based or nonprofit en25 tity, or other entity determined appropriate by the 


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1 Director of the Centers for Disease Control and Pre2 vention; 

3 ‘‘(2) serve a health professional shortage area, 

4 as determined by the Secretary; 

5 ‘‘(3) work with students, including those from 

6 racial and ethnic minority groups, that have ex7 pressed an interest in the health professions; and 

8 ‘‘(4) submit to the Secretary an application at 

9 such time, in such manner, and containing such in10 formation as the Secretary may require. 

11 ‘‘(c) USE OF FUNDS.—Grant awards under sub12 section (a) shall be used to support internships that will 

13 increase awareness among students of non-research-based, 

14 career opportunities in the following health professions: 

15 ‘‘(1) Medicine. 

16 ‘‘(2) Nursing. 

17 ‘‘(3) Public health. 

18 ‘‘(4) Pharmacy. 

19 ‘‘(5) Health administration and management. 

20 ‘‘(6) Health policy. 

21 ‘‘(7) Psychology. 

22 ‘‘(8) Dentistry. 

23 ‘‘(9) International health. 

24 ‘‘(10) Social work. 

25 ‘‘(11) Allied health. 


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1 ‘‘(12) Psychiatry. 

2 ‘‘(13) Hospice care. 

3 ‘‘(14) Community health, patient navigation, 

4 and peer support. 

5 ‘‘(15) Other professions determined appropriate 

6 by the Director of the Centers for Disease Control 

7 and Prevention. 

8 ‘‘(d) PRIORITY.—In awarding grants under sub9 section (a), the Director of the Centers for Disease Con10 trol and Prevention shall give priority to those entities 

11 that— 

12 ‘‘(1) serve a high proportion of individuals from 

13 disadvantaged backgrounds; 

14 ‘‘(2) have experience in health disparity elimi15 nation programs; 

16 ‘‘(3) facilitate the entry of disadvantaged indi17 viduals into institutions of higher education; and 

18 ‘‘(4) provide counseling or other services de19 signed to assist disadvantaged individuals in success20 fully completing their education at the postsecondary 

21 level. 

22 ‘‘(e) STIPENDS.— 

23 ‘‘(1) IN GENERAL.—Subject to paragraph (2), 

24 an entity receiving a grant under this section may 

25 use the funds made available through such grant to 


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1 award stipends for educational and living expenses 

2 to students participating in the internship supported 

3 by the grant. 

4 ‘‘(2) LIMITATIONS.—A stipend awarded under 

5 paragraph (1) to an individual— 

6 ‘‘(A) may not be provided for a period that 

7 exceeds 6 months; and 

8 ‘‘(B) may not exceed $20 per day for an 

9 individual (notwithstanding any other provision 

10 of law regarding the amount of a stipend). 

11 ‘‘(f) 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 2025 through 2029. 

15 ‘‘SEC. 3419. LOUIS STOKES PUBLIC HEALTH SCHOLARS 

16 PROGRAM. 

17 ‘‘(a) IN GENERAL.—The Director of the Centers for 

18 Disease Control and Prevention, in collaboration with the 

19 Deputy Assistant Secretary for Minority Health, shall 

20 award scholarships to eligible individuals under subsection 

21 (b) who seek a career in public health. 

22 ‘‘(b) ELIGIBILITY.—To be eligible to receive a schol23 arship under subsection (a), an individual shall— 

24 ‘‘(1) have interest, knowledge, or skill in public 

25 health research or public health practice, or other 


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1 health professions as determined appropriate by the 

2 Director of the Centers for Disease Control and Pre3 vention; 

4 ‘‘(2) reside in a health professional shortage 

5 area as determined by the Secretary; 

6 ‘‘(3) demonstrate promise for becoming a leader 

7 in public health; 

8 ‘‘(4) secure admission to a 4-year institution of 

9 higher education; and 

10 ‘‘(5) submit to the Secretary an application at 

11 such time, in such manner, and containing such in12 formation as the Secretary may require. 

13 ‘‘(c) USE OF FUNDS.—Amounts received under an 

14 award under subsection (a) shall be used to support oppor15 tunities for students to become public health professionals. 

16 ‘‘(d) PRIORITY.—In awarding grants under sub17 section (a), the Director shall give priority to those stu18 dents that— 

19 ‘‘(1) are from disadvantaged backgrounds; 

20 ‘‘(2) have secured admissions to an institution 

21 described in section 371(a) of the Higher Education 

22 Act of 1965; and 

23 ‘‘(3) have identified a health professional as a 

24 mentor at their institution described in subsection 


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1 (b)(4) and an academic advisor to assist in the com2 pletion of their baccalaureate degree. 

3 ‘‘(e) SCHOLARSHIPS.—The Secretary may approve 

4 payment of scholarships under this section for such indi5 viduals for any period of education in student under6 graduate tenure, except that such a scholarship may not 

7 be provided to an individual for more than 4 years, and 

8 such a scholarship may not exceed $10,000 per academic 

9 year for an individual (notwithstanding any other provi10 sion of law regarding the amount of a scholarship). 

11 ‘‘(f) 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 2025 through 2029. 

15 ‘‘SEC. 3420. PATSY MINK HEALTH AND GENDER RESEARCH 

16 FELLOWSHIP PROGRAM. 

17 ‘‘(a) IN GENERAL.—The Director of the Centers for 

18 Disease Control and Prevention, in collaboration with the 

19 Deputy Assistant Secretary for Minority Health, the As20 sistant Secretary for Mental Health and Substance Use, 

21 and the Director of the Indian Health Service, shall award 

22 research fellowships to eligible individuals under sub23 section (b) to conduct research that will examine gender 

24 and health disparities and to pursue a career in the health 

25 professions. 


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1 ‘‘(b) ELIGIBILITY.—To be eligible to receive a fellow2 ship under subsection (a), an individual shall— 

3 ‘‘(1) have experience in health research or pub4 lic health practice; 

5 ‘‘(2) reside in a health professional shortage 

6 area designated by the Secretary under section 332; 

7 ‘‘(3) have expressed an interest in the health 

8 professions; 

9 ‘‘(4) demonstrate promise for becoming a leader 

10 in the field of women’s sexual and reproductive 

11 health, including family planning; 

12 ‘‘(5) secure admission to a health professions 

13 school or graduate program with an emphasis in 

14 gender studies; and 

15 ‘‘(6) submit to the Secretary an application at 

16 such time, in such manner, and containing such in17 formation as the Secretary may require. 

18 ‘‘(c) USE OF FUNDS.—A fellowship awarded under 

19 subsection (a) to an eligible individual under subsection 

20 (b) shall be used to support an opportunity for the indi21 vidual to become a researcher and advance the research 

22 base on the intersection between gender and health. 

23 ‘‘(d) PRIORITY.—In awarding fellowships under sub24 section (a), the Director of the Centers for Disease ConVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 00203 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 trol and Prevention shall give priority to those applicants 

2 that— 

3 ‘‘(1) are from disadvantaged backgrounds; and 

4 ‘‘(2) have identified a mentor and academic ad5 visor who will assist in the completion of their grad6 uate or professional degree and have secured a re7 search assistant position with a researcher working 

8 in the area of gender and health. 

9 ‘‘(e) FELLOWSHIPS.—The Director of the Centers for 

10 Disease Control and Prevention may approve fellowships 

11 for individuals under this section for any period of edu12 cation in the student’s graduate or health profession ten13 ure, except that such a fellowship may not be provided 

14 to an individual for more than 3 years, and such a fellow15 ship may not exceed $18,000 per academic year for an 

16 individual (notwithstanding any other provision of law re17 garding the amount of a fellowship). 

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

19 are authorized to be appropriated to carry out this section 

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

21 2025 through 2029. 

22 ‘‘SEC. 3421. PAUL DAVID WELLSTONE INTERNATIONAL 

23 HEALTH FELLOWSHIP PROGRAM. 

24 ‘‘(a) IN GENERAL.—The Director of the Agency for 

25 Healthcare Research and Quality, in collaboration with 


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1 the Deputy Assistant Secretary for Minority Health, shall 

2 award research fellowships to eligible individuals under 

3 subsection (b) to advance their understanding of inter4 national health. 

5 ‘‘(b) ELIGIBILITY.—To be eligible to receive a fellow6 ship under subsection (a), an individual shall— 

7 ‘‘(1) have educational experience in the field of 

8 international health; 

9 ‘‘(2) reside in a health professional shortage 

10 area as determined by the Secretary; 

11 ‘‘(3) demonstrate promise for becoming a leader 

12 in the field of international health; 

13 ‘‘(4) be in the fourth year of a 4-year institu14 tion of higher education or a recent graduate of a 

15 4-year institution of higher education; and 

16 ‘‘(5) submit to the Secretary an application at 

17 such time, in such manner, and containing such in18 formation as the Secretary may require. 

19 ‘‘(c) USE OF FUNDS.—A fellowship awarded under 

20 subsection (a) to an eligible individual under subsection 

21 (b) shall be used to support an opportunity for the indi22 vidual to become a health professional and to advance the 

23 knowledge of the individual about international issues re24 lating to health care access and quality. 


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1 ‘‘(d) PRIORITY.—In awarding fellowships under sub2 section (a), the Director of the Agency for Healthcare Re3 search and Quality shall give priority to eligible individuals 

4 under subsection (b) that— 

5 ‘‘(1) are from a disadvantaged background; and 

6 ‘‘(2) have identified a mentor at a health pro7 fessions school or institution, an academic advisor to 

8 assist in the completion of their graduate or profes9 sional degree, and an advisor from an international 

10 health non-governmental organization, private volun11 teer organization, or other international institution 

12 or program that focuses on increasing health care 

13 access and quality for residents in developing coun14 tries. 

15 ‘‘(e) FELLOWSHIPS.—A fellowship awarded under 

16 this section may not— 

17 ‘‘(1) be provided to an eligible individual for 

18 more than a period of 6 months; 

19 ‘‘(2) be awarded to a graduate of a 4-year insti20 tution of higher education that has not been enrolled 

21 in such institution for more than 1 year; or 

22 ‘‘(3) exceed $4,000 per academic year (notwith23 standing any other provision of law regarding the 

24 amount of a fellowship). 


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

2 are authorized to be appropriated to carry out this section 

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

4 2025 through 2029. 

5 ‘‘SEC. 3422. EDWARD R. ROYBAL HEALTH SCHOLAR PRO6 GRAM. 

7 ‘‘(a) IN GENERAL.—The Director of the Agency for 

8 Healthcare Research and Quality, the Administrator of 

9 the Centers for Medicare & Medicaid Services, and the Ad10 ministrator of the Health Resources and Services Admin11 istration, in collaboration with the Deputy Assistant Sec12 retary for Minority Health, shall award grants to eligible 

13 entities under subsection (b) to expose entering graduate 

14 students to the health professions. 

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

16 under subsection (a), an entity shall— 

17 ‘‘(1) be a clinical, public health, or health serv18 ices organization, community-based, academic, or 

19 nonprofit entity, or other entity determined appro20 priate by the Director of the Agency for Healthcare 

21 Research and Quality; 

22 ‘‘(2) serve in a health professional shortage 

23 area designated by the Secretary under section 332; 

24 ‘‘(3) work with students obtaining a degree in 

25 the health professions; and 


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1 ‘‘(4) submit to the Secretary an application at 

2 such time, in such manner, and containing such in3 formation as the Secretary may require. 

4 ‘‘(c) USE OF FUNDS.—Amounts received under a 

5 grant awarded under subsection (a) shall be used to sup6 port opportunities that expose students to non-research7 based health professions, including— 

8 ‘‘(1) public health policy; 

9 ‘‘(2) health care and pharmaceutical policy; 

10 ‘‘(3) health care administration and manage11 ment; 

12 ‘‘(4) health economics; and 

13 ‘‘(5) other professions determined appropriate 

14 by the Director of the Agency for Healthcare Re15 search and Quality, the Administrator of the Centers 

16 for Medicare & Medicaid Services, or the Adminis17 trator of the Health Resources and Services Admin18 istration. 

19 ‘‘(d) PRIORITY.—In awarding grants under sub20 section (a), the Director of the Agency for Healthcare Re21 search and Quality, the Administrator of the Centers for 

22 Medicare & Medicaid Services, and the Administrator of 

23 the Health Resources and Services Administration, in col24 laboration with the Deputy Assistant Secretary for Minor25 ity Health, shall give priority to entities that— 


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1 ‘‘(1) have experience with health disparity elimi2 nation programs; 

3 ‘‘(2) facilitate training in the fields described in 

4 subsection (c); and 

5 ‘‘(3) provide counseling or other services de6 signed to assist students in successfully completing 

7 their education at the postsecondary level. 

8 ‘‘(e) STIPENDS.— 

9 ‘‘(1) IN GENERAL.—Subject to paragraph (2), 

10 an entity receiving a grant under this section may 

11 use the funds made available through such grant to 

12 award stipends for educational and living expenses 

13 to students participating in the opportunities sup14 ported by the grant. 

15 ‘‘(2) LIMITATIONS.—A stipend awarded under 

16 paragraph (1) to an individual— 

17 ‘‘(A) may not be provided for a period that 

18 exceeds 2 months; and 

19 ‘‘(B) may not exceed $100 per day (not20 withstanding any other provision of law regard21 ing the amount of a stipend). 

22 ‘‘(f) 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 2025 through 2029. 


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1 ‘‘SEC. 3423. LEADERSHIP FELLOWSHIP PROGRAMS. 

2 ‘‘(a) IN GENERAL.—The Secretary shall award 

3 grants to national minority medical or health professional 

4 associations to develop leadership fellowship programs for 

5 underrepresented health professionals in order to— 

6 ‘‘(1) assist such professionals in becoming fu7 ture leaders in public health and health care delivery 

8 institutions; and 

9 ‘‘(2) increase diversity in decision-making posi10 tions that can improve the health of underserved 

11 communities. 

12 ‘‘(b) USE OF FUNDS.—A leadership fellowship pro13 gram supported under this section shall— 

14 ‘‘(1) focus on training mid-career physicians 

15 and health care executives who have documented 

16 leadership experience and a commitment to public 

17 health services in underserved communities; and 

18 ‘‘(2) support Federal public health policy and 

19 budget programs, and priorities that impact health 

20 equity, through activities such as didactic lectures 

21 and leader site visits. 

22 ‘‘(c) PERIOD OF GRANTS.—The period during which 

23 payments are made under a grant awarded under sub24 section (a) may not exceed 3 years. 

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

26 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 2025 through 2029.’’. 

3 SEC. 3007. MCNAIR POSTBACCALAUREATE ACHIEVEMENT 

4 PROGRAM. 

5 Section 402E of the Higher Education Act of 1965 

6 (20 U.S.C. 1070a–15) is amended by striking subsection 

7 (g) and inserting the following: 

8 ‘‘(g) COLLABORATION IN HEALTH PROFESSION DI9 VERSITY TRAINING PROGRAMS.—The Secretary shall co10 ordinate with the Secretary of Health and Human Serv11 ices to ensure that there is collaboration between the goals 

12 of the program under this section and programs of the 

13 Health Resources and Services Administration that pro14 mote health workforce diversity. The Secretary of Edu15 cation shall take such measures as may be necessary to 

16 encourage students participating in projects assisted 

17 under this section to consider health profession careers. 

18 ‘‘(h) FUNDING.—From amounts appropriated pursu19 ant to the authority of section 402A(g), the Secretary 

20 shall, to the extent practicable, allocate funds for projects 

21 authorized by this section in an amount that is not less 

22 than $31,000,000 for each of the fiscal years 2025 

23 through 2029.’’. 


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1 SEC. 3008. 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 2006(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, 2025, 

22 in determining the hospital’s number of full23 time equivalent residents for purposes of this 

24 paragraph, all time spent by an intern or resi25 dent in an approved medical residency training 


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1 program shall be counted toward the determina2 tion of full-time equivalency if the hospital— 

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)) is amended— 

15 (1) in subclause (II), by striking ‘‘In deter16 mining’’ and inserting ‘‘Subject to subclause (IV), in 

17 determining’’; 

18 (2) in subclause (III), by striking ‘‘In deter19 mining’’ and inserting ‘‘Subject to subclause (IV), in 

20 determining’’; and 

21 (3) by inserting after subclause (III) the fol22 lowing new subclause: 

23 ‘‘(IV) For purposes of cost-reporting peri24 ods beginning on or after October 1, 2025, the 

25 provisions of subparagraph (M) of subsection 


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1 (h)(4) shall apply under this subparagraph in 

2 the same manner as they apply under such sub3 section.’’. 

4 SEC. 3009. DEVELOPING AND IMPLEMENTING STRATEGIES 

5 FOR LOCAL HEALTH EQUITY. 

6 (a) GRANTS.—The Secretary of Health and Human 

7 Services, acting jointly with the Secretary of Education 

8 and the Secretary of Labor, shall make grants to eligible 

9 institutions of higher educations for the purposes of— 

10 (1) in accordance with subsection (b), devel11 oping capacity— 

12 (A) to build an evidence base for successful 

13 strategies for increasing local health equity; and 

14 (B) to serve as national models of driving 

15 local health equity; and 

16 (2) in accordance with subsection (c), devel17 oping a strategic partnership with the community in 

18 which the institution is located. 

19 (b) DEVELOPING CAPACITY FOR INCREASING LOCAL

20 HEALTH EQUITY.—As a condition of receipt of a grant 

21 under subsection (a), an institution of higher education 

22 shall agree to use such grant to build an evidence base 

23 for successful strategies for increasing local health equity, 

24 and to serve as a national model of driving local health 

25 equity, by supporting— 


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1 (1) resources to strengthen institutional metrics 

2 and capacity to execute institution-wide health work3 force goals that can serve as models for increasing 

4 health equity in communities across the United 

5 States; 

6 (2) collaborations among a cohort of institu7 tions in implementing systemic change, partnership 

8 development, and programmatic efforts supportive of 

9 health equity goals across disciplines and popu10 lations; and 

11 (3) enhanced or newly developed data systems 

12 and research infrastructure capable of informing 

13 current and future workforce efforts and building a 

14 foundation for a broader research agenda targeting 

15 urban health disparities. 

16 (c) STRATEGIC PARTNERSHIPS.—As a condition of 

17 receipt of a grant under subsection (a), an institution of 

18 higher education shall agree to use the grant to develop 

19 a strategic partnership with the community in which such 

20 institution is located for the purposes of— 

21 (1) strengthening connections between such in22 stitution and the community— 

23 (A) to improve evaluation of, and address, 

24 the health and health workforce needs of such 

25 community; and 


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1 (B) to engage such community in health 

2 workforce development; 

3 (2) developing, enhancing, or accelerating inno4 vative undergraduate and graduate programs in the 

5 biomedical sciences and health professions; and 

6 (3) strengthening pipeline programs in the bio7 medical sciences and health professions, including by 

8 developing partnerships between institutions of high9 er education and elementary schools and secondary 

10 schools to recruit the next generation of health pro11 fessionals earlier in the pipeline to a health care ca12 reer. 

13 (d) DEFINITION OF ELIGIBLE INSTITUTION OF

14 HIGHER EDUCATION.—For purposes of this section, the 

15 term ‘‘eligible institution of higher education’’ includes— 

16 (1) a program authorized under section 317(a) 

17 of the Higher Education Act of 1965 (20 U.S.C. 

18 1059d(a)); and 

19 (2) a professional or graduate institution de20 scribed in section 326 of such Act (20 U.S.C. 

21 1063b). 

22 (e) AUTHORIZATION OF APPROPRIATIONS.—There 

23 are authorized to be appropriated to carry out this section 

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

25 2025 through 2029. 


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1 SEC. 3010. HEALTH PROFESSIONS WORKFORCE FUND. 

2 (a) ESTABLISHMENT.—There is established in the 

3 Health Resources and Services Administration of the De4 partment of Health and Human Services a Health Profes5 sions Workforce Fund to provide for expanded and sus6 tained national investment in the health professions and 

7 nursing workforce development programs under titles VII 

8 and title VIII of the Public Health Service Act (42 U.S.C. 

9 292 et seq.; 42 U.S.C. 296 et seq.). 

10 (b) FUNDING.— 

11 (1) IN GENERAL.—There is authorized to be 

12 appropriated, and there is appropriated, out of any 

13 monies in the Treasury not otherwise appropriated, 

14 to the Health Professions Workforce Fund— 

15 (A) $392,000,000 for fiscal year 2025; 

16 (B) $412,000,000 for fiscal year 2026; 

17 (C) $432,000,000 for fiscal year 2027; 

18 (D) $454,000,000 for fiscal year 2028; 

19 (E) $476,000,000 for fiscal year 2029; 

20 (F) $500,000,000 for fiscal year 2030; 

21 (G) $525,000,000 for fiscal year 2031; and 

22 (H) $552,000,000 for fiscal year 2032. 

23 (2) HEALTH PROFESSIONS EDUCATION PRO24 GRAMS.—For the purpose of carrying out health 

25 professions education programs authorized under 

26 title VII of the Public Health Service Act (42 U.S.C. 


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1 292 et seq.), in addition to any other amounts au2 thorized to be appropriated for such purpose, there 

3 is authorized to be appropriated out of any monies 

4 in the Health Professions Workforce Fund, the fol5 lowing: 

6 (A) $265,000,000 for fiscal year 2025. 

7 (B) $278,000,000 for fiscal year 2026. 

8 (C) $292,000,000 for fiscal year 2027. 

9 (D) $307,000,000 for fiscal year 2028. 

10 (E) $322,000,000 for fiscal year 2029. 

11 (F) $338,000,000 for fiscal year 2030. 

12 (G) $355,000,000 for fiscal year 2031. 

13 (H) $373,000,000 for fiscal year 2032. 

14 (3) NURSING WORKFORCE DEVELOPMENT PRO15 GRAMS.—For the purpose of carrying out nursing 

16 workforce development programs authorized under 

17 title VIII of the Public Health Service Act (42 

18 U.S.C. 296 et seq.), in addition to any other 

19 amounts authorized to be appropriated for such pur20 pose, there is authorized to be appropriated out of 

21 any monies in the Health Professions Workforce 

22 Fund, the following: 

23 (A) $127,000,000 for fiscal year 2025. 

24 (B) $134,000,000 for fiscal year 2026. 

25 (C) $140,000,000 for fiscal year 2027. 


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1 (D) $147,000,000 for fiscal year 2028. 

2 (E) $154,000,000 for fiscal year 2029. 

3 (F) $162,000,000 for fiscal year 2030. 

4 (G) $170,000,000 for fiscal year 2031. 

5 (H) $179,000,000 for fiscal year 2032. 

6 SEC. 3011. FUTURE ADVANCEMENT OF ACADEMIC NURS7 ING. 

8 (a) SUPPORT FOR NURSING EDUCATION AND THE

9 FUTURE NURSING WORKFORCE.—Part D of title VIII of 

10 the Public Health Service Act (42 U.S.C. 296p et seq.) 

11 is amended by adding at the end the following: 

12 ‘‘SEC. 832. NURSING EDUCATION ENHANCEMENT AND MOD13 ERNIZATION GRANTS IN UNDERSERVED 

14 AREAS. 

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

16 the Administrator of the Health Resources and Services 

17 Administration, may award grants to schools of nursing 

18 for— 

19 ‘‘(1) increasing the number of faculty and stu20 dents at such schools in order to enhance the pre21 paredness of the United States for, and the ability 

22 of the United States to address and quickly respond 

23 to, public health emergencies declared under section 

24 319 and pandemics; or 


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1 ‘‘(2) the enhancement and modernization of 

2 nursing education programs. 

3 ‘‘(b) PRIORITY.—In selecting grant recipients under 

4 this section, the Secretary shall give priority to schools of 

5 nursing that— 

6 ‘‘(1) are located in a medically underserved 

7 community; 

8 ‘‘(2) are located in a health professional short9 age area as defined under section 332(a); or 

10 ‘‘(3) are institutions of higher education listed 

11 under section 371(a) of the Higher Education Act of 

12 1965. 

13 ‘‘(c) CONSIDERATION.—In awarding grants under 

14 this section, the Secretary, to the extent practicable, may 

15 ensure equitable distribution of awards among the geo16 graphic regions of the United States. 

17 ‘‘(d) USE OF FUNDS.—A school of nursing that re18 ceives a grant under this section may use the funds award19 ed through such grant for activities that include— 

20 ‘‘(1) enhancing enrollment and retention of stu21 dents at such school, with a priority for students 

22 from disadvantaged backgrounds (including racial or 

23 ethnic groups underrepresented in the nursing work24 force), individuals from rural and underserved areas, 

25 low-income individuals, and first generation college 


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1 students (as defined in section 402A(h)(3) of the 

2 Higher Education Act of 1965); 

3 ‘‘(2) creating, supporting, or modernizing edu4 cational programs and curriculum at such school; 

5 ‘‘(3) retaining current faculty, and hiring new 

6 faculty, with an emphasis on faculty from racial or 

7 ethnic groups who are underrepresented in the nurs8 ing workforce; 

9 ‘‘(4) modernizing infrastructure at such school, 

10 including audiovisual or other equipment, personal 

11 protective equipment, simulation and augmented re12 ality resources, telehealth technologies, and virtual 

13 and physical laboratories; 

14 ‘‘(5) partnering with a health care facility, 

15 nurse-managed health clinic, community health cen16 ter, or other facility that provides health care in 

17 order to provide educational opportunities for the 

18 purpose of establishing or expanding clinical edu19 cation; 

20 ‘‘(6) enhancing and expanding nursing pro21 grams that prepare nurse researchers and scientists; 

22 ‘‘(7) establishing nurse-led intradisciplinary and 

23 interprofessional educational partnerships; and 


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1 ‘‘(8) other activities that the Secretary deter2 mines further the development, improvement, and 

3 expansion of schools of nursing. 

4 ‘‘(e) REPORTS FROM ENTITIES.—Each school of 

5 nursing awarded a grant under this section shall submit 

6 an annual report to the Secretary on the activities con7 ducted under such grant, and other information as the 

8 Secretary may require. 

9 ‘‘(f) REPORT TO CONGRESS.—Not later than 5 years 

10 after the date of the enactment of this section, the Sec11 retary shall submit to the Committee on Health, Edu12 cation, Labor, and Pensions of the Senate and the Com13 mittee on Energy and Commerce of the House of Rep14 resentatives a report that provides a summary of the ac15 tivities and outcomes associated with grants made under 

16 this section. Such report shall include— 

17 ‘‘(1) a list of schools of nursing receiving grants 

18 under this section, including the primary geographic 

19 location of any school of nursing that was improved 

20 or expanded through such a grant; 

21 ‘‘(2) the total number of students who are en22 rolled at or who have graduated from any school of 

23 nursing that was improved or expanded through a 

24 grant under this section, which such statistic shall— 


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1 ‘‘(A) to the extent such information is 

2 available, be deidentified and disaggregated by 

3 race, ethnicity, age, sex, geographic region, dis4 ability status, and other relevant factors; and 

5 ‘‘(B) include an indication of the number 

6 of such students who are from racial or ethnic 

7 groups underrepresented in the nursing work8 force, such students who are from rural or un9 derserved areas, such students who are low-in10 come students, and such students who are first 

11 generation college students (as defined in sec12 tion 402A(h)(3) of the Higher Education Act of 

13 1965); 

14 ‘‘(3) to the extent such information is available, 

15 the effects of the grants awarded under this section 

16 on retaining and hiring of faculty, including any in17 crease in diverse faculty, the number of clinical edu18 cation partnerships, the modernization of nursing 

19 education infrastructure, and other ways this section 

20 helps address and quickly respond to public health 

21 emergencies and pandemics; 

22 ‘‘(4) recommendations for improving the grants 

23 awarded under this section; and 

24 ‘‘(5) any other considerations as the Secretary 

25 determines appropriate. 


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1 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—To 

2 carry out this section, there is authorized to be appro3 priated $1,000,000,000, to remain available until ex4 pended.’’. 

5 (b) STRENGTHENING NURSE EDUCATION.—The 

6 heading of part D of title VIII of the Public Health Serv7 ice Act (42 U.S.C. 296p et seq.) is amended by striking 

8 ‘‘BASIC’’. 

9 SEC. 3012. SENSE OF CONGRESS RELATING TO GRADUATE 

10 MEDICAL EDUCATION. 

11 It is the sense of Congress that eliminating the limit 

12 of the number of residency positions that receive some 

13 level of Medicare support under section 1886(h) of the So14 cial Security Act (42 U.S.C. 1395ww(h)), also referred to 

15 as the Medical graduate medical education cap, is critical 

16 to— 

17 (1) ensuring an appropriate supply of physi18 cians to meet the health care needs in the United 

19 States; 

20 (2) facilitating equitable access for all who seek 

21 health care; 

22 (3) increasing the racial and ethnic diversity of 

23 physicians in the United States; and 

24 (4) mitigating disparities in health and health 

25 care. 


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1 SEC. 3013. CAREER SUPPORT FOR SKILLED, INTERNATION2 ALLY EDUCATED HEALTH PROFESSIONALS. 

3 (a) GRANTS TO ELIGIBLE ENTITIES.— 

4 (1) AUTHORITY TO PROVIDE GRANTS.—The 

5 Secretary of Health and Human Services (in this 

6 section referred to as the ‘‘Secretary’’), acting 

7 through the Bureau of Health Workforce within the 

8 Health Resources and Services Administration, the 

9 National Institute on Minority Health and Health 

10 Disparities, or the Office of Minority Health, may 

11 award grants to eligible entities under paragraph (2) 

12 to carry out activities described in subsection (b). 

13 (2) ELIGIBILITY.—To be eligible to receive a 

14 grant under this section, an entity shall— 

15 (A) be a clinical, public health, or health 

16 services organization, a community-based or 

17 nonprofit entity, an academic institution, a 

18 faith-based organization, a State, county, or 

19 local government, an area health education cen20 ter, or another entity determined appropriate by 

21 the Secretary; and 

22 (B) submit to the Secretary an application 

23 at such time, in such manner, and containing 

24 such information as the Secretary may require. 

25 (b) AUTHORIZED ACTIVITIES.—A grant awarded 

26 under this section shall be used— 


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1 (1) to provide services to assist unemployed and 

2 underemployed skilled immigrants, residing in the 

3 United States, who have legal, permanent work au4 thorization and who are internationally educated 

5 health professionals, enter into the health workforce 

6 of the United States with employment matching 

7 their health professional skills and education, and 

8 advance in employment to positions that better 

9 match their health professional education and exper10 tise; 

11 (2) to provide training opportunities to reduce 

12 barriers to entry and advancement in the health 

13 workforce for skilled, internationally educated immi14 grants; 

15 (3) to educate employers regarding the abilities 

16 and capacities of internationally educated health 

17 professionals; 

18 (4) to assist in the evaluation of foreign creden19 tials; 

20 (5) to support preceptorships for international 

21 medical graduates in hospital primary care training; 

22 and 

23 (6) to facilitate access to contextualized and ac24 celerated courses on English as a second language. 


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1 SEC. 3014. 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. 3015. CONRAD STATE 30 PROGRAM; PHYSICIAN RETEN18 TION. 

19 (a) CONRAD STATE 30 PROGRAM EXTENSION.— 

20 (1) IN GENERAL.—Section 220(c) of the Immi21 gration and Nationality Technical Corrections Act of 

22 1994 (Public Law 103–416; 8 U.S.C. 1182 note) is 

23 amended by striking ‘‘September 30, 2015’’ and in24 serting ‘‘the date that is 3 years after the date of 

25 the enactment of the Health Equity and Account26 ability Act of 2024’’. 


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1 (2) EFFECTIVE DATE.—The amendment made 

2 by paragraph (1) shall take effect as if enacted on 

3 September 30, 2018. 

4 (b) RETAINING PHYSICIANS WHO HAVE PRACTICED

5 IN MEDICALLY UNDERSERVED COMMUNITIES.—Section 

6 201(b)(1) of the Immigration and Nationality Act (8 

7 U.S.C. 1151(b)(1)) is amended by adding at the end the 

8 following: 

9 ‘‘(F)(i) Alien physicians who have completed 

10 service requirements of a waiver requested under 

11 section 203(b)(2)(B)(ii), including— 

12 ‘‘(I) alien physicians who completed such 

13 service before the date of the enactment of the 

14 Health Equity and Accountability Act of 2024; 

15 and 

16 ‘‘(II) the spouse or children of an alien 

17 physician described in subclause (I). 

18 ‘‘(ii) Nothing in this subparagraph may be con19 strued— 

20 ‘‘(I) to prevent the filing of a petition with 

21 the Secretary of Homeland Security for classi22 fication under section 204(a) or the filing of an 

23 application for adjustment of status under sec24 tion 245 by an alien physician described in 

25 clause (i)(I) before the date on which such alien 


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1 physician completed the service described in 

2 section 214(l) or worked full-time as a physi3 cian for an aggregate of 5 years at the location 

4 identified in the section 214(l) waiver or in an 

5 area or areas designated by the Secretary of 

6 Health and Human Services as having a short7 age of health care professionals; or 

8 ‘‘(II) to permit the Secretary of Homeland 

9 Security to grant a petition or application de10 scribed in subclause (I) until the alien has sat11 isfied all of the requirements of the waiver re12 ceived under section 214(l).’’. 

13 (c) EMPLOYMENT PROTECTIONS FOR PHYSICIANS.— 

14 (1) EXCEPTIONS TO 2-YEAR FOREIGN RESI15 DENCY REQUIREMENT.—Section 214(l)(1) of the 

16 Immigration and Nationality Act (8 U.S.C. 

17 1184(l)(1)) is amended— 

18 (A) in the matter preceding subparagraph 

19 (A), by striking ‘‘Attorney General’’ and insert20 ing ‘‘Secretary of Homeland Security’’; 

21 (B) in subparagraph (A), by striking ‘‘Di22 rector of the United States Information Agen23 cy’’ and inserting ‘‘Secretary of State’’; 


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1 (C) in subparagraph (B), by inserting ‘‘, 

2 except as provided in paragraphs (7) and (8)’’ 

3 before the semicolon at the end; 

4 (D) in subparagraph (C), by amending 

5 clauses (i) and (ii) to read as follows: 

6 ‘‘(i) the alien demonstrates a bona 

7 fide offer of full-time employment at a 

8 health facility or health care organization, 

9 which employment has been determined by 

10 the Secretary of Homeland Security to be 

11 in the public interest; and 

12 ‘‘(ii) the alien— 

13 ‘‘(I) has accepted employment 

14 with the health facility or health care 

15 organization in a geographic area or 

16 areas which are designated by the 

17 Secretary of Health and Human Serv18 ices as having a shortage of health 

19 care professionals; 

20 ‘‘(II) begins employment by the 

21 later of the date that is— 

22 ‘‘(aa) 120 days after receiv23 ing such waiver; 

24 ‘‘(bb) 120 days after com25 pleting graduate medical eduVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 00230 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 cation or training under a pro2 gram approved pursuant to sec3 tion 212(j)(1); or 

4 ‘‘(cc) 120 days after receiv5 ing nonimmigrant status or em6 ployment authorization, if the 

7 alien or the alien’s employer peti8 tions for such nonimmigrant sta9 tus or employment authorization 

10 not later than 120 days after the 

11 date on which the alien completes 

12 his or her graduate medical edu13 cation or training under a pro14 gram approved pursuant to sec15 tion 212(j)(1); and 

16 ‘‘(III) agrees to continue to work 

17 for a total of not less than 3 years in 

18 the status authorized for such employ19 ment under this subsection, except as 

20 provided in paragraph (8); and’’; and 

21 (E) in subparagraph (D), in the matter 

22 preceding clause (i), by inserting ‘‘except as 

23 provided in paragraph (8),’’ before ‘‘in the 

24 case’’. 


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1 (2) ALLOWABLE VISA STATUS FOR PHYSICIANS

2 FULFILLING WAIVER REQUIREMENTS IN MEDICALLY

3 UNDERSERVED AREAS.—Section 214(l)(2)(A) of 

4 such Act (8 U.S.C. 1184(l)(2)(A)) is amended to 

5 read as follows: 

6 ‘‘(A) Upon the request of an interested 

7 Federal agency or an interested State agency 

8 for recommendation of a waiver under this sec9 tion by a physician who is maintaining valid 

10 nonimmigrant status under section 

11 101(a)(15)(J) and received a favorable rec12 ommendation by the Secretary of State, the 

13 Secretary of Homeland Security may adjust the 

14 status of such physician to any status author15 ized for employment under this Act. The nu16 merical limitations set forth in subsection 

17 (g)(1)(A) shall not apply to any alien whose 

18 status is adjusted pursuant to this subpara19 graph.’’. 

20 (3) VIOLATION OF AGREEMENTS.—Section 

21 214(l)(3)(A) of such Act (8 U.S.C. 1184(l)(3)(A)) is 

22 amended by inserting ‘‘substantial requirement of 

23 an’’ before ‘‘agreement entered into’’. 

24 (4) PHYSICIAN EMPLOYMENT IN UNDERSERVED

25 AREAS.—Section 214(l) of such Act, as amended by 


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1 this subsection, is further amended by adding at the 

2 end the following: 

3 ‘‘(4)(A) If an interested State agency denies an 

4 application for a waiver under paragraph (1)(B) 

5 from a physician pursuing graduate medical edu6 cation or training pursuant to section 101(a)(15)(J) 

7 because the State has requested the maximum num8 ber of waivers permitted for that fiscal year, the 

9 physician’s nonimmigrant status shall be extended 

10 for up to 6 months if the physician agrees to seek 

11 a waiver under this subsection (except for paragraph 

12 (1)(D)(ii)) to work for an employer described in 

13 paragraph (1)(C) in a State that has not yet re14 quested the maximum number of waivers. 

15 ‘‘(B) Such physician shall be authorized to 

16 work only for the employer referred to in subpara17 graph (A) during the period beginning on the date 

18 on which a new waiver application is filed with such 

19 State and ending on the earlier of— 

20 ‘‘(i) the date on which the Secretary of 

21 Homeland Security denies such waiver; or 

22 ‘‘(ii) the date on which the Secretary ap23 proves an application for adjustment of status 

24 under paragraph (2)(A) pursuant to the ap25 proval of such waiver.’’. 


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1 (5) CONTRACT REQUIREMENTS.—Section 214(l) 

2 of such Act, as amended by this subsection, is fur3 ther amended by adding at the end the following: 

4 ‘‘(5) An alien granted a waiver under para5 graph (1)(C) shall enter into an employment agree6 ment with the contracting health facility or health 

7 care organization that— 

8 ‘‘(A) specifies— 

9 ‘‘(i) the maximum number of on-call 

10 hours per week (which may be a monthly 

11 average) that the alien will be expected to 

12 be available; and 

13 ‘‘(ii) the compensation the alien will 

14 receive for on-call time; 

15 ‘‘(B) specifies— 

16 ‘‘(i) whether the contracting facility or 

17 organization— 

18 ‘‘(I) has secured medical mal19 practice liability protection for the 

20 alien under section 224(g) of the Pub21 lic Health Service Act (42 U.S.C. 

22 233(g); or 

23 ‘‘(II) will pay the alien’s mal24 practice insurance premiums; and 


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1 ‘‘(ii) the amount of such liability pro2 tection that will be provided; 

3 ‘‘(C) describes all of the work locations 

4 that the alien will work and includes a state5 ment that the contracting facility or organiza6 tion will not add additional work locations with7 out the approval of the Federal agency or State 

8 agency that requested the waiver; and 

9 ‘‘(D) does not include a non-compete provi10 sion. 

11 ‘‘(6) An alien granted a waiver under this sub12 section whose employment relationship with a health 

13 facility or health care organization terminates under 

14 paragraph (1)(C)(ii) during the 3-year service period 

15 required under paragraph (1) shall be considered to 

16 be maintaining lawful status in an authorized period 

17 of stay during the 120-day period referred to in 

18 items (aa) and (bb) of subclause (III) of paragraph 

19 (1)(C)(ii) or the 45-day period referred to in sub20 clause (III)(cc) of such paragraph.’’. 

21 (6) RECAPTURING WAIVER SLOTS LOST TO

22 OTHER STATES.—Section 214(l) of such Act, as 

23 amended by this subsection, is further amended by 

24 adding at the end the following: 


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1 ‘‘(7) If a recipient of a waiver under this sub2 section terminates the recipient’s employment with a 

3 health facility or health care organization pursuant 

4 to paragraph (1)(C)(ii), including termination of em5 ployment because of circumstances described in 

6 paragraph (1)(C)(ii)(III), and accepts new employ7 ment with such a facility or organization in a dif8 ferent State, the State from which the alien is de9 parting may be granted an additional waiver by the 

10 Secretary of State for use in the fiscal year in which 

11 the alien’s employment was terminated.’’. 

12 (7) EXCEPTION TO 3-YEAR WORK REQUIRE13 MENT.—Section 214(l) of such Act, as amended by 

14 this subsection, is further amended by adding at the 

15 end the following: 

16 ‘‘(8) The 3-year work requirement set forth in 

17 subparagraphs (C) and (D) of paragraph (1) shall 

18 not apply if— 

19 ‘‘(A)(i) the Secretary of Homeland Secu20 rity determines the existence of extenuating cir21 cumstances, including violations by the em22 ployer of the employment agreement with the 

23 alien or of labor and employment laws, which 

24 justify a lesser period of employment at such 

25 facility or organization; and 


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1 ‘‘(ii) the alien demonstrates, not later than 

2 120 days after the employment termination 

3 date (unless the Secretary determines that ex4 tenuating circumstances would justify an exten5 sion), another bona fide offer of employment at 

6 a health facility or health care organization in 

7 a geographic area or areas designated by the 

8 Secretary of Health and Human Services as 

9 having a shortage of health care professionals, 

10 for the remainder of such 3-year period; 

11 ‘‘(B)(i) the interested State agency that re12 quested the waiver attests to the existence of 

13 extenuating circumstances, including violations 

14 by the employer of the employment agreement 

15 with the alien or of labor and employment laws, 

16 which justify a lesser period of employment at 

17 such facility or organization; and 

18 ‘‘(ii) the alien demonstrates, not later than 

19 120 days after the employment termination 

20 date (unless the Secretary determines that ex21 tenuating circumstances would justify an exten22 sion), another bona fide offer of employment at 

23 a health facility or health care organization in 

24 a geographic area or areas designated by the 

25 Secretary of Health and Human Services as 


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1 having a shortage of health care professionals, 

2 for the remainder of such 3-year period; or 

3 ‘‘(C) the alien— 

4 ‘‘(i) elects not to pursue a determina5 tion of extenuating circumstances pursuant 

6 to subparagraph (A) or (B); 

7 ‘‘(ii) terminates the alien’s employ8 ment relationship with the health facility 

9 or health care organization at which the 

10 alien was employed; 

11 ‘‘(iii) demonstrates, not later than 45 

12 days after the employment termination 

13 date, another bona fide offer of employ14 ment at a health facility or health care or15 ganization in a geographic area or areas, 

16 in the State that requested the alien’s 

17 waiver, which are designated by the Sec18 retary of Health and Human Services as 

19 having a shortage of health care profes20 sionals; and 

21 ‘‘(iv) agrees to be employed for the re22 mainder of such 3-year period, and 1 addi23 tional year for each termination under 

24 clause (ii).’’. 

25 (d) ALLOTMENT OF CONRAD STATE 30 WAIVERS.— 


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1 (1) IN GENERAL.—Section 214(l) of the Immi2 gration and Nationality Act (8 U.S.C. 1184(l)), as 

3 amended by subsection (c), is further amended by 

4 adding at the end the following: 

5 ‘‘(9)(A)(i) All States shall be allotted a total of 35 

6 waivers under paragraph (1)(B) for a fiscal year if 90 per7 cent of the waivers available to the States receiving at 

8 least 5 waivers were used in the previous fiscal year. 

9 ‘‘(ii) When an allotment occurs under clause (i), all 

10 States shall be allotted an additional 5 waivers under 

11 paragraph (1)(B) for each subsequent fiscal year if 90 

12 percent of the waivers available to the States receiving at 

13 least 5 waivers were used in the previous fiscal year. If 

14 the States are allotted 45 or more waivers for a fiscal year, 

15 the States will only receive an additional increase of 5 

16 waivers the following fiscal year if 95 percent of the waiv17 ers available to the States receiving at least 1 waiver were 

18 used in the previous fiscal year. 

19 ‘‘(B) Any increase in allotments under subparagraph 

20 (A) shall be maintained indefinitely, unless in a fiscal year 

21 the total number of such waivers granted is 5 percent 

22 lower than in the last year in which there was an increase 

23 in the number of waivers allotted pursuant to this para24 graph, in which case— 


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1 ‘‘(i) the number of waivers allotted shall be de2 creased by 5 for all States beginning in the next fis3 cal year; and 

4 ‘‘(ii) each additional 5 percent decrease in such 

5 waivers granted from the last year in which there 

6 was an increase in the allotment, shall result in an 

7 additional decrease of 5 waivers allotted for all 

8 States, provided that the number of waivers allotted 

9 for all States shall not drop below 30.’’. 

10 (2) ACADEMIC MEDICAL CENTERS.—Section 

11 214(l)(1)(D) of such Act, as amended by subsection 

12 (c)(1)(E), is further amended— 

13 (A) in clause (ii), by striking ‘‘and’’ at the 

14 end; 

15 (B) in clause (iii), by striking the period at 

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

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

18 ‘‘(iv) in the case of a request by an inter19 ested State agency— 

20 ‘‘(I) the head of such agency deter21 mines that the alien is to practice medicine 

22 in, or be on the faculty of a residency pro23 gram at, an academic medical center (as 

24 defined in section 411.355(e)(2) of title 42, 

25 Code of Federal Regulations, or a similar 


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1 successor regulation), without regard to 

2 whether such facility is located within an 

3 area designated by the Secretary of Health 

4 and Human Services as having a shortage 

5 of health care professionals; and 

6 ‘‘(II) the head of such agency deter7 mines that— 

8 ‘‘(aa) the alien physician’s work 

9 is in the public interest; and 

10 ‘‘(bb) the grant of such waiver 

11 would not cause the number of the 

12 waivers granted on behalf of aliens for 

13 such State for a fiscal year to exceed 

14 3 (within the limitation in subpara15 graph (B) and subject to paragraph 

16 (6)), in accordance with the conditions 

17 of this clause.’’. 

18 (e) AMENDMENTS TO THE PROCEDURES, DEFINI19 TIONS, AND OTHER PROVISIONS RELATED TO PHYSICIAN

20 IMMIGRATION.— 

21 (1) DUAL INTENT FOR PHYSICIANS SEEKING

22 GRADUATE MEDICAL TRAINING.—Section 214(b) of 

23 the Immigration and Nationality Act (8 U.S.C. 

24 1184(b)) is amended by striking ‘‘and other than a 

25 nonimmigrant described in any provision of section 


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1 101(a)(15)(H)(i) except subclause (b1) of such sec2 tion)’’ and inserting ‘‘a nonimmigrant described in 

3 any provision of section 101(a)(15)(H)(i) (except 

4 subclause (b1) of such section), and an alien coming 

5 to the United States to receive graduate medical 

6 education or training as described in section 212(j) 

7 or to take examinations required to receive graduate 

8 medical education or training as described in section 

9 212(j))’’. 

10 (2) PHYSICIAN NATIONAL INTEREST WAIVER

11 CLARIFICATIONS.— 

12 (A) PRACTICE AND GEOGRAPHIC AREA.— 

13 Section 203(b)(2)(B)(ii)(I) of the Immigration 

14 and Nationality Act (8 U.S.C. 

15 1153(b)(2)(B)(ii)(I)) is amended by striking 

16 items (aa) and (bb) and inserting the following: 

17 ‘‘(aa) the alien physician agrees to 

18 work on a full-time basis practicing pri19 mary care, specialty medicine, or a com20 bination thereof, in an area or areas des21 ignated by the Secretary of Health and 

22 Human Services as having a shortage of 

23 health care professionals, or at a health 

24 care facility under the jurisdiction of the 

25 Secretary of Veterans Affairs; or 


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1 ‘‘(bb) the alien physician is pursuing 

2 such waiver based upon service at a facility 

3 or facilities that serve patients who reside 

4 in a geographic area or areas designated 

5 by the Secretary of Health and Human 

6 Services as having a shortage of health 

7 care professionals (without regard to 

8 whether such facility or facilities are lo9 cated within such an area) and a Federal 

10 agency, or a local, county, regional, or 

11 State department of public health deter12 mines the alien physician’s work was or 

13 will be in the public interest.’’. 

14 (B) FIVE-YEAR SERVICE REQUIREMENT.— 

15 Section 203(b)(2)(B)(ii) of such Act, as amend16 ed by subparagraph (A), is further amended— 

17 (i) by moving subclauses (II), (III), 

18 and (IV) 4 ems to the left; and 

19 (ii) in subclause (II)— 

20 (I) by inserting ‘‘(aa)’’ after 

21 ‘‘(II)’’; and 

22 (II) by adding at the end the fol23 lowing: 

24 ‘‘(bb) The 5-year service requirement 

25 described in item (aa) shall begin on the 


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1 date on which the alien physician begins 

2 work in the shortage area in any legal sta3 tus and not on the date on which an immi4 grant visa petition is filed or approved. 

5 Such service shall be aggregated without 

6 regard to when such service began and 

7 without regard to whether such service 

8 began during or in conjunction with a 

9 course of graduate medical education. 

10 ‘‘(cc) An alien physician shall not be 

11 required to submit an employment contract 

12 with a term exceeding the balance of the 5- 

13 year commitment yet to be served or an 

14 employment contract dated within a min15 imum time period before filing a visa peti16 tion under this subsection. 

17 ‘‘(dd) An alien physician shall not be 

18 required to file additional immigrant visa 

19 petitions upon a change of work location 

20 from the location approved in the original 

21 national interest immigrant petition.’’. 

22 (3) TECHNICAL CLARIFICATION REGARDING AD23 VANCED DEGREE FOR PHYSICIANS.—Section 

24 203(b)(2)(A) of such Act is amended by adding at 

25 the end the following: ‘‘An alien physician holding a 


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1 foreign medical degree that has been deemed suffi2 cient for acceptance by an accredited United States 

3 medical residency or fellowship program is a member 

4 of the professions holding an advanced degree or its 

5 equivalent.’’. 

6 (4) SHORT-TERM WORK AUTHORIZATION FOR

7 PHYSICIANS COMPLETING THEIR RESIDENCIES.— 

8 (A) IN GENERAL.—A physician completing 

9 graduate medical education or training de10 scribed in section 212(j) of the Immigration 

11 and Nationality Act (8 U.S.C. 1182(j)) as a 

12 nonimmigrant described in section 

13 101(a)(15)(H)(i) of such Act (8 U.S.C. 

14 1101(a)(15)(H)(i))— 

15 (i) shall have such nonimmigrant sta16 tus automatically extended until October 1 

17 of the fiscal year for which a petition for 

18 a continuation of such nonimmigrant sta19 tus has been submitted in a timely manner 

20 and the employment start date for the ben21 eficiary of such petition is October 1 of 

22 that fiscal year; and 

23 (ii) shall be authorized to be employed 

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1 tween the filing of such petition and Octo2 ber 1 of such fiscal year. 

3 (B) TERMINATION.—The physician’s sta4 tus and employment authorization shall termi5 nate on the date that is 30 days after the date 

6 on which a petition described in clause (i)(I) is 

7 rejected, denied, or revoked. 

8 (C) AUTOMATIC EXTENSION.—A physi9 cian’s status and employment authorization will 

10 automatically extend to October 1 of the next 

11 fiscal year if all of the visas described in section 

12 101(a)(15)(H)(i) of the Immigration and Na13 tionality Act (8 U.S.C. 1101(a)(15)(H)(i)) that 

14 were authorized to be issued for the fiscal year 

15 have been issued. 

16 (5) APPLICABILITY OF SECTION 212(e) TO

17 SPOUSES AND CHILDREN OF J–1 EXCHANGE VISI18 TORS.—A spouse or child of an exchange visitor de19 scribed in section 101(a)(15)(J) of the Immigration 

20 and Nationality Act (8 U.S.C. 1101(a)(15)(J)) shall 

21 not be subject to the requirements under section 

22 212(e) of such Act (8 U.S.C. 1182(e)). 

23 (f) ANNUAL CONRAD STATE 30 J–1 VISA WAIVER

24 PROGRAM STATISTICAL REPORT.—The Director of U.S. 

25 Citizenship and Immigration Service shall submit an anVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 00246 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 nual report to Congress and to the Secretary of Health 

2 and Human Services that identifies the number of aliens 

3 admitted during the most recently concluded fiscal year 

4 as a result of the Conrad State 30 J–1 Visa Waiver Pro5 gram established under sections 212(e) and 214(l) of the 

6 Immigration and Nationality Act (8 U.S.C. 1182(e) and 

7 1184(l)), broken down by State. 

8 SEC. 3016. GRANTS FOR SCHOOLS OF MEDICINE AND 

9 SCHOOLS OF OSTEOPATHIC MEDICINE IN UN10 DERSERVED AREAS. 

11 Subpart II of part C of title VII of the Public Health 

12 Service Act (42 U.S.C. 293m et seq.) is amended by add13 ing at the end the following: 

14 ‘‘SEC. 749C. GRANTS FOR SCHOOLS OF MEDICINE AND 

15 SCHOOLS OF OSTEOPATHIC MEDICINE IN UN16 DERSERVED AREAS. 

17 ‘‘(a) IN GENERAL.—The Secretary may award grants 

18 to institutions of higher education (including consortiums 

19 of such institutions) for the establishment, improvement, 

20 or expansion of a school of medicine or osteopathic medi21 cine, or a branch campus of a school of medicine or osteo22 pathic medicine. 

23 ‘‘(b) PRIORITY.—In selecting grant recipients under 

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1 tution of higher education (or consortium of such institu2 tions) that— 

3 ‘‘(1) proposes to use the grant for the establish4 ment of a school of medicine or osteopathic medi5 cine, or a branch campus of a school of medicine or 

6 osteopathic medicine, in an area— 

7 ‘‘(A) in which— 

8 ‘‘(i) no other such school is based; or 

9 ‘‘(ii) in the case in which the school of 

10 medicine or osteopathic medicine proposed 

11 to be established would be a minority-serv12 ing institution, no other minority-serving 

13 institution that includes a school of medi14 cine or osteopathic medicine is based; and 

15 ‘‘(B) that is a medically underserved com16 munity or a health professional shortage area; 

17 or 

18 ‘‘(2) is a minority-serving institution described 

19 in section 371(a) of the Higher Education Act of 

20 1965 or an institution or program described in sec21 tion 326(e) of such Act. 

22 ‘‘(c) CONSIDERATIONS.—In awarding grants under 

23 this section, the Secretary, to the extent practicable, may 

24 ensure equitable distribution of awards among the geo25 graphical regions of the United States. 


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1 ‘‘(d) USE OF FUNDS.—An institution of higher edu2 cation (or a consortium of such institutions)— 

3 ‘‘(1) shall use grant amounts received under 

4 this section to— 

5 ‘‘(A) recruit, enroll, and retain medical 

6 students who are pursuing a degree of doctor of 

7 medicine or doctor of osteopathy, including in8 dividuals who are from disadvantaged back9 grounds (including racial and ethnic groups 

10 underrepresented among medical students and 

11 health professions), individuals from rural and 

12 underserved areas, low-income individuals, and 

13 first generation college students, at a school of 

14 medicine or osteopathic medicine or a branch 

15 campus of a school of medicine or osteopathic 

16 medicine; and 

17 ‘‘(B) develop, implement, and expand cur18 riculum that emphasizes care for rural and un19 derserved populations, including accessible and 

20 culturally and linguistically appropriate care 

21 and services, at such school or branch campus; 

22 and 

23 ‘‘(2) may use grant amounts received under this 

24 section to— 

25 ‘‘(A) plan and construct— 


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1 ‘‘(i) a school of medicine or osteo2 pathic medicine, or a branch campus of a 

3 school of medicine or osteopathic medicine, 

4 in an area in which no other such school 

5 is based; or 

6 ‘‘(ii) a school of medicine or osteo7 pathic medicine, or a branch campus of a 

8 school of medicine or osteopathic medicine, 

9 that will be a minority-serving institution, 

10 in an area in which no other such school 

11 that is a minority-serving institution is 

12 based; 

13 ‘‘(B) plan, develop, and meet criteria for 

14 accreditation for a school of medicine or osteo15 pathic medicine or a branch campus of a school 

16 of medicine or osteopathic medicine; 

17 ‘‘(C) hire faculty, including faculty from 

18 racial and ethnic groups who are underrep19 resented among the medical and other health 

20 professions, and other staff to serve at such a 

21 school or branch campus; 

22 ‘‘(D) support educational programs at such 

23 a school or branch campus; 

24 ‘‘(E) modernize and expand infrastructure 

25 at such a school or branch campus; and 


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1 ‘‘(F) support other activities that the Sec2 retary determines further the establishment, 

3 improvement, or expansion of a school of medi4 cine or osteopathic medicine or a branch cam5 pus of a school of medicine or osteopathic medi6 cine. 

7 ‘‘(e) APPLICATION.—To be eligible to receive a grant 

8 under subsection (a), an institution of higher education 

9 (or a consortium of such institutions), shall submit an ap10 plication to the Secretary at such time, in such manner, 

11 and containing such information as the Secretary may re12 quire, including a description of the institution’s or con13 sortium’s planned activities described in subsection (d). 

14 ‘‘(f) REPORTING.— 

15 ‘‘(1) REPORTS FROM ENTITIES.—Each institu16 tion of higher education, or consortium of such insti17 tutions, awarded a grant under this section shall 

18 submit an annual report to the Secretary on the ac19 tivities conducted under such grant, and other infor20 mation as the Secretary may require. 

21 ‘‘(2) REPORT TO CONGRESS.—Not later than 5 

22 years after the date of enactment of this section and 

23 every 5 years thereafter, the Secretary shall submit 

24 to the Committee on Health, Education, Labor, and 

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1 ergy and Commerce of the House of Representatives 

2 a report that provides a summary of the activities 

3 and outcomes associated with grants made under 

4 this section. Such reports shall include— 

5 ‘‘(A) a list of awardees, including their pri6 mary geographic location, and location of any 

7 school of medicine or osteopathic medicine, or a 

8 branch campus of a school of medicine or osteo9 pathic medicine that was established, improved, 

10 or expanded under this program; 

11 ‘‘(B) the total number of students (includ12 ing the number of students from racial and eth13 nic groups underrepresented among medical 

14 students and health professions, low-income 

15 students, and first generation college students) 

16 who— 

17 ‘‘(i) are enrolled at or who have grad18 uated from any school of medicine or os19 teopathic medicine, or a branch campus of 

20 a school of medicine or osteopathic medi21 cine, that was established, improved, or ex22 panded under this program, deidentified 

23 and disaggregated by race, ethnicity, age, 

24 sex, geographic region, disability status, 


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1 and other relevant factors, to the extent 

2 such information is available; and 

3 ‘‘(ii) who subsequently participate in 

4 an accredited internship or medical resi5 dency program upon graduation from any 

6 school of medicine or osteopathic medicine, 

7 or a branch campus of a school of medicine 

8 or osteopathic medicine, that was estab9 lished, improved, or expanded under this 

10 program, deidentified and disaggregated by 

11 race, ethnicity, age, sex, geographic region, 

12 disability status, medical specialty pursued, 

13 and other relevant factors, to the extent 

14 such information is available; 

15 ‘‘(C) the effects of such program on the 

16 health care provider workforce, including any 

17 impact on demographic representation 

18 disaggregated by race, ethnicity, and sex, and 

19 the fields or specialties pursued by students 

20 who have graduated from any school of medi21 cine or osteopathic medicine, or a branch cam22 pus of a school of medicine or osteopathic medi23 cine, that was established, improved, or ex24 panded under this program; 


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1 ‘‘(D) the effects of such program on health 

2 care access in underserved areas, including 

3 medically underserved communities and health 

4 professional shortage areas; and 

5 ‘‘(E) recommendations for improving the 

6 program described in this section, and any 

7 other considerations as the Secretary deter8 mines appropriate. 

9 ‘‘(3) PUBLIC AVAILABILITY.—The Secretary 

10 shall make reports submitted under paragraph (2) 

11 publicly available on the website of the Department 

12 of Health and Human Services. 

13 ‘‘(g) DEFINITIONS.—In this section: 

14 ‘‘(1) BRANCH CAMPUS.— 

15 ‘‘(A) IN GENERAL.—The term ‘branch 

16 campus’, with respect to a school of medicine or 

17 osteopathic medicine, means an additional loca18 tion of such school that is geographically apart 

19 and independent of the main campus, at which 

20 the school offers at least 50 percent of the pro21 gram leading to a degree of doctor of medicine 

22 or doctor of osteopathy that is offered at the 

23 main campus. 

24 ‘‘(B) INDEPENDENCE FROM MAIN CAM25 PUS.—For purposes of subparagraph (A), the 


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1 location of a school described in such subpara2 graph shall be considered to be independent of 

3 the main campus described in such subpara4 graph if the location— 

5 ‘‘(i) is permanent in nature; 

6 ‘‘(ii) offers courses in educational pro7 grams leading to a degree, certificate, or 

8 other recognized educational credential; 

9 ‘‘(iii) has its own faculty and adminis10 trative or supervisory organization; and 

11 ‘‘(iv) has its own budgetary and hiring 

12 authority. 

13 ‘‘(2) FIRST GENERATION COLLEGE STUDENT.— 

14 The term ‘first generation college student’ has the 

15 meaning given such term in section 402A(h)(3) of 

16 the Higher Education Act of 1965. 

17 ‘‘(3) HEALTH PROFESSIONAL SHORTAGE

18 AREA.—The term ‘health professional shortage area’ 

19 has the meaning given such term in section 332(a). 

20 ‘‘(4) INSTITUTION OF HIGHER EDUCATION.— 

21 The term ‘institution of higher education’ has the 

22 meaning given such term in section 101 of the High23 er Education Act of 1965. 


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1 ‘‘(5) MEDICALLY UNDERSERVED COMMUNITY.— 

2 The term ‘medically underserved community’ has the 

3 meaning given such term in section 799B(6). 

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

5 is authorized to be appropriated such sums as may be nec6 essary to carry out this section.’’. 

7 TITLE IV—IMPROVING HEALTH 

8 CARE ACCESS AND QUALITY 

9 SEC. 4000. DEFINITION. 

10 In this title and the amendments made by this title, 

11 the term ‘‘health care’’ includes all health care needed 

12 throughout the life cycle and the end of life. 

13 Subtitle A—Reducing Barriers to 

14 Accessing Care 

15 SEC. 4001. PROTECTING PROTECTED AREAS. 

16 Section 287 of the Immigration and Nationality Act 

17 (8 U.S.C. 1357) is amended— 

18 (1) by striking ‘‘the Service’’ each place such 

19 term appears and inserting ‘‘the Department of 

20 Homeland Security’’; 

21 (2) by striking ‘‘Attorney General’’ each place 

22 such term appears and inserting ‘‘Secretary of 

23 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, inspec22 tion interview, request for identification, search, 

23 seizure, service of charging documents or sub24 poenas, or surveillance for the purposes of im25 migration enforcement; and 


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1 ‘‘(ii) includes an enforcement action at, or 

2 focused on, a protected area that is part of a 

3 joint case led by another law enforcement agen4 cy. 

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 ‘protected area’ includes all of 

5 the physical space located within 1,000 feet of— 

6 ‘‘(i) any medical treatment or mental 

7 health care facility, including any hospital, doc8 tor’s office, health clinic, alcohol or drug pre9 vention, counseling, or treatment facilities, sy10 ringe exchange services, vaccination, treatment, 

11 or testing sites, emergent or urgent care facil12 ity, sites that serve pregnant individuals, or 

13 community health centers; 

14 ‘‘(ii) any public or private school, including 

15 any known and licensed day care facility, pre16 school, sites of early childhood programs, pri17 mary school, secondary school, postsecondary 

18 school (including colleges and universities), or 

19 other institution of learning (including voca20 tional or trade schools); 

21 ‘‘(iii) any scholastic or education-related 

22 activity or event or before or after school pro23 gram, including field trips and interscholastic 

24 events; 

25 ‘‘(iv) any school bus or school bus stop; 


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1 ‘‘(v) any place where children gather, such 

2 as a playground, a recreation center, a library, 

3 a foster care facility, or a group home for chil4 dren; 

5 ‘‘(vi) any physical structure of an organiza6 tion or subdivision of government that— 

7 ‘‘(I) assists children, pregnant women, 

8 victims of crime or abuse, or individuals 

9 with significant mental or physical disabil10 ities; 

11 ‘‘(II) provides social services and as12 sistance, including homeless shelters, com13 munity-based organizations, facilities that 

14 serve disabled persons, drug or alcohol 

15 counseling and treatment facilities, food 

16 banks or food pantries, and other places 

17 providing emergency and disaster services 

18 or assistance with food and nutrition, 

19 housing affordability and income or other 

20 services funded by State or local govern21 ment, charitable giving, the Special Sup22 plemental Nutrition Program for Women, 

23 Infants, and Children (WIC), Supple24 mental Nutrition Assistance Program 

25 (SNAP), Temporary Assistance for Needy 


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1 Families (TANF), Social Security, or the 

2 United States Housing Act; or 

3 ‘‘(III) provides hospice, palliative, or 

4 other available end-of-life care services to 

5 terminally ill persons; 

6 ‘‘(vii) any church, synagogue, mosque, or 

7 other place of worship or religious study, in8 cluding buildings rented for the purpose of reli9 gious services, retreats, counseling, workshops, 

10 instruction, and education; 

11 ‘‘(viii) any Federal, State, or local court12 house, including the office of an individual’s 

13 legal counsel or representative, and a probation, 

14 parole, or supervised release office; 

15 ‘‘(ix) the site of a funeral, grave-side cere16 mony, rosary, wedding, or other religious cere17 mony or observance; 

18 ‘‘(x) any public demonstration, such as a 

19 march, a rally, or a parade; 

20 ‘‘(xi) any domestic violence shelter, rape 

21 crisis center, child advocacy center, supervised 

22 visitation center, family justice center, or victim 

23 services provider; 

24 ‘‘(xii) any congressional district office; 


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1 ‘‘(xiii) indoor and outdoor premises of a 

2 State department of motor vehicles; 

3 ‘‘(xiv) a place where disaster or emergency 

4 response and relief is provided, including evacu5 ation routes, places where shelter or emergency 

6 supplies, food, or water are distributed, or 

7 places where registration for disaster-relief as8 sistance or family reunification is underway; or 

9 ‘‘(xv) any other location specified by the 

10 Secretary of Homeland Security for purposes of 

11 this subsection. 

12 ‘‘(2)(A) An enforcement action may not take place 

13 at, or be focused on, a protected area unless— 

14 ‘‘(i) the action involves exigent circumstances; 

15 and 

16 ‘‘(ii) prior approval for the enforcement action 

17 was obtained. 

18 ‘‘(B) If an enforcement action is initiated pursuant 

19 to subparagraph (A) and the exigent circumstances per20 mitting the enforcement action cease, the enforcement ac21 tion shall be discontinued until such exigent circumstances 

22 reemerge. 

23 ‘‘(C) If an enforcement action is carried out in viola24 tion of this subsection— 


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1 ‘‘(i) no information resulting from the enforce2 ment action may be entered into the record or re3 ceived into evidence in a removal proceeding result4 ing from the enforcement action; and 

5 ‘‘(ii) the noncitizen who is the subject of such 

6 removal proceeding may file a motion for the imme7 diate termination of the removal proceeding. 

8 ‘‘(3)(A) This subsection shall apply to any enforce9 ment action by officers or agents of the Department of 

10 Homeland Security, including— 

11 ‘‘(i) officers or agents of U.S. Immigration and 

12 Customs Enforcement; 

13 ‘‘(ii) officers or agents of U.S. Customs and 

14 Border Protection; and 

15 ‘‘(iii) any individual designated to perform im16 migration enforcement functions pursuant to sub17 section (g). 

18 ‘‘(B) While carrying out an enforcement action within 

19 a protected area, officers and agents referred to in sub20 paragraph (A) shall make every effort— 

21 ‘‘(i) to limit the time spent in the protected 

22 area; 

23 ‘‘(ii) to limit the enforcement action in the pro24 tected area to the person or persons for whom prior 

25 approval was obtained; and 


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1 ‘‘(iii) to conduct themselves discreetly. 

2 ‘‘(C) If, while carrying out an enforcement action 

3 that is not initiated in or focused on a protected area, offi4 cers or agents are led into a protected area, and no exigent 

5 circumstance and prior approval with respect to the pro6 tected area, such officers or agents shall— 

7 ‘‘(i) cease before taking any further enforce8 ment action; 

9 ‘‘(ii) conduct themselves in a discreet manner; 

10 ‘‘(iii) maintain surveillance on an individual; 

11 and 

12 ‘‘(iv) immediately consult their supervisor in 

13 order to determine whether such enforcement action 

14 should be discontinued. 

15 ‘‘(D) The limitations under this paragraph shall not 

16 apply to the transportation of an individual apprehended 

17 at or near a land or sea border to a hospital or health 

18 care provider for the purpose of providing medical care 

19 to such individual. 

20 ‘‘(4)(A) Each official specified in subparagraph (B) 

21 shall ensure that the employees under his or her super22 vision receive annual training regarding compliance 

23 with— 

24 ‘‘(i) the requirements under this subsection with 

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1 tected areas and enforcement actions that lead offi2 cers or agents to a protected area; and 

3 ‘‘(ii) the requirements under section 239 of this 

4 Act and section 384 of the Illegal Immigration Re5 form and Immigrant Responsibility Act of 1996 (8 

6 U.S.C. 1367). 

7 ‘‘(B) The officials specified in this subparagraph 

8 are— 

9 ‘‘(i) the Chief Counsel of each Field Office of 

10 U.S. Immigration and Customs Enforcement; 

11 ‘‘(ii) each Field Office Director of U.S. Immi12 gration and Customs Enforcement; 

13 ‘‘(iii) each Special Agent in Charge of U.S. Im14 migration and Customs Enforcement; 

15 ‘‘(iv) each Chief Patrol Agent of U.S. Customs 

16 and Border Protection; 

17 ‘‘(v) the Director of Field Operations of U.S. 

18 Customs and Border Protection; 

19 ‘‘(vi) the Director of Air and Marine Operations 

20 of U.S. Customs and Border Protection; 

21 ‘‘(vii) the Internal Affairs Special Agent in 

22 Charge of U.S. Customs and Border Protection; and 

23 ‘‘(viii) the chief law enforcement officer of each 

24 State or local law enforcement agency that enters 


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1 into a written agreement with the Department of 

2 Homeland Security pursuant to subsection (g). 

3 ‘‘(5) Not later than 180 days after the date of the 

4 enactment of the Health Equity and Accountability Act 

5 of 2024, the Secretary of Homeland Security shall modify 

6 the Notice to Appear form (Form I–862)— 

7 ‘‘(A) to provide the subject of an enforcement 

8 action with information, written in plain language, 

9 summarizing the restrictions against enforcement 

10 actions at protected areas (as described in this sub11 section) and the remedies available to the individual 

12 if such action violates such restrictions; 

13 ‘‘(B) to ensure that the information provided 

14 pursuant to subparagraph (A) is accessible to an in15 dividual with limited English proficiency; and 

16 ‘‘(C) to ensure that the subject of an enforce17 ment action is not permitted to verify that the offi18 cers or agents that carried out such action complied 

19 with the restrictions set forth in this subsection. 

20 ‘‘(6)(A) The Director of U.S. Immigration and Cus21 toms Enforcement and the Commissioner of U.S. Customs 

22 and Border Protection shall each submit an annual report 

23 to the appropriate congressional committees that includes 

24 the information set forth in subparagraph (B) with respect 

25 to the respective agency. 


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1 ‘‘(B) Each report submitted pursuant to subpara2 graph (A) shall include, with respect to the submitting 

3 agency during the reporting period— 

4 ‘‘(i) the number of enforcement actions that 

5 were carried out at, or focused on, a protected area; 

6 ‘‘(ii) the number of enforcement actions in 

7 which officers or agents were subsequently led to a 

8 protected area; and 

9 ‘‘(iii) for each enforcement action described in 

10 clause (i) or (ii)— 

11 ‘‘(I) the date on which such action oc12 curred; 

13 ‘‘(II) the specific site, city, county, and 

14 State in which such action occurred; 

15 ‘‘(III) if the site of the enforcement action 

16 was in a protected area— 

17 ‘‘(aa) the identification of the pro18 tected area; 

19 ‘‘(bb) the reasons such action was 

20 taken in such area; 

21 ‘‘(cc) if such action was taken without 

22 prior approval, certification that notifica23 tion to headquarters of a submitting agen24 cy was provided after such action took 

25 place; and 


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1 ‘‘(dd) a report describing what oc2 curred during and immediately after such 

3 action; 

4 ‘‘(IV) the components of the agency in5 volved in the enforcement action; 

6 ‘‘(V) a description of the enforcement ac7 tion, including the nature of the criminal activ8 ity of its intended target; 

9 ‘‘(VI) the number of individuals, if any, ar10 rested or taken into custody; 

11 ‘‘(VII) the number of collateral arrests, if 

12 any, and the reasons for each such arrest; 

13 ‘‘(VIII) a certification whether the location 

14 administrator of a protected area was contacted 

15 before, during, or after the enforcement action; 

16 and 

17 ‘‘(IX) the percentage of all of the staff 

18 members and supervisors reporting to the offi19 cials listed in paragraph (4)(B) who completed 

20 the training required under paragraph (4)(A). 

21 ‘‘(7) Nothing in the subsection may be construed— 

22 ‘‘(A) to affect the authority of Federal, State, 

23 or local law enforcement agencies— 


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1 ‘‘(i) to enforce generally applicable Federal 

2 or State criminal laws unrelated to immigra3 tion; or 

4 ‘‘(ii) to protect residents from imminent 

5 threats to public safety; or 

6 ‘‘(B) to limit or override the protections pro7 vided in— 

8 ‘‘(i) section 239; or 

9 ‘‘(ii) section 384 of the Illegal Immigration 

10 Reform and Immigrant Responsibility Act of 

11 1996 (8 U.S.C. 1367).’’. 

12 SEC. 4002. REPEAL OF REQUIREMENT FOR DOCUMENTA13 TION EVIDENCING CITIZENSHIP OR NATION14 ALITY UNDER THE MEDICAID PROGRAM. 

15 (a) REPEAL.—Subsections (i)(22) and (x) of section 

16 1903 of the Social Security Act (42 U.S.C. 1396b) are 

17 each repealed. 

18 (b) CONFORMING AMENDMENTS.— 

19 (1) STATE PAYMENTS FOR MEDICAL ASSIST20 ANCE.—Section 1902 of the Social Security Act (42 

21 U.S.C. 1396a) is amended— 

22 (A) by amending paragraph (46) of sub23 section (a) to read as follows: 

24 ‘‘(46) provide that information is requested and 

25 exchanged for purposes of income and eligibility 


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1 verification in accordance with a State system which 

2 meets the requirements of section 1137 of this 

3 Act;’’; 

4 (B) in subsection (e)(13)(A)(i)— 

5 (i) in the matter preceding subclause 

6 (I), by striking ‘‘sections 1902(a)(46)(B) 

7 and 1137(d)’’ and inserting ‘‘section 

8 1137(d)’’; and 

9 (ii) in subclause (IV), by striking 

10 ‘‘1902(a)(46)(B) or’’; and 

11 (C) by striking subsection (ee). 

12 (2) REPEAL.—Subsection (c) of section 6036 of 

13 the Deficit Reduction Act of 2005 (42 U.S.C. 1396b 

14 note) is repealed. 

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

16 this section shall take effect on the date of enactment of 

17 this Act. 

18 SEC. 4003. LIFT THE BAR ACT. 

19 (a) ELIMINATION OF ARBITRARY ELIGIBILITY RE20 STRICTIONS.— 

21 (1) IN GENERAL.—Sections 402, 403, 411, 412, 

22 421, and 422 of the Personal Responsibility and 

23 Work Opportunity Reconciliation Act of 1996 (8 

24 U.S.C. 1612, 1613, 1621, 1622, 1631, and 1632) 

25 are repealed. 


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1 (2) CONFORMING AMENDMENTS.—Title IV of 

2 the Personal Responsibility and Work Opportunity 

3 Reconciliation Act of 1996 (8 U.S.C. 1601 et seq.) 

4 is amended— 

5 (A) in section 401(b)(5) (8 U.S.C. 

6 1611(b)(5)), by striking ‘‘the program defined 

7 in section 402(a)(3)(A) (relating to the supple8 mental security income program)’’ and inserting 

9 ‘‘the Supplemental Security Income Program 

10 under title XVI of the Social Security Act (42 

11 U.S.C. 1381 et seq.)’’; 

12 (B) in section 404(a) (8 U.S.C. 1614(a)), 

13 by striking ‘‘, 402, or 403’’; 

14 (C) in section 413 (8 U.S.C. 1625)— 

15 (i) by striking ‘‘A State’’ and insert16 ing the following: 

17 ‘‘(a) STATE OR LOCAL PUBLIC BENEFIT DE18 FINED.—In this section, the term ‘State or local public 

19 benefit’— 

20 ‘‘(1) except as provided in paragraphs (2) and 

21 (3), means— 

22 ‘‘(A) any grant, contract, loan, professional 

23 license, or commercial license provided by an 

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1 propriated funds of a State or local govern2 ment; and 

3 ‘‘(B) any retirement, welfare, health, dis4 ability, public or assisted housing, postsec5 ondary education, food assistance, unemploy6 ment benefit, or any other similar benefit for 

7 which payments or assistance are provided to 

8 an individual, household, or family eligibility 

9 unit by an agency of a State or local govern10 ment or by appropriated funds of a State or 

11 local government; 

12 ‘‘(2) does not apply— 

13 ‘‘(A) to any contract, professional license, 

14 or commercial license for a nonimmigrant 

15 whose visa for entry is related to such employ16 ment in the United States, or to a citizen of a 

17 freely associated state, if section 141 of the ap18 plicable compact of free association approved in 

19 Public Law 99–239 or 99–658 (or a successor 

20 provision) is in effect; 

21 ‘‘(B) with respect to benefits for an alien 

22 who as a work authorized nonimmigrant or as 

23 an alien lawfully admitted for permanent resi24 dence under the Immigration and Nationality 

25 Act qualified for such benefits and for whom 


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1 the United States under reciprocal treaty agree2 ments is required to pay benefits, as determined 

3 by the Secretary of State, after consultation 

4 with the Attorney General; or 

5 ‘‘(C) to the issuance of a professional li6 cense to, or the renewal of a professional license 

7 by, a foreign national not physically present in 

8 the United States; and 

9 ‘‘(3) does not include any Federal public ben10 efit. 

11 ‘‘(b) PROOF OF ELIGIBILITY REQUIREMENT.—A 

12 State’’; and 

13 (ii) in subsection (b), as redesignated, 

14 by striking ‘‘(as defined in section 

15 411(c))’’; 

16 (D) in section 432(d) (8 U.S.C. 1642(d)), 

17 by striking ‘‘(as defined in section 411(c))’’ and 

18 inserting ‘‘(as defined in section 413(a))’’; 

19 (E) in section 435 (8 U.S.C. 1645), by 

20 striking ‘‘(as provided under section 403)’’; and 

21 (F) in section 436 (8 U.S.C. 1646)— 

22 (i) by striking ‘‘the food stamp pro23 gram (as defined in section 402(a)(3)(B))’’ 

24 and inserting ‘‘the supplemental nutrition 

25 assistance program established under the 


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1 Food and Nutrition Act of 2008 (7 U.S.C. 

2 2011 et seq.)’’; and 

3 (ii) by striking ‘‘the supplemental se4 curity income program (as defined in sec5 tion 402(a)(3)(A))’’ and inserting ‘‘the 

6 Supplemental Security Income Program 

7 under title XVI of the Social Security Act 

8 (42 U.S.C. 1381 et seq.)’’. 

9 (b) QUALIFIED NONCITIZENS.—Title IV of the Per10 sonal Responsibility and Work Opportunity Reconciliation 

11 Act of 1996 (8 U.S.C. 1601 et seq.) is amended— 

12 (1) in the title header, by striking ‘‘ALIENS’’ 

13 and inserting ‘‘NONCITIZENS’’; 

14 (2) in the header of section 401 (8 U.S.C. 

15 1611), by striking ‘‘ALIENS WHO ARE NOT

16 QUALIFIED ALIENS’’ and inserting ‘‘NONCITI17 ZENS WHO ARE NOT QUALIFIED NONCITI18 ZENS’’; 

19 (3) by striking ‘‘qualified alien’’ each place such 

20 term appears and inserting ‘‘qualified noncitizen’’; 

21 (4) by striking ‘‘qualified aliens’’ each place 

22 such term appears and inserting ‘‘qualified nonciti23 zens’’; 


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1 (5) by striking ‘‘qualified alien’s’’ each place 

2 such term appears and inserting ‘‘qualified nonciti3 zen’s’’; 

4 (6) by striking ‘‘an alien’’ each place such term 

5 appears and inserting ‘‘a noncitizen’’; 

6 (7) by striking ‘‘alien’’ each place such term ap7 pears and inserting ‘‘noncitizen’’; 

8 (8) by striking ‘‘aliens’’ each place such term 

9 appears and inserting ‘‘noncitizens’’; and 

10 (9) by striking ‘‘alien’s’’ each place such term 

11 appears and inserting ‘‘noncitizen’s’’. 

12 (c) ACCESS TO BASIC SERVICES FOR LAWFULLY RE13 SIDING NONCITIZENS.—Section 431 of the Personal Re14 sponsibility and Work Opportunity Reconciliation Act of 

15 1996 (8 U.S.C. 1641) is amended— 

16 (1) by striking subsection (b) and inserting the 

17 following: 

18 ‘‘(b) QUALIFIED NONCITIZEN.—For purposes of this 

19 title, the term ‘qualified noncitizen’ means a noncitizen 

20 who, at the time the noncitizen applies for, receives, or 

21 attempts to receive a Federal public benefit, is lawfully 

22 present in the United States.’’; 

23 (2) in subsection (c)— 


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1 (A) in the header, by striking ‘‘QUALIFIED

2 ALIENS’’ and inserting ‘‘QUALIFIED NONCITI3 ZENS’’; 

4 (B) in paragraph (3), by striking ‘‘or’’ at 

5 the end; 

6 (C) in paragraph (4), by striking the pe7 riod at the end and inserting ‘‘; or’’; and 

8 (D) by inserting after paragraph (4) the 

9 following: 

10 ‘‘(5) a noncitizen— 

11 ‘‘(A) in a category that was treated as law12 fully present for purposes of section 1101 of the 

13 Patient Protection and Affordable Care Act of 

14 2010 (42 U.S.C. 18001); 

15 ‘‘(B) who met the requirements of section 

16 402(a)(2)(D) of the Personal Responsibility and 

17 Work Opportunity Reconciliation Act of 1996 

18 (8 U.S.C. 1612(a)(2)(D)) on or before January 

19 1, 2021; 

20 ‘‘(C) who is granted special immigrant ju21 venile status as described by section 

22 101(a)(27)(J) of the Immigration and Nation23 ality Act (8 U.S.C. 1101(a)(27)(J)); 

24 ‘‘(D) who has a pending, bona fide applica25 tion for nonimmigrant status under section 


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1 101(a)(15)(U) of the Immigration and Nation2 ality Act (8 U.S.C. 1101(1)(15)(U)); 

3 ‘‘(E) who was granted relief under the De4 ferred Action for Childhood Arrivals program; 

5 or 

6 ‘‘(F) who is not described in subpara7 graphs (A) through (E), is not a citizen of the 

8 United States, resides in a State or territory of 

9 the United States, and is authorized by Federal 

10 law to be present in the United States.’’; and 

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

12 ‘‘(d) NONCITIZEN.—In this title, the term ‘noncit13 izen’ means any individual who is not a citizen of the 

14 United States.’’. 

15 (d) CHILD NUTRITION PROGRAMS.—Section 742 of 

16 the Personal Responsibility and Work Opportunity Rec17 onciliation Act of 1996 (8 U.S.C. 1615) is amended— 

18 (1) in subsection (a)— 

19 (A) in the header by striking ‘‘SCHOOL

20 LUNCH AND BREAKFAST PROGRAMS’’ and in21 serting ‘‘CHILD NUTRITION PROGRAMS’’; 

22 (B) by striking ‘‘the school lunch pro23 gram’’ and inserting ‘‘any program’’; and 


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1 (C) by striking ‘‘the school breakfast pro2 gram under section 4 of the’’ and inserting 

3 ‘‘any program under’’; and 

4 (2) in subsection (b), by amending paragraph 

5 (1) to read as follows: 

6 ‘‘(1) IN GENERAL.—A State may not deny ben7 efits under programs established under the provi8 sions of law described in paragraph (2) on the basis 

9 of an individual’s citizenship or immigration sta10 tus.’’. 

11 (e) EXCLUSION OF MEDICAL ASSISTANCE EXPENDI12 TURES FOR CITIZENS OF FREELY ASSOCIATED STATES.— 

13 Section 1108(h) of the Social Security Act (42 U.S.C. 

14 1308(h)) is amended— 

15 (1) by striking ‘‘Expenditures’’ and inserting: 

16 ‘‘(1) IN GENERAL.—Expenditures’’; and 

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

18 ‘‘(2) EXCEPTION.—With respect to eligibility 

19 for benefits under a State plan approved under title 

20 XIX (other than medical assistance described in sec21 tion 401(b)(1)(A) of the Personal Responsibility and 

22 Work Opportunity Reconciliation Act of 1996 (8 

23 U.S.C. 1611(b)(1)(A))), paragraph (1) shall not 

24 apply to any individual who lawfully resides in 1 of 

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1 cordance with the Compacts of Free Association be2 tween the Government of the United States and the 

3 Governments of the Federated States of Micronesia, 

4 the Republic of the Marshall Islands, and the Re5 public of Palau and shall not apply, at the option of 

6 the Governor of Puerto Rico, the Virgin Islands, 

7 Guam, the Northern Mariana Islands, or American 

8 Samoa as communicated to the Secretary of Health 

9 and Human Services in writing, to any individual 

10 who lawfully resides in the respective territory in ac11 cordance with such Compacts.’’. 

12 (f) CHILDREN’S HEALTH INSURANCE PROGRAM.— 

13 Effective January 1, 2025, section 2107(e)(1) of the So14 cial Security Act (42 U.S.C. 1397gg(e)(1)) is amended— 

15 (1) by striking subparagraph (P); and 

16 (2) by redesignating subparagraphs (Q), (R), 

17 (S), (T), and (U) as subparagraphs (P), (Q), (R), 

18 (S), and (T), respectively. 

19 (g) CONFORMING AMENDMENTS.— 

20 (1) SUPPLEMENTAL FOOD ASSISTANCE PRO21 GRAM.—The Food and Nutrition Act of 2008 (7 

22 U.S.C. 2011 et seq.) is amended— 

23 (A) in section 5 (7 U.S.C. 2014)— 

24 (i) in subsection (d)(10), by striking 

25 ‘‘(k)’’ and inserting ‘‘(j)’’; 


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1 (ii) by striking subsection (i); and 

2 (iii) by redesignating subsections (j), 

3 (k), (l), (m), and (n) as subsections (i), (j), 

4 (k), (l), and (m), respectively; 

5 (B) in section 6 (7 U.S.C. 2015)— 

6 (i) in subsection (f), by striking ‘‘an 

7 alien lawfully admitted for permanent’’ and 

8 all that follows through the end of the sub9 section and inserting ‘‘a noncitizen who is 

10 lawfully present in the United States.’’; 

11 and 

12 (ii) in subsection (s)(2), by striking 

13 ‘‘(i), (k), (l), (m), and (n)’’ and inserting 

14 ‘‘(j), (k), (l), and (m)’’; and 

15 (C) in section 11(e)(2)(B)(v)(II) (7 U.S.C. 

16 2020(e)(2)(B)(v)(II)) by striking ‘‘aliens’’ and 

17 inserting ‘‘noncitizens’’. 

18 (2) MEDICAID.—Section 1903(v) of the Social 

19 Security Act (42 U.S.C. 1396b(v)) is amended— 

20 (A) in paragraph (1), by striking ‘‘admit21 ted for’’ and all that follows and inserting 

22 ‘‘present in the United States.’’; and 

23 (B) by striking paragraph (4). 


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1 (3) HOUSING ASSISTANCE.—Section 214(a) of 

2 the Housing and Community Development Act of 

3 1980 (42 U.S.C. 1436a(a)) is amended— 

4 (A) by redesignating paragraphs (6) and 

5 (7) as paragraphs (7) and (8), respectively; and 

6 (B) by inserting after paragraph (5) the 

7 following: 

8 ‘‘(6) a qualified noncitizen (as defined in sec9 tion 431 of the Personal Responsibility and Work 

10 Opportunity Reconciliation Act of 1996 (8 U.S.C. 

11 1641));’’. 

12 (4) ASSISTANCE NOT TREATED AS DEBT AB13 SENT FRAUD.—Section 213A of the Immigration 

14 and Nationality Act (8 U.S.C. 1183a) is amended— 

15 (A) in subsection (a)(3)— 

16 (i) in subparagraph (A), by striking 

17 ‘‘(as provided under section 403 of the 

18 Personal Responsibility and Work Oppor19 tunity Reconciliation Act of 1996)’’; and 

20 (ii) in subparagraph (B), in the un21 designated matter following clause (ii), by 

22 striking ‘‘(as provided under section 403 of 

23 the Personal Responsibility and Work Op24 portunity Reconciliation Act of 1996)’’; 

25 and 


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1 (B) in subsection (b)(1)(A) is amended by 

2 striking ‘‘benefit,’’ and inserting ‘‘benefit by 

3 fraud,’’. 

4 (h) FEDERAL AGENCY GUIDANCE.—Not later than 

5 180 days after the date of the enactment of this Act, each 

6 Federal agency affected by any of the amendments made 

7 by this section shall issue guidance with respect to the im8 plementation of such amendments. 

9 (i) EFFECTIVE DATE.—Except as otherwise provided 

10 in this section, the amendments made by this section— 

11 (1) shall take effect on the date of the enact12 ment of this Act; and 

13 (2) shall apply to services furnished on or after 

14 the date that is 180 days after the date on which 

15 any guidance is issued pursuant to subsection (h). 

16 SEC. 4004. IMPROVE AFFORDABILITY AND REDUCE PRE17 MIUM COSTS OF HEALTH INSURANCE FOR 

18 CONSUMERS. 

19 (a) IN GENERAL.—Section 36B(b)(3)(A) of the In20 ternal Revenue Code of 1986 is amended to read as fol21 lows: 

22 ‘‘(A) APPLICABLE PERCENTAGE.—The ap23 plicable percentage for any taxable year shall be 

24 the percentage such that the applicable percent25 age for any taxpayer whose household income is 


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1 within an income tier specified in the following 

2 table shall increase, on a sliding scale in a lin3 ear manner, from the initial premium percent4 age to the final premium percentage specified in 

5 such table for such income tier: 

‘‘In the case of household income (expressed as a 

percent of poverty line) within the following income tier: 

The initial 

premium 

percentage 

is— 

The final 

premium 

percentage 

is— 

Up to 150 percent .................................................. 0.0 0.0

150 percent up to 200 percent ............................... 0.0 3.0

200 percent up to 250 percent ............................... 3.0 4.0

250 percent up to 300 percent ............................... 4.0 6.0

300 percent up to 400 percent ............................... 6.0 8.5

400 percent and higher .......................................... 8.5 8.5.’’. 

6 (b) CONFORMING AMENDMENTS.—Section 36B(c)(1) 

7 of the Internal Revenue Code of 1986 is amended— 

8 (1) by striking ‘‘but does not exceed 400 per9 cent’’ in subparagraph (A), and 

10 (2) by striking subparagraph (E). 

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

12 this section shall apply to taxable years beginning after 

13 December 31, 2023. 

14 SEC. 4005. REMOVING CITIZENSHIP AND IMMIGRATION 

15 BARRIERS TO ACCESS TO AFFORDABLE 

16 HEALTH CARE UNDER THE ACA. 

17 (a) IN GENERAL.— 

18 (1) PREMIUM TAX CREDITS.—Section 36B of 

19 the Internal Revenue Code of 1986 is amended— 


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1 (A) in subsection (c)(1), by amending sub2 paragraph (B) to read as follows: 

3 ‘‘(B) SPECIAL RULE FOR CERTAIN INDI4 VIDUALS INELIGIBLE FOR MEDICAID DUE TO

5 STATUS.—If— 

6 ‘‘(i) a taxpayer has a household in7 come which is not greater than 100 per8 cent of an amount equal to the poverty line 

9 for a family of the size involved, 

10 ‘‘(ii) the taxpayer is a noncitizen who 

11 is not eligible for the Medicaid program 

12 under title XIX of the Social Security Act 

13 by reason of the individual’s immigration 

14 status, 

15 ‘‘(iii) the taxpayer is ineligible for 

16 minimum essential coverage under section 

17 5000A(f)(1)(A)(ii), and 

18 ‘‘(iv) under the Medicaid eligibility 

19 criteria for noncitizens in effect on Decem20 ber 26, 2020, the taxpayer would be ineli21 gible for such minimum essential coverage 

22 by reason of the taxpayer’s immigration 

23 status, 

24 the taxpayer shall, for purposes of the credit 

25 under this section, be treated as an applicable 


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1 taxpayer with a household income which is 

2 equal to 100 percent of the poverty line for a 

3 family of the size involved.’’. 

4 (B) by striking subsection (e). 

5 (2) COST-SHARING REDUCTIONS.—Section 1402 

6 of the Patient Protection and Affordable Care Act 

7 (42 U.S.C. 18071) is amended— 

8 (A) by striking subsection (e); and 

9 (B) by redesignating subsections (f) and 

10 (g) as subsections (e) and (f), respectively. 

11 (3) BASIC HEALTH PROGRAM ELIGIBILITY.— 

12 Section 1331(e)(1)(B) of the Patient Protection and 

13 Affordable Care Act (42 U.S.C. 18051(e)(1)(B)) is 

14 amended by striking ‘‘lawfully present in the United 

15 States,’’. 

16 (4) RESTRICTIONS ON FEDERAL PAYMENTS.— 

17 Section 1412 of the Patient Protection and Afford18 able Care Act (42 U.S.C. 18082) is amended— 

19 (A) by striking subsection (d); and 

20 (B) by redesignating subsection (e) as sub21 section (d). 

22 (5) REQUIREMENT TO MAINTAIN MINIMUM ES23 SENTIAL COVERAGE.—Section 5000A(d) of the In24 ternal Revenue Code of 1986 is amended— 

25 (A) by striking paragraph (3); and 


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1 (B) by redesignating paragraph (4) as 

2 paragraph (3). 

3 (b) CONFORMING AMENDMENTS.— 

4 (1) ESTABLISHMENT OF PROGRAM.—Section 

5 1411(a) of the Patient Protection and Affordable 

6 Care Act (42 U.S.C. 18081(a)) is amended— 

7 (A) by striking paragraph (1); and 

8 (B) by redesignating paragraphs (2), (3), 

9 and (4) as paragraphs (1), (2), and (3), respec10 tively. 

11 (2) QUALIFIED INDIVIDUALS.—Section 1312(f) 

12 of the Patient Protection and Affordable Care Act 

13 (42 U.S.C. 18032(f)) is amended— 

14 (A) in the heading, by striking ‘‘; ACCESS

15 LIMITED TO CITIZENS AND LAWFUL RESI16 DENTS’’; and 

17 (B) by striking paragraph (3). 

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

19 this section shall apply to years, plan years, and taxable 

20 years, as applicable, beginning after December 31, 2024. 

21 SEC. 4006. HEAL FOR IMMIGRANT FAMILIES ACT. 

22 (a) CONSISTENCY IN HEALTH INSURANCE COV23 ERAGE FOR INDIVIDUALS WITH FEDERALLY AUTHOR24 IZED PRESENCE, INCLUDING DEFERRED ACTION.— 


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1 (1) IN GENERAL.—For purposes of eligibility 

2 under any of the provisions described in paragraph 

3 (2), all individuals granted federally authorized pres4 ence in the United States shall be considered to be 

5 lawfully present in the United States. 

6 (2) PROVISIONS DESCRIBED.—The provisions 

7 described in this paragraph are the following: 

8 (A) EXCHANGE ELIGIBILITY.—Section 

9 1411 of the Patient Protection and Affordable 

10 Care Act (42 U.S.C. 18031). 

11 (B) REDUCED COST-SHARING ELIGI12 BILITY.—Section 1402 of the Patient Protec13 tion and Affordable Care Act (42 U.S.C. 

14 18071). 

15 (C) PREMIUM SUBSIDY ELIGIBILITY.—Sec16 tion 36B of the Internal Revenue Code of 1986 

17 (26 U.S.C. 36B). 

18 (D) MEDICAID AND CHIP ELIGIBILITY.— 

19 Titles XIX and XXI of the Social Security Act, 

20 including under section 1903(v) of such Act (42 

21 U.S.C. 1396b(v)). 

22 (3) EFFECTIVE DATE.— 

23 (A) IN GENERAL.—Paragraph (1) shall 

24 take effect on the date of enactment of this Act. 


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1 (B) TRANSITION THROUGH SPECIAL EN2 ROLLMENT PERIOD.—In the case of an indi3 vidual described in paragraph (1) who, before 

4 the first day of the first annual open enrollment 

5 period under subparagraph (B) of section 

6 1311(c)(6) of the Patient Protection and Af7 fordable Care Act (42 U.S.C. 18031(c)(6)) be8 ginning after the date of enactment of this Act, 

9 is granted federally authorized presence in the 

10 United States and who, as a result of such sub11 section, qualifies for a subsidy under a provi12 sion described in subparagraph (B) or (C) of 

13 paragraph (2), the Secretary of Health and 

14 Human Services shall establish a special enroll15 ment period under subparagraph (C) of such 

16 section 1311(c)(6) during which such individual 

17 may enroll in qualified health plans through 

18 Exchanges under title I of the Patient Protec19 tion and Affordable Care Act and qualify for 

20 such a subsidy. For such an individual who has 

21 been granted federally authorized presence in 

22 the United States as of the date of enactment 

23 of this Act, such special enrollment period shall 

24 begin not later than 90 days after such date of 

25 enactment. Nothing in this paragraph shall be 


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1 construed as affecting the authority of the Sec2 retary to establish additional special enrollment 

3 periods under such subparagraph (C). 

4 (b) STATE OPTION TO EXPAND MEDICAID AND

5 CHIP TO INDIVIDUALS WITHOUT LAWFUL PRESENCE.— 

6 (1) MEDICAID.— 

7 (A) IN GENERAL.—Section 

8 1902(a)(10)(A)(ii) of the Social Security Act 

9 (42 U.S.C. 1396a(a)(10)(A)(ii)) is amended— 

10 (i) in subclause (XXII), by striking 

11 ‘‘or’’ at the end; 

12 (ii) in subclause (XXIII), by striking 

13 the semicolon and inserting ‘‘; or’’; and 

14 (iii) by adding at the end the fol15 lowing new subclause: 

16 ‘‘(XXIV) who would be eligible 

17 under the State plan (or waiver of 

18 such plan) under this title if they were 

19 citizens of the United States;’’. 

20 (B) CONFORMING AMENDMENT.—Section 

21 1905(a) of the Social Security Act (42 U.S.C. 

22 1396d(a)) is amended, in the matter preceding 

23 paragraph (1)— 

24 (i) in the matter designated as clause 

25 (xvi), by striking ‘‘or’’ at the end; 


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1 (ii) in the matter designated as clause 

2 (xvii), by adding ‘‘or’’ at the end; and 

3 (iii) by inserting after the matter des4 ignated as clause (xvii) the following: 

5 ‘‘(xviii) individuals described in section 

6 1902(a)(10)(A)(ii)(XXIV),’’. 

7 (2) CHIP.—Title XXI of the Social Security 

8 Act (42 U.S.C. 1397aa et seq.) is amended by in9 serting after section 2112 the following new section: 

10 ‘‘SEC. 2112A. STATE OPTION TO PROVIDE COVERAGE FOR 

11 INDIVIDUALS WITHOUT LAWFUL PRESENCE. 

12 ‘‘A State may elect through an amendment to its 

13 State child health plan under section 2102 to treat an in14 dividual as a targeted low-income child or a targeted low15 income pregnant woman for purposes of this title if such 

16 individual would otherwise be included as such a child or 

17 such a pregnant woman (as applicable) under such plan 

18 if the individual were a citizen of the United States.’’. 

19 (3) NONAPPLICATION OF ELIGIBILITY PROHIBI20 TION.—Section 401(a) of the Personal Responsi21 bility and Work Opportunity Reconciliation Act of 

22 1996 (42 U.S.C. 1611(a)) is amended by adding at 

23 the end the following new sentence: ‘‘The preceding 

24 sentence shall not apply with respect to a nonciti25 zen’s eligibility under a State plan (or waiver of such 


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1 plan) under title XIX of the Social Security Act or 

2 under a State child health plan (or waiver of such 

3 plan) under title XXI of such Act to the extent that 

4 such State has elected to make such individual so el5 igible pursuant to section 1902(a)(10)(A)(ii)(XXIV) 

6 or 2112A of such Act, respectively.’’. 

7 (c) PRESERVING ACCESS TO COVERAGE.— 

8 (1) IN GENERAL.—Nothing in this section, in9 cluding the amendments made by this section, shall 

10 prevent lawfully present noncitizens who are ineli11 gible for full benefits under the Medicaid program 

12 under title XIX of the Social Security Act from se13 curing a credit for which such lawfully present non14 citizens would be eligible under section 36B(c)(1)(B) 

15 of the Internal Revenue Code of 1986 and under the 

16 Medicaid provisions for lawfully present noncitizens, 

17 as in effect on the date prior to the date of enact18 ment of this Act. 

19 (2) DEFINITION.—For purposes of paragraph 

20 (1), the term ‘‘full benefits’’ means, with respect to 

21 an individual and State, medical assistance for all 

22 services covered under the State plan under title 

23 XIX of the Social Security Act that is not less in 

24 amount, duration, or scope, or is determined by the 

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1 stantially equivalent to the medical assistance avail2 able for an individual described in section 

3 1902(a)(10)(A)(i) of the Social Security Act (42 

4 U.S.C. 1396a(a)(10)(A)(i)). 

5 SEC. 4007. STUDY ON THE UNINSURED. 

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

7 Human Services (in this section referred to as the ‘‘Sec8 retary’’) shall— 

9 (1) conduct a study, in accordance with the 

10 standards under section 3101 of the Public Health 

11 Service Act (42 U.S.C. 300kk), on the demographic 

12 characteristics of the population of individuals who 

13 do not have health insurance or oral health coverage; 

14 and 

15 (2) predict, based on such study, the demo16 graphic characteristics of the population of individ17 uals who would remain without health insurance 

18 after the end of any annual open enrollment or any 

19 special enrollment period or upon enactment and im20 plementation of any legislative changes to the Pa21 tient Protection and Affordable Care Act (Public 

22 Law 111–148) that affect the number of persons eli23 gible for health insurance. 

24 (b) REPORTING REQUIREMENTS.— 


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1 (1) IN GENERAL.—Not later than 12 months 

2 after the date of the enactment of this Act, the Sec3 retary shall submit to the Congress the results of 

4 the study under subsection (a)(1) and the prediction 

5 made under subsection (a)(2). 

6 (2) REPORTING OF DEMOGRAPHIC CHARACTER7 ISTICS.—The Secretary shall— 

8 (A) report the demographic characteristics 

9 under paragraphs (1) and (2) of subsection (a) 

10 on the basis of racial and ethnic minority group 

11 (as defined in section 1707(g)(1) of the Public 

12 Health Service Act), and stratify the reporting 

13 on each racial and ethnic minority group by 

14 other demographic characteristics that can im15 pact access to health insurance, such as sexual 

16 orientation, gender identity, primary language, 

17 disability status, sex, socioeconomic status, age 

18 group, citizenship, and immigration status, in a 

19 manner consistent with title I of this Act, in20 cluding the amendments made by such title; 

21 and 

22 (B) not use such report, or any informa23 tion gathered in preparing such report— 

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1 ment action by any entity, including the 

2 Department of Homeland Security; or 

3 (ii) for the exploitation of, or discrimi4 nation against, communities of color or the 

5 LGBTQ+ population. 

6 SEC. 4008. MEDICAID FALLBACK COVERAGE PROGRAM FOR 

7 LOW-INCOME ADULTS IN NON-EXPANSION 

8 STATES. 

9 (a) IN GENERAL.—As soon as possible after the date 

10 of enactment of this Act the Secretary of Health and 

11 Human Services (in this section referred to as the ‘‘Sec12 retary’’) shall— 

13 (1) directly or by contract, establish a program 

14 that offers eligible individuals the opportunity to en15 roll in health benefits coverage that meets the re16 quirements described in subsection (c) and any re17 quirements applicable to such coverage pursuant to 

18 subsection (d); and 

19 (2) ensure that such program is administered 

20 consistent with the requirements of section 

21 431.10(c)(2) of title 42, Code of Federal Regula22 tions. 

23 (b) DEFINITION OF ELIGIBLE INDIVIDUAL.—In this 

24 section, the term ‘‘eligible individual’’ means an individual 

25 who— 


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1 (1) is described in section 

2 1902(a)(10)(A)(i)(VIII) of the Social Security Act 

3 (42 U.S.C. 1396a(a)(10)(A)(i)(VIII)); 

4 (2) resides in a State that— 

5 (A) does not expend amounts for medical 

6 assistance under title XIX of the Social Secu7 rity Act (42 U.S.C. 1396 et seq.) for all individ8 uals described in such section; and 

9 (B) did not expend amounts for medical 

10 assistance under such title for all such individ11 uals as of the date of enactment of this Act; 

12 and 

13 (3) would not be eligible for medical assistance 

14 under such State’s plan for medical assistance under 

15 title XIX of the Social Security Act (42 U.S.C. 1396 

16 et seq.), or a waiver of such plan, as such plan or 

17 waiver was in effect on such date. 

18 (c) HEALTH BENEFITS COVERAGE REQUIRE19 MENTS.—The requirements described in this subsection 

20 with respect to health benefits coverage are the following: 

21 (1) ESSENTIAL HEALTH BENEFITS.—At a min22 imum, the coverage meets the minimum standards 

23 required under paragraph (5) of section 1937(b) of 

24 the Social Security Act (42 U.S.C. 1396u–7(b)) for 

25 benchmark coverage described in paragraph (1) of 


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1 such section or benchmark equivalent coverage de2 scribed in paragraph (2) of such section. 

3 (2) PREMIUMS AND COST-SHARING.—No pre4 miums are imposed for the coverage, and deduct5 ibles, cost-sharing, or similar charges may only be 

6 imposed in accordance with the requirements im7 posed on State Medicaid plans under section 1916 of 

8 the Social Security Act (42 U.S.C. 1396o). 

9 (d) APPLICATION OF REQUIREMENTS AND PROVI10 SIONS OF TITLE XIX OF THE SOCIAL SECURITY ACT.— 

11 The Secretary shall specify that— 

12 (1) any requirement applicable to the furnishing 

13 of medical assistance under title XIX of the Social 

14 Security Act (42 U.S.C. 1396 et seq.) by States that 

15 have elected to make medical assistance available to 

16 individuals described in section 

17 1902(a)(10)(A)(i)(VIII) of such title (42 U.S.C. 

18 1396a(a)(10)(A)(i)(VIII)) that does not conflict with 

19 the requirements specified in subsection (c) applies 

20 to the program established under this section; and 

21 (2) other provisions of such title apply to such 

22 program. 

23 (e) NO STATE MANDATE.—Nothing in this section 

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1 tures related to the program established under this section 

2 and the Secretary shall not impose any such requirement. 

3 (f) FUNDING.—There are appropriated to the Sec4 retary for each fiscal year beginning with fiscal year 2025 

5 from any funds in the Treasury not otherwise appro6 priated, such sums as are necessary to carry out this sec7 tion. 

8 SEC. 4009. INCREASE AND EXTENSION OF TEMPORARY EN9 HANCED FMAP FOR STATES WHICH BEGIN TO 

10 EXPEND AMOUNTS FOR CERTAIN MANDA11 TORY INDIVIDUALS. 

12 (a) IN GENERAL.—Section 1905(ii)(1) of the Social 

13 Security Act (42 U.S.C. 1396d(ii)(1)) is amended— 

14 (1) by striking ‘‘8-quarter period’’ and inserting 

15 ‘‘40-quarter period’’; and 

16 (2) by striking ‘‘5 percentage points’’ and in17 serting ‘‘10 percentage points’’. 

18 (b) EFFECTIVE DATE.—The amendments made by 

19 this section shall take effect as if included in the enact20 ment of section 9814 of the American Rescue Plan Act 

21 of 2021 (Public Law 117–2). 


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1 Subtitle B—Improvement of 

2 Coverage 

3 SEC. 4101. MEDICAID IN THE TERRITORIES. 

4 (a) ELIMINATION OF GENERAL MEDICAID FUNDING

5 LIMITATIONS (‘‘CAP’’) FOR TERRITORIES.— 

6 (1) IN GENERAL.—Section 1108 of the Social 

7 Security Act (42 U.S.C. 1308) is amended— 

8 (A) in subsection (f), in the matter pre9 ceding paragraph (1), by striking ‘‘subsections 

10 (g) and (h)’’ and inserting ‘‘subsections (g), 

11 (h), and (j)’’; 

12 (B) in subsection (g)(2), in the matter pre13 ceding subparagraph (A), by inserting ‘‘sub14 section (j) and’’ after ‘‘subject to’’; 

15 (C) in subsection (i), by striking paragraph 

16 (4); and 

17 (D) by adding at the end the following new 

18 subsection: 

19 ‘‘(j) SUNSET OF MEDICAID FUNDING LIMITATIONS

20 FOR PUERTO RICO, THE VIRGIN ISLANDS, GUAM, THE

21 NORTHERN MARIANA ISLANDS, AND AMERICAN SAMOA.— 

22 Subsections (f) and (g) shall not apply to Puerto Rico, 

23 the Virgin Islands, Guam, the Northern Mariana Islands, 

24 and American Samoa beginning with fiscal year 2025.’’. 

25 (2) CONFORMING AMENDMENTS.— 


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1 (A) Section 1902(j) of the Social Security 

2 Act (42 U.S.C. 1396a(j)) is amended by strik3 ing ‘‘, the limitation in section 1108(f),,’’. 

4 (B) Section 1903(u) of the Social Security 

5 Act (42 U.S.C. 1396b(u)) is amended by strik6 ing paragraph (4). 

7 (3) EFFECTIVE DATE.—The amendments made 

8 by this subsection shall apply beginning with fiscal 

9 year 2025. 

10 (b) ELIMINATION OF SPECIFIC FEDERAL MEDICAL

11 ASSISTANCE PERCENTAGE (FMAP) LIMITATION FOR

12 PUERTO RICO.—Section 1905 of the Social Security Act 

13 (42 U.S.C. 1396d) is amended— 

14 (1) in subsection (b), in the first sentence, by 

15 inserting ‘‘for fiscal years before fiscal year 2026’’ 

16 after ‘‘American Samoa’’; and 

17 (2) in subsection (ff)(2), by striking ‘‘2027’’ 

18 and inserting ‘‘2025’’. 

19 (c) PERMITTING MEDICAID DSH ALLOTMENTS FOR

20 TERRITORIES.—Section 1923(f) of the Social Security Act 

21 (42 U.S.C. 1396r–4(f)) is amended— 

22 (1) in paragraph (6), by adding at the end the 

23 following new subparagraph: 

24 ‘‘(C) TERRITORIES.— 


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1 ‘‘(i) FISCAL YEAR 2025.—For fiscal 

2 year 2025, the DSH allotment for Puerto 

3 Rico, the Virgin Islands, Guam, the North4 ern Mariana Islands, and American Samoa 

5 shall bear the same ratio to $300,000,000 

6 as the ratio of the number of individuals 

7 who are low-income or uninsured and re8 siding in such respective territory (as esti9 mated from time to time by the Secretary) 

10 bears to the sums of the number of such 

11 individuals residing in all of the territories. 

12 ‘‘(ii) SUBSEQUENT FISCAL YEAR.— 

13 For each subsequent fiscal year, the DSH 

14 allotment for each such territory is subject 

15 to an increase in accordance with para16 graph (3).’’; and 

17 (2) in paragraph (9), by inserting before the pe18 riod at the end the following: ‘‘, and includes, begin19 ning with fiscal year 2025, Puerto Rico, the Virgin 

20 Islands, Guam, the Northern Mariana Islands, and 

21 American Samoa’’. 


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1 SEC. 4102. EXTENSION OF THE SUPPLEMENTAL SECURITY 

2 INCOME PROGRAM TO PUERTO RICO, THE 

3 UNITED STATES VIRGIN ISLANDS, GUAM, AND 

4 AMERICAN SAMOA. 

5 (a) IN GENERAL.—Section 303 of the Social Security 

6 Amendments of 1972 (86 Stat. 1484) is amended by strik7 ing subsection (b). 

8 (b) CONFORMING AMENDMENTS.— 

9 (1) DEFINITION OF STATE.—Section 

10 1101(a)(1) of the Social Security Act (42 U.S.C. 

11 1301(a)(1)) is amended by striking the 5th sentence 

12 and inserting the following: ‘‘Such term when used 

13 in title XVI includes Puerto Rico, the United States 

14 Virgin Islands, Guam, and American Samoa.’’. 

15 (2) ELIMINATION OF LIMIT ON TOTAL PAY16 MENTS TO THE TERRITORIES.—Section 1108 of 

17 such Act (42 U.S.C. 1308) is amended— 

18 (A) in the section heading, by striking ‘‘; 

19 LIMITATION ON TOTAL PAYMENTS’’; 

20 (B) by striking subsection (a); and 

21 (C) in subsection (c), by striking para22 graphs (2) and (4) and redesignating para23 graphs (3) and (5) as paragraphs (2) and (4), 

24 respectively. 


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1 (3) UNITED STATES NATIONALS TREATED THE

2 SAME AS CITIZENS.—Section 1614(a)(1)(B) of such 

3 Act (42 U.S.C. 1382c(a)(1)(B)) is amended— 

4 (A) in clause (i)(I), by inserting ‘‘or na5 tional,’’ after ‘‘citizen’’; 

6 (B) in clause (i)(II), by adding ‘‘; or’’ at 

7 the end; and 

8 (C) in clause (ii), by inserting ‘‘or na9 tional’’ after ‘‘citizen’’. 

10 (4) TERRITORIES INCLUDED IN GEOGRAPHIC

11 MEANING OF UNITED STATES.—Section 1614(e) of 

12 such Act (42 U.S.C. 1382c(e)) is amended by strik13 ing ‘‘and the District of Columbia’’ and inserting ‘‘, 

14 the District of Columbia, Puerto Rico, the United 

15 States Virgin Islands, Guam, and American 

16 Samoa’’. 

17 (c) WAIVER AUTHORITY.—The Commissioner of So18 cial Security may waive or modify any statutory require19 ment relating to the provision of benefits under the Sup20 plemental Security Income Program under title XVI of the 

21 Social Security Act in Puerto Rico, the United States Vir22 gin Islands, Guam, or American Samoa, to the extent that 

23 the Commissioner deems it necessary in order to adapt 

24 the program to the needs of the territory involved. 


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1 (d) EFFECTIVE DATE.—This section and the amend2 ments made by this section shall take effect on the 1st 

3 day of the 1st Federal fiscal year that begins 1 year or 

4 more after the date of the enactment of this Act. 

5 SEC. 4103. EXTENSION OF MEDICARE SECONDARY PAYER. 

6 (a) IN GENERAL.—Section 1862(b)(1)(C) of the So7 cial Security Act (42 U.S.C. 1395y(b)(1)(C)) is amend8 ed— 

9 (1) in the last sentence, by inserting ‘‘, and be10 fore January 1, 2025’’ after ‘‘prior to such date)’’; 

11 and 

12 (2) by adding at the end the following new sen13 tence: ‘‘Effective for items and services furnished on 

14 or after January 1, 2025 (with respect to periods 

15 beginning on or after the date that is 42 months 

16 prior to such date), clauses (i) and (ii) shall be ap17 plied by substituting ‘42-month’ for ‘12-month’ each 

18 place it appears.’’. 

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

20 this section shall take effect on the date of enactment of 

21 this Act. For purposes of determining an individual’s sta22 tus under section 1862(b)(1)(C) of the Social Security Act 

23 (42 U.S.C. 1395y(b)(1)(C)), as amended by subsection 

24 (a), an individual who is within the coordinating period 

25 as of the date of enactment of this Act shall have that 


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1 period extended to the full 42 months described in the last 

2 sentence of such section, as added by the amendment 

3 made by subsection (a)(2). 

4 SEC. 4104. INDIAN DEFINED IN TITLE I OF THE PATIENT 

5 PROTECTION AND AFFORDABLE CARE ACT. 

6 (a) DEFINITION OF INDIAN.—Section 1304 of the 

7 Patient Protection and Affordable Care Act (42 U.S.C. 

8 18024) is amended by adding at the end the following: 

9 ‘‘(f) INDIAN.—In this title: 

10 ‘‘(1) IN GENERAL.—The term ‘Indian’ means— 

11 ‘‘(A) an Indian, a California Indian, or an 

12 Urban Indian (as those terms are defined in 

13 section 4 of the Indian Health Care Improve14 ment Act (25 U.S.C. 1603)); or 

15 ‘‘(B) an individual who is of Indian de16 scent and a member of an Indian community 

17 served by a local facility or program of the In18 dian Health Service. 

19 ‘‘(2) INCLUSIONS.—The term ‘Indian’ includes 

20 the following individuals: 

21 ‘‘(A) A member of a federally recognized 

22 Indian Tribe. 

23 ‘‘(B) A resident of an urban center who 

24 meets 1 or more of the following criteria: 


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1 ‘‘(i) A member of a Tribe, band, or 

2 other organized group of Indians, including 

3 those Tribes, bands, or groups terminated 

4 since 1940 and those recognized as of the 

5 date of enactment of the Health Equity 

6 and Accountability Act of 2024 or later by 

7 the State in which they reside, or being a 

8 descendant, in the first or second degree, 

9 of any such member. 

10 ‘‘(ii) An Eskimo or Aleut or other 

11 Alaska Native. 

12 ‘‘(iii) An individual who is determined 

13 to be an Indian under regulations promul14 gated by the Secretary. 

15 ‘‘(C) An individual who is considered by 

16 the Secretary of the Interior to be an Indian for 

17 any purpose. 

18 ‘‘(D) An individual who is considered by 

19 the Secretary to be an Indian for purposes of 

20 eligibility for services provided by the Indian 

21 Health Service, including as a California In22 dian, Eskimo, Aleut, or other Alaska Native.’’. 

23 (b) CONFORMING AMENDMENTS.— 

24 (1) AFFORDABLE CHOICES OF HEALTH BEN25 EFIT PLANS.—Section 1311(c)(6)(D) of the Patient 


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1 Protection and Affordable Care Act (42 U.S.C. 

2 18031(c)(6)(D)) is amended by striking ‘‘(as defined 

3 in section 4 of the Indian Health Care Improvement 

4 Act)’’. 

5 (2) REDUCED COST-SHARING FOR INDIVIDUALS

6 ENROLLING IN QUALIFIED HEALTH PLANS.—Section 

7 1402(d) of the Patient Protection and Affordable 

8 Care Act (42 U.S.C. 18071(d)) is amended— 

9 (A) in paragraph (1), in the matter pre10 ceding subparagraph (A), by striking ‘‘(as de11 fined in section 4(d) of the Indian Self-Deter12 mination and Education Assistance Act (25 

13 U.S.C. 450b(d)))’’; and 

14 (B) in paragraph (2), in the matter pre15 ceding subparagraph (A), by striking ‘‘(as so 

16 defined)’’. 

17 (3) EXEMPTION FROM PENALTY FOR NOT

18 MAINTAINING MINIMUM ESSENTIAL COVERAGE.— 

19 Section 5000A(e) of the Internal Revenue Code of 

20 1986 is amended by striking paragraph (3) and in21 serting the following: 

22 ‘‘(3) INDIANS.—Any applicable individual who 

23 is an Indian (as defined in section 1304(f) of the 

24 Patient Protection and Affordable Care Act).’’. 


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1 (c) EFFECTIVE DATE OF IRC AMENDMENT.—The 

2 amendment made by subsection (b)(3) shall apply to tax3 able years beginning after the date of the enactment of 

4 this Act. 

5 SEC. 4105. REMOVING MEDICARE BARRIER TO HEALTH 

6 CARE. 

7 (a) PART A.—Section 1818(a)(3)(B) of the Social 

8 Security Act (42 U.S.C. 1395i–2(a)(3)(B)) is amended by 

9 striking ‘‘an alien’’ and all that follows through ‘‘under 

10 this section’’ and inserting ‘‘an individual who is lawfully 

11 present in the United States’’. 

12 (b) PART B.—Section 1836(a)(2)(B) of the Social 

13 Security Act (42 U.S.C. 1395o(a)(2)(B)) is amended by 

14 striking ‘‘an alien’’ and all that follows through ‘‘under 

15 this part’’ and inserting ‘‘an individual who is lawfully 

16 present in the United States’’. 

17 SEC. 4106. LOWERING MEDICARE PREMIUMS AND PRE18 SCRIPTION DRUG COSTS. 

19 (a) MEDICARE COST ASSISTANCE PROGRAM.— 

20 (1) IN GENERAL.—Title XVIII of the Social Se21 curity Act (42 U.S.C. 1395 et seq.) is amended by 

22 adding at the end the following new section: 

23 ‘‘SEC. 1899C. MEDICARE COST ASSISTANCE PROGRAM. 

24 ‘‘(a) IN GENERAL.—Effective beginning January 1, 

25 2025, in the case of a Medicare Cost Assistance Program 


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1 eligible individual (as defined in subsection (b)(1)), the 

2 Secretary shall provide Medicare cost assistance for the 

3 following costs incurred with respect to the individual: 

4 ‘‘(1) Premiums under section 1818. 

5 ‘‘(2) Premiums under section 1839. 

6 ‘‘(3) Coinsurance under this title (including co7 insurance described in section 1813). 

8 ‘‘(4) Deductibles established under this title (in9 cluding those described in section 1813 and section 

10 1833(b)). 

11 ‘‘(5) The difference between the amount that is 

12 paid under section 1833(a) and the amount that 

13 would be paid under such section if any reference to 

14 a percent less than 100 percent therein were deemed 

15 a reference to ‘100 percent’. 

16 ‘‘(b) DETERMINATION OF ELIGIBILITY.— 

17 ‘‘(1) MEDICARE COST ASSISTANCE PROGRAM

18 ELIGIBLE INDIVIDUAL DEFINED.—The term ‘Medi19 care Cost Assistance Program eligible individual’ 

20 means an individual who— 

21 ‘‘(A) is eligible for, and is receiving, med22 ical assistance for the payment of medicare 

23 cost-sharing under a State Medicaid program 

24 pursuant to clause (i), (iii), or (iv) of section 

25 1902(a)(10)(E) as of December 31, 2024; or 


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1 ‘‘(B)(i) is entitled to hospital insurance 

2 benefits under part A (including an individual 

3 entitled to such benefits pursuant to an enroll4 ment under section 1818); and 

5 ‘‘(ii) has income at or below 200 percent of 

6 the poverty line applicable to a family of the 

7 size involved. 

8 ‘‘(2) JOINT DETERMINATION BY COMMISSIONER

9 OF SOCIAL SECURITY FOR LIS AND MEDICARE COST

10 ASSISTANCE.— 

11 ‘‘(A) IN GENERAL.—The determination of 

12 whether an individual is a Medicare Cost As13 sistance Program eligible individual shall be de14 termined by the Commissioner of Social Secu15 rity (referred to in this section as the ‘Commis16 sioner’) jointly with the determination of wheth17 er an individual is a subsidy eligible individual 

18 described in section 1860D–14(a)(3). Such de19 termination shall be made with respect to eligi20 bility for Medicare cost assistance under this 

21 section and premium and cost-sharing subsidies 

22 under section 1860D–14 upon application of an 

23 individual for a determination with respect to 

24 eligibility for either such assistance or such sub25 sidies. There are authorized to be appropriated 


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1 to the Social Security Administration such 

2 sums as may be necessary for the determination 

3 of eligibility under this paragraph. 

4 ‘‘(B) EFFECTIVE PERIOD.—Determina5 tions under this paragraph with respect to eligi6 bility for each of such assistance or such sub7 sidies shall be effective beginning with the 

8 month in which the individual applies for a de9 termination described in subparagraph (A) and 

10 shall remain in effect until such time as the 

11 Secretary determines the individual is no longer 

12 eligible as determined under subparagraph 

13 (C)(ii). 

14 ‘‘(C) REDETERMINATIONS.—With respect 

15 to eligibility determinations under this para16 graph— 

17 ‘‘(i) redeterminations shall be made at 

18 the same time with respect to eligibility for 

19 Medicare cost assistance under this section 

20 and cost-sharing subsidies under section 

21 1860D–14, but not more frequently than 

22 once every 12 months; 

23 ‘‘(ii) a redetermination shall automati24 cally determine that an individual remains 


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1 eligible for such assistance or subsidies un2 less— 

3 ‘‘(I) the Commissioner has infor4 mation indicating that the individual’s 

5 circumstances have changed such that 

6 the individual is no longer eligible for 

7 such assistance or subsidies; 

8 ‘‘(II) the Commissioner sends no9 tice to the individual regarding such 

10 information that requests a response 

11 either confirming or correcting such 

12 information; and 

13 ‘‘(III) the individual either con14 firms such information or fails to pro15 vide documentation indicating that 

16 such circumstances have not changed 

17 within 60 days of receiving the notice 

18 described in subclause (II); 

19 ‘‘(iii) the Commissioner shall establish 

20 procedures for appeals of such determina21 tions that are similar to the procedures de22 scribed in the third sentence of section 

23 1631(c)(1)(A); and 

24 ‘‘(iv) judicial review of the final deci25 sion of the Commissioner made after a 


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1 hearing shall be available to the same ex2 tent, and with the same limitations, as pro3 vided in subsections (g) and (h) of section 

4 205. 

5 ‘‘(D) TREATMENT OF MEDICAID BENE6 FICIARIES.—The Secretary shall provide that 

7 individuals who are full-benefit dual eligible in8 dividuals (as defined in section 1935(c)(6)) or 

9 who are recipients of supplemental security in10 come benefits under title XVI shall be treated 

11 as a Medicare Cost Assistance Program eligible 

12 individual and, in the case of such individual 

13 who is a part D eligible individual, a subsidy el14 igible individual described in section 1860D– 

15 14(a)(3). 

16 ‘‘(E) SIMPLIFIED APPLICATION FORM.— 

17 ‘‘(i) IN GENERAL.—The Secretary 

18 shall develop and distribute a simplified 

19 application form for use by individuals in 

20 applying for Medicare cost assistance 

21 under this section and premium and cost22 sharing subsidies under section 1860D–14. 

23 Such form shall be easily readable based 

24 on culturally fluid language for all demo25 graphics beyond just the various languages 


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1 offered. An audio version, digital version, 

2 and photo-voice option should also be pro3 vided for all learners. The Secretary shall 

4 provide for the translation of such applica5 tion form into at least the 10 languages 

6 (other than English) that are most often 

7 used by individuals applying for hospital 

8 insurance benefits under section 226 or 

9 226A and shall make the translated forms 

10 available to the Commissioner of Social Se11 curity. 

12 ‘‘(ii) CONSULTATION.—In developing 

13 the form under clause (i), the Secretary 

14 shall consult with beneficiary groups. 

15 ‘‘(3) INCOME DETERMINATIONS.—For purposes 

16 of applying this section— 

17 ‘‘(A) in the case of an individual who is 

18 not treated as a Medicare Cost Assistance Pro19 gram eligible individual or a subsidy eligible in20 dividual under paragraph (2)(D), income shall 

21 be determined in the manner described under 

22 section 1612 for purposes of the supplemental 

23 security income program, except that support 

24 and maintenance furnished in kind shall not be 

25 counted as income; and 


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1 ‘‘(B) the term ‘poverty line’ has the mean2 ing given such term in section 673(2) of the 

3 Community Services Block Grant Act (42 

4 U.S.C. 9902(2)), including any revision re5 quired by such section. 

6 ‘‘(c) BENEFICIARY PROTECTIONS.— 

7 ‘‘(1) IN GENERAL.—In the case in which the 

8 payment for Medicare cost assistance for a Medicare 

9 Cost Assistance Program eligible individual with re10 spect to an item or service is reduced or eliminated, 

11 the individual shall not have any legal liability to 

12 make payment to a provider of services (as defined 

13 in section 1861(u)), a supplier (as defined in section 

14 1861(d)), or to an organization described in section 

15 1903(m)(1)(A) for the service, and any lawful sanc16 tion that may be imposed upon a provider of serv17 ices, a supplier, or such an organization for excess 

18 charges under this title or title XIX shall apply to 

19 the imposition of any charge imposed upon the indi20 vidual in such case. 

21 ‘‘(2) CLARIFICATION.—This paragraph shall 

22 not be construed as preventing payment of any 

23 medicare cost assistance by a medicare supplemental 

24 policy or an employer retiree health plan on behalf 

25 of an individual. 


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1 ‘‘(d) ADMINISTRATION.— 

2 ‘‘(1) IN GENERAL.—The Secretary shall estab3 lish procedures for the administration of the pro4 gram under this section. 

5 ‘‘(2) FUNDING.—For purposes of carrying out 

6 this section, the Secretary shall make payments from 

7 the Federal Hospital Insurance Trust Fund under 

8 section 1817 and the Federal Supplementary Med9 ical Insurance Trust Fund under section 1841, in 

10 such proportion as the Secretary determines appro11 priate, of such amounts as the Secretary determines 

12 necessary to provide Medicare cost assistance under 

13 this section. 

14 ‘‘(e) REFERENCES TO MEDICARE COST-SHARING.— 

15 Effective beginning January 1, 2025, any reference to 

16 medicare cost-sharing described in section 1905(p) shall 

17 be deemed a reference to Medicare cost assistance under 

18 this section. 

19 ‘‘(f) OUTREACH EFFORTS.—For provisions relating 

20 to outreach efforts to increase awareness of the availability 

21 of Medicare cost assistance, see section 1144.’’. 

22 (2) SPECIAL ENROLLMENT PERIOD.— 

23 (A) NO PREMIUM PENALTY.—Section 

24 1839(b) of the Social Security Act (42 U.S.C. 

25 1395r(b)) is amended, in the last sentence, by 


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1 inserting the following before the period: ‘‘or, 

2 effective beginning January 1, 2025, for indi3 viduals who are Medicare Cost Assistance Pro4 gram eligible individuals (as defined in section 

5 1899C(b)(1)).’’. 

6 (B) SPECIAL ENROLLMENT PERIOD.—Sec7 tion 1837 of the Social Security Act (42 U.S.C. 

8 1395p) is amended by adding at the end the 

9 following new subsection: 

10 ‘‘(p) SPECIAL ENROLLMENT PERIOD FOR MEDICARE

11 COST ASSISTANCE PROGRAM ELIGIBLE INDIVIDUAL.— 

12 ‘‘(1) IN GENERAL.—Effective beginning Janu13 ary 1, 2025, the Secretary shall establish special en14 rollment periods for Medicare Cost Assistance Pro15 gram eligible individuals (as defined in section 

16 1899C(b)(1)). 

17 ‘‘(2) COVERAGE PERIOD.—In the case of an in18 dividual who enrolls during the special enrollment 

19 period provided under paragraph (1), the coverage 

20 period under this part shall— 

21 ‘‘(A) begin on the first day of the first 

22 month in which the individual applies for a de23 termination under section 1899C(b)(2)(A); and 

24 ‘‘(B) remain in effect until such time as 

25 the Secretary determines the individual is no 


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1 longer eligible as determined under section 

2 1899C(b)(2)(C)(ii).’’. 

3 (C) CONFORMING SUNSET OF STATE

4 AGREEMENTS RELATING TO ENROLLMENT OF

5 QUALIFIED MEDICARE BENEFICIARIES.— 

6 (i) PART A.—Section 1818(g) of the 

7 Social Security Act (42 U.S.C. 1395i–2(g)) 

8 is amended by adding at the end the fol9 lowing new paragraph: 

10 ‘‘(3) SUNSET.—This subsection shall not apply on or 

11 after January 1, 2025.’’. 

12 (ii) PART B.—Section 1843(h) of the 

13 Social Security Act (42 U.S.C. 1395v(h)) 

14 is amended by adding at the end the fol15 lowing new paragraph: 

16 ‘‘(4) SUNSET WITH RESPECT TO QUALIFIED MEDI17 CARE BENEFICIARIES.—This subsection shall not apply 

18 with respect to qualified medicare beneficiaries on or after 

19 January 1, 2025.’’. 

20 (3) PUBLIC AWARENESS CAMPAIGN.—Section 

21 1144 of the Social Security Act (42 U.S.C. 1320b– 

22 14) is amended by adding at the end the following 

23 new subsection: 

24 ‘‘(d) PUBLIC AWARENESS CAMPAIGN.— 


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1 ‘‘(1) IN GENERAL.—The Commissioner shall 

2 conduct a public awareness campaign to educate 

3 Medicare beneficiaries on the availability of Medicare 

4 cost assistance for low-income individuals under sec5 tion 1899C. 

6 ‘‘(2) COORDINATION.—In carrying out the pub7 lic awareness campaign under paragraph (1), the 

8 Commissioner shall coordinate with State health in9 surance assistance programs described in subsection 

10 (a)(1)(A) of section 119 of the Medicare Improve11 ments for Patients and Providers Act of 2008 (42 

12 U.S.C. 1395b–3 note), the Administrator of the Ad13 ministration for Community Living, and the Admin14 istrator of the Centers for Medicare & Medicaid 

15 Services. 

16 ‘‘(3) FUNDING.—There is appropriated to the 

17 Commissioner, out of any funds in the Treasury not 

18 otherwise appropriated, $10,000,000 for each of fis19 cal years 2025 through 2029, to provide grants to 

20 State health insurance assistance programs to carry 

21 out outreach and education activities under the pub22 lic awareness campaign pursuant to this sub23 section.’’. 

24 (b) MOVING MEDICARE COST-SHARING BENEFITS

25 FROM MEDICAID TO MEDICARE.— 


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1 (1) ENDING MOST MEDICARE COST-SHARING

2 BENEFITS UNDER MEDICAID.—Section 1902(a)(10) 

3 of the Social Security Act (42 U.S.C. 1396a(a)(10)) 

4 is amended— 

5 (A) by inserting ‘‘for calendar quarters be6 ginning before January 1, 2025,’’ before ‘‘for 

7 making’’ each place it appears in clauses (i), 

8 (iii), and (iv) of subparagraph (E); and 

9 (B) in the matter following subparagraph 

10 (G)— 

11 (i) by inserting ‘‘furnished during cal12 endar quarters beginning before January 

13 1, 2025’’ after ‘‘(described in section 

14 1905(p)(3))’’; 

15 (ii) by striking ‘‘(XV)’’ and inserting 

16 ‘‘, (XV)’’; 

17 (iii) by striking ‘‘and (XVIII)’’ and in18 serting ‘‘, (XVIII)’’; 

19 (iv) by striking ‘‘and (XIX)’’ and in20 serting ‘‘(XIX)’’; and 

21 (v) by inserting ‘‘, and (XX) no med22 ical assistance for medicare cost-sharing, 

23 other than medical assistance for medicare 

24 cost-sharing for qualified disabled and 

25 working individuals described in section 


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1 1905(s), shall be made available after Jan2 uary 1, 2025’’ before the semicolon at the 

3 end. 

4 (2) CONFORMING AMENDMENTS.— 

5 (A) TITLE XIX.— 

6 (i) Section 1903(i) of such Act (42 

7 U.S.C. 1396b(i)), as amended by section 

8 4002, is amended— 

9 (I) in paragraph (26), by striking 

10 ‘‘or’’ at the end; 

11 (II) in paragraph (27), by strik12 ing the period at the end and insert13 ing ‘‘; or’’; and 

14 (III) by inserting after paragraph 

15 (27) the following new paragraph: 

16 ‘‘(28) with respect to any amount expended for 

17 medical assistance for medicare cost-sharing (other 

18 than medical assistance for medicare cost-sharing 

19 for qualified disabled and working individuals de20 scribed in section 1905(s)) furnished during cal21 endar quarters beginning on or after January 1, 

22 2025.’’. 

23 (ii) Section 1905(a) of such Act (42 

24 U.S.C. 1396d(a)) is amended, in the first 

25 sentence, by inserting ‘‘furnished during 


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1 calendar quarters beginning before Janu2 ary 1, 2025’’ after ‘‘medicare cost-shar3 ing’’. 

4 (iii) Section 1933(g) of such Act (42 

5 U.S.C. 1396u–3(g)) is amended— 

6 (I) in paragraph (2)(Q), by strik7 ing ‘‘paragraph (4), for each subse8 quent year’’ and inserting ‘‘para9 graphs (4) and (5), for each subse10 quent year before 2025’’; and 

11 (II) by adding at the end the fol12 lowing: 

13 ‘‘(5) SUNSET.—No individual shall be selected 

14 to be a qualifying individual for any calendar year 

15 or period under this section beginning on or after 

16 January 1, 2025, and no State allocation shall be 

17 made for any fiscal year or period under this section 

18 beginning on or after January 1, 2025.’’. 

19 (iv) Section 1935(a) of such Act (42 

20 U.S.C. 1396u–5(a)) is amended— 

21 (I) in paragraph (2)(A), by strik22 ing ‘‘make determinations’’ and in23 serting ‘‘prior to January 1, 2025, 

24 make determinations’’; and 


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1 (II) in paragraph (3), by insert2 ing ‘‘prior to January 1, 2025,’’ be3 fore ‘‘the State shall’’. 

4 (c) ENHANCING PRESCRIPTION DRUG AFFORD5 ABILITY BY EXPANDING ACCESS TO ASSISTANCE WITH

6 OUT-OF-POCKET COSTS UNDER MEDICARE PART D FOR

7 LOW-INCOME SENIORS AND INDIVIDUALS WITH DISABIL8 ITIES.— 

9 (1) EXPANDING ACCESS.—Section 1860D–14 of 

10 the Social Security Act (42 U.S.C. 1395w–114) is 

11 amended— 

12 (A) in subsection (a)— 

13 (i) in paragraph (1), in the matter 

14 preceding subparagraph (A)— 

15 (I) by striking ‘‘150 percent’’ and 

16 inserting ‘‘200 percent’’; and 

17 (II) by striking ‘‘and who meets 

18 the resources requirement described in 

19 paragraph (3)(D) (or, with respect to 

20 a plan year beginning on or after Jan21 uary 1, 2025, paragraph (3)(E)) or 

22 who is covered under this paragraph 

23 under paragraph (3)(B)(i)’’; 

24 (ii) by striking paragraph (2); 

25 (iii) in paragraph (3)— 


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1 (I) in subparagraph (A)— 

2 (aa) in clause (i), by adding 

3 ‘‘and’’ at the end; 

4 (bb) in clause (ii)— 

5 (AA) by striking ‘‘150 

6 percent’’ and inserting ‘‘200 

7 percent’’; and 

8 (BB) by striking ‘‘; 

9 and’’ at the end and insert10 ing a period; and 

11 (cc) by striking clause (iii); 

12 (II) by striking subparagraphs 

13 (B) and (C) and inserting the fol14 lowing: 

15 ‘‘(B) DETERMINATIONS.—For provisions 

16 relating to joint determinations with respect to 

17 eligibility for Medicare cost assistance under 

18 section 1899C and premium and cost-sharing 

19 subsidies under this section, see section 

20 1899C(b)(2). 

21 ‘‘(C) INCOME DETERMINATIONS.—For pur22 poses of applying this section— 

23 ‘‘(i) in the case of an individual who 

24 is not treated as a Medicare cost-sharing 

25 assistance eligible individual and a subsidy 


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1 eligible individual under section 

2 1899C(b)(2)(D), income shall be deter3 mined in the manner described under sec4 tion 1612 for purposes of the supplemental 

5 security income program, except that sup6 port and maintenance furnished in kind 

7 shall not be counted as income; and 

8 ‘‘(ii) the term ‘poverty line’ has the 

9 meaning given such term in section 673(2) 

10 of the Community Services Block Grant 

11 Act (42 U.S.C. 9902(2)), including any re12 vision required by such section.’’; and 

13 (III) by striking subparagraphs 

14 (D), (E), and (G); and 

15 (iv) in paragraph (4)— 

16 (I) in subparagraph (A)— 

17 (aa) by striking ‘‘(A) CO18 PAYMENT FOR LOWEST INCOME

19 DUAL ELIGIBLE INDIVIDUALS.— 

20 ’’; 

21 (bb) by redesignating 

22 clauses (i) and (ii) as subpara23 graphs (A) and (B), respectively 

24 and indenting appropriately; and 


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•S 4773 IS

1 (cc) by moving the flush text 

2 at the end 2 ems to the left; and 

3 (II) by striking subparagraph 

4 (B); and 

5 (B) in subsection (c)(1), in the second sen6 tence, by striking ‘‘subsections (a)(1)(D) and 

7 (a)(2)(E)’’ and inserting ‘‘subsection 

8 (a)(1)(D)’’. 

9 (2) TREATMENT OF REDUCTION OF COST-SHAR10 ING FOR INDIVIDUALS RECEIVING HOME AND COM11 MUNITY-BASED SERVICES.—Section 1860D– 

12 14(a)(1)(D)(i) of the Social Security Act (42 U.S.C. 

13 1395w–114(a)(1)(D)(i)) is amended— 

14 (A) by striking ‘‘who would be such an in15 stitutionalized individual or couple, if the full16 benefit dual eligible individual were not’’; and 

17 (B) by striking ‘‘or subsection (c) or (d) of 

18 section 1915 or under a State plan amendment 

19 under subsection (i) of such section’’ and in20 serting ‘‘, section 1115A, section 1915, or 

21 under a State plan amendment’’. 

22 (3) EFFECTIVE DATE.—The amendments made 

23 by this subsection shall apply to plan year 2025 and 

24 subsequent plan years. 


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1 SEC. 4107. REDUCING COST-SHARING, ALIGNING INCOME 

2 AND RESOURCE ELIGIBILITY TESTS, SIMPLI3 FYING ENROLLMENT, AND OTHER PROGRAM 

4 IMPROVEMENTS FOR LOW-INCOME BENE5 FICIARIES. 

6 (a) INCREASE IN INCOME ELIGIBILITY TO 135 PER7 CENT OF FPL FOR QUALIFIED MEDICARE BENE8 FICIARIES.— 

9 (1) IN GENERAL.—Section 1905(p)(2)(A) of the 

10 Social Security Act (42 U.S.C. 1396d(p)(2)(A)) is 

11 amended by striking ‘‘shall be at least the percent 

12 provided under subparagraph (B) (but not more 

13 than 100 percent) of the official poverty line’’ and 

14 all that follows through the period at the end and 

15 inserting the following: ‘‘shall be— 

16 ‘‘(i) before January 1, 2025, at least 

17 the percent provided under subparagraph 

18 (B) (but not more than 100 percent) of 

19 the official poverty line (as defined by the 

20 Office of Management and Budget, and re21 vised annually in accordance with section 

22 673(2) of the Community Services Block 

23 Grant Act (42 U.S.C. 9902(2)) applicable 

24 to a family of the size involved; and 

25 ‘‘(ii) on or after January 1, 2025, 

26 equal to 135 percent of the official poverty 


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•S 4773 IS

1 line (as so defined and revised) applicable 

2 to a family of the size involved.’’. 

3 (2) NOT COUNTING IN-KIND SUPPORT AND

4 MAINTENANCE AS INCOME.—Section 1905(p)(2)(D) 

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

6 1396d(p)(2)(D)) is amended by adding at the end 

7 the following new clause: 

8 ‘‘(iii) In determining income under this sub9 section, support and maintenance furnished in kind 

10 shall not be counted as income.’’. 

11 (b) INCREASE IN INCOME ELIGIBILITY TO 200 PER12 CENT OF FPL FOR SPECIFIED LOW-INCOME MEDICARE

13 BENEFICIARIES.— 

14 (1) ELIGIBILITY OF INDIVIDUALS WITH IN15 COMES BELOW 150 PERCENT OF FPL.—Section 

16 1902(a)(10)(E) of the Social Security Act (42 

17 U.S.C. 1396a(a)(10)(E)) is amended— 

18 (A) by adding ‘‘and’’ at the end of clause 

19 (ii); 

20 (B) in clause (iii)— 

21 (i) by striking ‘‘and 120 percent in 

22 1995 and years thereafter’’ and inserting 

23 ‘‘120 percent in 1995 and years thereafter 

24 before 2025, and 200 percent in 2025 and 

25 years thereafter’’; and 


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1 (ii) by striking ‘‘and’’ at the end; and 

2 (C) by striking clause (iv). 

3 (2) REFERENCES.—Section 1905(p)(1) of the 

4 Social Security Act (42 U.S.C. 1396d(p)(1)) is 

5 amended by adding at and below subparagraph (C) 

6 the following flush sentence: 

7 ‘‘The term ‘specified low-income medicare beneficiary’ 

8 means an individual described in section 

9 1902(a)(10)(E)(iii).’’. 

10 (3) CONFORMING AMENDMENTS.— 

11 (A) The first sentence of section 1905(b) 

12 of such Act (42 U.S.C. 1396d(b)) is amended 

13 by striking ‘‘and section 1933(d)’’. 

14 (B) Section 1933 of such Act (42 U.S.C. 

15 1396u–3) is repealed. 

16 (c) 100 PERCENT FMAP.—Section 1905 of the So17 cial Security Act (42 U.S.C. 1396d) is amended— 

18 (1) in subsection (b), by striking ‘‘and (ii)’’ and 

19 inserting ‘‘(ii), and (kk)’’; and 

20 (2) amended by adding at the end the following 

21 new subsection: 

22 ‘‘(kk) INCREASED FMAP FOR EXPANDED MEDICARE

23 COST-SHARING POPULATIONS.— 

24 ‘‘(1) IN GENERAL.—Notwithstanding subsection 

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1 graph (2) the Federal medical assistance percentage 

2 shall be equal to 100 percent. 

3 ‘‘(2) EXPENDITURES DESCRIBED.—The expend4 itures described in this paragraph are expenditures 

5 made on or after January 1, 2025, for medical as6 sistance for medicare cost-sharing provided to any 

7 individual under clause (i), (ii), or (iii) of section 

8 1902(a)(10)(E) who would not have been eligible for 

9 medicare cost-sharing under any such clause under 

10 the income or resource eligibility standards in effect 

11 on October 1, 2018.’’. 

12 (d) CONSOLIDATION OF LOW-INCOME SUBSIDY RE13 SOURCE ELIGIBILITY TESTS.— 

14 (1) IN GENERAL.—Section 1860D–14(a)(3) of 

15 the Social Security Act (42 U.S.C. 1395w– 

16 114(a)(3)) is amended— 

17 (A) by striking subparagraph (D); 

18 (B) by redesignating subparagraphs (E) 

19 through (G) as subparagraphs (D) through (F), 

20 respectively; and 

21 (C) in the heading of subparagraph (D), as 

22 so redesignated, by striking ‘‘ALTERNATIVE RE23 SOURCE’’ and inserting ‘‘RESOURCE’’. 

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1 TIONS.—Section 1860D–14(a)(3) of the Social Secu2 rity Act (42 U.S.C. 1395w–114(a)(3)), as amended 

3 by paragraph (1), is amended by striking subpara4 graph (F) and inserting the following new subpara5 graphs: 

6 ‘‘(F) RESOURCE EXCLUSIONS.—In deter7 mining the resources of an individual (and the 

8 eligible spouse of the individual, if any) under 

9 section 1613 for purposes of subparagraph 

10 (D)— 

11 ‘‘(i) no part of the value of any life in12 surance policy shall be taken into account; 

13 ‘‘(ii) no part of the value of any vehi14 cle shall be taken into account; 

15 ‘‘(iii) there shall be excluded an 

16 amount equal to $1,500 each with respect 

17 to any individual or eligible spouse of an 

18 individual who attests that some of the re19 sources of such individual or spouse will be 

20 used to meet the burial and related ex21 penses of such individual or spouse; and 

22 ‘‘(iv) no balance in, or benefits re23 ceived under, an employee pension benefit 

24 plan (as defined in section 3 of the Em25 ployee Retirement Income Security Act of 


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1 1974 (29 U.S.C. 1002)) shall be taken into 

2 account. 

3 ‘‘(G) FAMILY SIZE.—In determining the 

4 size of the family of an individual for purposes 

5 of determining the income eligibility of such in6 dividual under this section, an individual’s fam7 ily shall consist of— 

8 ‘‘(i) the individual; 

9 ‘‘(ii) the individual’s spouse who lives 

10 in the same household as the individual (if 

11 any); and 

12 ‘‘(iii) any other individuals who— 

13 ‘‘(I) are related to the individual 

14 whose income eligibility is in question 

15 or such individual’s spouse who lives 

16 in the same household; 

17 ‘‘(II) are living in the same 

18 household as such individual; and 

19 ‘‘(III) are dependent on such in20 dividual or such individual’s spouse 

21 who is living in the same household 

22 for at least one-half of their financial 

23 support.’’. 


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1 (3) CONFORMING AMENDMENTS.—Section 

2 1860D–14(a) of the Social Security Act (42 U.S.C. 

3 1395w–114(a)) is amended— 

4 (A) in paragraph (1), in the matter pre5 ceding subparagraph (A), by inserting ‘‘(as de6 termined under paragraph (3)(G))’’ after ‘‘fam7 ily of the size involved’’; and 

8 (B) in paragraph (3), as amended by para9 graphs (1) and (2)— 

10 (i) in subparagraph (A), in the matter 

11 preceding clause (i), by striking ‘‘subpara12 graph (F)’’ and inserting ‘‘subparagraph 

13 (E)’’; 

14 (ii) in subparagraph (A)(ii), by insert15 ing ‘‘(as determined under subparagraph 

16 (G))’’ after ‘‘family of the size involved’’; 

17 (iii) in subparagraph (A)(iii), by strik18 ing ‘‘or (E)’’; 

19 (iv) in subparagraph (B)(v), in the 

20 matter preceding subclause (I), by striking 

21 ‘‘subparagraph (F)’’ and inserting ‘‘sub22 paragraph (E)’’; and 

23 (v) in subparagraph (D)(i), in the 

24 matter preceding subclause (I), by striking 

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1 sion provided under subparagraph (G)’’ 

2 and inserting ‘‘subject to the resource ex3 clusions provided under subparagraph 

4 (F)’’. 

5 (e) ALIGNMENT OF LOW-INCOME SUBSIDY AND

6 MEDICARE SAVINGS PROGRAM INCOME AND RESOURCE

7 ELIGIBILITY TESTS.— 

8 (1) APPLICATION OF MEDICAID SPOUSAL IM9 POVERISHMENT RESOURCE ALLOWANCE TO MSP AND

10 LIS RESOURCE ELIGIBILITY.—Section 1905(p)(1)(C) 

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

12 1396d(p)(1)(C)) is amended to read as follows: 

13 ‘‘(C) whose resources (as determined under sec14 tion 1613 for purposes of the supplemental security 

15 income program subject to the resource exclusions 

16 under subparagraph (F) of section 1860D–14(a)(3)) 

17 do not exceed— 

18 ‘‘(i) in the case of an individual with a 

19 spouse, an amount equal to the sum of the first 

20 amount specified in subsection (f)(2)(A)(i) of 

21 section 1924 (as adjusted under subsection (g) 

22 of such section) and the amount specified in 

23 subsection (f)(2)(A)(ii)(II) of such section (as 

24 so adjusted); or 


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1 ‘‘(ii) in the case of an individual who does 

not have a spouse, an amount equal to 1 2 ⁄2 of 

3 the amount described in clause (i).’’. 

4 (2) APPLICATION TO QDWIS.—Section 

5 1905(s)(3) of the Social Security Act (42 U.S.C. 

6 1396d(s)(3)) is amended to read as follows: 

7 ‘‘(3) whose resources (as determined under sec8 tion 1613 for purposes of the supplemental security 

9 income program subject to the resource exclusions 

10 under subparagraph (F) of section 1860D–14(a)(3)) 

11 do not exceed— 

12 ‘‘(A) in the case of an individual with a 

13 spouse, the amount in effect for the year under 

14 clause (i) of subsection (p)(1)(C); and 

15 ‘‘(B) in the case of an individual who does 

16 not have a spouse, the amount in effect for the 

17 year under clause (ii) of subsection (p)(1)(C); 

18 and’’. 

19 (3) APPLICATION TO LIS.—Clause (i) of section 

20 1860D–14(a)(3)(D) of the Social Security Act (42 

21 U.S.C. 1395w–114(a)(3)(D)), as redesignated and 

22 amended by subsection (d)(1), is amended to read as 

23 follows: 

24 ‘‘(i) IN GENERAL.—The resources re25 quirement of this subparagraph is that an 


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•S 4773 IS

1 individual’s resources (as determined under 

2 section 1613 for purposes of the supple3 mental security income program subject to 

4 the resource exclusions provided under 

5 subparagraph (F)) do not exceed the 

6 amount in effect for the year under section 

7 1905(p)(1)(C)(ii).’’. 

8 (f) ENROLLMENT SIMPLIFICATIONS.— 

9 (1) APPLICATION OF 3-MONTH RETROACTIVE

10 ELIGIBILITY TO QMBS.— 

11 (A) IN GENERAL.—Section 1902(e)(8) of 

12 the Social Security Act (42 U.S.C. 1396a(e)(8)) 

13 is amended by striking ‘‘after the end of the 

14 month in which the determination first occurs’’ 

15 and inserting ‘‘in or after the third month be16 fore the month in which the individual makes 

17 application for assistance’’. 

18 (B) PROCESS FOR SUBMITTING CLAIMS

19 DURING RETROACTIVE ELIGIBILITY PERIOD.— 

20 Section 1902(e)(8) of the Social Security Act 

21 (42 U.S.C. 1396a(e)(8)) is further amended by 

22 adding at the end the following: ‘‘The Secretary 

23 shall provide for a process under which claims 

24 for medical assistance under the State plan may 

25 be submitted for services furnished to such an 


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1 individual during such 3-month period before 

2 the month in which the individual made appli3 cation for assistance.’’. 

4 (C) CONFORMING AMENDMENT.—Section 

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

6 1396d(a)) is amended, in the matter preceding 

7 paragraph (1), by striking ‘‘or, in the case of 

8 medicare cost-sharing with respect to a quali9 fied medicare beneficiary described in sub10 section (p)(1), if provided after the month in 

11 which the individual becomes such a bene12 ficiary’’. 

13 (2) STATE OPTION FOR 12-MONTH CONTINUOUS

14 ELIGIBILITY FOR SLMBS AND QWDIS.—Section 

15 1902(e)(12) of the Social Security Act (42 U.S.C. 

16 1396a(e)(12)) is amended— 

17 (A) by redesignating subparagraphs (A) 

18 and (B) as clauses (i) and (ii), respectively; 

19 (B) by inserting ‘‘(A)’’ after ‘‘(12)’’; and 

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

21 ‘‘(B) At the option of the State, the plan may provide 

22 that an individual who is determined to be eligible for ben23 efits under a State plan approved under this title under 

24 any of the following eligibility categories, or who is rede25 termined to be eligible for such benefits under any of such 


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1 categories, shall be considered to meet the eligibility re2 quirements met on the date of application and shall re3 main eligible for those benefits until the end of the 12- 

4 month period following the date of the determination or 

5 redetermination of eligibility, except that a State may pro6 vide for such determinations more frequently, but not 

7 more frequently than once every 6 months for an indi8 vidual: 

9 ‘‘(i) A specified low-income medicare beneficiary 

10 described in subsection (a)(10)(E)(iii) of this section 

11 who is determined eligible for medicare cost-sharing 

12 described in section 1905(p)(3)(A)(ii). 

13 ‘‘(ii) A qualified disabled and working indi14 vidual described in section 1905(s) who is deter15 mined eligible for medicare cost-sharing described in 

16 section 1905(p)(3)(A)(i).’’. 

17 (3) STATE OPTION TO USE EXPRESS LANE ELI18 GIBILITY FOR THE MEDICARE SAVINGS PROGRAM.— 

19 Section 1902(e)(13)(A) of the Social Security Act 

20 (42 U.S.C. 1396a(e)(13)(A)) is amended by adding 

21 at the end the following new clause: 

22 ‘‘(iii) STATE OPTION TO EXTEND EXPRESS

23 LANE ELIGIBILITY TO OTHER POPULATIONS.— 

24 ‘‘(I) IN GENERAL.—At the option of 

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1 sions of this paragraph with respect to de2 termining eligibility under this title for an 

3 eligible individual (as defined in subclause 

4 (II)). In applying this paragraph in the 

5 case of a State making such an option, any 

6 reference in this paragraph to a child with 

7 respect to this title (other than a reference 

8 to child health assistance) shall be deemed 

9 to be a reference to an eligible individual. 

10 ‘‘(II) ELIGIBLE INDIVIDUAL DE11 FINED.—In this clause, the term ‘eligible 

12 individual’ means any of the following: 

13 ‘‘(aa) A qualified medicare bene14 ficiary described in section 1905(p)(1) 

15 for purposes of determining eligibility 

16 for medicare cost-sharing (as defined 

17 in section 1905(p)(3)). 

18 ‘‘(bb) A specified low-income 

19 medicare beneficiary described in sub20 section (a)(10)(E)(iii) of this section 

21 for purposes of determining eligibility 

22 for medicare cost-sharing described in 

23 section 1905(p)(3)(A)(ii). 

24 ‘‘(cc) A qualified disabled and 

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1 tion 1905(s) for purposes of deter2 mining eligibility for medicare cost3 sharing described in section 

4 1905(p)(3)(A)(i).’’. 

5 (g) MEDICAID TREATMENT OF CERTAIN MEDICARE

6 PROVIDERS.—Section 1902(n) of the Social Security Act 

7 (42 U.S.C. 1396a(n)) is amended by adding at the end 

8 the following new paragraph: 

9 ‘‘(4) A State plan shall not deny a claim from a pro10 vider or supplier with respect to medicare cost-sharing de11 scribed in subparagraph (B), (C), or (D) of section 

12 1905(p)(3) for an item or service which is eligible for pay13 ment under title XVIII on the basis that the provider or 

14 supplier does not have a provider agreement in effect 

15 under this title or does not otherwise serve all individuals 

16 entitled to medical assistance under this title. The State 

17 shall create a mechanism through which providers or sup18 pliers that do not otherwise have provider agreements with 

19 the State can bill the State for medicare cost-sharing for 

20 qualified medicare beneficiaries.’’. 

21 (h) ELIGIBILITY FOR OTHER PROGRAMS.—Section 

22 1905(p) of the Social Security Act (42 U.S.C. 1396d(p)) 

23 is amended by adding at the end the following new para24 graph: 


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1 ‘‘(7) Notwithstanding any other provision of law, any 

2 medical assistance for some or all medicare cost-sharing 

3 under this title shall not be considered income or resources 

4 in determining eligibility for, or the amount of assistance 

5 or benefits provided under, any other public benefit pro6 vided under Federal law or the law of any State or polit7 ical subdivision thereof.’’. 

8 (i) TREATMENT OF QUALIFIED MEDICARE BENE9 FICIARIES, SPECIFIED LOW-INCOME MEDICARE BENE10 FICIARIES, AND OTHER DUAL ELIGIBLES AS MEDICARE

11 BENEFICIARIES.—Section 1862 of the Social Security Act 

12 (42 U.S.C. 1395y) is amended by adding at the end the 

13 following new subsection: 

14 ‘‘(p) TREATMENT OF QUALIFIED MEDICARE BENE15 FICIARIES (QMBS), SPECIFIED LOW-INCOME MEDICARE

16 BENEFICIARIES (SLMBS), AND OTHER DUAL ELIGI17 BLES.—Nothing in this title shall be construed as author18 izing a provider of services or supplier to discriminate 

19 (through a private contractual arrangement or otherwise) 

20 against an individual who is otherwise entitled to services 

21 under this title on the basis that the individual is a quali22 fied medicare beneficiary (as defined in section 

23 1905(p)(1)), a specified low-income medicare beneficiary, 

24 or is otherwise eligible for medical assistance for medicare 

25 cost-sharing or other benefits under title XIX.’’. 


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1 (j) ADDITIONAL FUNDING FOR STATE HEALTH IN2 SURANCE ASSISTANCE PROGRAMS.— 

3 (1) GRANTS.— 

4 (A) IN GENERAL.—The Secretary of 

5 Health and Human Services (in this subsection 

6 referred to as the ‘‘Secretary’’) shall use 

7 amounts made available under subparagraph 

8 (B) to make grants to States for State health 

9 insurance assistance programs receiving assist10 ance under section 4360 of the Omnibus Budg11 et Reconciliation Act of 1990 (42 U.S.C. 

12 1395b–4). 

13 (B) FUNDING.—For purposes of making 

14 grants under this subsection, the Secretary 

15 shall provide for the transfer, from the Federal 

16 Hospital Insurance Trust Fund under section 

17 1817 of the Social Security Act (42 U.S.C. 

18 1395i) and the Federal Supplementary Medical 

19 Insurance Trust Fund under section 1841 of 

20 such Act (42 U.S.C. 1395t), in the same pro21 portion as the Secretary determines under sec22 tion 1853(f) of such Act (42 U.S.C. 1395w– 

23 23(f)), of $50,000,000 to the Centers for Medi24 care & Medicaid Services Program Management 

25 Account for each of the fiscal years 2025 


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1 through 2029, to remain available until ex2 pended. 

3 (2) AMOUNT OF GRANTS.—The amount of a 

4 grant to a State under this subsection from the total 

5 amount made available under paragraph (1) shall be 

6 equal to the sum of the amount allocated to the 

7 State under paragraph (3)(A) and the amount allo8 cated to the State under subparagraph (3)(B). 

9 (3) ALLOCATION TO STATES.— 

10 (A) ALLOCATION BASED ON PERCENTAGE

11 OF LOW-INCOME BENEFICIARIES.—The amount 

12 allocated to a State under this subparagraph 

from 2 13 ⁄3 of the total amount made available 

14 under paragraph (1) shall be based on the num15 ber of individuals who meet the requirement 

16 under subsection (a)(3)(A)(ii) of section 

17 1860D–14 of the Social Security Act (42 

18 U.S.C. 1395w–114) but who have not enrolled 

19 to receive a subsidy under such section 1860D– 

20 14 relative to the total number of individuals 

21 who meet the requirement under such sub22 section (a)(3)(A)(ii) in each State, as estimated 

23 by the Secretary. 

24 (B) ALLOCATION BASED ON PERCENTAGE

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1 cated to a State under this subparagraph from 

1 2 ⁄3 of the total amount made available under 

3 paragraph (1) shall be based on the number of 

4 part D eligible individuals (as defined in section 

5 1860D–1(a)(3)(A) of such Act (42 U.S.C. 

6 1395w–101(a)(3)(A))) residing in a rural area 

7 relative to the total number of such individuals 

8 in each State, as estimated by the Secretary. 

9 (4) PORTION OF GRANT BASED ON PERCENT10 AGE OF LOW-INCOME BENEFICIARIES TO BE USED

11 TO PROVIDE OUTREACH TO INDIVIDUALS WHO MAY

12 BE SUBSIDY ELIGIBLE INDIVIDUALS OR ELIGIBLE

13 FOR THE MEDICARE SAVINGS PROGRAM.—Each 

14 grant awarded under this subsection with respect to 

15 amounts allocated under paragraph (3)(A) shall be 

16 used to provide outreach to individuals who may be 

17 subsidy eligible individuals (as defined in section 

18 1860D–14(a)(3)(A) of the Social Security Act (42 

19 U.S.C. 1395w–114(a)(3)(A))) or eligible for the pro20 gram of medical assistance for payment of the cost 

21 of medicare cost-sharing under the Medicaid pro22 gram pursuant to sections 1902(a)(10)(E) and 1933 

23 of such Act (42 U.S.C. 1396a(a)(10)(E), 1396u–3). 

24 (k) EFFECTIVE DATE.— 


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1 (1) IN GENERAL.—Except as provided in para2 graph (2), the amendments and repeal made by this 

3 section take effect on January 1, 2025, and, with re4 spect to title XIX of the Social Security Act, apply 

5 to calendar quarters beginning on or after January 

6 1, 2025. 

7 (2) EXCEPTION FOR STATE LEGISLATION.—In 

8 the case of a State plan for medical assistance under 

9 title XIX of the Social Security Act which the Sec10 retary of Health and Human Services determines re11 quires State legislation (other than legislation appro12 priating funds) in order for the plan to meet the ad13 ditional requirements imposed by the amendments 

14 and repeal made by this section, the State plan shall 

15 not be regarded as failing to comply with the re16 quirements of such title solely on the basis of its 

17 failure to meet these additional requirements before 

18 the first day of the first calendar quarter beginning 

19 after the close of the first regular session of the 

20 State legislature that begins after the date of the en21 actment of this Act. For purposes of the previous 

22 sentence, in the case of a State that has a 2-year 

23 legislative session, each year of such session shall be 

24 deemed to be a separate regular session of the State 

25 legislature. 


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1 SEC. 4108. 100 PERCENT FMAP FOR MEDICAL ASSISTANCE 

2 PROVIDED BY URBAN INDIAN ORGANIZA3 TIONS. 

4 (a) IN GENERAL.—The third sentence of section 

5 1905(b) of the Social Security Act (42 U.S.C. 1396d(b)) 

6 is amended by striking ‘‘for the 8 fiscal year quarters be7 ginning with the first fiscal year quarter beginning after 

8 the date of the enactment of the American Rescue Plan 

9 Act of 2021,’’ and inserting ‘‘and’’. 

10 (b) EFFECTIVE DATE.—The amendment made by 

11 this section shall apply to medical assistance provided on 

12 or after the date of enactment of this Act. 

13 SEC. 4109. 100 PERCENT FMAP FOR MEDICAL ASSISTANCE 

14 PROVIDED TO A NATIVE HAWAIIAN THROUGH 

15 A FEDERALLY QUALIFIED HEALTH CENTER 

16 OR A NATIVE HAWAIIAN HEALTH CARE SYS17 TEM UNDER THE MEDICAID PROGRAM. 

18 (a) IN GENERAL.—The third sentence of section 

19 1905(b) of the Social Security Act (42 U.S.C. 1396d(b)) 

20 is amended by striking ‘‘, for such 8 fiscal year quarters’’. 

21 (b) EFFECTIVE DATE.—The amendment made by 

22 this section shall apply to medical assistance provided on 

23 or after the date of enactment of this Act. 


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1 SEC. 4110. REPEAL OF REQUIREMENT FOR ESTATE RECOV2 ERY UNDER THE MEDICAID PROGRAM. 

3 Section 1917 of the Social Security Act (42 U.S.C. 

4 1396p) is amended— 

5 (1) in subsection (a)— 

6 (A) by amending paragraph (1) to read as 

7 follows: 

8 ‘‘(1) No lien may be imposed against the prop9 erty of any individual prior to his death on account 

10 of medical assistance paid or to be paid on his behalf 

11 under the State plan, except pursuant to the judg12 ment of a court on account of benefits incorrectly 

13 paid on behalf of such individual.’’; 

14 (B) by striking paragraph (2); 

15 (C) in paragraph (3), by striking ‘‘(1)(B)’’ 

16 and inserting ‘‘(1)’’; and 

17 (D) by redesignating paragraph (3) as 

18 paragraph (2); and 

19 (2) by amending subsection (b) to read as fol20 lows: 

21 ‘‘(b) ADJUSTMENT OR RECOVERY OF MEDICAL AS22 SISTANCE CORRECTLY PAID UNDER A STATE PLAN.—No 

23 adjustment or recovery of any medical assistance correctly 

24 paid on behalf of an individual under the State plan may 

25 be made.’’. 


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1 SEC. 4111. ALLOW FOR SUSPENSION OF MEDICARE BENE2 FITS AND PREMIUM LIABILITY FOR INDIVID3 UALS WHO ARE INCARCERATED AND PRO4 VIDE A SPECIAL ENROLLMENT PERIOD 

5 AROUND THE DATE OF RELEASE. 

6 (a) SPECIAL ENROLLMENT PERIOD FOR INDIVID7 UALS INCARCERATED AT TIME OF MEDICARE ELIGI8 BILITY.—Section 1837(i) of the Social Security Act (42 

9 U.S.C. 1395p(i)) is amended by adding at the end the fol10 lowing new paragraph: 

11 ‘‘(5)(A) In the case of an individual who— 

12 ‘‘(i) at the time the individual first satis13 fies paragraph (1) or (2) of section 1836(a), is 

14 incarcerated; or 

15 ‘‘(ii) has elected not to enroll (or to be 

16 deemed enrolled) under this section during the 

17 individual’s initial enrollment period; 

18 there shall be a special enrollment period de19 scribed in subparagraph (B). 

20 ‘‘(B) The special enrollment period re21 ferred to in subparagraph (A) is the 6-month 

22 period beginning on the first day after which 

23 the individual is no longer incarcerated.’’. 

24 (b) PREMIUM AMOUNT.—Section 1839(a) of the So25 cial Security Act (42 U.S.C. 1395r(a)) is amended— 


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1 (1) in paragraph (1), in the second sentence, by 

2 striking ‘‘and (7),’’ and inserting ‘‘(7), and (8),’’; 

3 and 

4 (2) by adding at the end the following new 

5 paragraph: 

6 ‘‘(8) In the case of an individual whose coverage pe7 riod includes months in which by reason of custody under 

8 penal authority coverage is excluded pursuant to section 

9 1862(a)(3), the premium amount for such months such 

10 individual is in custody under penal authority shall be 

11 zero.’’. 

12 (c) CONFORMING AMENDMENT.—Section 1818(d)(5) 

13 of the Social Security Act (42 U.S.C. 1395i–2(d)(5)) is 

14 amended by adding at the end the following: 

15 ‘‘(D) In the case of an individual who is a 

16 person who is excluded from coverage pursuant 

17 to section 1862(a)(3) by reason of custody 

18 under penal authority, the amount of the 

19 monthly premium for such individual shall be 

20 zero for any month in which such individual is 

21 in custody under penal authority.’’. 

22 SEC. 4112. FEDERAL EMPLOYEE HEALTH BENEFITS PLANS. 

23 (a) COVERAGE OF PREGNANCY.—The Director of the 

24 Office of Personnel Management shall issue such regula25 tions as are necessary to ensure that pregnancy is considVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 00349 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 ered a change in family status and a qualifying life event 

2 for an individual who is eligible to enroll, but is not en3 rolled, in a health benefits plan under chapter 89 of title 

4 5, United States Code. 

5 (b) EFFECTIVE DATE.—The requirement in para6 graph (1) shall apply with respect to any contract entered 

7 into under section 8902 of title 5, United States Code, 

8 on or after the date that is 1 year after the date of enact9 ment of this Act. 

10 SEC. 4113. CONTINUATION OF MEDICAID INCOME ELIGI11 BILITY STANDARD FOR PREGNANT INDIVID12 UALS AND INFANTS. 

13 Section 1902(l)(2)(A) of the Social Security Act (42 

14 U.S.C. 1396a(l)(2)(A)) is amended— 

15 (1) in clause (i), by striking ‘‘and not more 

16 than 185 percent’’; 

17 (2) in clause (ii)— 

18 (A) in subclause (I), by striking ‘‘and’’ 

19 after the comma; 

20 (B) in subclause (II), by striking the pe21 riod at the end and inserting ‘‘, and’’; and 

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

23 ‘‘(III) January 1, 2025, is the 

24 percentage provided under clause 

25 (v).’’; and 


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

2 clause: 

3 ‘‘(v) The percentage provided under 

4 clause (ii) for medical assistance provided 

5 on or after January 1, 2025, with respect 

6 to individuals described in subparagraph 

7 (A) or (B) of paragraph (1) shall not be 

8 less than— 

9 ‘‘(I) the percentage specified for 

10 such individuals by the State in an 

11 amendment to its State plan (whether 

12 approved or not) as of January 1, 

13 2014; or 

14 ‘‘(II) if no such percentage is 

15 specified as of January 1, 2014, the 

16 percentage established for such indi17 viduals under the State’s authorizing 

18 legislation or provided for under the 

19 State’s appropriations as of that 

20 date.’’. 


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1 Subtitle C—Expansion of Access 

2 PART 1—GENERAL PROVISIONS 

3 SEC. 4201. AMENDMENT TO THE PUBLIC HEALTH SERVICE 

4 ACT. 

5 Title XXXIV of the Public Health Service Act, as 

6 amended by titles I, II, and III of this Act, is further 

7 amended by inserting after subtitle C the following: 

8 ‘‘Subtitle D—Reconstruction and 

9 Improvement Grants for Public 

10 Health Care Facilities Serving 

11 Pacific Islanders and the Insu12 lar Areas 

13 ‘‘SEC. 3441. GRANT SUPPORT FOR QUALITY IMPROVEMENT 

14 INITIATIVES. 

15 ‘‘(a) IN GENERAL.—The Secretary, in collaboration 

16 with the Administrator of the Health Resources and Serv17 ices Administration, the Director of the Agency for 

18 Healthcare Research and Quality, and the Administrator 

19 of the Centers for Medicare & Medicaid Services, shall 

20 award grants to eligible entities for the conduct of dem21 onstration projects to improve the quality of and access 

22 to health care. 

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

24 under subsection (a), an entity shall— 


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1 ‘‘(1) be a health center, hospital, health plan, 

2 health system, community clinic, hospice or palliative 

3 care provider, or other health entity determined ap4 propriate by the Secretary— 

5 ‘‘(A) that, by legal mandate or explicitly 

6 adopted mission, provides patients with access 

7 to services regardless of their ability to pay; 

8 ‘‘(B) that provides care or treatment for a 

9 substantial number of patients who are unin10 sured, are receiving assistance under a State 

11 plan under title XIX of the Social Security Act 

12 (or under a waiver of such plan), or are mem13 bers of vulnerable populations, as determined 

14 by the Secretary; and 

15 ‘‘(C)(i) with respect to which, not less than 

16 50 percent of the entity’s patient population is 

17 made up of racial and ethnic minority groups; 

18 or 

19 ‘‘(ii) that— 

20 ‘‘(I) serves a disproportionate percent21 age of local patients who are from a racial 

22 and ethnic minority group, or has a patient 

23 population at least 50 percent of which is 

24 composed of individuals with limited 

25 English proficiency; and 


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1 ‘‘(II) provides an assurance that 

2 amounts received under the grant will be 

3 used only to support quality improvement 

4 activities in the racial and ethnic minority 

5 group served; and 

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

7 application at such time, in such manner, and con8 taining such information as the Secretary may re9 quire. 

10 ‘‘(c) PRIORITY.—In awarding grants under sub11 section (a), the Secretary shall give priority to eligible enti12 ties that— 

13 ‘‘(1) demonstrate an intent to operate as part 

14 of a health care partnership, network, collaborative, 

15 coalition, or alliance where each member entity con16 tributes to the design, implementation, and evalua17 tion of the proposed intervention; or 

18 ‘‘(2) intend to use funds to carry out system19 wide changes with respect to health care quality im20 provement, including— 

21 ‘‘(A) improved systems for data collection 

22 and reporting; 

23 ‘‘(B) innovative collaborative or similar 

24 processes; 


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1 ‘‘(C) group programs with behavioral or 

2 self-management interventions; 

3 ‘‘(D) case management services; 

4 ‘‘(E) physician or patient reminder sys5 tems; 

6 ‘‘(F) educational interventions; 

7 ‘‘(G) comprehensive and patient-centric 

8 health care; 

9 ‘‘(H) creation and distribution of education 

10 materials on available health care options; or 

11 ‘‘(I) other activities determined appropriate 

12 by the Secretary. 

13 ‘‘(d) USE OF FUNDS.—An entity shall use amounts 

14 received under a grant under subsection (a) to support 

15 the implementation and evaluation of health care quality 

16 improvement activities or minority health and health care 

17 disparity reduction activities that include— 

18 ‘‘(1) with respect to health care systems, activi19 ties relating to improving— 

20 ‘‘(A) patient safety; 

21 ‘‘(B) timeliness of care; 

22 ‘‘(C) effectiveness of care; 

23 ‘‘(D) efficiency of care; 

24 ‘‘(E) patient centeredness; 

25 ‘‘(F) health information technology; 


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1 ‘‘(G) accessibility and availability of infor2 mation on health care; 

3 ‘‘(H) comprehensiveness of health care; 

4 and 

5 ‘‘(I) patient involvement and choice in 

6 health care; and 

7 ‘‘(2) with respect to patients, activities relating 

8 to— 

9 ‘‘(A) staying healthy; 

10 ‘‘(B) getting well, mentally and physically; 

11 ‘‘(C) living effectively with illness or dis12 ability; 

13 ‘‘(D) preparing for end of life and ensuring 

14 that end-of-life care is accessible and available, 

15 as well as coping with end-of-life issues; and 

16 ‘‘(E) shared decision making. 

17 ‘‘(e) COMMON DATA SYSTEMS.—The Secretary shall 

18 provide financial and other technical assistance to grant19 ees under this section for the development of common data 

20 systems. 

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

22 are authorized to be appropriated to carry out this section 

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

24 2025 through 2032. 


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1 ‘‘SEC. 3442. CENTERS OF EXCELLENCE. 

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

3 the Administrator of the Health Resources and Services 

4 Administration, shall designate centers of excellence at 

5 public hospitals, and other health systems serving large 

6 numbers of patients from minority populations, that— 

7 ‘‘(1) meet the requirements of section 

8 3441(b)(1); 

9 ‘‘(2) demonstrate excellence in providing care to 

10 minority populations; and 

11 ‘‘(3) demonstrate excellence in reducing dispari12 ties in health and health care. 

13 ‘‘(b) REQUIREMENTS.—A hospital or health system 

14 that serves as a center of excellence under subsection (a) 

15 shall— 

16 ‘‘(1) design, implement, and evaluate programs 

17 and policies relating to the delivery of care in ra18 cially, ethnically, and linguistically diverse popu19 lations; 

20 ‘‘(2) provide training and technical assistance 

21 to other hospitals and health systems relating to the 

22 provision of high-quality health care to minority pop23 ulations; and 

24 ‘‘(3) develop activities for graduate or con25 tinuing medical education that institutionalize a 


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1 focus on cultural competence training for health care 

2 providers. 

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

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

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

6 2025 through 2032. 

7 ‘‘SEC. 3443. RECONSTRUCTION AND IMPROVEMENT GRANTS 

8 FOR PUBLIC HEALTH CARE FACILITIES SERV9 ING PACIFIC ISLANDERS AND THE INSULAR 

10 AREAS. 

11 ‘‘(a) IN GENERAL.—The Secretary shall provide di12 rect financial assistance to designated health care pro13 viders and community health centers in American Samoa, 

14 Guam, the Commonwealth of the Northern Mariana Is15 lands, the United States Virgin Islands, Puerto Rico, and 

16 Hawaii for the purposes of reconstructing and improving 

17 health care facilities and services in a culturally competent 

18 and sustainable manner. 

19 ‘‘(b) ELIGIBILITY.—To be eligible to receive direct fi20 nancial assistance under subsection (a), an entity shall be 

21 a public health facility or community health center located 

22 in American Samoa, Guam, the Commonwealth of the 

23 Northern Mariana Islands, the United States Virgin Is24 lands, Puerto Rico, or Hawaii that— 

25 ‘‘(1) is owned or operated by— 


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1 ‘‘(A) the Government of American Samoa, 

2 Guam, the Commonwealth of the Northern 

3 Mariana Islands, the United States Virgin Is4 lands, Puerto Rico, or Hawaii or a unit of local 

5 government; or 

6 ‘‘(B) a nonprofit organization; and 

7 ‘‘(2)(A) provides care or treatment for a sub8 stantial number of patients who are uninsured, are 

9 receiving assistance under title XVIII of the Social 

10 Security Act or under a State plan under title XIX 

11 of such Act (or under a waiver of such plan), or are 

12 members of a vulnerable population, as determined 

13 by the Secretary; or 

14 ‘‘(B) serves a disproportionate percentage of 

15 local patients that are from a racial and ethnic mi16 nority group. 

17 ‘‘(c) REPORT.—Not later than 180 days after the 

18 date of enactment of this title and annually thereafter, the 

19 Secretary shall submit to the Congress and the President 

20 a report that includes an assessment of health resources 

21 and facilities serving populations in American Samoa, 

22 Guam, the Commonwealth of the Northern Mariana Is23 lands, the United States Virgin Islands, Puerto Rico, and 

24 Hawaii. In preparing such report, the Secretary shall— 


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1 ‘‘(1) consult with and obtain information on all 

2 health care facilities needs from the entities receiv3 ing direct financial assistance under subsection (a); 

4 ‘‘(2) include all amounts of Federal assistance 

5 received by each such entity in the preceding fiscal 

6 year; 

7 ‘‘(3) review the total unmet needs of health care 

8 facilities serving American Samoa, Guam, the Com9 monwealth of the Northern Mariana Islands, the 

10 United States Virgin Islands, Puerto Rico, and Ha11 waii, including needs for renovation and expansion 

12 of existing facilities; 

13 ‘‘(4) include a strategic plan for addressing the 

14 needs of each such population identified in the re15 port; and 

16 ‘‘(5) evaluate the effectiveness of the care pro17 vided by measuring patient outcomes and cost meas18 ures. 

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

20 are authorized to be appropriated such sums as necessary 

21 to carry out this section.’’. 

22 SEC. 4202. BORDER HEALTH GRANTS. 

23 (a) DEFINITIONS.—In this section: 

24 (1) BORDER AREA.—The term ‘‘border area’’ 

25 means the United States-Mexico Border Area, as deVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 00360 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 fined in section 8 of the United States-Mexico Bor2 der Health Commission Act (22 U.S.C. 290n–6). 

3 (2) ELIGIBLE ENTITY.—The term ‘‘eligible enti4 ty’’ means an entity that is located in the border 

5 area and is any of the following: 

6 (A) A State, local government, or Tribal 

7 government. 

8 (B) A public institution of higher edu9 cation. 

10 (C) A nonprofit health organization. 

11 (D) A community health center. 

12 (E) A community clinic that is a health 

13 center receiving assistance under section 330 of 

14 the Public Health Service Act (42 U.S.C. 

15 254b). 

16 (F) A nonprofit organization serving immi17 grants. 

18 (b) AUTHORIZATION.—From funds appropriated pur19 suant to subsection (f), the Secretary of Health and 

20 Human Services (in this section referred to as the ‘‘Sec21 retary’’), acting through the United States members of the 

22 United States-Mexico Border Health Commission, shall 

23 award grants to eligible entities to address priorities and 

24 recommendations to improve the health of border area 

25 residents that are established by— 


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1 (1) the United States members of the United 

2 States-Mexico Border Health Commission; 

3 (2) the State border health offices; and 

4 (3) the Secretary. 

5 (c) APPLICATION.—An eligible entity that desires a 

6 grant under subsection (b) shall submit an application to 

7 the Secretary at such time, in such manner, and con8 taining such information as the Secretary may require and 

9 demonstrating the entity’s capacity to provide culturally 

10 and linguistically appropriate services to border area resi11 dents. 

12 (d) USE OF FUNDS.—An eligible entity that receives 

13 a grant under subsection (b) shall use the grant funds 

14 for— 

15 (1) programs relating to— 

16 (A) maternal and child health; 

17 (B) primary care and preventative health; 

18 (C) public health and public health infra19 structure; 

20 (D) musculoskeletal health and obesity; 

21 (E) health education and promotion; 

22 (F) oral health; 

23 (G) mental and behavioral health; 

24 (H) substance use disorders; 


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1 (I) health conditions that have a high prev2 alence in the border area; 

3 (J) medical and health services research; 

4 (K) workforce training and development; 

5 (L) community health workers, patient 

6 navigators, and promotores; 

7 (M) health care infrastructure problems in 

8 the border area (including planning and con9 struction grants); 

10 (N) health disparities in the border area; 

11 (O) environmental health; 

12 (P) outreach and enrollment services with 

13 respect to Federal programs (including pro14 grams authorized under titles XIX and XXI of 

15 the Social Security Act (42 U.S.C. 1396 et seq.; 

16 42 U.S.C. 1397aa et seq.)); 

17 (Q) end-of-life care; and 

18 (R) addressing social determinants of 

19 health; and 

20 (2) other programs determined appropriate by 

21 the Secretary. 

22 (e) SUPPLEMENT, NOT SUPPLANT.—Amounts pro23 vided to an eligible entity awarded a grant under sub24 section (b) shall be used to supplement and not supplant 


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1 other funds available to the eligible entity to carry out the 

2 activities described in subsection (d). 

3 (f) AUTHORIZATION OF APPROPRIATIONS.—There 

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

5 $200,000,000 for fiscal year 2025, and such sums as may 

6 be necessary for each succeeding fiscal year. 

7 SEC. 4203. CRITICAL ACCESS HOSPITAL IMPROVEMENTS. 

8 (a) ELIMINATION OF ISOLATION TEST FOR COST9 BASED AMBULANCE REIMBURSEMENT.— 

10 (1) IN GENERAL.—Section 1834(l)(8) of the 

11 Social Security Act (42 U.S.C. 1395m(l)(8)) is 

12 amended— 

13 (A) in subparagraph (B)— 

14 (i) by striking ‘‘owned and’’; and 

15 (ii) by inserting ‘‘(including when 

16 such services are provided by the entity 

17 under an arrangement with the hospital)’’ 

18 after ‘‘hospital’’; and 

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

20 subparagraph (B) and all that follows and in21 serting a period. 

22 (2) EFFECTIVE DATE.—The amendments made 

23 by this subsection shall apply to services furnished 

24 on or after January 1, 2025. 


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1 (b) PROVISION OF A MORE FLEXIBLE ALTERNATIVE

2 TO THE CAH DESIGNATION 25 INPATIENT BED LIMIT

3 REQUIREMENT.— 

4 (1) IN GENERAL.—Section 1820(c)(2) of the 

5 Social Security Act (42 U.S.C. 1395i–4(c)(2)) is 

6 amended— 

7 (A) in subparagraph (B)(iii), by striking 

8 ‘‘provides not more than’’ and inserting ‘‘sub9 ject to subparagraph (F), provides not more 

10 than’’; and 

11 (B) by adding at the end the following new 

12 subparagraph: 

13 ‘‘(F) ALTERNATIVE TO 25 INPATIENT BED

14 LIMIT REQUIREMENT.— 

15 ‘‘(i) IN GENERAL.—A State may elect 

16 to treat a facility, with respect to the des17 ignation of the facility for a cost reporting 

18 period, as satisfying the requirement of 

19 subparagraph (B)(iii) relating to a max20 imum number of acute care inpatient beds 

21 if the facility elects, in accordance with a 

22 method specified by the Secretary and be23 fore the beginning of the cost reporting pe24 riod, to meet the requirement under clause 

25 (ii). 


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1 ‘‘(ii) ALTERNATE REQUIREMENT.— 

2 The requirement under this clause, with 

3 respect to a facility and a cost reporting 

4 period, is that the total number of inpa5 tient bed days described in subparagraph 

6 (B)(iii) during such period will not exceed 

7 7,300. For purposes of this subparagraph, 

8 an individual who is an inpatient in a bed 

9 in the facility for a single day shall be 

10 counted as one inpatient bed day. 

11 ‘‘(iii) WITHDRAWAL OF ELECTION.— 

12 The option described in clause (i) shall not 

13 apply to a facility for a cost reporting pe14 riod if the facility (for any two consecutive 

15 cost reporting periods during the previous 

16 5 cost-reporting periods) was treated under 

17 such option and had a total number of in18 patient bed days for each of such two cost 

19 reporting periods that exceeded the num20 ber specified in such clause.’’. 

21 (2) EFFECTIVE DATE.—The amendments made 

22 by paragraph (1) shall apply to cost reporting peri23 ods beginning on or after the date of the enactment 

24 of this Act. 


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1 SEC. 4204. MEDICARE REMOTE MONITORING PILOT 

2 PROJECTS. 

3 (a) PILOT PROJECTS.— 

4 (1) IN GENERAL.—Not later than 9 months 

5 after the date of enactment of this Act, the Sec6 retary of Health and Human Services (in this sec7 tion referred to as the ‘‘Secretary’’) shall conduct 

8 pilot projects under title XVIII of the Social Secu9 rity Act (42 U.S.C. 1395 et seq.) for the purpose of 

10 providing incentives to home health agencies to uti11 lize home monitoring and communications tech12 nologies that— 

13 (A) enhance health and health care out14 comes for Medicare beneficiaries; and 

15 (B) reduce expenditures under such title. 

16 (2) SITE REQUIREMENTS.— 

17 (A) URBAN AND RURAL.—The Secretary 

18 shall conduct the pilot projects under this sec19 tion in both urban and rural areas. 

20 (B) SITE IN A SMALL STATE.—The Sec21 retary shall conduct at least 3 of the pilot 

22 projects in a State with a population of less 

23 than 1,000,000. 

24 (3) DEFINITION OF HOME HEALTH AGENCY.— 

25 In this section, the term ‘‘home health agency’’ has 


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1 the meaning given that term in section 1861(o) of 

2 the Social Security Act (42 U.S.C. 1395x(o)). 

3 (b) MEDICARE BENEFICIARIES WITHIN THE SCOPE

4 OF PROJECTS.—The Secretary shall specify the criteria 

5 for identifying those Medicare beneficiaries who shall be 

6 considered within the scope of the pilot projects under this 

7 section for purposes of the application of subsection (c) 

8 and for the assessment of the effectiveness of the home 

9 health agency in achieving the objectives of this section. 

10 Such criteria may provide for the inclusion in the projects 

11 of Medicare beneficiaries who begin receiving home health 

12 services under title XVIII of the Social Security Act (42 

13 U.S.C. 1395 et seq.) after the date of the implementation 

14 of the projects. 

15 (c) INCENTIVES.— 

16 (1) PERFORMANCE TARGETS.—The Secretary 

17 shall establish for each home health agency partici18 pating in a pilot project under this section a per19 formance target using one of the following meth20 odologies, as determined appropriate by the Sec21 retary: 

22 (A) ADJUSTED HISTORICAL PERFORMANCE

23 TARGET.—The Secretary shall establish for the 

24 agency— 


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1 (i) a base expenditure amount equal 

2 to the average total payments made to the 

3 agency under parts A and B of title XVIII 

4 of the Social Security Act (42 U.S.C. 1395 

5 et seq.) for Medicare beneficiaries deter6 mined to be within the scope of the pilot 

7 project in a base period determined by the 

8 Secretary; and 

9 (ii) an annual per capita expenditure 

10 target for such beneficiaries, reflecting the 

11 base expenditure amount adjusted for risk 

12 and adjusted growth rates. 

13 (B) COMPARATIVE PERFORMANCE TAR14 GET.—The Secretary shall establish for the 

15 agency a comparative performance target equal 

16 to the average total payments under such parts 

17 A and B during the pilot project for comparable 

18 individuals in the same geographic area that 

19 are not determined to be within the scope of the 

20 pilot project. 

21 (2) INCENTIVE.—Subject to paragraph (3), the 

22 Secretary shall pay to each participating home care 

23 agency an incentive payment for each year under the 

24 pilot project equal to a portion of the Medicare savVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 00369 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 ings realized for such year relative to the perform2 ance target under paragraph (1). 

3 (3) LIMITATION ON EXPENDITURES.—The Sec4 retary shall limit incentive payments under this sec5 tion in order to ensure that the aggregate expendi6 tures under title XVIII of the Social Security Act 

7 (42 U.S.C. 1395 et seq.) (including incentive pay8 ments under this subsection) do not exceed the 

9 amount that the Secretary estimates would have 

10 been expended if the pilot projects under this section 

11 had not been implemented. 

12 (d) WAIVER AUTHORITY.—The Secretary may waive 

13 such provisions of titles XI and XVIII of the Social Secu14 rity Act (42 U.S.C. 1301 et seq.; 42 U.S.C. 1395 et seq.) 

15 as the Secretary determines to be appropriate for the con16 duct of the pilot projects under this section. 

17 (e) REPORT TO CONGRESS.—Not later than 5 years 

18 after the date that the first pilot project under this section 

19 is implemented, the Secretary shall submit to Congress a 

20 report on the pilot projects. Such report shall contain a 

21 detailed description of issues related to the expansion of 

22 the projects under subsection (f) and recommendations for 

23 such legislation and administrative actions as the Sec24 retary considers appropriate. 


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1 (f) EXPANSION.—If the Secretary determines that 

2 any of the pilot projects under this section enhance health 

3 outcomes for Medicare beneficiaries and reduce expendi4 tures under title XVIII of the Social Security Act (42 

5 U.S.C. 1395 et seq.), the Secretary may initiate com6 parable projects in additional areas. 

7 (g) INCENTIVE PAYMENTS HAVE NO EFFECT ON

8 OTHER MEDICARE PAYMENTS TO AGENCIES.—An incen9 tive payment under this section— 

10 (1) shall be in addition to the payments that a 

11 home health agency would otherwise receive under 

12 title XVIII of the Social Security Act for the provi13 sion of home health services; and 

14 (2) shall have no effect on the amount of such 

15 payments. 

16 SEC. 4205. COMMUNITY HEALTH CENTER COLLABORATIVE 

17 ACCESS EXPANSION. 

18 Section 330(r)(4) of the Public Health Service Act 

19 (42 U.S.C. 254b(r)(4)) is amended— 

20 (1) in subparagraph (A), by striking ‘‘primary 

21 health care services’’ each place it appears and in22 serting ‘‘primary health care and other mental, den23 tal, and physical health services’’; and 

24 (2) in subparagraph (B)— 


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1 (A) in clause (i), by striking ‘‘and’’ at the 

2 end; 

3 (B) in clause (ii), by striking the period at 

4 the end and inserting ‘‘; and’’; and 

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

6 ‘‘(iii) in the case of a rural health 

7 clinic described in such subparagraph— 

8 ‘‘(I) that such clinic provides, to 

9 the extent possible, enabling services, 

10 such as transportation and language 

11 assistance (including translation and 

12 interpretation); and 

13 ‘‘(II) that the primary health 

14 care and other services described in 

15 such subparagraph are subject to full 

16 reimbursement according to the pro17 spective payment system for Federally 

18 qualified health center services under 

19 section 1834(o) of the Social Security 

20 Act.’’. 

21 SEC. 4206. FACILITATING THE PROVISION OF TELEHEALTH 

22 SERVICES ACROSS STATE LINES. 

23 (a) IN GENERAL.—For purposes of expediting the 

24 provision of telehealth services, for which payment is made 

25 under the Medicare Program established under title XVIII 


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1 of the Social Security Act (42 U.S.C. 1395 et seq.). across 

2 State lines, the Secretary of Health and Human Services 

3 shall, in consultation with representatives of States, physi4 cians, health care practitioners, and patient advocates, en5 courage and facilitate the adoption of provisions allowing 

6 for multistate practitioner practice across State lines. 

7 (b) DEFINITIONS.—In subsection (a): 

8 (1) TELEHEALTH SERVICE.—The term ‘‘tele9 health service’’ has the meaning given that term in 

10 subparagraph (F) of section 1834(m)(4) of the So11 cial Security Act (42 U.S.C. 1395m(m)(4)). 

12 (2) PHYSICIAN, PRACTITIONER.—The terms 

13 ‘‘physician’’ and ‘‘practitioner’’ have the meaning 

14 given those terms in subparagraphs (D) and (E), re15 spectively, of section 1834(m)(4) of the Social Secu16 rity Act (42 U.S.C. 1395m(m)(4)). 

17 (3) MEDICARE PROGRAM.—The term ‘‘Medicare 

18 Program’’ means the program of health insurance 

19 administered by the Secretary of Health and Human 

20 Services under title XVIII of the Social Security Act 

21 (42 U.S.C. 1395 et seq.). 

22 SEC. 4207. SCORING OF PREVENTIVE HEALTH SAVINGS. 

23 Section 202 of the Congressional Budget and Im24 poundment Control Act of 1974 (2 U.S.C. 602) is amend25 ed by adding at the end the following: 


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1 ‘‘(h) SCORING OF PREVENTIVE HEALTH SAVINGS.— 

2 ‘‘(1) DETERMINATION BY THE DIRECTOR.— 

3 Upon a request by the chairman or ranking minority 

4 member of the Committee on the Budget of the Sen5 ate, or by the chairman or ranking minority member 

6 of the Committee on the Budget of the House of 

7 Representatives, the Director shall determine if a 

8 proposed measure would result in reductions in 

9 budget outlays in budgetary outyears through the 

10 use of preventive health and preventive health serv11 ices. 

12 ‘‘(2) PROJECTIONS.—If the Director determines 

13 that a measure would result in substantial reduc14 tions in budget outlays as described in paragraph 

15 (1), the Director— 

16 ‘‘(A) shall include, in any projection pre17 pared by the Director, a description and esti18 mate of the reductions in budget outlays in the 

19 budgetary outyears and a description of the 

20 basis for such conclusions; and 

21 ‘‘(B) may prepare a budget projection that 

22 includes some or all of the budgetary outyears, 

23 notwithstanding the time periods for projections 

24 described in subsection (e) and sections 308, 

25 402, and 424. 


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1 ‘‘(3) DEFINITIONS.—As used in this sub2 section— 

3 ‘‘(A) the term ‘budgetary outyears’ means 

4 the 2 consecutive 10-fiscal-year periods begin5 ning with the first fiscal year that is 10 years 

6 after the budget year provided for in the most 

7 recently agreed to concurrent resolution on the 

8 budget; and 

9 ‘‘(B) the term ‘preventive health’ means an 

10 action that focuses on the health of the public, 

11 individuals, and defined populations in order to 

12 protect, promote, and maintain health, wellness, 

13 and functional ability, and prevent disease, dis14 ability, and premature death that is dem15 onstrated by credible and publicly available epi16 demiological projection models, incorporating 

17 clinical trials or observational studies in hu18 mans, to avoid future health care costs.’’. 

19 SEC. 4208. SENSE OF CONGRESS ON MAINTENANCE OF EF20 FORT PROVISIONS REGARDING CHILDREN’S 

21 HEALTH. 

22 It is the sense of the Congress that— 

23 (1) the maintenance of effort provisions added 

24 to sections 1902 and 2105(d) of the Social Security 

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1 tions 2001(b) and 2101(b) of the Patient Protection 

2 and Affordable Care Act were intended to maintain 

3 the eligibility standards for the Medicaid program 

4 under title XIX of the Social Security Act (42 

5 U.S.C. 1396 et seq.) and Children’s Health Insur6 ance Program under title XXI of such Act (42 

7 U.S.C. 1397aa et seq.) to protect vulnerable and dis8 abled adults, children, and senior citizens, many of 

9 whom are also members of communities of color; 

10 (2) the maintenance of effort provisions for 

11 children’s coverage have been extended by the Con12 gress through September 30, 2029; 

13 (3) the maintenance of effort provisions ensure 

14 the continued success of the Medicaid program and 

15 Children’s Health Insurance Program and were in16 tended to specifically protect vulnerable and disabled 

17 children, many of whom are also members of com18 munities of color; and 

19 (4) the maintenance of effort provisions must 

20 be strictly enforced and proposals to weaken or 

21 waive the maintenance of effort provisions must not 

22 be considered. 


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1 SEC. 4209. PROTECTION OF THE HHS OFFICES OF MINOR2 ITY HEALTH. 

3 (a) IN GENERAL.—Pursuant to section 1707A of the 

4 Public Health Service Act (42 U.S.C. 300u–6a), the Of5 fices of Minority Health established within the Centers for 

6 Disease Control and Prevention, the Health Resources 

7 and Services Administration, the Substance Abuse and 

8 Mental Health Services Administration, the Agency for 

9 Healthcare Research and Quality, the Food and Drug Ad10 ministration, and the Centers for Medicare & Medicaid 

11 Services, are offices that, regardless of change in the 

12 structure of the Department of Health and Human Serv13 ices, shall report to the Secretary of Health and Human 

14 Services. 

15 (b) SENSE OF CONGRESS.—It is the sense of the 

16 Congress that the Offices of Minority Health referred to 

17 in subsection (a) play a critical role in addressing health 

18 disparities and should be adequately funded and given a 

19 prominent role in evaluating and establishing health poli20 cies and programs. 

21 SEC. 4210. OFFICE OF MINORITY HEALTH IN VETERANS 

22 HEALTH ADMINISTRATION OF DEPARTMENT 

23 OF VETERANS AFFAIRS. 

24 (a) ESTABLISHMENT AND FUNCTIONS.—Subchapter 

25 I of chapter 73 of title 38, United States Code, is amended 

26 by inserting after section 7308 the following new section: 


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1 ‘‘§ 7308A. Office of Minority Health 

2 ‘‘(a) ESTABLISHMENT.—There is established in the 

3 Department within the Office of the Under Secretary for 

4 Health an office to be known as the ‘Office of Minority 

5 Health’ (in this section referred to as the ‘Office’). 

6 ‘‘(b) HEAD.—The Director of the Office of Minority 

7 Health shall be the head of the Office. The Director of 

8 the Office of Minority Health shall be appointed by the 

9 Under Secretary for Health from among individuals quali10 fied to perform the duties of the position. 

11 ‘‘(c) FUNCTIONS.—The functions of the Office are as 

12 follows: 

13 ‘‘(1) To establish short-range and long-range 

14 goals and objectives and coordinate all other activi15 ties within the Veterans Health Administration that 

16 relate to disease prevention, health promotion, health 

17 care services delivery, health and health care edu18 cation, health care quality, and health care research 

19 concerning veterans who are members of a racial or 

20 ethnic minority group. 

21 ‘‘(2) To support research, demonstrations, and 

22 evaluations to test new and innovative models for 

23 the discharge of activities described in paragraph 

24 (1). 


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1 ‘‘(3) To increase knowledge and understanding 

2 of health risk factors for veterans who are members 

3 of a racial or ethnic minority group. 

4 ‘‘(4) To develop mechanisms that support bet5 ter health care information dissemination, education, 

6 prevention, and services delivery to veterans from 

7 disadvantaged backgrounds, including veterans who 

8 are members of a racial or ethnic minority group. 

9 ‘‘(5) To enter into contracts or agreements with 

10 appropriate public and nonprofit private entities to 

11 develop and carry out programs to provide bilingual 

12 or interpretive services to assist veterans who are 

13 members of a racial or ethnic minority group and 

14 who lack proficiency in speaking the English lan15 guage in accessing and receiving health care services 

16 through the Veterans Health Administration. 

17 ‘‘(6) To carry out programs to improve access 

18 to health care services through the Veterans Health 

19 Administration for veterans with limited proficiency 

20 in speaking the English language, including the de21 velopment and evaluation of demonstration and pilot 

22 projects for that purpose. 

23 ‘‘(7) To advise the Under Secretary for Health 

24 on matters relating to the development, implementa25 tion, and evaluation of health professions education 


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1 in decreasing disparities in health care outcomes be2 tween veterans who are members of a racial or eth3 nic minority group and other veterans, including cul4 tural competency as a method of eliminating such 

5 health disparities. 

6 ‘‘(8) To perform such other functions and du7 ties as the Secretary or the Under Secretary for 

8 Health considers appropriate. 

9 ‘‘(d) DEFINITIONS.—In this section: 

10 ‘‘(1) The term ‘racial or ethnic minority group’ 

11 means any of the following: 

12 ‘‘(A) American Indians (including Alaska 

13 Natives, Eskimos, and Aleuts). 

14 ‘‘(B) Asian Americans. 

15 ‘‘(C) Native Hawaiians and Pacific Island16 ers. 

17 ‘‘(D) Blacks. 

18 ‘‘(E) Hispanics. 

19 ‘‘(2) The term ‘Hispanic’ means individuals 

20 whose origin is from Mexico, Puerto Rico, Cuba, 

21 Central or South America, or any other Spanish22 speaking country.’’. 

23 (b) CLERICAL AMENDMENT.—The table of sections 

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1 ing after the item relating to section 7308 the following 

2 new item: 

‘‘7308A. Office of Minority Health.’’. 

3 SEC. 4211. STUDY OF DSH PAYMENTS TO ENSURE HOSPITAL 

4 ACCESS FOR LOW-INCOME PATIENTS. 

5 (a) IN GENERAL.—Not later than January 1, 2025, 

6 the Comptroller General of the United States shall con7 duct a study on how amendments made by the Patient 

8 Protection and Affordable Care Act (Public Law 111– 

9 148) and the Health Care and Education Reconciliation 

10 Act of 2010 (Public Law 111–152) to titles XVIII and 

11 XIX of the Social Security Act (42 U.S.C. 1395 et seq.; 

12 42 U.S.C. 1396 et seq.) relating to disproportionate share 

13 hospital adjustment payments under Medicare and Med14 icaid (and subsequent amendments made with respect to 

15 such payments) affect the timely access to health care 

16 services for low-income patients. Such study shall— 

17 (1) evaluate and examine whether States elect18 ing to make medical assistance available under sec19 tion 1902(a)(10)(A)(i)(VIII) of the Social Security 

20 Act (42 U.S.C. 1396a(a)(10)(A)(i)(VIII)) (including 

21 States making such an election through a waiver of 

22 the State plan) to individuals described in such sec23 tion mitigate the need for payments to dispropor24 tionate share hospitals under section 1886(d)(5)(F) 

25 of the Social Security Act (42 U.S.C. 


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1 1395ww(d)(5)(F)) and section 1923 of such Act (42 

2 U.S.C. 1396r–4), including the impact of such 

3 States electing to make medical assistance available 

4 to such individuals on— 

5 (A) the number of individuals in the 

6 United States who are without health insurance 

7 and the distribution of such individuals in rela8 tion to areas primarily served by dispropor9 tionate share hospitals; and 

10 (B) the low-income utilization rate of such 

11 hospitals and the resulting fiscal sustainability 

12 of such hospitals; 

13 (2) evaluate the appropriate level and distribu14 tion of such payments among such disproportionate 

15 share hospitals for purposes of— 

16 (A) sufficiently accounting for the level of 

17 uncompensated care provided by such hospitals 

18 to low-income patients; and 

19 (B) providing timely access to health care 

20 services for individuals in medically underserved 

21 areas; and 

22 (3) assess, with respect to such disproportionate 

23 share hospitals— 

24 (A) the role played by such hospitals in 

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1 tient, and outpatient health services, including 

2 end-of-life services, as well as the location of 

3 such hospitals in relation to medically under4 served areas; and 

5 (B) the extent to which such hospitals sat6 isfy the requirements established for charitable 

7 hospital organizations under section 501(r) of 

8 the Internal Revenue Code of 1986 with respect 

9 to community health needs assessments, finan10 cial assistance policy requirements, limitations 

11 on charges, and billing and collection require12 ments. 

13 (b) REPORTS.— 

14 (1) REPORT TO CONGRESS.—Not later than 

15 180 days after the date on which the study under 

16 subsection (a) is completed, the Comptroller General 

17 of the United States shall submit to the Committee 

18 on Energy and Commerce of the House of Rep19 resentatives and the Committee on Finance of the 

20 Senate a report that contains— 

21 (A) the results of the study; 

22 (B) recommendations to Congress for any 

23 legislative changes to the payments to dis24 proportionate share hospitals under section 

25 1886(d)(5)(F) of the Social Security Act (42 


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1 U.S.C. 1395ww(d)(5)(F)) and section 1923 of 

2 such Act (42 U.S.C. 1396r–4) that are needed 

3 to ensure access to health services for low-in4 come patients that— 

5 (i) are based on the number of indi6 viduals without health insurance, the 

7 amount of uncompensated care provided by 

8 such hospitals, and the impact of reduced 

9 payment levels on low-income communities; 

10 and 

11 (ii) takes into account any reports 

12 submitted by the Secretary of the Treas13 ury, in consultation with the Secretary of 

14 Health and Human Services, to congres15 sional committees regarding the costs in16 curred by charitable hospital organizations 

17 for charity care, bad debt, nonreimbursed 

18 expenses for services provided to individ19 uals under the Medicare program under 

20 title XVIII of the Social Security Act and 

21 the Medicaid program under title XIX of 

22 such Act, and any community benefit ac23 tivities provided by such organizations. 

24 (2) REPORT TO THE SECRETARY OF HEALTH

25 AND HUMAN SERVICES.—Not later than 180 days 


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1 after the date on which the study under subsection 

2 (a) is completed, the Comptroller General of the 

3 United States shall submit to the Secretary of 

4 Health and Human Services a report that con5 tains— 

6 (A) the results of the study; and 

7 (B) any recommendations for purposes of 

8 assisting in the development of the methodology 

9 for the adjustment of payments to dispropor10 tionate share hospitals, as required under sec11 tion 1886(r) of the Social Security Act (42 

12 U.S.C. 1395ww(r)) and the reduction of such 

13 payments under section 1923(f)(7) of such Act 

14 (42 U.S.C. 1396r–4(f)(7)), taking into account 

15 the reports referred to in paragraph (1)(B)(ii). 

16 SEC. 4212. REAUTHORIZATION OF PROGRAMS UNDER THE 

17 NATIVE HAWAIIAN HEALTH CARE IMPROVE18 MENT ACT. 

19 (a) NATIVE HAWAIIAN HEALTH CARE SYSTEMS.— 

20 Section 6(h)(1) of the Native Hawaiian Health Care Im21 provement Act (42 U.S.C. 11705(h)(1)) is amended by 

22 striking ‘‘may be necessary for fiscal years 1993 through 

23 2019’’ and inserting ‘‘are necessary’’. 

24 (b) ADMINISTRATIVE GRANT FOR PAPA OLA

25 LOKAHI.—Section 7(b) of the Native Hawaiian Health 


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1 Care Improvement Act (42 U.S.C. 11706(b)) is amended 

2 by striking ‘‘may be necessary for fiscal years 1993 

3 through 2019’’ and inserting ‘‘are necessary’’. 

4 (c) NATIVE HAWAIIAN HEALTH SCHOLARSHIPS.— 

5 Section 10(c) of the Native Hawaiian Health Care Im6 provement Act (42 U.S.C. 11709(c)) is amended by strik7 ing ‘‘may be necessary for fiscal years 1993 through 

8 2019’’ and inserting ‘‘are necessary’’. 

9 PART 2—RURAL 

10 SEC. 4221. ESTABLISHMENT OF RURAL COMMUNITY HOS11 PITAL (RCH) PROGRAM. 

12 (a) IN GENERAL.—Section 1861 of the Social Secu13 rity Act (42 U.S.C. 1395x), as amended by section 

14 2007(b)(1), is amended by adding at the end of the fol15 lowing new subsection: 

16 ‘‘Rural Community Hospital; Rural Community Hospital 

17 Services 

18 ‘‘(ooo)(1) The term ‘rural community hospital’ means 

19 a hospital (as defined in subsection (e)) that— 

20 ‘‘(A) is located in a rural area (as defined in 

21 section 1886(d)(2)(D)) or treated as being so lo22 cated pursuant to section 1886(d)(8)(E); 

23 ‘‘(B) subject to paragraph (2), has less than 51 

24 acute care inpatient beds, as reported in its most re25 cent cost report; 


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1 ‘‘(C) makes available 24-hour emergency care 

2 services; 

3 ‘‘(D) subject to paragraph (3), has a provider 

4 agreement in effect with the Secretary and is open 

5 to the public as of January 1, 2010; and 

6 ‘‘(E) applies to the Secretary for such designa7 tion. 

8 ‘‘(2) For purposes of paragraph (1)(B), beds in a 

9 psychiatric or rehabilitation unit of the hospital which is 

10 a distinct part of the hospital shall not be counted. 

11 ‘‘(3) Paragraph (1)(D) shall not be construed to pro12 hibit any of the following from qualifying as a rural com13 munity hospital: 

14 ‘‘(A) A replacement facility (as defined by the 

15 Secretary in regulations in effect on January 1, 

16 2012) with the same service area (as defined by the 

17 Secretary in regulations in effect on such date). 

18 ‘‘(B) A facility obtaining a new provider num19 ber pursuant to a change of ownership. 

20 ‘‘(C) A facility which has a binding written 

21 agreement with an outside, unrelated party for the 

22 construction, reconstruction, lease, rental, or financ23 ing of a building as of January 1, 2012. 

24 ‘‘(4) Nothing in this subsection shall be construed as 

25 prohibiting a critical access hospital from qualifying as a 


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1 rural community hospital if the critical access hospital 

2 meets the conditions otherwise applicable to hospitals 

3 under subsection (e) and section 1866. 

4 ‘‘(5) Nothing in this subsection shall be construed as 

5 prohibiting a rural community hospital participating in 

6 the demonstration program under section 410A of the 

7 Medicare Prescription Drug, Improvement, and Mod8 ernization Act of 2003 (42 U.S.C. 1395ww note; Public 

9 Law 108–173) from qualifying as a rural community hos10 pital if the rural community hospital meets the conditions 

11 otherwise applicable to hospitals under subsection (e) and 

12 section 1866.’’. 

13 (b) PAYMENT.— 

14 (1) INPATIENT HOSPITAL SERVICES.—Section 

15 1814 of the Social Security Act (42 U.S.C. 1395f) 

16 is amended by adding at the end the following new 

17 subsection: 

18 ‘‘Payment for Inpatient Services Furnished in Rural 

19 Community Hospitals 

20 ‘‘(m) The amount of payment under this part for in21 patient hospital services furnished in a rural community 

22 hospital, other than such services furnished in a psy23 chiatric or rehabilitation unit of the hospital which is a 

24 distinct part, is, at the election of the hospital in the appli25 cation referred to in section 1861(ooo)(1)(E)— 


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1 ‘‘(1) 101 percent of the reasonable costs of pro2 viding such services, without regard to the amount 

3 of the customary or other charge, or 

4 ‘‘(2) the amount of payment provided for under 

5 the prospective payment system for inpatient hos6 pital services under section 1886(d).’’. 

7 (2) OUTPATIENT SERVICES.—Section 1834 of 

8 the Social Security Act (42 U.S.C. 1395m) is 

9 amended by adding at the end the following new 

10 subsection: 

11 ‘‘(aa) PAYMENT FOR OUTPATIENT SERVICES FUR12 NISHED IN RURAL COMMUNITY HOSPITALS.—The 

13 amount of payment under this part for outpatient services 

14 furnished in a rural community hospital is, at the election 

15 of the hospital in the application referred to in section 

16 1861(ooo)(1)(E)— 

17 ‘‘(1) 101 percent of the reasonable costs of pro18 viding such services, without regard to the amount 

19 of the customary or other charge and any limitation 

20 under section 1861(v)(1)(U), or 

21 ‘‘(2) the amount of payment provided for under 

22 the prospective payment system for covered OPD 

23 services under section 1833(t).’’. 

24 (3) EXEMPTION FROM 30-PERCENT REDUCTION

25 IN REIMBURSEMENT FOR BAD DEBT.—Section 


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1 1861(v)(1)(T) of the Social Security Act (42 U.S.C. 

2 1395x(v)(1)(T)) is amended in the matter preceding 

3 clause (i) by inserting ‘‘(other than for a rural com4 munity hospital)’’ after ‘‘In determining such rea5 sonable costs for hospitals’’. 

6 (c) BENEFICIARY COST-SHARING FOR OUTPATIENT

7 SERVICES.—Section 1834(aa) of the Social Security Act 

8 (as added by subsection (b)(2)) is amended— 

9 (1) by redesignating paragraphs (1) and (2) as 

10 subparagraphs (A) and (B), respectively; 

11 (2) by inserting ‘‘(1)’’ after ‘‘(aa)’’; and 

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

13 ‘‘(2) The amounts of beneficiary cost-sharing for out14 patient services furnished in a rural community hospital 

15 under this part shall be as follows: 

16 ‘‘(A) For items and services that would have 

17 been paid under section 1833(t) if furnished by a 

18 hospital, the amount of cost-sharing determined 

19 under paragraph (8) of such section. 

20 ‘‘(B) For items and services that would have 

21 been paid under section 1833(h) if furnished by a 

22 provider of services or supplier, no cost-sharing shall 

23 apply. 

24 ‘‘(C) For all other items and services, the 

25 amount of cost-sharing that would apply to the item 


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1 or service under the methodology that would be used 

2 to determine payment for such item or service if pro3 vided by a physician, provider of services, or sup4 plier, as the case may be.’’. 

5 (d) CONFORMING AMENDMENTS.— 

6 (1) PART A PAYMENT.—Section 1814(b) of the 

7 Social Security Act (42 U.S.C. 1395f(b)) is amended 

8 in the matter preceding paragraph (1) by inserting 

9 ‘‘other than inpatient hospital services furnished by 

10 a rural community hospital,’’ after ‘‘critical access 

11 hospital services,’’. 

12 (2) PART B PAYMENT.—Section 1833(a) of the 

13 Social Security Act (42 U.S.C. 1395l(a)), as amend14 ed by section 2207(b)(3), is amended— 

15 (A) by striking ‘‘and’’ at the end of para16 graph (10); 

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

18 paragraph (11) and inserting ‘‘; and’’; and 

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

20 ‘‘(12) in the case of outpatient services fur21 nished by a rural community hospital, the amounts 

22 described in section 1834(aa).’’. 

23 (3) TECHNICAL AMENDMENTS.— 

24 (A) CONSULTATION WITH STATE AGEN25 CIES.—Section 1863 of the Social Security Act 


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1 (42 U.S.C. 1395z) is amended by striking ‘‘and 

2 (dd)(2)’’ and inserting ‘‘(dd)(2), and (ooo)(1)’’. 

3 (B) PROVIDER AGREEMENTS.—Section 

4 1866(a)(2)(A) of the Social Security Act (42 

5 U.S.C. 1395cc(a)(2)(A)) is amended by insert6 ing ‘‘section 1834(aa)(2),’’ after ‘‘section 

7 1833(b),’’. 

8 (e) EFFECTIVE DATE.—The amendments made by 

9 this section shall apply to items and services furnished on 

10 or after the date that is 30 days after the date of the 

11 enactment of this Act. 

12 SEC. 4222. RURAL HEALTH QUALITY ADVISORY COMMIS13 SION AND DEMONSTRATION PROJECTS. 

14 (a) RURAL HEALTH QUALITY ADVISORY COMMIS15 SION.— 

16 (1) ESTABLISHMENT.—Not later than 6 

17 months after the date of the enactment of this sec18 tion, the Secretary of Health and Human Services 

19 (in this section referred to as the ‘‘Secretary’’) shall 

20 establish a commission to be known as the ‘‘Rural 

21 Health Quality Advisory Commission’’ (in this sec22 tion referred to as the ‘‘Commission’’). 

23 (2) DUTIES OF COMMISSION.— 

24 (A) NATIONAL PLAN.—The Commission 

25 shall develop, coordinate, and facilitate impleVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 00392 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 mentation of a national plan for rural health 

2 quality improvement. The national plan shall— 

3 (i) identify objectives for rural health 

4 quality improvement; 

5 (ii) identify strategies to eliminate 

6 known gaps in rural health system capacity 

7 and improve rural health quality; and 

8 (iii) provide recommendations for 

9 Federal programs to identify opportunities 

10 for strengthening and aligning policies and 

11 programs to improve rural health quality. 

12 (B) DEMONSTRATION PROJECTS.—The 

13 Commission shall design demonstration projects 

14 to recommend to the Secretary to test alter15 native models for rural health quality improve16 ment, including with respect to both personal 

17 and population health. 

18 (C) MONITORING.—The Commission shall 

19 monitor progress toward the objectives identi20 fied pursuant to subparagraph (A)(i). 

21 (3) MEMBERSHIP.— 

22 (A) NUMBER.—The Commission shall be 

23 composed of 11 members appointed by the Sec24 retary. 


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1 (B) SELECTION.—The Secretary shall se2 lect the members of the Commission from 

3 among individuals with significant rural health 

4 care and health care quality expertise, including 

5 expertise in clinical health care, health care 

6 quality research, end-of-life care, population or 

7 public health, or purchaser organizations. 

8 (4) CONTRACTING AUTHORITY.—Subject to the 

9 availability of funds, the Commission may enter into 

10 contracts and make other arrangements, as may be 

11 necessary to carry out the duties described in para12 graph (2). 

13 (5) STAFF.—Upon the request of the Commis14 sion, the Secretary may detail, on a reimbursable 

15 basis, any of the personnel of the Office of Rural 

16 Health Policy of the Health Resources and Services 

17 Administration, the Agency for Healthcare Research 

18 and Quality, or the Centers for Medicare & Medicaid 

19 Services to the Commission to assist in carrying out 

20 this subsection. 

21 (6) REPORTS TO CONGRESS.—Not later than 1 

22 year after the establishment of the Commission, and 

23 annually thereafter, the Commission shall submit a 

24 report to the Congress on rural health quality. Each 

25 such report shall include the following: 


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1 (A) An inventory of relevant programs and 

2 recommendations for improved coordination and 

3 integration of policy and programs. 

4 (B) An assessment of achievement of the 

5 objectives identified in the national plan devel6 oped under paragraph (2) and recommenda7 tions for realizing such objectives. 

8 (C) Recommendations on Federal legisla9 tion, regulations, or administrative policies to 

10 enhance rural health quality and outcomes. 

11 (b) RURAL HEALTH QUALITY DEMONSTRATION

12 PROJECTS.— 

13 (1) IN GENERAL.—Not later than 270 days 

14 after the date of the enactment of this section, the 

15 Secretary, in consultation with the Rural Health 

16 Quality Advisory Commission, the Office of Rural 

17 Health Policy of the Health Resources and Services 

18 Administration, the Agency for Healthcare Research 

19 and Quality, and the Centers for Medicare & Med20 icaid Services, shall make grants to eligible entities 

21 for a total of 5 demonstration projects to implement 

22 and evaluate methods for improving the quality of 

23 health care in rural communities. Each such dem24 onstration project shall include— 

25 (A) alternative community models that— 


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1 (i) will achieve greater integration of 

2 personal and population health services; 

3 and 

4 (ii) address safety, effectiveness, 

5 patient- or community-centeredness, timeli6 ness, efficiency, and equity (the 6 aims 

7 identified by the National Academy of 

8 Medicine (formerly known as the ‘‘Institute 

9 of Medicine’’) in its report entitled ‘‘Cross10 ing the Quality Chasm: A New Health Sys11 tem for the 21st Century’’ released on 

12 March 1, 2001); 

13 (B) innovative approaches to the financing 

14 and delivery of health care services to achieve 

15 rural health quality and accessibility goals for 

16 patients; and 

17 (C) development of quality improvement 

18 support structures to assist rural health sys19 tems and professionals in the provision of 

20 health care (such as workforce support struc21 tures, quality monitoring and reporting, clinical 

22 care protocols, and information technology ap23 plications). 


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1 (2) ELIGIBLE ENTITIES.—In this subsection, 

2 the term ‘‘eligible entity’’ means a consortium 

3 that— 

4 (A) shall include— 

5 (i) at least one health care provider or 

6 health care delivery system located in a 

7 rural area; and 

8 (ii) at least one organization rep9 resenting multiple community stakeholders; 

10 and 

11 (B) may include other partners such as 

12 rural research centers. 

13 (3) CONSULTATION.—In developing the pro14 gram for awarding grants under this subsection, the 

15 Secretary shall consult with the Administrator of the 

16 Agency for Healthcare Research and Quality, rural 

17 health care providers, rural health care researchers, 

18 and private and nonprofit groups (including national 

19 associations) which are undertaking similar efforts. 

20 (4) EXPEDITED WAIVERS.—The Secretary shall 

21 expedite the processing of any waiver that— 

22 (A) is authorized under title XVIII or XIX 

23 of the Social Security Act (42 U.S.C. 1395 et 

24 seq.; 42 U.S.C. 1396 et seq.); and 


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1 (B) is necessary to carry out a demonstra2 tion project under this subsection. 

3 (5) DEMONSTRATION PROJECT SITES.—The 

4 Secretary shall ensure that the 5 demonstration 

5 projects funded under this subsection are conducted 

6 at a variety of sites representing the diversity of 

7 rural communities in the United States. 

8 (6) DURATION.—Each demonstration project 

9 under this subsection shall be for a period of 4 

10 years. 

11 (7) INDEPENDENT EVALUATION.—The Sec12 retary shall enter into an arrangement with an enti13 ty that has experience working directly with rural 

14 health systems for the conduct of an independent 

15 evaluation of the program carried out under this 

16 subsection. 

17 (8) REPORT.—Not later than 1 year after the 

18 conclusion of all of the demonstration projects fund19 ed under this subsection, the Secretary shall submit 

20 a report to the Congress on the results of such 

21 projects. The report shall include— 

22 (A) an evaluation of patient access to care, 

23 patient outcomes, and an analysis of the cost24 effectiveness of each such project; and 


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1 (B) recommendations on Federal legisla2 tion, regulations, or administrative policies to 

3 enhance rural health quality and outcomes. 

4 (c) APPROPRIATIONS.— 

5 (1) IN GENERAL.—Out of funds in the Treas6 ury not otherwise appropriated, there are appro7 priated to the Secretary to carry out this section 

8 $30,000,000 for the period of fiscal years 2025 

9 through 2029. 

10 (2) AVAILABILITY.— 

11 (A) IN GENERAL.—Except as provided in 

12 subparagraph (B), funds appropriated under 

13 paragraph (1) shall remain available for ex14 penditure through fiscal year 2028. 

15 (B) REPORT.—For purposes of carrying 

16 out subsection (b)(8), funds appropriated under 

17 paragraph (1) shall remain available for ex18 penditure through fiscal year 2029. 

19 (3) RESERVATION.—Of the amount appro20 priated under paragraph (1), the Secretary shall re21 serve— 

22 (A) $5,000,000 to carry out subsection (a); 

23 and 

24 (B) $25,000,000 to carry out subsection 

25 (b), of which— 


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1 (i) 2 percent shall be for the provision 

2 of technical assistance to grant recipients; 

3 and 

4 (ii) 5 percent shall be for the inde5 pendent evaluation under subsection 

6 (b)(7). 

7 SEC. 4223. RURAL HEALTH CARE SERVICES. 

8 Section 330A of the Public Health Service Act (42 

9 U.S.C. 254c) is amended to read as follows: 

10 ‘‘SEC. 330A. RURAL HEALTH CARE SERVICES OUTREACH, 

11 RURAL HEALTH NETWORK DEVELOPMENT, 

12 DELTA RURAL DISPARITIES AND HEALTH 

13 SYSTEMS DEVELOPMENT, AND SMALL RURAL 

14 HEALTH CARE PROVIDER QUALITY IMPROVE15 MENT GRANT PROGRAMS. 

16 ‘‘(a) PURPOSE.—The purpose of this section is to 

17 provide for grants— 

18 ‘‘(1) under subsection (b), to promote rural 

19 health care services outreach; 

20 ‘‘(2) under subsection (c), to provide for the 

21 planning and implementation of integrated health 

22 care networks in rural areas; 

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1 parities and to promote and enhance health system 

2 development; and 

3 ‘‘(4) under subsection (e), to provide for the 

4 planning and implementation of small rural health 

5 care provider quality improvement activities. 

6 ‘‘(b) RURAL HEALTH CARE SERVICES OUTREACH

7 GRANTS.— 

8 ‘‘(1) GRANTS.—The Director of the Office of 

9 Rural Health Policy of the Health Resources and 

10 Services Administration (referred to in this section 

11 as the ‘Director’) may award grants to eligible enti12 ties to promote rural health care services outreach 

13 by expanding the delivery of health care services to 

14 include new and enhanced services in rural areas. 

15 The Director may award the grants for periods of 

16 not more than 3 years. 

17 ‘‘(2) ELIGIBILITY.—To be eligible to receive a 

18 grant under this subsection for a project, an enti19 ty— 

20 ‘‘(A) shall be a rural public or rural non21 profit private entity, a facility that qualifies as 

22 a rural health clinic under title XVIII of the 

23 Social Security Act, a public or nonprofit entity 

24 existing exclusively to provide services to mi25 grant and seasonal farm workers in rural areas, 


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1 or a Tribal government whose grant-funded ac2 tivities will be conducted within federally recog3 nized Tribal areas; 

4 ‘‘(B) shall represent a consortium com5 posed of members— 

6 ‘‘(i) that include 3 or more independ7 ently owned health care entities; and 

8 ‘‘(ii) that may be nonprofit or for9 profit entities; and 

10 ‘‘(C) shall not previously have received a 

11 grant under this subsection for the same or a 

12 similar project, unless the entity is proposing to 

13 expand the scope of the project or the area that 

14 will be served through the project. 

15 ‘‘(3) APPLICATIONS.—To be eligible to receive a 

16 grant under this subsection, an eligible entity shall 

17 prepare and submit to the Director an application at 

18 such time, in such manner, and containing such in19 formation as the Director may require, including— 

20 ‘‘(A) a description of the project that the 

21 eligible entity will carry out using the funds 

22 provided under the grant; 

23 ‘‘(B) a description of the manner in which 

24 the project funded under the grant will meet 


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1 the health care needs of rural populations in 

2 the local community or region to be served; 

3 ‘‘(C) a plan for quantifying how health 

4 care needs will be met through identification of 

5 the target population and benchmarks of service 

6 delivery or health status, such as— 

7 ‘‘(i) quantifiable measurements of 

8 health and health care status improvement 

9 for projects focusing on health promotion; 

10 or 

11 ‘‘(ii) benchmarks of increased access 

12 to primary and end-of-life care, including 

13 tracking factors such as the number and 

14 type of primary and end-of-life care visits, 

15 identification of a medical home, or other 

16 general measures of such access; 

17 ‘‘(D) a description of how the local com18 munity or region to be served will be involved 

19 in the development and ongoing operations of 

20 the project; 

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; 


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1 ‘‘(G) the administrative capacity to submit 

2 annual performance data electronically as speci3 fied by the Director; and 

4 ‘‘(H) other such information as the Direc5 tor determines to be appropriate. 

6 ‘‘(c) RURAL HEALTH NETWORK DEVELOPMENT

7 GRANTS.— 

8 ‘‘(1) GRANTS.— 

9 ‘‘(A) IN GENERAL.—The Director may 

10 award rural health network development grants 

11 to eligible entities to promote, through planning 

12 and implementation, the development of inte13 grated health care networks that have combined 

14 the functions of the entities participating in the 

15 networks in order to— 

16 ‘‘(i) achieve efficiencies and economies 

17 of scale; 

18 ‘‘(ii) expand access to, coordinate, and 

19 improve the quality of the health care de20 livery system through development of orga21 nizational efficiencies; 

22 ‘‘(iii) implement health information 

23 technology to achieve efficiencies, reduce 

24 medical errors, and improve quality; 


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1 ‘‘(iv) coordinate care and manage 

2 chronic and terminal illness; and 

3 ‘‘(v) strengthen the rural health care 

4 system as a whole and across all facets of 

5 the health care delivery system, including 

6 end-of-life care, in such a manner as to 

7 show a quantifiable return on investment 

8 to the participants in the network. 

9 ‘‘(B) GRANT PERIODS.—The Director may 

10 award such a rural health network development 

11 grant— 

12 ‘‘(i) for a period of 3 years for imple13 mentation activities; or 

14 ‘‘(ii) for a period of 1 year for plan15 ning activities to assist in the initial devel16 opment of an integrated health care net17 work, if the proposed participants in the 

18 network do not have a history of collabo19 rative efforts and a 3-year grant would be 

20 inappropriate. 

21 ‘‘(2) ELIGIBILITY.—To be eligible to receive a 

22 grant under this subsection, an entity— 

23 ‘‘(A) shall be a rural public or rural non24 profit private entity, a facility that qualifies as 

25 a rural health clinic under title XVIII of the 


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1 Social Security Act, a public or nonprofit entity 

2 existing exclusively to provide services to mi3 grant and seasonal farm workers in rural areas, 

4 or a Tribal government whose grant-funded ac5 tivities will be conducted within federally recog6 nized Tribal areas; 

7 ‘‘(B) shall represent a network composed 

8 of participants— 

9 ‘‘(i) that include 3 or more independ10 ently owned health care entities; and 

11 ‘‘(ii) that may be nonprofit or for12 profit entities; and 

13 ‘‘(C) shall not previously have received a 

14 grant under this subsection (other than a 1- 

15 year grant for planning activities) for the same 

16 or a similar project. 

17 ‘‘(3) APPLICATIONS.—To be eligible to receive a 

18 grant under this subsection, an eligible entity, in 

19 consultation with the appropriate State office of 

20 rural health or another appropriate State entity, 

21 shall prepare and submit to the Director an applica22 tion at such time, in such manner, and containing 

23 such information as the Director may require, in24 cluding— 


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1 ‘‘(A) a description of the project that the 

2 eligible entity will carry out using the funds 

3 provided under the grant; 

4 ‘‘(B) an explanation of the reasons why 

5 Federal assistance is required to carry out the 

6 project; 

7 ‘‘(C) a description of— 

8 ‘‘(i) the history of collaborative activi9 ties carried out by the participants in the 

10 network; 

11 ‘‘(ii) the degree to which the partici12 pants are ready to integrate their func13 tions; and 

14 ‘‘(iii) how the local community or re15 gion to be served will benefit from and be 

16 involved in the activities carried out by the 

17 network; 

18 ‘‘(D) a description of how the local com19 munity or region to be served will experience in20 creased access to quality health care services 

21 across the continuum of care as a result of the 

22 integration activities carried out by the net23 work, including a description of— 

24 ‘‘(i) return on investment for the com25 munity and the network members; and 


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1 ‘‘(ii) other quantifiable performance 

2 measures that show the benefit of the net3 work activities; 

4 ‘‘(E) a plan for sustaining the project after 

5 Federal support for the project has ended; 

6 ‘‘(F) a description of how the project will 

7 be evaluated; 

8 ‘‘(G) the administrative capacity to submit 

9 annual performance data electronically as speci10 fied by the Director; and 

11 ‘‘(H) other such information as the Direc12 tor determines to be appropriate. 

13 ‘‘(d) DELTA RURAL DISPARITIES AND HEALTH SYS14 TEMS DEVELOPMENT GRANTS.— 

15 ‘‘(1) GRANTS.—The Director may award grants 

16 to eligible entities to support reduction of health dis17 parities, improve access to health care, and enhance 

18 rural health system development in the Delta Re19 gion. 

20 ‘‘(2) ELIGIBILITY.—To be eligible to receive a 

21 grant under this subsection, an entity shall be a 

22 rural public or rural nonprofit private entity, a facil23 ity that qualifies as a rural health clinic under title 

24 XVIII of the Social Security Act, a public or non25 profit entity existing exclusively to provide services 


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1 to migrant and seasonal farm workers in rural 

2 areas, or a Tribal government whose grant-funded 

3 activities will be conducted within federally recog4 nized Tribal areas. 

5 ‘‘(3) APPLICATIONS.—To be eligible to receive a 

6 grant under this subsection, an eligible entity shall 

7 prepare and submit to the Director an application at 

8 such time, in such manner, and containing such in9 formation as the Director may require, including— 

10 ‘‘(A) a description of the project that the 

11 eligible entity will carry out using the funds 

12 provided under the grant; 

13 ‘‘(B) an explanation of the reasons why 

14 Federal assistance is required to carry out the 

15 project; 

16 ‘‘(C) a description of the manner in which 

17 the project funded under the grant will meet 

18 the health care needs of the Delta Region; 

19 ‘‘(D) a description of how the local com20 munity or region to be served will experience in21 creased access to quality health care services as 

22 a result of the activities carried out by the enti23 ty; 


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1 ‘‘(E) a description of how health dispari2 ties will be reduced or the health system will be 

3 improved; 

4 ‘‘(F) a plan for sustaining the project after 

5 Federal support for the project has ended; 

6 ‘‘(G) a description of how the project will 

7 be evaluated including process and outcome 

8 measures related to the quality of care provided 

9 or how the health care system improves its per10 formance; 

11 ‘‘(H) a description of how the grantee will 

12 develop an advisory group made up of rep13 resentatives of the communities to be served to 

14 provide guidance to the grantee to best meet 

15 community need; and 

16 ‘‘(I) other such information as the Director 

17 determines to be appropriate. 

18 ‘‘(e) SMALL RURAL HEALTH CARE PROVIDER QUAL19 ITY IMPROVEMENT GRANTS.— 

20 ‘‘(1) GRANTS.—The Director may award grants 

21 to provide for the planning and implementation of 

22 small rural health care provider quality improvement 

23 activities. The Director may award the grants for 

24 periods of 1 to 3 years. 


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1 ‘‘(2) ELIGIBILITY.—To be eligible for a grant 

2 under this subsection, an entity— 

3 ‘‘(A) shall be— 

4 ‘‘(i) a rural public or rural nonprofit 

5 private health care provider or provider of 

6 health care services, such as a rural health 

7 clinic; or 

8 ‘‘(ii) another rural provider or net9 work of small rural providers identified by 

10 the Director as a key source of local care; 

11 and 

12 ‘‘(B) shall not previously have received a 

13 grant under this subsection for the same or a 

14 similar project. 

15 ‘‘(3) PREFERENCE.—In awarding grants under 

16 this subsection, the Director shall give preference to 

17 facilities that qualify as rural health clinics under 

18 title XVIII of the Social Security Act. 

19 ‘‘(4) APPLICATIONS.—To be eligible to receive a 

20 grant under this subsection, an eligible entity shall 

21 prepare and submit to the Director an application at 

22 such time, in such manner, and containing such in23 formation as the Director may require, including— 


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1 ‘‘(A) a description of the project that the 

2 eligible entity will carry out using the funds 

3 provided under the grant; 

4 ‘‘(B) an explanation of the reasons why 

5 Federal assistance is required to carry out the 

6 project; 

7 ‘‘(C) a description of the manner in which 

8 the project funded under the grant will assure 

9 continuous quality improvement in the provision 

10 of services by the entity; 

11 ‘‘(D) a description of how the local com12 munity or region to be served will experience in13 creased access to quality health care services as 

14 a result of the activities carried out by the enti15 ty; 

16 ‘‘(E) a plan for sustaining the project after 

17 Federal support for the project has ended; 

18 ‘‘(F) a description of how the project will 

19 be evaluated including process and outcome 

20 measures related to the quality of care pro21 vided; and 

22 ‘‘(G) other such information as the Direc23 tor determines to be appropriate. 

24 ‘‘(f) GENERAL REQUIREMENTS.— 


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1 ‘‘(1) PROHIBITED USES OF FUNDS.—An entity 

2 that receives a grant under this section may not use 

3 funds provided through the grant— 

4 ‘‘(A) to build or acquire real property; or 

5 ‘‘(B) for construction. 

6 ‘‘(2) COORDINATION WITH OTHER AGENCIES.— 

7 The Director shall coordinate activities carried out 

8 under grant programs described in this section, to 

9 the extent practicable, with Federal and State agen10 cies and nonprofit organizations that are operating 

11 similar grant programs, to maximize the effect of 

12 public dollars in funding meritorious proposals. 

13 ‘‘(g) REPORT.—Not later than September 30, 2025, 

14 the Secretary shall prepare and submit to the appropriate 

15 committees of Congress a report on the progress and ac16 complishments of the grant programs described in sub17 sections (b), (c), (d), and (e). 

18 ‘‘(h) DEFINITION OF DELTA REGION.—In this sec19 tion, the term ‘Delta Region’ has the meaning given to 

20 the term ‘region’ in section 382A of the Consolidated 

21 Farm and Rural Development Act (7 U.S.C. 2009aa). 

22 ‘‘(i) 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 2025 through 2028.’’. 


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1 PART 3—INDIAN COMMUNITIES 

2 SEC. 4231. ASSISTANT SECRETARY OF THE INDIAN HEALTH 

3 SERVICE. 

4 (a) REFERENCES.—Any reference in a law, regula5 tion, document, paper, or other record of the United 

6 States to the Director of the Indian Health Service shall 

7 be deemed to be a reference to the Assistant Secretary 

8 of the Indian Health Service. 

9 (b) EXECUTIVE SCHEDULE.—Section 5315 of title 5, 

10 United States Code, is amended, in the matter relating 

11 to the Assistant Secretaries of Health and Human Serv12 ices, by striking ‘‘(6)’’ and inserting ‘‘(7), 1 of whom shall 

13 be the Assistant Secretary of the Indian Health Service’’. 

14 (c) CONFORMING AMENDMENT.—Section 5316 of 

15 title 5, United States Code, is amended by striking ‘‘Direc16 tor, Indian Health Service, Department of Health and 

17 Human Services.’’. 

18 SEC. 4232. EXTENSION OF FULL FEDERAL MEDICAL ASSIST19 ANCE PERCENTAGE TO INDIAN HEALTH 

20 CARE PROVIDERS. 

21 Section 1905(a)(9) of the Social Security Act (42 

22 U.S.C. 1396d(a)(9)) is amended to read as follows: 

23 ‘‘(9) clinic services furnished by or under the 

24 direction of a physician, without regard to whether 

25 the clinic itself is administered by a physician, in26 cluding— 


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1 ‘‘(A) such services furnished outside the 

2 clinic by clinic personnel to an eligible indi3 vidual who does not reside in a permanent 

4 dwelling or does not have a fixed home or mail5 ing address; and 

6 ‘‘(B) such services furnished outside the 

7 clinic by any Indian Health Service facility, a 

8 health program or facility operated by a tribe or 

9 tribal organization under the Indian Self-Deter10 mination Act (Public Law 93–638), or an 

11 urban Indian organization receiving funds 

12 under title V of the Indian Health Care Im13 provement Act;’’. 

14 SEC. 4233. CONFERRING WITH URBAN INDIAN ORGANIZA15 TIONS. 

16 Section 514 of the Indian Health Care Improvement 

17 Act (25 U.S.C. 1660d) is amended by striking subsection 

18 (b) and inserting the following: 

19 ‘‘(b) REQUIREMENT.—The Secretary shall ensure 

20 that the Service and other agencies and offices of the De21 partment and the Department of Veterans Affairs confer, 

22 to the maximum extent practicable, with urban Indian or23 ganizations in carrying out— 

24 ‘‘(1) this Act; and 


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1 ‘‘(2) other provisions of law relating to Indian 

2 health care.’’. 

3 PART 4—PROVIDERS 

4 SEC. 4241. AVAILABILITY OF NON-ENGLISH LANGUAGE 

5 SPEAKING PROVIDERS. 

6 (a) IN GENERAL.—Section 1311(c)(1)(B) of the Pa7 tient Protection and Affordable Care Act (42 U.S.C. 

8 18031(c)(1)(B)) is amended by inserting before the semi9 colon the following: ‘‘and the ability of such provider to 

10 provide care in a language other than English either 

11 through the provider speaking such language or by the 

12 provider having a qualified interpreter for an individual 

13 with limited English proficiency (as defined in section 

14 3400 of such Act) who speaks such language available 

15 during office hours’’. 

16 (b) EFFECTIVE DATE.—The amendment made by 

17 subsection (a) shall not apply to any plan beginning on 

18 or prior to the date that is 1 year after the date of the 

19 enactment of this Act. 

20 SEC. 4242. ACCESS TO ESSENTIAL COMMUNITY PROVIDERS. 

21 (a) ESSENTIAL COMMUNITY PROVIDERS.—Section 

22 1311(c)(1)(C) of the Patient Protection and Affordable 

23 Care Act (42 U.S.C. 18031(c)(1)(C)) is amended— 

24 (1) by inserting ‘‘(i)’’ after ‘‘(C)’’; and 


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1 (2) by adding at the end the following new 

2 clauses: 

3 ‘‘(ii) not later than January 1, 2025, in4 crease the percentage of essential community 

5 providers as described in clause (i) included in 

6 its network by 10 percent annually (based on 

7 the level in the plan for 2023) until 90 percent 

8 of all federally qualified health centers and 75 

9 percent of all other such essential community 

10 providers in the contract service area are in-net11 work; and 

12 ‘‘(iii) include at least one essential commu13 nity provider in each of the essential community 

14 provider categories described in section 

15 156.235(a)(2)(ii)(B) of title 45, Code of Fed16 eral Regulations (as in effect on the date of en17 actment of the Health Equity and Account18 ability Act of 2024), in each county in the serv19 ice area, where available;’’. 

20 (b) REPORTING REQUIREMENTS.—Section 

21 1311(e)(3) of the Patient Protection and Affordable Care 

22 Act (42 U.S.C. 18031(e)(3)) is amended by adding at the 

23 end the following new subparagraph: 

24 ‘‘(E) DATA ON ESSENTIAL COMMUNITY

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1 fied health plans to submit annually to the Sec2 retary data on the percentage of essential com3 munity providers as described in clause (ii) of 

4 subsection (c)(1)(C), by county, that contract 

5 with each qualified health plan offered in that 

6 county and the percentage of such essential 

7 community providers, by category as described 

8 in clause (iii) of such subsection, that contract 

9 with each qualified health plan offered in that 

10 county. Such data shall be made available to 

11 the general public.’’. 

12 (c) ESSENTIAL COMMUNITY PROVIDER PROVISIONS

13 APPLIED UNDER MEDICARE AND MEDICAID.— 

14 (1) MEDICARE.—Section 1852(d)(1) of the So15 cial Security Act (42 U.S.C. 1395w–22(d)(1)) is 

16 amended— 

17 (A) by striking ‘‘and’’ at the end of sub18 paragraph (D); 

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

20 subparagraph (E) and inserting ‘‘; and’’; and 

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

22 subparagraph: 

23 ‘‘(F) the plan meets the requirements of 

24 clauses (ii) and (iii) of section 1311(c)(1)(C) of 

25 the Patient Protection and Affordable Care Act 


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1 (relating to inclusion in networks of essential 

2 community providers).’’. 

3 (2) MEDICAID.—Section 1932(b)(5) of the So4 cial Security Act (42 U.S.C. 1396u–2(b)(5)) is 

5 amended— 

6 (A) by striking ‘‘and’’ at the end of sub7 paragraph (A); 

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

9 subparagraph (B) and inserting ‘‘; and’’; and 

10 (C) by adding at the end the following new 

11 subparagraph: 

12 ‘‘(C) meets the requirements of clauses (ii) 

13 and (iii) of section 1311(c)(1)(C) of the Patient 

14 Protection and Affordable Care Act (relating to 

15 inclusion in networks of essential community 

16 providers) with respect to services offered in the 

17 service area involved.’’. 

18 SEC. 4243. PROVIDER NETWORK ADEQUACY IN COMMU19 NITIES OF COLOR. 

20 (a) IN GENERAL.—Section 1311(c)(1)(B) of the Pa21 tient Protection and Affordable Care Act (42 U.S.C. 

22 18031(c)(1)(B)), as amended by section 4241(a), is fur23 ther amended— 

24 (1) by inserting ‘‘(i)’’ after ‘‘(B)’’; and 


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1 (2) by adding at the end the following new 

2 clauses: 

3 ‘‘(ii) meet such network adequacy stand4 ards as the Secretary may establish with regard 

5 to— 

6 ‘‘(I) appointment wait time; 

7 ‘‘(II) travel time and distance to 

8 health care provider facilities and providers 

9 by public and private transit; 

10 ‘‘(III) hours of operation to accommo11 date individuals who cannot come to pro12 vider appointments during standard busi13 ness hours; 

14 ‘‘(IV) availability of health care op15 tions for patients; and 

16 ‘‘(V) other network adequacy stand17 ards to ensure that care through these 

18 plans is accessible to diverse communities, 

19 including individuals with limited English 

20 proficiency as defined in section 3400 of 

21 such Act; and 

22 ‘‘(iii) provide coverage for services for en23 rollees through out-of-network providers at no 

24 additional cost to the enrollees in cases where 

25 in-network providers are unable to comply with 


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1 the standards established under subclause (III) 

2 or (IV) of clause (ii) for such services and the 

3 out-of-network providers can deliver such serv4 ices in compliance with such standards;’’. 

5 (b) EFFECTIVE DATE.—The amendments made by 

6 subsection (a) shall not apply to plans beginning on or 

7 prior to the date that is 1 year after the date of the enact8 ment of the Health Equity and Accountability Act of 

9 2024. 

10 PART 5—DENTAL 

11 SEC. 4251. IMPROVING ACCESS TO DENTAL CARE. 

12 (a) REPORTS TO CONGRESS.— 

13 (1) GAO REPORTS.—Not later than 1 year 

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

15 Comptroller General of the United States shall sub16 mit to Congress— 

17 (A) a report on the Alaska Dental Health 

18 Aide Therapists program and the Dental Ther19 apist and Advanced Dental Therapist programs 

20 in Minnesota, to assess the effectiveness of den21 tal therapists in— 

22 (i) improving access to timely dental 

23 care among communities of color; 

24 (ii) providing high-quality care; 


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1 (iii) providing culturally competent 

2 care; and 

3 (iv) providing accessible care to people 

4 with disabilities; 

5 (B) a report on State variations in the use 

6 of dental hygienists and the effectiveness of ex7 panding the scope of practice for dental hygien8 ists in— 

9 (i) improving access to timely dental 

10 care among communities of color; 

11 (ii) providing high-quality care; 

12 (iii) providing culturally competent 

13 care; and 

14 (iv) providing accessible care to people 

15 with disabilities; and 

16 (C) a report on the use of telehealth serv17 ices to enhance services provided by dental hy18 gienists and therapists, including recommenda19 tions for any modifications to the Medicare pro20 gram under title XVIII of the Social Security 

21 Act (42 U.S.C. 1395 et seq.) and the Medicaid 

22 program under title XIX of such Act (42 

23 U.S.C. 1396 et seq.) to better provide for tele24 health consultations in conjunction with thera25 pists’ and hygienists’ care. 


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1 (2) HRSA REPORT ON DENTAL SHORTAGE

2 AREAS.—Not later than 1 year after the date of the 

3 enactment of this Act, the Secretary of Health and 

4 Human Services, acting through the Administrator 

5 of the Health Resources and Services Administra6 tion, shall submit to Congress a report which details 

7 geographic dental access shortages and the pre8 paredness of dental providers to offer culturally and 

9 linguistically appropriate, affordable, accessible, and 

10 timely services. 

11 (b) EXPANSION OF DENTAL HEALTH AID THERA12 PISTS IN TRIBAL AND URBAN INDIAN COMMUNITIES.— 

13 Section 119 of the Indian Health Care Improvement Act 

14 (25 U.S.C. 1616l) is amended— 

15 (1) in subsection (d)— 

16 (A) by striking paragraph (2) and insert17 ing the following: 

18 ‘‘(2) REQUIREMENTS; EXCLUSION.—Subject to 

19 paragraphs (3) and (4), in establishing a national 

20 program under paragraph (1), the Secretary— 

21 ‘‘(A) shall not reduce the amounts pro22 vided for the Community Health Aide Program 

23 described in subsections (a) and (b); 


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1 ‘‘(B) shall exclude dental health aide thera2 pist services from services covered under that 

3 Program; and 

4 ‘‘(C) shall include urban Indian organiza5 tions.’’; and 

6 (B) in paragraph (3)— 

7 (i) in the paragraph heading, by strik8 ing ‘‘OR TRIBAL ORGANIZATION’’ and in9 serting ‘‘, TRIBAL ORGANIZATION, OR

10 URBAN INDIAN ORGANIZATION’’; and 

11 (ii) in each of subparagraphs (A) and 

12 (B), by striking ‘‘or tribal organization’’ 

13 and inserting ‘‘, tribal organization, or 

14 urban Indian organization’’; and 

15 (2) in subsection (e), by striking ‘‘or a tribal or16 ganization’’ and inserting ‘‘a tribal organization, or 

17 an urban Indian organization’’. 

18 (c) COVERAGE OF DENTAL SERVICES UNDER THE

19 MEDICARE PROGRAM.— 

20 (1) COVERAGE.—Section 1861(s)(2) of the So21 cial Security Act (42 U.S.C. 1395x(s)(2)) is amend22 ed— 

23 (A) in subparagraph (JJ), by inserting 

24 ‘‘and’’ at the end; and 


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1 (B) by adding at the end the following new 

2 subparagraph: 

3 ‘‘(KK) dental and oral health services (as de4 fined in subsection (ppp));’’. 

5 (2) DENTAL AND ORAL HEALTH SERVICES DE6 FINED.—Section 1861 of the Social Security Act (42 

7 U.S.C. 1395x), as amended by sections 2007(b) and 

8 4221(a), is amended by adding at the end the fol9 lowing new subsection: 

10 ‘‘Dental and Oral Health Services 

11 ‘‘(ppp)(1) The term ‘dental and oral health services’ 

12 means services (as defined by the Secretary) that are nec13 essary to prevent disease and promote oral health, restore 

14 oral structures to health and function, and treat emer15 gency conditions, including— 

16 ‘‘(A) routine diagnostic and preventive care 

17 such as dental cleanings, exams, and x-rays; 

18 ‘‘(B) basic dental services such as fillings and 

19 extractions; 

20 ‘‘(C) major dental services such as root canals, 

21 crowns, and dentures; 

22 ‘‘(D) emergency dental care; and 

23 ‘‘(E) other necessary services related to dental 

24 and oral health (as defined by the Secretary). 


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1 ‘‘(2) For purposes of paragraph (1), such term shall 

2 include mobile and portable oral health services (as de3 fined by the Secretary) that— 

4 ‘‘(A) are provided for the purpose of over5 coming mobility, transportation, and access barriers 

6 for individuals; and 

7 ‘‘(B) satisfy the standards and certification re8 quirements established under section 1902(a)(82) 

9 for the State in which the services are provided.’’. 

10 (3) PAYMENT AND COINSURANCE.—Section 

11 1833(a)(1) of the Social Security Act (42 U.S.C. 

12 1395l(a)(1)) is amended— 

13 (A) by striking ‘‘and’’ before ‘‘(HH)’’; and 

14 (B) by inserting before the semicolon at 

15 the end the following: ‘‘and (II) with respect to 

16 dental and oral health services (as defined in 

17 section 1861(ppp)), the amount paid shall be (i) 

18 in the case of such services that are preventive, 

19 100 percent of the lesser of the actual charge 

20 for the services or the amount determined 

21 under the payment basis determined under sec22 tion 1848, and (ii) in the case of all other such 

23 services, 80 percent of the lesser of the actual 

24 charge for the services or the amount deterVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 00426 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 mined under the payment basis determined 

2 under section 1848’’. 

3 (4) PAYMENT UNDER PHYSICIAN FEE SCHED4 ULE.—Section 1848(j)(3) of the Social Security Act 

5 (42 U.S.C. 1395w–4(j)(3)) is amended by inserting 

6 ‘‘, (2)(KK),’’ after ‘‘(including administration of the 

7 health 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, 2026. 

21 (d) REQUIRING MEDICAID COVERAGE OF DENTAL

22 AND ORAL HEALTH SERVICES FOR ADULTS.— 

23 (1) IN GENERAL.— 

24 (A) MANDATORY COVERAGE.— 

25 (i) IN GENERAL.— 


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1 (I) REQUIREMENT.—Section 

2 1902(a)(10)(A) of the Social Security 

3 Act (42 U.S.C. 1396a(a)(10)(A)) is 

4 amended by inserting ‘‘(10),’’ before 

5 ‘‘(13)(B),’’. 

6 (II) MEDICALLY NEEDY.— 

7 (aa) IN GENERAL.—Section 

8 1902(a)(10)(C)(iv) of such Act 

9 (42 U.S.C. 1396a(a)(10)(C)(iv)) 

10 is amended by inserting ‘‘(10),’’ 

11 before ‘‘(13)(B)’’. 

12 (bb) RULE OF CONSTRUC13 TION.—Nothing in this section or 

14 the amendments made by this 

15 section shall be construed to limit 

16 the access of an individual resid17 ing in an institutional setting to 

18 dental and oral health services 

19 (as such term is defined in sec20 tion 1905(ll) of the Social Secu21 rity Act, as added by paragraph 

22 (2)(B)). 

23 (III) EFFECTIVE DATE.—The 

24 amendments made by clauses (i) and 

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1 itures for medical assistance in cal2 endar quarters beginning on or after 

3 January 1, 2026. 

4 (ii) BENCHMARK COVERAGE.—Section 

5 1937(b)(5) of the Social Security Act (42 

6 U.S.C. 1396u–7(b)(5)) is amended by 

7 striking the period and inserting ‘‘, and, 

8 beginning January 1, 2026, coverage of 

9 dental and oral health services (as such 

10 term is defined in section 1905(ll)).’’. 

11 (iii) OPTIONAL APPLICATION TO TER12 RITORIES.—Section 1902(j) of the Social 

13 Security Act (42 U.S.C. 1396a(j)) is 

14 amended— 

15 (I) by striking ‘‘this title, the 

16 Secretary’’ and inserting ‘‘this title— 

17 ‘‘(1) in the case of a State other than the 50 

18 States and the District of Columbia the requirement 

19 under subsection (a)(10)(A) to provide the care and 

20 services listed in paragraph (10) of section 1905(a) 

21 shall be optional; and 

22 ‘‘(2) the Secretary’’; and 

23 (II) by striking the second 

24 comma after ‘‘section 1108(f)’’. 


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1 (B) DEFINITION OF DENTAL AND ORAL

2 HEALTH SERVICES.—Section 1905 of the Social 

3 Security Act (42 U.S.C. 1396d), as amended by 

4 section 4107(c), is amended— 

5 (i) in subsection (a)(10), by inserting 

6 ‘‘and dental and oral health services (as 

7 defined in subsection (ll))’’ after ‘‘dental 

8 services’’; and 

9 (ii) by adding at the end the following 

10 new subsection: 

11 ‘‘(ll) DENTAL AND ORAL HEALTH SERVICES.—For 

12 purposes of subsection (a)(10), the term ‘dental and oral 

13 health services’ means dentures and denture services, im14 plants and implant services, and services necessary to pre15 vent oral disease and promote oral health, restore oral 

16 structures to health and function, reduce oral pain, and 

17 treat emergency oral conditions, that are furnished by a 

18 provider who is legally authorized to furnish such items 

19 and services under State law (or the State regulatory 

20 mechanism provided by State law).’’. 

21 (C) CONFORMING AMENDMENT.— 

22 (i) IN GENERAL.—Section 

23 1905(a)(10) of the Social Security Act (42 

24 U.S.C. 1396d(a)(10)), as amended by 


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1 paragraph (2), is amended by striking 

2 ‘‘dental services and’’. 

3 (ii) EFFECTIVE DATE.—The amend4 ment made by subparagraph (A) shall take 

5 effect on January 1, 2026. 

6 (2) STATE OPTION FOR ADDITIONAL DENTAL

7 AND ORAL HEALTH BENEFITS.—Section 

8 1905(a)(13) of the Social Security Act (42 U.S.C. 

9 1396d(a)(13)) is amended by inserting the following 

10 new subparagraph after subparagraph (C): 

11 ‘‘(D) at State option, such items and serv12 ices related to dental and oral health services 

13 (as defined in subsection (ll)) that are in addi14 tion to those identified in such subsection (ll) as 

15 the State may specify;’’. 

16 (3) INCREASED FMAP.— 

17 (A) MEDICAID.—Section 1905 of the So18 cial Security Act (42 U.S.C. 1396d), as amend19 ed by paragraph (1), is further amended— 

20 (i) in subsection (b), by striking ‘‘and 

21 (kk)’’ and inserting ‘‘(kk), and (mm)’’; 

22 (ii) in subsection (ff), by striking 

23 ‘‘and (ii)’’ and inserting ‘‘, (ii), and 

24 (mm)’’; and 


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1 (iii) by adding at the end the fol2 lowing new subsection: 

3 ‘‘(mm) INCREASED FMAP FOR EXPENDITURES RE4 LATED TO DENTAL AND ORAL HEALTH SERVICES.— 

5 ‘‘(1) IN GENERAL.— 

6 ‘‘(A) 50 STATES AND DC.—Notwith7 standing subsection (b), in the case of a State 

8 that is 1 of the 50 States or the District of Co9 lumbia, during the 12-quarter period that be10 gins on January 1, 2026, the Federal medical 

11 assistance percentage shall be equal to 100 per12 cent with respect to amounts expended by the 

13 State for medical assistance for dental and oral 

14 health services authorized under paragraph (10) 

15 of subsection (a). In no case may the applica16 tion of this subparagraph result in the Federal 

17 medical assistance percentage determined for a 

18 State with respect to expenditures described in 

19 this subparagraph exceeding 100 percent. 

20 ‘‘(B) TERRITORIES.— 

21 ‘‘(i) IN GENERAL.—Notwithstanding 

22 subsection (b), in the case of a State that 

23 is Puerto Rico, the Virgin Islands, Guam, 

24 the Northern Mariana Islands, or Amer25 ican Samoa, during a period described in 


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1 clause (ii), the Federal medical assistance 

2 percentage shall be equal to 100 percent 

3 with respect to amounts expended by the 

4 State for medical assistance for any item 

5 or service that is included in dental and 

6 oral health services authorized under para7 graph (10) of subsection (a). In no case 

8 may the application of this clause result in 

9 the Federal medical assistance percentage 

10 determined for a State with respect to ex11 penditures described in this clause exceed12 ing 100 percent. 

13 ‘‘(ii) PERIOD DESCRIBED.—A period 

14 described in this clause is, with respect to 

15 an item or service described in clause (i) 

16 and a State described in such clause, the 

17 12-quarter period that begins with the first 

18 quarter beginning on or after January 1, 

19 2026, in which such item or service is first 

20 covered under the State plan or under a 

21 waiver of such plan. 

22 ‘‘(2) EXCLUSIONS.—The Federal medical as23 sistance percentage specified in paragraph (1) shall 

24 not apply to amounts expended for medical assist25 ance during any period for— 


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1 ‘‘(A) additional items and services author2 ized under paragraph (13)(D) of subsection (a); 

3 or 

4 ‘‘(B) items and services furnished to an in5 dividual if, as of the date of enactment of this 

6 subsection, medical assistance was available to 

7 such individual for such items and services or 

8 medicare cost-sharing under the State plan or 

9 a waiver of such plan.’’. 

10 (B) EXCLUSION OF AMOUNTS ATTRIB11 UTABLE TO INCREASED FMAP FROM TERRI12 TORIAL CAPS.—Section 1108 of the Social Se13 curity Act (42 U.S.C. 1308), as amended by 

14 section 4101, is amended— 

15 (i) in subsection (f), in the matter 

16 preceding paragraph (1), by striking ‘‘(h), 

17 and (j)’’ and inserting ‘‘(h), (j), and (k)’’; 

18 and 

19 (ii) by adding at the end the fol20 lowing: 

21 ‘‘(k) EXCLUSION FROM CAPS OF AMOUNTS ATTRIB22 UTABLE TO INCREASED FMAP FOR COVERAGE OF DEN23 TAL AND ORAL HEALTH SERVICES.—Any additional 

24 amount paid to Puerto Rico, the Virgin Islands, Guam, 

25 the Northern Mariana Islands, and American Samoa for 


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1 expenditures for medical assistance that is attributable to 

2 an increase in the Federal medical assistance percentage 

3 applicable to such expenditures under section 1905(mm) 

4 shall not be taken into account for purposes of applying 

5 payment limits under subsections (f) and (g).’’. 

6 (e) ORAL HEALTH SERVICES AS AN ESSENTIAL

7 HEALTH BENEFIT.—Section 1302(b) of the Patient Pro8 tection and Affordable Care Act (42 U.S.C. 18022(b)), as 

9 amended by section 2013(a), is further amended— 

10 (1) in paragraph (1)— 

11 (A) in subparagraph (J), by striking ‘‘oral 

12 and’’; and 

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

14 ‘‘(L) Oral health services for children and 

15 adults.’’; and 

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

17 ‘‘(6) ORAL HEALTH SERVICES.—For purposes 

18 of paragraph (1)(L), the term ‘oral health services’ 

19 means services (as defined by the Secretary) that 

20 are necessary to prevent any oral disease and pro21 mote oral health, restore oral structures to health 

22 and function, and treat emergency oral conditions.’’. 

23 (f) DEMONSTRATION PROGRAM ON TRAINING AND

24 EMPLOYMENT OF ALTERNATIVE DENTAL HEALTH CARE

25 PROVIDERS FOR DENTAL HEALTH CARE SERVICES FOR


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1 VETERANS IN RURAL AND OTHER UNDERSERVED COM2 MUNITIES.— 

3 (1) DEMONSTRATION PROGRAM AUTHORIZED.— 

4 The Secretary of Veterans Affairs may carry out a 

5 demonstration program to establish programs to 

6 train and employ alternative dental health care pro7 viders in order to increase access to dental health 

8 care services for veterans who are entitled to such 

9 services from the Department of Veterans Affairs 

10 and reside in rural and other underserved commu11 nities. 

12 (2) TELEHEALTH.—For purposes of alternative 

13 dental health care providers and other dental care 

14 providers who are licensed to provide clinical care, 

15 dental services provided under the demonstration 

16 program under this subsection may be administered 

17 by such providers through telehealth-enabled collabo18 ration and supervision when appropriate and fea19 sible. 

20 (3) ALTERNATIVE DENTAL HEALTH CARE PRO21 VIDERS DEFINED.—In this subsection, the term ‘‘al22 ternative dental health care providers’’ has the 

23 meaning given that term in section 340G–1(a)(2) of 

24 the Public Health Service Act (42 U.S.C. 256g– 

25 1(a)(2)). 


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1 (4) AUTHORIZATION OF APPROPRIATIONS.— 

2 There are authorized to be appropriated such sums 

3 as are necessary to carry out the demonstration pro4 gram under this subsection. 

5 (g) DEMONSTRATION PROGRAM ON TRAINING AND

6 EMPLOYMENT OF ALTERNATIVE DENTAL HEALTH CARE

7 PROVIDERS FOR DENTAL HEALTH CARE SERVICES FOR

8 MEMBERS OF THE ARMED FORCES AND DEPENDENTS

9 LACKING READY ACCESS TO SUCH SERVICES.— 

10 (1) DEMONSTRATION PROGRAM AUTHORIZED.— 

11 The Secretary of Defense may carry out a dem12 onstration program to establish programs to train 

13 and employ alternative dental health care providers 

14 in order to increase access to dental health care 

15 services for members of the Armed Forces and their 

16 dependents who lack ready access to such services, 

17 including the following individuals: 

18 (A) Members and dependents who reside in 

19 rural areas or areas otherwise underserved by 

20 dental health care providers. 

21 (B) Members of a reserve component of 

22 the Armed Forces in active status who are po23 tentially deployable. 

24 (2) TELEHEALTH.—For purposes of alternative 

25 dental health care providers and other dental care 


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1 providers who are licensed to provide clinical care, 

2 dental services provided under the demonstration 

3 program under this subsection may be administered 

4 by such providers through telehealth-enabled collabo5 ration and supervision when appropriate and fea6 sible. 

7 (3) DEFINITIONS.—In this subsection: 

8 (A) ACTIVE STATUS.—The term ‘‘active 

9 status’’ has the meaning given that term in sec10 tion 101(d) of title 10, United States Code. 

11 (B) ALTERNATIVE DENTAL HEALTH CARE

12 PROVIDERS.—The term ‘‘alternative dental 

13 health care providers’’ has the meaning given 

14 that term in section 340G–1(a)(2) of the Public 

15 Health Service Act (42 U.S.C. 256g–1(a)(2)). 

16 (4) AUTHORIZATION OF APPROPRIATIONS.— 

17 There are authorized to be appropriated such sums 

18 as are necessary to carry out the demonstration pro19 gram under this subsection. 

20 (h) DEMONSTRATION PROGRAM ON TRAINING AND

21 EMPLOYMENT OF ALTERNATIVE DENTAL HEALTH CARE

22 PROVIDERS FOR DENTAL HEALTH CARE SERVICES FOR

23 PRISONERS WITHIN THE CUSTODY OF THE BUREAU OF

24 PRISONS.— 


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1 (1) DEMONSTRATION PROGRAM AUTHORIZED.— 

2 The Attorney General, acting through the Director 

3 of the Bureau of Prisons, may carry out a dem4 onstration program to establish programs to train 

5 and employ alternative dental health care providers 

6 in order to increase access to dental health services 

7 for prisoners within the custody of the Bureau of 

8 Prisons. 

9 (2) TELEHEALTH.—For purposes of alternative 

10 dental health care providers and other dental care 

11 providers who are licensed to provide clinical care, 

12 dental services provided under the demonstration 

13 program under this subsection may be administered 

14 by such providers through telehealth-enabled collabo15 ration and supervision when appropriate and fea16 sible. 

17 (3) ALTERNATIVE DENTAL HEALTH CARE PRO18 VIDERS DEFINED.—In this subsection, the term ‘‘al19 ternative dental health care providers’’ has the 

20 meaning given that term in section 340G–1(a)(2) of 

21 the Public Health Service Act (42 U.S.C. 256g– 

22 1(a)(2)). 

23 (4) AUTHORIZATION OF APPROPRIATIONS.— 

24 There are authorized to be appropriated such sums 


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1 as are necessary to carry out the demonstration pro2 gram under this subsection. 

3 (i) DEMONSTRATION PROGRAM ON TRAINING AND

4 EMPLOYMENT OF ALTERNATIVE DENTAL HEALTH CARE

5 PROVIDERS FOR DENTAL HEALTH CARE SERVICES

6 UNDER THE INDIAN HEALTH SERVICE.— 

7 (1) DEMONSTRATION PROGRAM AUTHORIZED.— 

8 The Secretary of Health and Human Services, act9 ing through the Indian Health Service, may carry 

10 out a demonstration program to establish programs 

11 to train and employ alternative dental health care 

12 providers in order to help eliminate oral health dis13 parities and increase access to dental services 

14 through health programs operated by the Indian 

15 Health Service, Indian tribes, tribal organizations, 

16 and Urban Indian organizations. 

17 (2) TELEHEALTH.—For purposes of alternative 

18 dental health care providers and other dental care 

19 providers who are licensed to provide clinical care, 

20 dental services provided under the demonstration 

21 program under this subsection may be administered 

22 by such providers through telehealth-enabled collabo23 ration and supervision when appropriate and fea24 sible. 

25 (3) DEFINITIONS.—In this subsection: 


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1 (A) ALTERNATIVE DENTAL HEALTH CARE

2 PROVIDERS DEFINED.—The term ‘‘alternative 

3 dental health care providers’’ has the meaning 

4 given that term in section 340G–1(a)(2) of the 

5 Public Health Service Act (42 U.S.C. 256g– 

6 1(a)(2)). 

7 (B) INDIAN HEALTH CARE IMPROVEMENT

8 ACT.—The terms ‘‘Indian tribe’’, ‘‘tribal organi9 zation’’, and ‘‘Urban Indian organization’’ have 

10 the meaning given the terms in section 4 of the 

11 Indian Health Care Improvement Act (25 

12 U.S.C. 1603). 

13 (4) AUTHORIZATION OF APPROPRIATIONS.— 

14 There are authorized to be appropriated such sums 

15 as are necessary to carry out the demonstration pro16 gram under this subsection. 

17 SEC. 4252. ORAL HEALTH LITERACY AND AWARENESS CAM18 PAIGN. 

19 The Public Health Service Act is amended by insert20 ing after section 340G–1 of such Act (42 U.S.C. 256g– 

21 1) the following: 

22 ‘‘SEC. 340G–2. ORAL HEALTH LITERACY AND AWARENESS. 

23 ‘‘(a) CAMPAIGN.—The Secretary, acting through the 

24 Administrator of the Health Resources and Services Ad25 ministration, shall establish a public education campaign 


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1 (referred to in this subsection as the ‘campaign’) across 

2 all relevant programs of the Health Resources and Serv3 ices Administration (including the health center program, 

4 oral health workforce programs, maternal and child health 

5 programs, the Ryan White HIV/AIDS Program, and rural 

6 health programs) to increase oral health literacy and 

7 awareness. 

8 ‘‘(b) STRATEGIES.—In carrying out the campaign, 

9 the Secretary shall identify oral health literacy and aware10 ness strategies that are evidence based and focused on oral 

11 health care education, including education on prevention 

12 of oral disease such as early childhood and other caries, 

13 periodontal disease, and oral cancer. 

14 ‘‘(c) FOCUS.—The Secretary shall design the cam15 paign to communicate directly with specific populations, 

16 including children, pregnant women, parents, the elderly, 

17 individuals with disabilities, and ethnic and racial minority 

18 populations, including Indians, Alaska Natives, and Na19 tive Hawaiians, in a culturally and linguistically appro20 priate manner. 

21 ‘‘(d) OUTCOMES.—In carrying out the campaign, the 

22 Secretary shall include a process for measuring outcomes 

23 and effectiveness. 

24 ‘‘(e) REPORT TO CONGRESS.—Not later than 3 years 

25 after the date of enactment of this section, the Secretary 


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1 shall submit to the Committee on Energy and Commerce 

2 of the House of Representatives and the Committee on 

3 Health, Education, Labor, and Pensions of the Senate a 

4 report on the outcomes and effectiveness of the campaign. 

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

6 carry out this section, there is authorized to be appro7 priated $750,000 for each of fiscal years 2025 through 

8 2029.’’. 

9 SEC. 4253. ENSURING KIDS HAVE ACCESS TO MEDICALLY 

10 NECESSARY DENTAL CARE ACT. 

11 (a) PROHIBITION OF LIFETIME OR ANNUAL LIMITS

12 ON DENTAL BENEFITS UNDER THE CHILDREN’S

13 HEALTH INSURANCE PROGRAM.— 

14 (1) IN GENERAL.—Section 2103(c)(6) of the 

15 Social Security Act (42 U.S.C. 1397cc(c)(6)) is 

16 amended— 

17 (A) in subparagraph (A), by inserting ‘‘, 

18 subject to subparagraph (D),’’ after ‘‘shall in19 clude’’; 

20 (B) in subparagraph (B), by striking ‘‘A 

21 State’’ and inserting ‘‘Subject to subparagraph 

22 (D), a State’’; and 

23 (C) by adding at the end the following new 

24 subparagraph: 


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1 ‘‘(D) NO LIFETIME OR ANNUAL LIMITS ON

2 DENTAL BENEFITS.—A State shall not establish 

3 lifetime or annual limits on the dollar value of 

4 benefits for dental services provided under the 

5 State child health plan to a targeted low-income 

6 child, and, in the case that the State elects to 

7 provide pregnancy-related assistance pursuant 

8 to section 2112, to a targeted low-income preg9 nant woman (as defined in section 2112(d)), in10 cluding benefits for such services that are pro11 vided through dental coverage that is otherwise 

12 equivalent to a benchmark dental package de13 scribed in subparagraph (C).’’. 

14 (2) EFFECTIVE DATE.—The amendments made 

15 by this subsection shall take effect on the date that 

16 is 6 months after the date of enactment of this Act. 

17 (b) REQUIRING WRAPAROUND COVERAGE OF DEN18 TAL SERVICES FOR CERTAIN CHILDREN UNDER CHIP.— 

19 (1) IN GENERAL.—Section 2110(b)(5) of the 

20 Social Security Act (42 U.S.C. 1397jj(b)(5)) is 

21 amended— 

22 (A) in the paragraph header, by striking 

23 ‘‘OPTION’’ and inserting ‘‘REQUIREMENT’’; 

24 (B) in subparagraph (A), by striking ‘‘may 

25 waive’’ and inserting ‘‘shall waive’’; and 


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1 (C) in subparagraph (C)— 

2 (i) in the subparagraph header, by 

3 striking ‘‘CONDITIONS’’ and inserting ‘‘RE4 QUIREMENTS’’; and 

5 (ii) by striking ‘‘may not offer dental6 only supplemental coverage under this 

7 paragraph unless the State satisfies the 

8 following conditions’’ and inserting ‘‘shall 

9 offer dental-only supplemental coverage 

10 under this paragraph in accordance with 

11 the following requirements’’. 

12 (2) EFFECTIVE DATE.—The amendments made 

13 by this subsection shall take effect on the date that 

14 is 6 months after the date of enactment of this Act. 

15 Subtitle D—Advancing Health Eq16 uity Through Payment and De17 livery Reform 

18 SEC. 4301. CENTERS FOR MEDICARE & MEDICAID SERVICES 

19 REPORTING AND VALUE-BASED PROGRAMS. 

20 (a) ADVANCING HEALTH EQUITY IN REPORTING AND

21 VALUE-BASED PAYMENT PROGRAMS.— 

22 (1) IN GENERAL.—The Administrator of the 

23 Centers for Medicare & Medicaid Services (in this 

24 section referred to as the ‘‘Administrator’’) shall re25 quire that a clinician or other professional particiVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 00445 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 pating in any pay-for-reporting or value-based pay2 ment program stratify clinical quality measures by 

3 disparity variables, including race, ethnicity, sex, pri4 mary language, disability status, sexual orientation, 

5 gender identity, and socioeconomic status. A clini6 cian or other professional may use existing demo7 graphic data collection fields in certified electronic 

8 health record technology (as defined in section 

9 1848(o)(4) of the Social Security Act (42 U.S.C. 

10 1395w–4(o)(4))) to carry out such data stratifica11 tion under the preceding sentence. Such stratified 

12 data will assist clinicians and other professionals in 

13 the identification of disparities obscured in aggre14 gated data and assist with the provision of interven15 tions that target reducing those disparities. 

16 (2) CLINICIAN.—In assessing performance in 

17 any value-based payment program, the Adminis18 trator shall incorporate a clinician or other profes19 sional’s performance in reducing disparities across 

20 race, ethnicity, sex, primary language, disability sta21 tus, sexual orientation, gender identity, and socio22 economic status. Linking performance payments to 

23 the reduction of health care disparities across such 

24 variables will assist in holding clinicians and other 


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1 professionals accountable for providing quality care 

2 that can lead to decreased health inequities. 

3 (3) REQUIREMENT OF ADOPTION OF CERT.—All 

4 entities, clinicians, or other professionals partici5 pating in the Quality Payment Program of the Cen6 ters for Medicare & Medicaid Services shall be re7 quired to adopt 2015 certified electronic health 

8 record technology (as so defined) as a condition of 

9 participating in such program. 

10 (b) QUALITY IMPROVEMENT ACTIVITIES.—The Ad11 ministrator, upon yearly review of the Quality Payment 

12 Program, shall add quality improvement activities that im13 plement the Culturally and Linguistically Accessible 

14 Standards (CLAS) as Improvement Activities under the 

15 Quality Payment Program. 

16 SEC. 4302. DEVELOPMENT AND TESTING OF DISPARITY RE17 DUCING DELIVERY AND PAYMENT MODELS. 

18 (a) IN GENERAL.—The Center for Medicare and 

19 Medicaid Innovation established under section 1115A of 

20 the Social Security Act (42 U.S.C. 1315a) (in this section 

21 referred to as the ‘‘CMI’’) shall establish a dedicated fund 

22 to identify, test, evaluate, and scale delivery and payment 

23 models under the applicable titles (as defined in subsection 

24 (a)(4)(B) of such section) that target health disparities 

25 among racial and ethnic minorities, including models that 


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1 support high-value nonmedical services that address so2 cially determined barriers to health in all stages of the 

3 life cycle through end-of-life, including English proficiency 

4 status, low health and health care literacy, lack of access 

5 to health care planning, including end-of-life care plan6 ning, case management, transportation, enrollment assist7 ance needs, stable and affordable housing, utility assist8 ance, employment and career development, and nutrition 

9 and food security which will help to reduce disparities and 

10 impact the overall cost of care. 

11 (b) AMENDMENT TO SOCIAL SECURITY ACT.—The 

12 second sentence of section 1115A(a)(1) of the Social Secu13 rity Act (42 U.S.C. 1315a(a)(1)) is amended by inserting 

14 ‘‘and improve health equity’’ after ‘‘expenditures’’. 

15 (c) PILOT PROGRAMS.—The CMI shall prioritize the 

16 testing of models under such section 1115A that include 

17 partnerships with entities, including community-based or18 ganizations or other nonprofit entities, to help address so19 cially determined barriers to health and health care. 

20 (d) ALTERNATIVES.—Any model tested by the CMI 

21 under such 1115A shall include measures to assess and 

22 track the impact of the model on health disparities, using 

23 existing measures such as the Healthcare Disparities and 

24 Cultural Competency Measures endorsed by the entity 

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1 rity Act (42 U.S.C. 1395aaa(a)), and stratified by race, 

2 ethnicity, English proficiency, gender identity, sexual ori3 entation, and disability status. 

4 SEC. 4303. DIVERSITY IN CENTERS FOR MEDICARE AND 

5 MEDICAID CONSULTATION. 

6 (a) IN GENERAL.—In carrying out the duties under 

7 this subtitle, the CMI shall consult clinical and analytical 

8 experts with expertise in medicine and health care man9 agement, specifically such experts with expertise in— 

10 (1) the health care needs of minority, rural, and 

11 underserved populations; and 

12 (2) the financial needs of safety net, commu13 nity-based, rural, and critical access providers, in14 cluding federally qualified health centers. 

15 (b) OPEN DOOR FORUMS.—The CMI shall use open 

16 door forums or other mechanisms to seek external feed17 back from interested parties and incorporate that feedback 

18 into the development of models. 

19 SEC. 4304. SUPPORTING SAFETY NET AND COMMUNITY20 BASED PROVIDERS TO COMPETE IN VALUE21 BASED PAYMENT SYSTEMS. 

22 (a) IN GENERAL.—Any pay-for-performance or alter23 native payment model that is developed and tested by the 

24 Center for Medicare and Medicaid Innovation established 

25 under section 1115A of the Social Security Act (42 U.S.C. 


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1 1315a), or any other agency of the Department of Health 

2 and Human Services with respect to the programs under 

3 titles XVIII, XIX, or XXI of such Act, shall be assessed 

4 for potential impact on safety net, community-based, and 

5 critical access providers, including Federally qualified 

6 health centers. 

7 (b) NEW MODELS.—The rollout of any such models 

8 shall include training and additional up front resources for 

9 community-based and safety net providers to enable those 

10 providers to participate in the model. 

11 SEC. 4305. IMPROVING ACCESS TO CARE FOR MEDICARE 

12 AND MEDICAID BENEFICIARIES. 

13 Section 1115A of the Social Security Act (42 U.S.C. 

14 1315a) is amended— 

15 (1) in subsection (a)— 

16 (A) in the last sentence of paragraph (1), 

17 by inserting ‘‘advance health equity and’’ before 

18 ‘‘improve the coordination’’; and 

19 (B) in the first sentence of paragraph 

20 (3)— 

21 (i) by inserting ‘‘(including the Office 

22 of Minority Health of the Centers for 

23 Medicare & Medicaid Services, the Office 

24 of Rural Health Policy of the Health Re25 sources and Services Administration, and 


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1 the Office on Women’s Health of the De2 partment of Health and Human Services)’’ 

3 after ‘‘relevant Federal agencies’’; and 

4 (ii) by striking ‘‘experts with expertise 

5 in medicine’’ and inserting ‘‘experts with 

6 expertise in medicine, the causes of health 

7 disparities and the social determinants of 

8 health, and’’; 

9 (2) in subsection (b)— 

10 (A) in paragraph (2)— 

11 (i) in subparagraph (A)— 

12 (I) by inserting the following 

13 after the first sentence: ‘‘Prior to se14 lecting a model under this paragraph, 

15 the Secretary shall consult with the 

16 Office of Minority Health of the Cen17 ters for Medicare & Medicaid Services, 

18 the Office of Rural Health Policy of 

19 the Health Resources and Services 

20 Administration, and the Office on 

21 Women’s Health of the Department of 

22 Health and Human Services to ensure 

23 that models under consideration ad24 dress health disparities and social de25 terminants of health as appropriate 


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1 for populations to be cared for under 

2 the model.’’; 

3 (II) by inserting ‘‘and, for models 

4 for which testing begins on or after 

5 January 1, 2025, address health eq6 uity as well as improving access to 

7 care received by individuals receiving 

8 benefits under such title’’ after ‘‘appli9 cable title’’; and 

10 (III) by adding at the end the 

11 following: ‘‘The models selected under 

12 this subparagraph shall include the 

13 social determinants of health payment 

14 model described in subsection (h), the 

15 testing of which shall begin not later 

16 than December 31, 2025.’’; and 

17 (ii) in subparagraph (C), by adding at 

18 the end the following new clauses: 

19 ‘‘(ix) Whether the model will affect 

20 access to care from providers and suppliers 

21 caring for high risk patients or operating 

22 in underserved areas. 

23 ‘‘(x) Whether the model has the po24 tential to reduce health disparities, includ25 ing minority and rural health disparities.’’; 


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1 (B) in paragraph (3)(B)— 

2 (i) in clause (i), by inserting ‘‘or 

3 health equity’’ after ‘‘quality of care’’; 

4 (ii) in clause (ii), by inserting ‘‘or in5 creasing health inequities’’ after ‘‘quality 

6 of care’’; and 

7 (iii) in clause (iii), by inserting ‘‘or 

8 health equity’’ after ‘‘quality of care’’; and 

9 (C) in paragraph (4)(A)— 

10 (i) in clause (i), by striking ‘‘; and’’ 

11 and inserting a semicolon; 

12 (ii) in clause (ii), by striking the pe13 riod and inserting ‘‘; and’’; and 

14 (iii) by adding at the end the fol15 lowing new clause: 

16 ‘‘(iii) for models for which testing be17 gins on or after January 1, 2025, the ex18 tent to which the model improves health 

19 equity.’’; 

20 (3) in subsection (c)— 

21 (A) in paragraph (1)— 

22 (i) in subparagraph (A), by inserting 

23 ‘‘or, beginning on or after January 1, 

24 2025, increasing health inequities’’ before 

25 the semicolon; and 


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1 (ii) in subparagraph (B), by inserting 

2 ‘‘or, beginning on or after January 1, 

3 2025, health equity’’ after ‘‘patient care’’; 

4 and 

5 (B) in paragraph (3), by inserting ‘‘or in6 crease health disparities experienced by bene7 ficiaries, including low-income, minority, or 

8 rural beneficiaries, or that such expansion 

9 would improve health equity’’ before the period; 

10 (4) in subsection (g), by adding at the end the 

11 following: ‘‘For reports submitted after the date of 

12 enactment of the Health Equity and Accountability 

13 Act of 2024, each such report shall include informa14 tion on the following: 

15 ‘‘(1) The interventions that address social de16 terminants of health, health disparities, or health eq17 uity in payment models selected by the CMI for test18 ing under this section. 

19 ‘‘(2) Estimated Federal savings achieved 

20 through reducing disparities, including rural and mi21 nority health disparities, improving health equity, or 

22 addressing social determinants of health. 

23 ‘‘(3) The effectiveness of interventions in miti24 gating negative health outcomes and higher costs as25 sociated with social determinants of health within 


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1 models selected by the Center for Medicare and 

2 Medicaid Innovation for testing. 

3 ‘‘(4) Other areas determined appropriate by the 

4 Secretary.’’; and 

5 (5) by adding at the end the following new sub6 section: 

7 ‘‘(h) SOCIAL DETERMINANTS OF HEALTH PAYMENT

8 MODEL.— 

9 ‘‘(1) IN GENERAL.—The social determinants of 

10 health payment model described in this subsection is 

11 a payment model that tests each of the payment and 

12 service delivery innovations described in paragraph 

13 (2) in a region determined appropriate by the Sec14 retary. 

15 ‘‘(2) PAYMENT AND SERVICE DELIVERY INNO16 VATIONS DESCRIBED.—For purposes of paragraph 

17 (1), the payment and service delivery innovations de18 scribed in this clause are the following: 

19 ‘‘(A) Payment and service delivery innova20 tions for behavioral health services, focusing on 

21 gathering actionable data to address the higher 

22 costs associated with beneficiaries with diag23 nosed behavioral conditions. 

24 ‘‘(B) Payment and service delivery innova25 tions targeting conditions or comorbidities of 


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1 individuals entitled or enrolled under the Medi2 care program under title XVIII and enrolled 

3 under a State plan under the Medicaid program 

4 under title XIX to increase capacity in under5 served areas. 

6 ‘‘(C) Payment and service delivery innova7 tions targeting conditions or comorbidities of 

8 applicable individuals to increase capacity in 

9 underserved areas. 

10 ‘‘(D) Payment and service delivery innova11 tions targeted on Medicaid eligible pregnant 

12 and postpartum women, up to one year after 

13 delivery.’’. 

14 Subtitle E—Health Empowerment 

15 Zones 

16 SEC. 4401. DESIGNATION OF HEALTH EMPOWERMENT 

17 ZONES. 

18 (a) IN GENERAL.—The Secretary may, at the request 

19 of an eligible community partnership described in sub20 section (b)(1), designate an eligible area described in sub21 section (b)(2) as a health empowerment zone for the pur22 pose of eligibility for a grant under section 4402. 

23 (b) ELIGIBILITY CRITERIA.— 


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1 (1) ELIGIBLE COMMUNITY PARTNERSHIP.—A 

2 community partnership is eligible to submit a re3 quest under this section if the partnership— 

4 (A) demonstrates widespread public sup5 port from key individuals and entities in the eli6 gible area, including members of the target 

7 community, State and local governments, non8 profit organizations including national and re9 gional intermediaries with demonstrated capac10 ity to serve low-income urban communities, and 

11 community and industry leaders, for designa12 tion of the eligible area as a health empower13 ment zone; and 

14 (B) includes representatives of— 

15 (i) a broad cross-section of stake16 holders and residents from communities in 

17 the eligible area experiencing dispropor18 tionate disparities in health status and 

19 health care; and 

20 (ii) organizations, facilities, and insti21 tutions that have a history of working 

22 within and serving such communities. 

23 (2) ELIGIBLE AREA.—An area is eligible to be 

24 designated as a health empowerment zone under this 

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1 rience disproportionate disparities in health status 

2 and health care. In determining whether a commu3 nity experiences such disparities, the Secretary shall 

4 consider data collected by the Department of Health 

5 and Human Services focusing on the following areas: 

6 (A) Access to affordable, high-quality 

7 health care services. 

8 (B) The prevalence of disproportionate 

9 rates of certain illnesses or diseases including 

10 the following: 

11 (i) Arthritis, osteoporosis, chronic 

12 back conditions, and other musculoskeletal 

13 diseases. 

14 (ii) Cancer. 

15 (iii) Chronic kidney disease. 

16 (iv) Diabetes. 

17 (v) Injury (intentional and uninten18 tional). 

19 (vi) Violence (intimate and non20 intimate). 

21 (vii) Maternal and paternal illnesses 

22 and diseases. 

23 (viii) Infant mortality. 

24 (ix) Mental illness and other disabil25 ities. 


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1 (x) Substance use disorder treatment 

2 and prevention, including underage drink3 ing. 

4 (xi) Nutrition, obesity, and overweight 

5 conditions. 

6 (xii) Heart disease. 

7 (xiii) Hypertension. 

8 (xiv) Cerebrovascular disease or 

9 stroke. 

10 (xv) Tuberculosis. 

11 (xvi) HIV/AIDS and other sexually 

12 transmitted infections. 

13 (xvii) Viral hepatitis. 

14 (xviii) Asthma. 

15 (xix) Tooth decay and other oral 

16 health issues. 

17 (C) Within the community, the historical 

18 and persistent presence of conditions that have 

19 been found to contribute to health disparities 

20 including any such conditions respecting any of 

21 the following: 

22 (i) Poverty. 

23 (ii) Educational status and the quality 

24 of community schools. 

25 (iii) Income. 


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1 (iv) Access to high-quality affordable 

2 health care. 

3 (v) Work and work environment. 

4 (vi) Environmental conditions in the 

5 community, including with respect to clean 

6 water, clean air, and the presence or ab7 sence of pollutants. 

8 (vii) Language and English pro9 ficiency. 

10 (viii) Access to affordable healthy 

11 food. 

12 (ix) Access to ethnically and culturally 

13 diverse health and human service providers 

14 and practitioners. 

15 (x) Access to culturally and linguis16 tically competent health and human serv17 ices and health and human service pro18 viders. 

19 (xi) Health-supporting infrastructure. 

20 (xii) Health insurance that is ade21 quate and affordable. 

22 (xiii) Race, racism, and bigotry (con23 scious and unconscious). 

24 (xiv) Sexual orientation. 

25 (xv) Health and health care literacy. 


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1 (xvi) Place of residence (such as 

2 urban areas, rural areas, and reservations 

3 of Indian Tribes). 

4 (xvii) Stress. 

5 (c) PROCEDURE.— 

6 (1) REQUEST.—A request under subsection (a) 

7 shall— 

8 (A) describe the bounds of the area to be 

9 designated as a health empowerment zone and 

10 the process used to select those bounds; 

11 (B) demonstrate that the partnership sub12 mitting the request is an eligible community 

13 partnership described in subsection (b)(1); 

14 (C) demonstrate that the area is an eligible 

15 area described in subsection (b)(2); 

16 (D) include a comprehensive assessment of 

17 disparities in health status and health care ex18 perience by one or more communities in the 

19 area; 

20 (E) set forth— 

21 (i) a vision and a set of values for the 

22 area; and 

23 (ii) a comprehensive and holistic set of 

24 goals to be achieved in the area through 


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1 designation as a health empowerment zone; 

2 and 

3 (F) include a strategic plan and an action 

4 plan for achieving the goals described in sub5 paragraph (E)(ii). 

6 (2) APPROVAL.—Not later than 60 days after 

7 the receipt of a request for designation of an area 

8 as a health empowerment zone under this section, 

9 the Secretary shall approve or disapprove the re10 quest. 

11 (d) MINIMUM NUMBER.—The Secretary— 

12 (1) shall designate not more than 110 health 

13 empowerment zones under this section; and 

14 (2) of such zones designated under paragraph 

15 (1), shall designate at least one health empowerment 

16 zone in each of the several States, the District of 

17 Columbia, and each territory or possession of the 

18 United States. 

19 SEC. 4402. ASSISTANCE TO THOSE SEEKING DESIGNATION. 

20 At the request of any organization or entity seeking 

21 to submit a request under section 4401(a), the Secretary 

22 shall provide technical assistance, and may award a grant, 

23 to assist such organization or entity— 

24 (1) to form an eligible community partnership 

25 described in section 4401(b)(1); 


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1 (2) to complete a health assessment, including 

2 an assessment of health disparities under section 

3 4401(c)(1)(D); or 

4 (3) to prepare and submit a request, including 

5 a strategic plan, in accordance with section 4401. 

6 SEC. 4403. BENEFITS OF DESIGNATION. 

7 (a) PRIORITY.—In awarding a grant under sub8 section (b), a Federal official shall give priority to any ap9 plicant that— 

10 (1) meets the eligibility criteria for the grant; 

11 (2) proposes to use the grant for activities in a 

12 health empowerment zone; and 

13 (3) demonstrates that such activities will di14 rectly and significantly further the goals of the stra15 tegic plan approved for such zone under section 

16 4401. 

17 (b) GRANTS FOR INITIAL IMPLEMENTATION OF

18 STRATEGIC PLAN.— 

19 (1) IN GENERAL.—Upon designating an eligible 

20 area as a health empowerment zone at the request 

21 of an eligible community partnership, the Secretary 

22 shall, subject to the availability of appropriations, 

23 make a grant to the community partnership for im24 plementation of the strategic plan for such zone. 


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1 (2) GRANT PERIOD.—A grant under paragraph 

2 (1) for a health empowerment zone shall be for a pe3 riod of 2 years and may be renewed, except that the 

4 total period of grants under paragraph (1) for such 

5 zone may not exceed 10 years. 

6 (3) LIMITATION.—In awarding grants under 

7 this subsection, the Secretary shall not give less pri8 ority to an applicant or reduce the amount of a 

9 grant because the Secretary rendered technical as10 sistance or made a grant to the same applicant 

11 under section 4401. 

12 (4) REPORTING.—The Secretary shall establish 

13 metrics for measuring the progress of grantees 

14 under this subsection and, based on such metrics, 

15 require each such grantee to report to the Secretary 

16 not less than every 6 months on the progress in im17 plementing the strategic plan for the health em18 powerment zone. 

19 SEC. 4404. DEFINITION OF SECRETARY. 

20 In this subtitle, the term ‘‘Secretary’’ means the Sec21 retary of Health and Human Services, acting through the 

22 Administrator of the Health Resources and Services Ad23 ministration and the Deputy Assistant Secretary for Mi24 nority Health, and in cooperation with the Director of the 

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1 tional Institute on Minority Health and Health Dispari2 ties. 

3 SEC. 4405. AUTHORIZATION OF APPROPRIATIONS. 

4 To carry out this subtitle, there is authorized to be 

5 appropriated $100,000,000 for fiscal year 2025. 

6 Subtitle F—Equitable Health Care 

7 for All 

8 SEC. 4501. DATA COLLECTION AND REPORTING. 

9 (a) REQUIRED REPORTING.— 

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

11 Human Services, in consultation with the Director 

12 for Civil Rights and Health Equity, the Director of 

13 the National Institutes of Health, the Administrator 

14 of the Centers for Medicare & Medicaid Services, the 

15 Director of the Agency for Healthcare Research and 

16 Quality, the Deputy Assistant Secretary for Minority 

17 Health, and the Director of the Centers for Disease 

18 Control and Prevention, shall by regulation require 

19 all health care providers and facilities that are re20 quired under other provisions of law to report data 

21 on specific health outcomes to the Department of 

22 Health and Human Services in aggregate form, to 

23 disaggregate such data by demographic characteris24 tics, including by race, national origin, sex (including 

25 sexual orientation and gender identity), disability, 


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1 and age, as well as any other factor that the Sec2 retary of Health and Human Services determines 

3 would be useful for determining a pattern of provi4 sion of inequitable health care. 

5 (2) PROPOSED REGULATIONS.—Not later than 

6 90 days after the date of enactment of this Act, the 

7 Secretary of Health and Human Services shall issue 

8 proposed regulations to carry out paragraph (1). 

9 (b) REPOSITORY.—The Secretary of Health and 

10 Human Services shall— 

11 (1) not later than 1 year after the date of en12 actment of this Act, establish a repository of the 

13 disaggregated data reported pursuant to subsection 

14 (a); 

15 (2) subject to paragraph (3), make the data in 

16 such repository publicly available; and 

17 (3) ensure that such repository does not contain 

18 any data that is individually identifiable. 

19 SEC. 4502. REQUIRING EQUITABLE HEALTH CARE IN THE 

20 HOSPITAL VALUE-BASED PURCHASING PRO21 GRAM. 

22 (a) EQUITABLE HEALTH CARE AS VALUE MEASURE23 MENT.—Section 1886(b)(3)(B)(viii) of the Social Security 

24 Act (42 U.S.C. 1395ww(b)(3)(B)(viii)) is amended by 

25 adding at the end the following new subclause: 


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1 ‘‘(XIII)(aa) Effective for payments beginning with 

2 fiscal year 2025, in expanding the number of measures 

3 under subclause (III), the Secretary shall adopt measures 

4 that relate to equitable health care furnished by hospitals 

5 in inpatient settings. 

6 ‘‘(bb) In carrying out this subclause, the Secretary 

7 shall solicit input and recommendations from individuals 

8 and groups representing communities of color and other 

9 protected classes and ensure measures adopted pursuant 

10 to this subclause account for social determinants of health, 

11 as defined in section 4505(e)(10) of the Health Equity 

12 and Accountability Act of 2024. 

13 ‘‘(cc) For purposes of this subclause, the term ‘equi14 table health care’ refers to the principle that high-quality 

15 care should be provided to all individuals and health care 

16 treatment and services should not vary on account of the 

17 real or perceived race, national origin, sex (including sex18 ual orientation and gender identity), disability, or age of 

19 an individual, as well as any other factor that the Sec20 retary determines would be useful for determining a pat21 tern of provision of inequitable health care.’’. 

22 (b) INCLUSION OF EQUITABLE HEALTH CARE MEAS23 URES.—Section 1886(o)(2)(B) of the Social Security Act 

24 (42 U.S.C. 1395ww(o)(2)(B)) is amended by adding at the 

25 end the following new clause: 


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1 ‘‘(iv) INCLUSION OF EQUITABLE

2 HEALTH CARE MEASURES.—Beginning in 

3 fiscal year 2025, measures selected under 

4 subparagraph (A) shall include the equi5 table health care measures described in 

6 subsection (b)(3)(B)(viii)(XIII).’’. 

7 SEC. 4503. PROVISION OF INEQUITABLE HEALTH CARE AS A 

8 BASIS FOR PERMISSIVE EXCLUSION FROM 

9 MEDICARE AND STATE HEALTH CARE PRO10 GRAMS. 

11 Section 1128(b) of the Social Security Act (42 U.S.C. 

12 1320a–7(b)) is amended by adding at the end the fol13 lowing new paragraph: 

14 ‘‘(18) PROVISION OF INEQUITABLE HEALTH

15 CARE.— 

16 ‘‘(A) IN GENERAL.—Subject to subpara17 graph (B), any health care provider that the 

18 Secretary determines has engaged in a pattern 

19 of providing inequitable health care (as defined 

20 in section 4505(e)(7) of the Health Equity and 

21 Accountability Act of 2024) on the basis of 

22 race, national origin, sex (including sexual ori23 entation and gender identity), disability, or age 

24 of an individual. 


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1 ‘‘(B) EXCEPTION.—For purposes of car2 rying out subparagraph (A), the Secretary shall 

3 not exclude any health care provider from par4 ticipation in the Medicare program under title 

5 XVIII of the Social Security Act or the Med6 icaid program under title XIX of such Act if 

7 the exclusion of such health care provider would 

8 result in increased difficulty in access to health 

9 care services for underserved or low-income 

10 communities.’’. 

11 SEC. 4504. OFFICE FOR CIVIL RIGHTS AND HEALTH EQUITY 

12 OF THE DEPARTMENT OF HEALTH AND 

13 HUMAN SERVICES. 

14 (a) NAME OF OFFICE.—Beginning on the date of en15 actment of this Act, the Office for Civil Rights of the De16 partment of Health and Human Services shall be known 

17 as the ‘‘Office for Civil Rights and Health Equity’’ of the 

18 Department of Health and Human Services. Any ref19 erence to the Office for Civil Rights of the Department 

20 of Health and Human Services in any law, regulation, 

21 map, document, record, or other paper of the United 

22 States shall be deemed to be a reference to the Office for 

23 Civil Rights and Health Equity. 

24 (b) HEAD OF OFFICE.—The head of the Office for 

25 Civil Rights and Health Equity shall be the Director for 


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1 Civil Rights and Health Equity, to be appointed by the 

2 President. Any reference to the Director of the Office for 

3 Civil Rights of the Department of Health and Human 

4 Services in any law, regulation, map, document, record, 

5 or other paper of the United States shall be deemed to 

6 be a reference to the Director for Civil Rights and Health 

7 Equity. 

8 SEC. 4505. PROHIBITING DISCRIMINATION IN HEALTH 

9 CARE. 

10 (a) PROHIBITING DISCRIMINATION.— 

11 (1) IN GENERAL.—No health care provider 

12 may, on the basis, in whole or in part, of race, sex 

13 (including sexual orientation and gender identity), 

14 disability, age, or religion, subject an individual to 

15 the provision of inequitable health care. 

16 (2) NOTICE OF PATIENT RIGHTS.—The Sec17 retary shall provide to each patient a notice of a pa18 tient’s rights under this section. 

19 (b) ADMINISTRATIVE COMPLAINT AND CONCILIATION

20 PROCESS.— 

21 (1) COMPLAINTS AND ANSWERS.— 

22 (A) IN GENERAL.—An aggrieved person 

23 may, not later than 1 year after an alleged vio24 lation of subsection (a) has occurred or con25 cluded, file a complaint with the Director allegVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 00470 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 ing provision of inequitable health care by a 

2 provider described in subsection (a). 

3 (B) COMPLAINT.—A complaint submitted 

4 pursuant to subparagraph (A) shall be in writ5 ing and shall contain such information and be 

6 in such form as the Director requires. 

7 (C) OATH OR AFFIRMATION.—The com8 plaint and any answer made under this sub9 section shall be made under oath or affirmation, 

10 and may be reasonably and fairly modified at 

11 any time. 

12 (2) RESPONSE TO COMPLAINTS.— 

13 (A) IN GENERAL.—Upon the filing of a 

14 complaint under this subsection, the following 

15 procedures shall apply: 

16 (i) COMPLAINANT NOTICE.—The Di17 rector shall serve notice upon the com18 plainant acknowledging receipt of such fil19 ing and advising the complainant of the 

20 time limits and procedures provided under 

21 this section. 

22 (ii) RESPONDENT NOTICE.—The Di23 rector shall, not later than 30 days after 

24 receipt of such filing— 


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1 (I) serve on the respondent a no2 tice of the complaint, together with a 

3 copy of the original complaint; and 

4 (II) advise the respondent of the 

5 procedural rights and obligations of 

6 respondents under this section. 

7 (iii) ANSWER.—The respondent may 

8 file, not later than 60 days after receipt of 

9 the notice from the Director, an answer to 

10 such complaint. 

11 (iv) INVESTIGATIVE DUTIES.—The Di12 rector shall— 

13 (I) make an investigation of the 

14 alleged provision of inequitable health 

15 care; and 

16 (II) complete such investigation 

17 within 180 days (unless it is impracti18 cable to complete such investigation 

19 within 180 days) after the filing of 

20 the complaint. 

21 (B) INVESTIGATIONS.— 

22 (i) PATTERN OR PRACTICE.—In the 

23 course of investigating the complaint, the 

24 Director may seek records of care provided 

25 to patients other than the complainant if 


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1 necessary to demonstrate or disprove an 

2 allegation of provision of inequitable health 

3 care or to determine whether there is a 

4 pattern or practice of such care. 

5 (ii) ACCOUNTING FOR SOCIAL DETER6 MINANTS OF HEALTH.—In investigating 

7 the complaint and reaching a determina8 tion on the validity of the complaint, the 

9 Director shall account for social deter10 minants of health and the effect of such 

11 social determinants on health care out12 comes. 

13 (iii) INABILITY TO COMPLETE INVES14 TIGATION.—If the Director is unable to 

15 complete (or finds it is impracticable to 

16 complete) the investigation within 180 

17 days after the filing of the complaint (or, 

18 if the Secretary takes further action under 

19 paragraph (6)(B) with respect to a com20 plaint, within 180 days after the com21 mencement of such further action), the Di22 rector shall notify the complainant and re23 spondent in writing of the reasons in24 volved. 


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1 (iv) REPORT TO STATE LICENSING

2 AUTHORITIES.—On concluding each inves3 tigation under this subparagraph, the Di4 rector shall provide to the appropriate 

5 State licensing authorities information 

6 specifying the results of the investigation. 

7 (C) REPORT.— 

8 (i) FINAL REPORT.—On completing 

9 each investigation under this paragraph, 

10 the Director shall prepare a final investiga11 tive report. 

12 (ii) MODIFICATION OF REPORT.—A 

13 final report under this subparagraph may 

14 be modified if additional evidence is later 

15 discovered. 

16 (3) CONCILIATION.— 

17 (A) IN GENERAL.—During the period be18 ginning on the date on which a complaint is 

19 filed under this subsection and ending on the 

20 date of final disposition of such complaint (in21 cluding during an investigation under para22 graph (2)(B)), the Director shall, to the extent 

23 feasible, engage in conciliation with respect to 

24 such complaint. 


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1 (B) CONCILIATION AGREEMENT.—A con2 ciliation agreement arising out of such concilia3 tion shall be an agreement between the re4 spondent and the complainant, and shall be 

5 subject to approval by the Director. 

6 (C) RIGHTS PROTECTED.—The Director 

7 shall approve a conciliation agreement only if 

8 the agreement protects the rights of the com9 plainant and other persons similarly situated. 

10 (D) PUBLICLY AVAILABLE AGREEMENT.— 

11 (i) IN GENERAL.—Subject to clause 

12 (ii), the Secretary shall make available to 

13 the public a copy of a conciliation agree14 ment entered into pursuant to this sub15 section unless the complainant and re16 spondent otherwise agree, and the Sec17 retary determines, that disclosure is not re18 quired to further the purposes of this sub19 section. 

20 (ii) LIMITATION.—A conciliation 

21 agreement that is made available to the 

22 public pursuant to clause (i) may not dis23 close individually identifiable health infor24 mation. 


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1 (4) FAILURE TO COMPLY WITH CONCILIATION

2 AGREEMENT.—Whenever the Director has reason3 able cause to believe that a respondent has breached 

4 a conciliation agreement, the Director shall refer the 

5 matter to the Attorney General to consider filing a 

6 civil action to enforce such agreement. 

7 (5) WRITTEN CONSENT FOR DISCLOSURE OF

8 INFORMATION.—Nothing said or done in the course 

9 of conciliation under this subsection may be made 

10 public, or used as evidence in a subsequent pro11 ceeding under this subsection, without the written 

12 consent of the parties to the conciliation. 

13 (6) PROMPT JUDICIAL ACTION.— 

14 (A) IN GENERAL.—If the Director deter15 mines at any time following the filing of a com16 plaint under this subsection that prompt judi17 cial action is necessary to carry out the pur18 poses of this subsection, the Director may rec19 ommend that the Attorney General promptly 

20 commence a civil action under subsection (d). 

21 (B) IMMEDIATE SUIT.—If the Director de22 termines at any time following the filing of a 

23 complaint under this subsection that the public 

24 interest would be served by allowing the com25 plainant to bring a civil action under subsection 


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1 (c) in a State or Federal court immediately, the 

2 Director shall certify that the administrative 

3 process has concluded and that the complainant 

4 may file such a suit immediately. 

5 (7) ANNUAL REPORT.—Not later than 1 year 

6 after the date of enactment of this Act, and annually 

7 thereafter, the Director shall make publicly available 

8 a report detailing the activities of the Office for Civil 

9 Rights and Health Equity under this subsection, in10 cluding— 

11 (A) the number of complaints filed and the 

12 basis on which the complaints were filed; 

13 (B) the number of investigations under14 taken as a result of such complaints; and 

15 (C) the disposition of all such investiga16 tions. 

17 (c) ENFORCEMENT BY PRIVATE PERSONS.— 

18 (1) IN GENERAL.— 

19 (A) CIVIL ACTION.— 

20 (i) IN SUIT.—A complainant under 

21 subsection (b) may commence a civil action 

22 to obtain appropriate relief with respect to 

23 an alleged violation of subsection (a), or 

24 for breach of a conciliation agreement 

25 under subsection (b), in an appropriate 


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1 district court of the United States or State 

2 court— 

3 (I) not sooner than the earliest 

4 of— 

5 (aa) the date a conciliation 

6 agreement is reached under sub7 section (b); 

8 (bb) the date of a final dis9 position of a complaint under 

10 subsection (b); or 

11 (cc) 180 days after the first 

12 day of the alleged violation; and 

13 (II) not later than 2 years after 

14 the final day of the alleged violation. 

15 (ii) STATUTE OF LIMITATIONS.—The 

16 computation of such 2-year period shall 

17 not include any time during which an ad18 ministrative proceeding (including inves19 tigation or conciliation) under subsection 

20 (b) was pending with respect to a com21 plaint under such subsection. 

22 (B) BARRING SUIT.—If the Director has 

23 obtained a conciliation agreement under sub24 section (b) regarding an alleged violation of 

25 subsection (a), no action may be filed under 


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1 this paragraph by the complainant involved 

2 with respect to the alleged violation except for 

3 the purpose of enforcing the terms of such an 

4 agreement. 

5 (2) RELIEF WHICH MAY BE GRANTED.— 

6 (A) IN GENERAL.—In a civil action under 

7 paragraph (1), if the court finds that a viola8 tion of subsection (a) or breach of a conciliation 

9 agreement has occurred, the court may award 

10 to the plaintiff actual and punitive damages, 

11 and may grant as relief, as the court deter12 mines to be appropriate, any permanent or tem13 porary injunction, temporary restraining order, 

14 or other order (including an order enjoining the 

15 defendant from engaging in a practice violating 

16 subsection (a) or ordering such affirmative ac17 tion as may be appropriate). 

18 (B) FEES AND COSTS.—In a civil action 

19 under paragraph (1), the court, in its discre20 tion, may allow the prevailing party, other than 

21 the United States, a reasonable attorney’s fee 

22 and costs. The United States shall be liable for 

23 such fees and costs to the same extent as a pri24 vate person. 


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1 (3) INTERVENTION BY ATTORNEY GENERAL.— 

2 Upon timely application, the Attorney General may 

3 intervene in a civil action under paragraph (1), if 

4 the Attorney General certifies that the case is of 

5 general public importance. 

6 (d) ENFORCEMENT BY THE ATTORNEY GENERAL.— 

7 (1) COMMENCEMENT OF ACTIONS.— 

8 (A) PATTERN OR PRACTICE CASES.—The 

9 Attorney General may commence a civil action 

10 in any appropriate district court of the United 

11 States if the Attorney General has reasonable 

12 cause to believe that any health care provider 

13 covered by subsection (a)— 

14 (i) is engaged in a pattern or practice 

15 that violates such subsection; or 

16 (ii) is engaged in a violation of such 

17 subsection that raises an issue of signifi18 cant public importance. 

19 (B) CASES BY REFERRAL.—The Director 

20 may determine, based on a pattern of com21 plaints, a pattern of violations, a review of data 

22 reported by a health care provider covered by 

23 subsection (a), or any other means, that there 

24 is reasonable cause to believe a health care pro25 vider is engaged in a pattern or practice that 


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1 violates subsection (a). If the Director makes 

2 such a determination, the Director shall refer 

3 the related findings to the Attorney General. If 

4 the Attorney General finds that such reasonable 

5 cause exists, the Attorney General may com6 mence a civil action in any appropriate district 

7 court of the United States. 

8 (2) ENFORCEMENT OF SUBPOENAS.—The At9 torney General, on behalf of the Director, or another 

10 party at whose request a subpoena is issued under 

11 this subsection, may enforce such subpoena in ap12 propriate proceedings in the district court of the 

13 United States for the district in which the person to 

14 whom the subpoena was addressed resides, was 

15 served, or transacts business. 

16 (3) RELIEF WHICH MAY BE GRANTED IN CIVIL

17 ACTIONS.— 

18 (A) IN GENERAL.—In a civil action under 

19 paragraph (1), the court— 

20 (i) may award such preventive relief, 

21 including a permanent or temporary in22 junction, temporary restraining order, or 

23 other order against the person responsible 

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1 essary to assure the full enjoyment of the 

2 rights granted by this subsection; 

3 (ii) may award such other relief as the 

4 court determines to be appropriate, includ5 ing monetary damages, to aggrieved per6 sons; and 

7 (iii) may, to vindicate the public inter8 est, assess punitive damages against the 

9 respondent— 

10 (I) in an amount not exceeding 

11 $500,000, for a first violation; and 

12 (II) in an amount not exceeding 

13 $1,000,000, for any subsequent viola14 tion. 

15 (B) FEES AND COSTS.—In a civil action 

16 under this subsection, the court, in its discre17 tion, may allow the prevailing party, other than 

18 the United States, a reasonable attorney’s fee 

19 and costs. The United States shall be liable for 

20 such fees and costs to the extent provided by 

21 section 2412 of title 28, United States Code. 

22 (4) INTERVENTION IN CIVIL ACTIONS.—Upon 

23 timely application, any person may intervene in a 

24 civil action commenced by the Attorney General 

25 under paragraphs (1) and (2) if the action involves 


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1 an alleged violation of subsection (a) with respect to 

2 which such person is an aggrieved person (including 

3 a person who is a complainant under subsection (b)) 

4 or a conciliation agreement to which such person is 

5 a party. 

6 (e) DEFINITIONS.—In this section: 

7 (1) AGGRIEVED PERSON.—The term ‘‘aggrieved 

8 person’’ means— 

9 (A) a person who believes that the person 

10 was or will be injured in violation of subsection 

11 (a); or 

12 (B) the personal representative or estate of 

13 a deceased person who was injured in violation 

14 of subsection (a). 

15 (2) DIRECTOR.—The term ‘‘Director’’ means 

16 the Director for Civil Rights and Health Equity of 

17 the Department of Health and Human Services. 

18 (3) DISABILITY.—The term ‘‘disability’’ has the 

19 meaning given such term in section 3 of the Ameri20 cans with Disabilities Act of 1990 (42 U.S.C. 

21 12102). 

22 (4) CONCILIATION.—The term ‘‘conciliation’’ 

23 means the attempted resolution of issues raised by 

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1 plaint, through informal negotiations involving the 

2 complainant, the respondent, and the Secretary. 

3 (5) CONCILIATION AGREEMENT.—The term 

4 ‘‘conciliation agreement’’ means a written agreement 

5 setting forth the resolution of the issues in concilia6 tion. 

7 (6) INDIVIDUALLY IDENTIFIABLE HEALTH IN8 FORMATION.—The term ‘‘individually identifiable 

9 health information’’ means any information, includ10 ing demographic information collected from an indi11 vidual— 

12 (A) that is created or received by a health 

13 care provider covered by subsection (a), health 

14 plan, employer, or health care clearinghouse; 

15 (B) that relates to the past, present, or fu16 ture physical or mental health or condition of, 

17 the provision of health care to, or the past, 

18 present, or future payment for the provision of 

19 health care to, the individual; and 

20 (C)(i) that identifies the individual; or 

21 (ii) with respect to which there is a reason22 able basis to believe that the information can be 

23 used to identify the individual. 

24 (7) PROVISION OF INEQUITABLE HEALTH

25 CARE.—The term ‘‘provision of inequitable health 


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1 care’’ means the provision of any health care service, 

2 by a health care provider in a manner that— 

3 (A) fails to meet a high-quality care stand4 ard, meaning the health care provider fails to— 

5 (i) avoid harm to patients as a result 

6 of the health services that are intended to 

7 help the patient; 

8 (ii) provide health services based on 

9 scientific knowledge to all and to all pa10 tients who benefit; 

11 (iii) refrain from providing services to 

12 patients not likely to benefit; 

13 (iv) provide care that is responsive to 

14 patient preferences, needs, and values; and 

15 (v) avoids waits or delays in care; and 

16 (B) is discriminatory in intent or effect 

17 based at least in part on a basis specified in 

18 subsection (a). 

19 (8) RESPONDENT.—The term ‘‘respondent’’ 

20 means the person or other entity accused in a com21 plaint of a violation of subsection (a). 

22 (9) SECRETARY.—The term ‘‘Secretary’’ means 

23 the Secretary of Health and Human Services. 

24 (10) SOCIAL DETERMINANTS OF HEALTH.—The 

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1 tions in the environments in which individuals live, 

2 work, attend school, and worship, that affect a wide 

3 range of health, functioning, and quality-of-life out4 comes and risks. 

5 (f) RULE OF CONSTRUCTION.—Nothing in this sec6 tion shall be construed as repealing or limiting the effect 

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

8 2000d et seq.), section 1557 of the Patient Protection and 

9 Affordable Care Act (42 U.S.C. 18116), section 504 of 

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

11 Age Discrimination Act of 1975 (42 U.S.C. 6101 et seq.). 

12 SEC. 4506. FEDERAL HEALTH EQUITY COMMISSION. 

13 (a) ESTABLISHMENT OF COMMISSION.— 

14 (1) IN GENERAL.—There is established the 

15 Federal Health Equity Commission (in this section 

16 referred to as the ‘‘Commission’’). 

17 (2) MEMBERSHIP.— 

18 (A) IN GENERAL.—The Commission shall 

19 be composed of— 

20 (i) 8 voting members appointed under 

21 subparagraph (B); and 

22 (ii) the nonvoting, ex officio members 

23 listed in subparagraph (C). 

24 (B) VOTING MEMBERS.—Not more than 4 

25 of the members described in subparagraph 


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1 (A)(i) shall at any one time be of the same po2 litical party. Such members shall have recog3 nized expertise in and personal experience with 

4 racial and ethnic health inequities, health care 

5 needs of vulnerable and marginalized popu6 lations, and health equity as a vehicle for im7 proving health status and health outcomes. 

8 Such members shall be appointed to the Com9 mission as follows: 

10 (i) 4 members of the Commission 

11 shall be appointed by the President. 

12 (ii) 2 members of the Commission 

13 shall be appointed by the President pro 

14 tempore of the Senate, upon the rec15 ommendations of the majority leader and 

16 the minority leader of the Senate. Each 

17 member appointed to the Commission 

18 under this clause shall be appointed from 

19 a different political party. 

20 (iii) 2 members of the Commission 

21 shall be appointed by the Speaker of the 

22 House of Representatives upon the rec23 ommendations of the majority leader and 

24 the minority leader of the House of Rep25 resentatives. Each member appointed to 


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1 the Commission under this clause shall be 

2 appointed from a different political party. 

3 (C) EX OFFICIO MEMBER.—The Commis4 sion shall have the following nonvoting, ex offi5 cio members: 

6 (i) The Director for Civil Rights and 

7 Health Equity of the Department of 

8 Health and Human Services. 

9 (ii) The Deputy Assistant Secretary 

10 for Minority Health of the Department of 

11 Health and Human Services. 

12 (iii) The Director of the National In13 stitute on Minority Health and Health Dis14 parities. 

15 (iv) The Chairperson of the Advisory 

16 Committee on Minority Health established 

17 under section 1707(c) of the Public Health 

18 Service Act (42 U.S.C. 300u–6(c)). 

19 (3) TERMS.—The term of office of each mem20 ber appointed under paragraph (2)(B) of the Com21 mission shall be 6 years. 

22 (4) CHAIRPERSON; VICE CHAIRPERSON.— 

23 (A) CHAIRPERSON.—The President shall, 

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1 graph (2)(B), designate a Chairperson from 

2 among the members of the Commission ap3 pointed under such paragraph. 

4 (B) VICE CHAIRPERSON.— 

5 (i) DESIGNATION.—The Speaker of 

6 the House of Representatives shall, in con7 sultation with the majority leaders and the 

8 minority leaders of the Senate and the 

9 House of Representatives and with the 

10 concurrence of a majority of the members 

11 of the Commission appointed under para12 graph (2)(B), designate a Vice Chairperson 

13 from among the members of the Commis14 sion appointed under such paragraph. The 

15 Vice Chairperson may not be a member of 

16 the same political party as the Chair17 person. 

18 (ii) DUTY.—The Vice Chairperson 

19 shall act in place of the Chairperson in the 

20 absence of the Chairperson. 

21 (5) REMOVAL OF MEMBERS.—The President 

22 may remove a member of the Commission only for 

23 neglect of duty or malfeasance in office. 

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

25 Commission appointed under paragraph (2)(B) shall 


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1 constitute a quorum of the Commission, but a lesser 

2 number of members may hold hearings. 

3 (b) DUTIES OF THE COMMISSION.— 

4 (1) IN GENERAL.—The Commission shall— 

5 (A) monitor and report on the implementa6 tion of this Act; and 

7 (B) investigate, monitor, and report on 

8 progress towards health equity and the elimi9 nation of health disparities. 

10 (2) ANNUAL REPORT.—The Commission 

11 shall— 

12 (A) submit to the President and Congress 

13 at least one report annually on health equity 

14 and health disparities; and 

15 (B) include in such report— 

16 (i) a description of actions taken by 

17 the Department of Health and Human 

18 Services and any other Federal agency re19 lated to health equity or health disparities; 

20 and 

21 (ii) recommendations on ensuring eq22 uitable health care and eliminating health 

23 disparities. 

24 (c) POWERS.— 

25 (1) HEARINGS.— 


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1 (A) IN GENERAL.—The Commission or, at 

2 the direction of the Commission, any sub3 committee or member of the Commission, may, 

4 for the purpose of carrying out this section, as 

5 the Commission or the subcommittee or mem6 ber considers advisable— 

7 (i) hold such hearings, meet and act 

8 at such times and places, take such testi9 mony, receive such evidence, and admin10 ister such oaths; and 

11 (ii) require, by subpoena or otherwise, 

12 the attendance and testimony of such wit13 nesses and the production of such books, 

14 records, correspondence, memoranda, pa15 pers, documents, tapes, and materials. 

16 (B) LIMITATION ON HEARINGS.—The 

17 Commission may hold a hearing under subpara18 graph (A)(i) only if the hearing is approved— 

19 (i) by a majority of the members of 

20 the Commission appointed under sub21 section (a)(2)(B); or 

22 (ii) by a majority of such members 

23 present at a meeting when a quorum is 

24 present. 


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1 (2) ISSUANCE AND ENFORCEMENT OF SUB2 POENAS.— 

3 (A) ISSUANCE.—A subpoena issued under 

4 paragraph (1) shall— 

5 (i) bear the signature of the Chair6 person of the Commission; and 

7 (ii) be served by any person or class 

8 of persons designated by the Chairperson 

9 for that purpose. 

10 (B) ENFORCEMENT.—In the case of contu11 macy or failure to obey a subpoena issued 

12 under paragraph (1), the United States district 

13 court for the district in which the subpoenaed 

14 person resides, is served, or may be found may 

15 issue an order requiring the person to appear at 

16 any designated place to testify or to produce 

17 documentary or other evidence. 

18 (C) NONCOMPLIANCE.—Any failure to 

19 obey the order of the court may be punished by 

20 the court as a contempt of court. 

21 (3) WITNESS ALLOWANCES AND FEES.— 

22 (A) IN GENERAL.—Section 1821 of title 

23 28, United States Code, shall apply to a witness 

24 requested or subpoenaed to appear at a hearing 

25 of the Commission. 


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1 (B) EXPENSES.—The per diem and mile2 age allowances for a witness shall be paid from 

3 funds available to pay the expenses of the Com4 mission. 

5 (4) POSTAL SERVICES.—The Commission may 

6 use the United States mails in the same manner and 

7 under the same conditions as other agencies of the 

8 Federal Government. 

9 (5) GIFTS.—The Commission may accept, use, 

10 and dispose of gifts or donations of services or prop11 erty. 

12 (d) ADMINISTRATIVE PROVISIONS.— 

13 (1) STAFF.— 

14 (A) DIRECTOR.—There shall be a full-time 

15 staff director for the Commission who shall— 

16 (i) serve as the administrative head of 

17 the Commission; and 

18 (ii) be appointed by the Chairperson 

19 with the concurrence of the Vice Chair20 person. 

21 (B) OTHER PERSONNEL.—The Commis22 sion may— 

23 (i) appoint such other personnel as it 

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1 erning appointments in the competitive 

2 service, and the provisions of chapter 51 

3 and subchapter III of chapter 53 of that 

4 title relating to classification and General 

5 Schedule pay rates; and 

6 (ii) may procure temporary and inter7 mittent services under section 3109(b) of 

8 title 5, United States Code, at rates for in9 dividuals not in excess of the daily equiva10 lent paid for positions at the maximum 

11 rate for GS–15 of the General Schedule 

12 under section 5332 of title 5, United 

13 States Code. 

14 (2) COMPENSATION OF MEMBERS.— 

15 (A) NON-FEDERAL EMPLOYEES.—Each 

16 member of the Commission who is not an offi17 cer or employee of the Federal Government 

18 shall be compensated at a rate equal to the 

19 daily equivalent of the annual rate of basic pay 

20 prescribed for level IV of the Executive Sched21 ule under section 5315 of title 5, United States 

22 Code, for each day (including travel time) dur23 ing which the member is engaged in the per24 formance of the duties of the Commission. 


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1 (B) FEDERAL EMPLOYEES.—Each member 

2 of the Commission who is an officer or em3 ployee of the Federal Government shall serve 

4 without compensation in addition to the com5 pensation received for the services of the mem6 ber as an office or employee of the Federal 

7 Government. 

8 (C) TRAVEL EXPENSES.—A member of the 

9 Commission shall be allowed travel expenses, in10 cluding per diem in lieu of subsistence, at rates 

11 authorized for an employee of an agency under 

12 subchapter I of chapter 57 of title 5, United 

13 States Code, while away from the home or reg14 ular place of business of the member in the per15 formance of the duties of the Commission. 

16 (3) COOPERATION.—The Commission may se17 cure directly from any Federal department or agency 

18 such information as the Commission considers nec19 essary to carry out this Act. Upon request of the 

20 Chairman of the Commission, the head of such de21 partment or agency shall furnish such information to 

22 the Commission. 

23 (e) PERMANENT COMMISSION.—Section 1013 of title 

24 5, United States Code, shall not apply to the Commission. 


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1 (f) AUTHORIZATION OF APPROPRIATIONS.—There 

2 are authorized to be appropriated for fiscal year 2025 and 

3 each fiscal year thereafter such sums as may be necessary 

4 to carry out the duties of the Commission. 

5 SEC. 4507. GRANTS FOR HOSPITALS TO PROMOTE EQUI6 TABLE HEALTH CARE AND OUTCOMES. 

7 (a) IN GENERAL.—Not later than 180 days after the 

8 date of the enactment of this Act, the Secretary of Health 

9 and Human Services (in this section referred to as the 

10 ‘‘Secretary’’) shall award grants to hospitals to promote 

11 equitable health care treatment and services, and reduce 

12 disparities in care and outcomes. 

13 (b) CONSULTATION.—In establishing the criteria for 

14 grants under this section and evaluating applications for 

15 such grants, the Secretary shall consult with the Director 

16 for Civil Rights and Health Equity of the Department of 

17 Health and Human Services. 

18 (c) USE OF FUNDS.—A hospital shall use funds re19 ceived from a grant under this section to establish or ex20 pand programs to provide equitable health care to all pa21 tients and to ensure equitable health care outcomes. Such 

22 uses may include— 

23 (1) providing explicit and implicit bias training 

24 to medical providers and staff; 


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1 (2) providing translation or interpretation serv2 ices for patients; 

3 (3) recruiting and training a diverse workforce; 

4 (4) tracking data related to care and outcomes; 

5 and 

6 (5) training on cultural sensitivity. 

7 (d) PRIORITY.—In awarding grants under this sec8 tion, the Secretary shall give priority to hospitals that 

9 have received disproportionate share hospital payments 

10 under section 1886(r) of the Social Security Act (42 

11 U.S.C. 1395ww(r)) or section 1923 of such Act (42 U.S.C. 

12 1396r–4) with respect to fiscal year 2023. 

13 (e) SUPPLEMENT, NOT SUPPLANT.—Grants awarded 

14 under this section shall be used to supplement, not sup15 plant, any nongovernment efforts, or other Federal, State, 

16 or local funds provided to a recipient. 

17 (f) EQUITABLE HEALTH CARE DEFINED.—The term 

18 ‘‘equitable health care’’ has the meaning given such term 

19 in section 1886(b)(3)(B)(viii)(XIII)(cc) of the Social Secu20 rity Act (42 U.S.C. 1395ww(b)(3)(B)(viii)(XIII)(cc)), as 

21 added by section 4502(a). 

22 (g) AUTHORIZATION OF APPROPRIATIONS.—To carry 

23 out this section, there are authorized to be appropriated 

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

25 2025 through 2029. 


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1 Subtitle G—Investing in Equity 

2 SEC. 4601. DEFINITIONS. 

3 In this subtitle: 

4 (1) ADVISORY COUNCIL.—The term ‘‘Advisory 

5 Council’’ means the Pay for Equity Council con6 vened under section 4603. 

7 (2) SECRETARY.—The term ‘‘Secretary’’ means 

8 the Secretary of Health and Human Services. 

9 (3) STRATEGY.—The term ‘‘Strategy’’ means 

10 the Pay for Equity Strategy set forth under section 

11 4602. 

12 SEC. 4602. STRATEGY TO INCENTIVIZE HEALTH EQUITY. 

13 (a) IN GENERAL.—The Secretary, in consultation 

14 with the heads of other appropriate Federal agencies, shall 

15 develop jointly with the Advisory Council and submit to 

16 the Committee on Finance of the Senate and the Com17 mittee on Energy and Commerce and the Committee on 

18 Ways and Means of the House of Representatives, and 

19 make publicly available on the internet website of the De20 partment of Health and Human Services, a Pay for Eq21 uity Strategy. 

22 (b) CONTENTS.—The Strategy shall establish goals 

23 for Federal programs, including those authorized under ti24 tles XVIII and XIX of the Social Security Act, to 

25 incentivize health equity, which may include at least— 


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1 (1) incorporating measures of equity into all 

2 payment models by 2026; 

3 (2) tying a percentage of reimbursement in 

4 value-based payment models to equity measure per5 formance by 2029; and 

6 (3) increasing the number of safety net pro7 viders participating in value-based payment by a set 

8 percentage by 2031. 

9 (c) DUTIES OF THE SECRETARY.—The Secretary, in 

10 carrying out subsection (a), shall oversee the following: 

11 (1) Collecting and making publicly available in12 formation submitted by the Advisory Council. 

13 (2) Coordinating and assessing existing Federal 

14 Government programs and activities to assess capac15 ity to meet equity goals. 

16 (3) Providing technical assistance, as appro17 priate, such as disseminating identified best prac18 tices and information sharing based on reports de19 veloped as a result of this subtitle. 

20 (d) INITIAL STRATEGY; UPDATES.—The Secretary 

21 shall— 

22 (1) not later than 18 months after the date of 

23 enactment of this Act, develop, publish, and submit 

24 to the Committee on Finance of the Senate and the 

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1 mittee on Ways and Means of the House of Rep2 resentatives the strategy outlined in subsection (a); 

3 and 

4 (2) biennially update, publish, and submit to 

5 Congress an updated strategy to— 

6 (A) reflect new developments, challenges, 

7 opportunities, and solutions; and 

8 (B) review progress and, based on the re9 sults of such review, recommend priority actions 

10 for improving the implementation of such rec11 ommendations, as appropriate. 

12 (e) PROCESS FOR PUBLIC INPUT.—The Secretary 

13 shall establish a process for public input to inform the de14 velopment of, and updates to, the Strategy, including a 

15 process for the public to submit recommendations to the 

16 Advisory Council and an opportunity for public comment 

17 on the proposed Strategy. 

18 SEC. 4603. PAY FOR EQUITY ADVISORY COUNCIL. 

19 (a) CONVENING.—The Secretary shall convene a Pay 

20 for Equity Advisory Council to advise and provide rec21 ommendations, including identified best practices, to the 

22 Secretary on the Pay for Equity Strategy. 

23 (b) MEMBERSHIP.— 

24 (1) IN GENERAL.—The members of the Advi25 sory Council shall consist of— 


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1 (A) the appointed members under para2 graph (2); and 

3 (B) the Federal members under paragraph 

4 (3). 

5 (2) APPOINTED MEMBERS.—In addition to the 

6 Federal members under paragraph (3), the Sec7 retary shall appoint not more than 15 voting mem8 bers of the Advisory Council who are not representa9 tives of Federal departments or agencies and who 

10 shall include at least 1 representative of each of the 

11 following: 

12 (A) Beneficiaries of Medicare and Med13 icaid. 

14 (B) Safety net health care providers. 

15 (C) Value-based payment experts. 

16 (D) Other members with expertise and 

17 lived experience the Secretary deems appro18 priate. 

19 (3) FEDERAL MEMBERS.—The Federal mem20 bers of the Advisory Council, who shall be nonvoting 

21 members, shall consist of the following: 

22 (A) The Administrator of the Centers for 

23 Medicare & Medicaid Services (or the Adminis24 trator’s designee). 


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1 (B) The Administrator of the Health Re2 sources and Services Administration. 

3 (4) DIVERSE REPRESENTATION.—The Sec4 retary shall ensure that the membership of the Advi5 sory Council reflects the diversity of individuals im6 pacted by Federal health payment programs. 

7 (c) MEETINGS.—The Advisory Council shall meet 

8 quarterly during the 1-year period beginning on the date 

9 of enactment of this Act and at least 3 times during each 

10 year thereafter. Meetings of the Advisory Council shall be 

11 open to the public. 

12 TITLE V—IMPROVING HEALTH 

13 OUTCOMES FOR WOMEN, 

14 GENDER-DIVERSE PEOPLE, 

15 CHILDREN, AND FAMILIES 

16 Subtitle A—Underserved 

17 Communities 

18 SEC. 5001. GRANTS TO PROMOTE HEALTH FOR UNDER19 SERVED COMMUNITIES. 

20 Part Q of title III of the Public Health Service Act 

21 (42 U.S.C. 280h et seq.) is amended by adding at the end 

22 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, may award 

7 grants to eligible entities— 

8 ‘‘(1) to promote health for medically under9 served communities, such as racial and ethnic minor10 ity women, racial and ethnic minority children, ado11 lescents, and lesbian, gay, bisexual, transgender, 

12 queer, nonbinary, gender-nonconforming, or ques13 tioning communities; 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 provide education and outreach regard21 ing enrollment in health insurance including the 

22 State Children’s Health Insurance Program under 

23 title XXI of the Social Security Act, Medicare under 

24 title XVIII of such Act, and Medicaid under title 

25 XIX of such Act; 


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1 ‘‘(2) to provide education and outreach in a 

2 community setting regarding health problems preva3 lent among medically underserved communities, and 

4 especially among racial and ethnic minority women, 

5 racial and ethnic minority children, adolescents, and 

6 lesbian, gay, bisexual, transgender, queer, nonbinary, 

7 gender-nonconforming, or questioning communities; 

8 ‘‘(3) to provide education and experiential 

9 learning opportunities and target risk factors and 

10 healthy behaviors that impede or contribute to 

11 achieving 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 provide education and refer target popu5 lations to appropriate health care agencies and com6 munity-based programs and organizations in order 

7 to increase access to quality health care services, in8 cluding 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 pregnant, birthing, and postpartum people and 

6 children, especially among racial and ethnic mi7 nority pregnant, birthing, and postpartum peo8 ple and children; or 

9 ‘‘(G) by providing referral and followup 

10 services. 

11 ‘‘(2) COMMUNITY SETTING.—The term ‘commu12 nity setting’ means a home or a community organi13 zation that serves a population. 

14 ‘‘(3) ELIGIBLE ENTITY.—The term ‘eligible en15 tity’ means— 

16 ‘‘(A) a unit of State, territorial, local, or 

17 Tribal government (including a federally recog18 nized Tribe or Alaska Native village); or 

19 ‘‘(B) a community-based organization. 

20 ‘‘(4) MEDICALLY UNDERSERVED COMMUNITY.— 

21 The term ‘medically underserved community’ means 

22 a community— 

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1 derserved population, as defined by section 

2 330(b)(3); 

3 ‘‘(B) a significant portion of which is a 

4 health professional shortage area as designated 

5 under section 332; and 

6 ‘‘(C) that includes populations that are lin7 guistically isolated, such as geographic areas 

8 with a shortage of health professionals able to 

9 provide linguistically appropriate services. 

10 ‘‘(5) SUPPORT.—The term ‘support’ means the 

11 provision of training, supervision, and materials 

12 needed to effectively deliver the services described in 

13 subsection (b), reimbursement for services, and 

14 other benefits. 

15 ‘‘(k) AUTHORIZATION OF APPROPRIATIONS.—There 

16 are authorized to be appropriated to carry out this section 

17 $15,000,000 for each of fiscal years 2025 through 2029.’’. 

18 Subtitle B—Pregnancy Screening 

19 SEC. 5101. PREGNANCY INTENTION SCREENING INITIATIVE 

20 DEMONSTRATION PROGRAM. 

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

22 (42 U.S.C. 280g et seq.) is amended by adding at the end 

23 the following: 


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1 ‘‘SEC. 399V–8. PREGNANCY INTENTION SCREENING INITIA2 TIVE DEMONSTRATION PROGRAM. 

3 ‘‘(a) PROGRAM ESTABLISHMENT.—The Secretary, 

4 acting through the Director of the Centers for Disease 

5 Control and Prevention, shall establish a demonstration 

6 program to facilitate the clinical adoption of pregnancy in7 tention screening initiatives by health care and social serv8 ices providers. 

9 ‘‘(b) GRANTS.—The Secretary may carry out the 

10 demonstration program through awarding grants to eligi11 ble entities to implement pregnancy intention screening 

12 initiatives, collect data, and evaluate such initiatives. 

13 ‘‘(c) ELIGIBLE ENTITIES.—To be eligible for a grant 

14 under this section, an entity shall— 

15 ‘‘(1) provide non-directive, comprehensive, 

16 medically accurate information; and 

17 ‘‘(2) be a community-based organization, vol18 untary health organization, public health depart19 ment, community health center, or other interested 

20 public or private primary, behavioral, or other health 

21 care or social service provider or organization. 

22 ‘‘(d) PREGNANCY INTENTION SCREENING INITIA23 TIVE.—For purposes of this section, the term ‘pregnancy 

24 intention screening initiative’ means any initiative by an 

25 eligible entity to routinely screen people with respect to 

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1 intended pregnancies or improve the likelihood of healthy 

2 pregnancies, in order to better provide health care that 

3 meets the contraceptive or pre-pregnancy needs and goals 

4 of such people. 

5 ‘‘(e) EVALUATION.— 

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

7 through the Director of the Centers for Disease 

8 Control and Prevention, shall, by grant or contract, 

9 and after consultation as described in paragraph (2), 

10 conduct an evaluation of the demonstration pro11 gram, with respect to pregnancy intention screening 

12 initiatives, conducted under this section. Such eval13 uation shall include: 

14 ‘‘(A) Assessment of the implementation of 

15 pregnancy intention screening protocols among 

16 a diverse group of patients and providers, in17 cluding collecting data on the experiences and 

18 outcomes for diverse patient populations in a 

19 variety of clinical settings. 

20 ‘‘(B) Analysis of outcome measures that 

21 will facilitate effective and widespread adoption 

22 of such protocols by health care providers for 

23 inquiring about and responding to pregnancy 

24 goals of people with both contraceptive and pre25 pregnancy care. 


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1 ‘‘(C) Consideration of health inequities 

2 among the population served. 

3 ‘‘(D) Assessment of the equitable and vol4 untary application of such initiatives to minor5 ity and medically underserved communities. 

6 ‘‘(E) Assessment of the training, capacity, 

7 and ongoing technical assistance needed for 

8 providers to effectively implement such preg9 nancy intention screening protocols. 

10 ‘‘(F) Assessment of whether referral sys11 tems for selected protocols follow evidence-based 

12 standards that ensure access to comprehensive 

13 health services and appropriate follow-up care. 

14 ‘‘(G) Measuring through rigorous methods 

15 the effect of such initiatives on key health out16 comes. 

17 ‘‘(2) CONSULTATION WITH INDEPENDENT, EX18 PERT ADVISORY PANEL.—In conducting the evalua19 tion under paragraph (1), the Director of the Cen20 ters for Disease Control and Prevention shall consult 

21 with physicians, physician assistants, advanced prac22 tice registered nurses, nurse midwives, and other 

23 health care providers who specialize in women’s 

24 health, and other experts in public health, clinical 

25 practice, program evaluation, and research. 


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1 ‘‘(3) REPORT.—Not later than one year after 

2 the last day of the demonstration program under 

3 this section, the Director of the Centers for Disease 

4 Control and Prevention shall— 

5 ‘‘(A) submit to Congress a report on the 

6 results of the evaluation conducted under para7 graph (1); and 

8 ‘‘(B) make the report publicly available. 

9 ‘‘(f) FUNDING.— 

10 ‘‘(1) AUTHORIZATION OF APPROPRIATIONS.— 

11 To carry out this section, there is authorized to be 

12 appropriated $10,000,000 for each of fiscal years 

13 2025 through 2029. 

14 ‘‘(2) LIMITATION.—Not more than 20 percent 

15 of funds appropriated to carry out this section pur16 suant to paragraph (1) for a fiscal year may be used 

17 for purposes of the evaluation under subsection 

18 (e).’’. 

19 SEC. 5102. BIRTH DEFECTS PREVENTION, RISK REDUCTION, 

20 AND AWARENESS. 

21 (a) IN GENERAL.—The Secretary shall establish and 

22 implement a birth defects prevention and public awareness 

23 program, consisting of the activities described in sub24 sections (b) and (c). 


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1 (b) NATIONWIDE MEDIA CAMPAIGN.—In carrying 

2 out subsection (a), the Secretary shall conduct or support 

3 a nationwide media campaign to increase awareness 

4 among health care providers and at-risk populations about 

5 pregnancy and breastfeeding information services. 

6 (c) GRANTS FOR PREGNANCY AND BREASTFEEDING

7 INFORMATION SERVICES.— 

8 (1) IN GENERAL.—In carrying out subsection 

9 (a), the Secretary shall award grants to State or re10 gional agencies or organizations for any of the fol11 lowing: 

12 (A) INFORMATION SERVICES.—The provi13 sion of, or campaigns to increase awareness 

14 about, pregnancy and breastfeeding information 

15 services. 

16 (B) SURVEILLANCE AND RESEARCH.—The 

17 conduct or support of— 

18 (i) surveillance of or research on— 

19 (I) maternal exposures and ma20 ternal health conditions that may in21 fluence the risk of birth defects, pre22 maturity, or other adverse pregnancy 

23 outcomes; and 


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1 (II) maternal exposures that may 

2 influence health risks to a breastfed 

3 infant; or 

4 (ii) networking to facilitate surveil5 lance or research described in this sub6 paragraph. 

7 (2) PREFERENCE FOR CERTAIN STATES.—The 

8 Secretary, in making any grant under this sub9 section, shall give preference to States, otherwise 

10 equally qualified, that have pregnancy and 

11 breastfeeding information services in place. 

12 (3) MATCHING FUNDS.—The Secretary may 

13 only award a grant under this subsection to a State 

14 or regional agency or organization that agrees, with 

15 respect to the costs to be incurred in carrying out 

16 the grant activities, to make available (directly or 

17 through donations from public or private entities) 

18 non-Federal funds toward such costs in an amount 

19 equal to not less than 25 percent of the amount of 

20 the grant. 

21 (4) COORDINATION.—The Secretary shall en22 sure that activities funded through a grant under 

23 this subsection are coordinated, to the maximum ex24 tent practicable, with other birth defects prevention 

25 and environmental health activities of the Federal 


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1 Government, including with respect to pediatric envi2 ronmental health specialty units and children’s envi3 ronmental health centers. 

4 (d) EVALUATION.—The Secretary shall provide for 

5 an evaluation of pregnancy and breastfeeding information 

6 services carried out by States to identify efficient and ef7 fective models of— 

8 (1) providing information; 

9 (2) raising awareness and increasing knowledge 

10 about birth defects prevention measures and tar11 geting education to at-risk groups; 

12 (3) modifying risk behaviors; or 

13 (4) other outcome measures as determined ap14 propriate by the Secretary. 

15 (e) DEFINITIONS.—In this section: 

16 (1) MATERNAL.—The term ‘‘maternal’’ refers 

17 to people who are pregnant or breastfeeding. 

18 (2) PREGNANCY AND BREASTFEEDING INFOR19 MATION SERVICES.—The term ‘‘pregnancy and 

20 breastfeeding information services’’ includes only— 

21 (A) information services to provide accu22 rate, evidence-based, clinical information re23 garding maternal exposures during pregnancy 

24 or breastfeeding that may be associated with 

25 birth defects, health risks to a breastfed infant, 


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1 or other health risks, such as exposures to 

2 medications, chemicals, infections, foodborne 

3 pathogens, illnesses, nutrition, lifestyle, or 

4 climate- and weather-related factors; 

5 (B) the provision of accurate, evidence6 based information weighing risks of exposures 

7 during breastfeeding against the benefits of 

8 breastfeeding; and 

9 (C) the provision of information described 

10 in subparagraph (A) or (B) through counselors, 

11 websites, fact sheets, telephonic or electronic 

12 communication, community outreach efforts, or 

13 other appropriate means. 

14 (3) SECRETARY.—The term ‘‘Secretary’’ means 

15 the Secretary of Health and Human Services, acting 

16 through the Director of the Centers for Disease 

17 Control and Prevention. 

18 (f) AUTHORIZATION OF APPROPRIATIONS.—To carry 

19 out this section, there are authorized to be appropriated— 

20 (1) $5,000,000 for fiscal year 2025; 

21 (2) $6,000,000 for fiscal year 2026; 

22 (3) $7,000,000 for fiscal year 2027; 

23 (4) $8,000,000 for fiscal year 2028; and 

24 (5) $9,000,000 for fiscal year 2029. 


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1 Subtitle C—Pregnancy-related 

2 Care 

3 SEC. 5201. COMMUNITY ACCESS, RESOURCES, AND EM4 POWERMENT FOR MOMS. 

5 (a) SHORT TITLE.—This section may be cited as the 

6 ‘‘Community Access, Resources, and Empowerment for 

7 Moms Act’’ or the ‘‘CARE for Moms Act’’. 

8 (b) IMPROVING FEDERAL EFFORTS WITH RESPECT

9 TO PREVENTION OF MATERNAL MORTALITY.— 

10 (1) FUNDING FOR STATE-BASED PERINATAL

11 QUALITY COLLABORATIVES DEVELOPMENT AND SUS12 TAINABILITY.— 

13 (A) IN GENERAL.—Not later than one year 

14 after the date of enactment of this Act, the Sec15 retary of Health and Human Services, acting 

16 through the Division of Reproductive Health of 

17 the Centers for Disease Control and Prevention 

18 (referred to in this paragraph as the ‘‘Sec19 retary’’), shall establish a grant program to be 

20 known as the ‘‘State-Based Perinatal Quality 

21 Collaborative Grant Program’’, under which the 

22 Secretary shall award grants to eligible entities 

23 for the purpose of development and sustain24 ability of State-based perinatal quality 

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1 lumbia, and eligible territories, in order to 

2 measurably improve perinatal care and 

3 perinatal health outcomes for pregnant and 

4 postpartum women and their infants. 

5 (B) GRANT AMOUNTS.—Grants awarded 

6 under this paragraph shall be in amounts not to 

7 exceed $250,000 per year, for the duration of 

8 the grant period. 

9 (C) STATE-BASED PERINATAL QUALITY

10 COLLABORATIVE DEFINED.—For purposes of 

11 this paragraph, the term ‘‘State-based perinatal 

12 quality collaborative’’ means a network of teams 

13 that— 

14 (i) is multidisciplinary in nature and 

15 includes the full range of perinatal and 

16 maternity care providers; 

17 (ii) works to improve measurable out18 comes for maternal and infant health by 

19 advancing evidence-informed clinical prac20 tices using quality improvement principles; 

21 (iii) works with hospital-based or out22 patient facility-based clinical teams, ex23 perts, and stakeholders, including patients 

24 and families, to spread best practices and 


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1 optimize resources to improve perinatal 

2 care and outcomes; 

3 (iv) employs strategies that include 

4 the use of the collaborative learning model 

5 to provide opportunities for hospitals and 

6 clinical teams to collaborate on improve7 ment strategies, rapid-response data to 

8 provide timely feedback to hospital and 

9 other clinical teams to track progress, and 

10 quality improvement science to provide 

11 support and coaching to hospital and clin12 ical teams; 

13 (v) has the goal of improving popu14 lation-level outcomes in maternal and in15 fant health; and 

16 (vi) has the goal of improving out17 comes of all birthing people, through the 

18 coordination, integration, and collaboration 

19 across birth settings. 

20 (D) AUTHORIZATION OF APPROPRIA21 TIONS.—For purposes of carrying out this 

22 paragraph, there is authorized to be appro23 priated $35,000,000 for each of fiscal years 

24 2025 through 2029. 


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1 (2) EXPANSION OF MEDICAID AND CHIP COV2 ERAGE FOR PREGNANT AND POSTPARTUM WOMEN.— 

3 (A) REQUIRING COVERAGE OF ORAL

4 HEALTH SERVICES FOR PREGNANT AND

5 POSTPARTUM WOMEN.— 

6 (i) MEDICAID.—Section 1905 of the 

7 Social Security Act (42 U.S.C. 1396d), as 

8 amended by section 4251(d)(3)(A), is 

9 amended— 

10 (I) in subsection (a)(4)— 

11 (aa) by striking ‘‘; and (D)’’ 

12 and inserting ‘‘; (D)’’; 

13 (bb) by striking ‘‘; and (E)’’ 

14 and inserting ‘‘; (E)’’; 

15 (cc) by striking ‘‘; and (F)’’ 

16 and inserting ‘‘; (F)’’; and 

17 (dd) by striking the semi18 colon at the end and inserting ‘‘; 

19 and (G) oral health services for 

20 pregnant and postpartum women 

21 (as defined in subsection (nn));’’; 

22 and 

23 (II) by adding at the end the fol24 lowing new subsection: 


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1 ‘‘(nn) ORAL HEALTH SERVICES FOR PREGNANT AND

2 POSTPARTUM WOMEN.— 

3 ‘‘(1) IN GENERAL.—For purposes of this title, 

4 the term ‘oral health services for pregnant and 

5 postpartum women’ means dental services necessary 

6 to prevent disease and promote oral health, restore 

7 oral structures to health and function, and treat 

8 emergency conditions that are furnished to a woman 

9 during pregnancy (or during the 1-year period be10 ginning on the last day of the pregnancy). 

11 ‘‘(2) COVERAGE REQUIREMENTS.—To satisfy 

12 the requirement to provide oral health services for 

13 pregnant and postpartum women, a State shall, at 

14 a minimum, provide coverage for preventive, diag15 nostic, periodontal, and restorative care consistent 

16 with recommendations for perinatal oral health care 

17 and dental care during pregnancy from the Amer18 ican Academy of Pediatric Dentistry and the Amer19 ican College of Obstetricians and Gynecologists.’’. 

20 (ii) CHIP.—Section 2103(c)(6) of the 

21 Social Security Act (42 U.S.C. 

22 1397cc(c)(6)) is amended— 

23 (I) in subparagraph (A)— 

24 (aa) by inserting ‘‘or a tar25 geted low-income pregnant 


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1 woman’’ after ‘‘targeted low-in2 come child’’; and 

3 (bb) by inserting ‘‘, and, in 

4 the case of a targeted low-income 

5 child who is pregnant or a tar6 geted low-income pregnant 

7 woman, satisfy the coverage re8 quirements specified in section 

9 1905(nn)’’ after ‘‘emergency con10 ditions’’; and 

11 (II) in subparagraph (B), by in12 serting ‘‘(but only if, in the case of a 

13 targeted low-income child who is preg14 nant or a targeted low-income preg15 nant woman, the benchmark dental 

16 benefit package satisfies the coverage 

17 requirements specified in section 

18 1905(nn))’’ after ‘‘subparagraph (C)’’. 

19 (B) REQUIRING 12-MONTH CONTINUOUS

20 COVERAGE OF FULL BENEFITS FOR PREGNANT

21 AND POSTPARTUM INDIVIDUALS UNDER MED22 ICAID AND CHIP.— 

23 (i) MEDICAID.—Section 1902 of the 

24 Social Security Act (42 U.S.C. 1396a) is 

25 amended— 


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1 (I) in subsection (a)— 

2 (aa) in paragraph (86), by 

3 striking ‘‘and’’ at the end; 

4 (bb) in paragraph (87), by 

5 striking the period at the end 

6 and inserting ‘‘; and’’; and 

7 (cc) by inserting after para8 graph (87) the following new 

9 paragraph: 

10 ‘‘(88) provide that the State plan is in compli11 ance with subsection (e)(16).’’; and 

12 (II) in subsection (e)(16)— 

13 (aa) in subparagraph (A), 

14 by striking ‘‘At the option of the 

15 State, the State plan (or waiver 

16 of such State plan) may provide’’ 

17 and inserting ‘‘A State plan (or 

18 waiver of such State plan) shall 

19 provide’’; 

20 (bb) in subparagraph (B), in 

21 the matter preceding clause (i), 

22 by striking ‘‘by a State making 

23 an election under this para24 graph’’ and inserting ‘‘under a 


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1 State plan (or a waiver of such 

2 State plan)’’; and 

3 (cc) by striking subpara4 graph (C). 

5 (ii) CHIP.— 

6 (I) IN GENERAL.—Section 

7 2107(e)(1)(J) of the Social Security 

8 Act (42 U.S.C. 1397gg(e)(1)(J)), as 

9 inserted by section 9822 of the Amer10 ican Rescue Plan Act of 2021 (Public 

11 Law 117–2), is amended to read as 

12 follows: 

13 ‘‘(J) Paragraphs (5) and (16) of section 

14 1902(e) (relating to the requirement to provide 

15 medical assistance under the State plan or 

16 waiver consisting of full benefits during preg17 nancy and throughout the 12-month 

18 postpartum period under title XIX).’’. 

19 (II) CONFORMING.—Section 

20 2112(d)(2)(A) of the Social Security 

21 Act (42 U.S.C. 1397ll(d)(2)(A)) is 

22 amended by striking ‘‘the month in 

23 which the 60-day period’’ and all that 

24 follows through ‘‘pursuant to section 

25 2107(e)(1),’’. 


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1 (C) MAINTENANCE OF EFFORT.— 

2 (i) MEDICAID.—Section 1902(l) of the 

3 Social Security Act (42 U.S.C. 1396a(l)) is 

4 amended by adding at the end the fol5 lowing new paragraph: 

6 ‘‘(5) During the period that begins on the date of 

7 enactment of this paragraph and ends on the date that 

8 is 5 years after such date of enactment, as a condition 

9 for receiving any Federal payments under section 1903(a) 

10 for calendar quarters occurring during such period, a 

11 State shall not have in effect, with respect to women who 

12 are eligible for medical assistance under the State plan 

13 or under a waiver of such plan on the basis of being preg14 nant or having been pregnant, eligibility standards, meth15 odologies, or procedures under the State plan or waiver 

16 that are more restrictive than the eligibility standards, 

17 methodologies, or procedures, respectively, under such 

18 plan or waiver that are in effect on the date of enactment 

19 of this paragraph.’’. 

20 (ii) CHIP.—Section 2105(d) of the 

21 Social Security Act (42 U.S.C. 1397ee(d)) 

22 is amended by adding at the end the fol23 lowing new paragraph: 

24 ‘‘(4) IN ELIGIBILITY STANDARDS FOR TAR25 GETED LOW-INCOME PREGNANT WOMEN.—During 


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1 the period that begins on the date of enactment of 

2 this paragraph and ends on the date that is 5 years 

3 after such date of enactment, as a condition of re4 ceiving payments under subsection (a) and section 

5 1903(a), a State that elects to provide assistance to 

6 women on the basis of being pregnant (including 

7 pregnancy-related assistance provided to targeted 

8 low-income pregnant women (as defined in section 

9 2112(d)), pregnancy-related assistance provided to 

10 women who are eligible for such assistance through 

11 application of section 1902(v)(4)(A)(i) under section 

12 2107(e)(1), or any other assistance under the State 

13 child health plan (or a waiver of such plan) which 

14 is provided to women on the basis of being preg15 nant) shall not have in effect, with respect to such 

16 women, eligibility standards, methodologies, or pro17 cedures under such plan (or waiver) that are more 

18 restrictive than the eligibility standards, methodolo19 gies, or procedures, respectively, under such plan (or 

20 waiver) that are in effect on the date of enactment 

21 of this paragraph.’’. 

22 (D) INFORMATION ON BENEFITS.—The 

23 Secretary of Health and Human Services shall 

24 make publicly available on the internet website 

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1 ices, information regarding benefits available to 

2 pregnant and postpartum women and under the 

3 Medicaid program and the Children’s Health 

4 Insurance Program, including information on— 

5 (i) benefits that States are required to 

6 provide to pregnant and postpartum 

7 women under such programs; 

8 (ii) optional benefits that States may 

9 provide to pregnant and postpartum 

10 women under such programs; and 

11 (iii) the availability of different kinds 

12 of benefits for pregnant and postpartum 

13 women, including oral health and mental 

14 health benefits and breastfeeding services 

15 and supplies, under such programs. 

16 (E) FEDERAL FUNDING FOR COST OF EX17 TENDED MEDICAID AND CHIP COVERAGE FOR

18 POSTPARTUM WOMEN.— 

19 (i) MEDICAID.—Section 1905 of the 

20 Social Security Act (42 U.S.C. 1396d), as 

21 amended by title IV and subparagraph 

22 (A)(i)(II), is further amended— 

23 (I) in subsection (b), by striking 

24 ‘‘and (mm)’’ and inserting ‘‘(mm), 

25 and (oo)’’; and 


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1 (II) by adding at the end the fol2 lowing: 

3 ‘‘(oo) INCREASED FMAP FOR EXTENDED MEDICAL

4 ASSISTANCE FOR POSTPARTUM INDIVIDUALS.— 

5 ‘‘(1) IN GENERAL.—Notwithstanding subsection 

6 (b), the Federal medical assistance percentage for a 

7 State, with respect to amounts expended by such 

8 State for medical assistance for an individual who is 

9 eligible for such assistance on the basis of being 

10 pregnant or having been pregnant that is provided 

11 during the 305-day period that begins on the 60th 

12 day after the last day of the individual’s pregnancy 

13 (including any such assistance provided during the 

14 month in which such period ends), shall be equal 

15 to— 

16 ‘‘(A) during the first 20-quarter period for 

17 which this subsection is in effect with respect to 

18 a State, 100 percent; and 

19 ‘‘(B) with respect to a State, during each 

20 quarter thereafter, 90 percent. 

21 ‘‘(2) EXCLUSION FROM TERRITORIAL CAPS.— 

22 Any payment made to a territory for expenditures 

23 for medical assistance for an individual described in 

24 paragraph (1) that is subject to the Federal medical 

25 assistance percentage specified under paragraph (1) 


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1 shall not be taken into account for purposes of ap2 plying payment limits under subsections (f) and (g) 

3 of section 1108.’’. 

4 (ii) CHIP.—Section 2105(c) of the 

5 Social Security Act (42 U.S.C. 1397ee(c)) 

6 is amended by adding at the end the fol7 lowing new paragraph: 

8 ‘‘(13) ENHANCED PAYMENT FOR EXTENDED

9 ASSISTANCE PROVIDED TO PREGNANT WOMEN.— 

10 Notwithstanding subsection (b), the enhanced 

11 FMAP, with respect to payments under subsection 

12 (a) for expenditures under the State child health 

13 plan (or a waiver of such plan) for assistance pro14 vided under the plan (or waiver) to a woman who is 

15 eligible for such assistance on the basis of being 

16 pregnant (including pregnancy-related assistance 

17 provided to a targeted low-income pregnant woman 

18 (as defined in section 2112(d)), pregnancy-related 

19 assistance provided to a woman who is eligible for 

20 such assistance through application of section 

21 1902(v)(4)(A)(i) under section 2107(e)(1), or any 

22 other assistance under the plan (or waiver) provided 

23 to a woman who is eligible for such assistance on the 

24 basis of being pregnant) during the 305-day period 

25 that begins on the 60th day after the last day of her 


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1 pregnancy (including any such assistance provided 

2 during the month in which such period ends), shall 

3 be equal to— 

4 ‘‘(A) during the first 20-quarter period for 

5 which this subsection is in effect with respect to 

6 a State, 100 percent; and 

7 ‘‘(B) with respect to a State, during each 

8 quarter thereafter, 90 percent.’’. 

9 (F) GUIDANCE ON STATE OPTIONS FOR

10 MEDICAID COVERAGE OF DOULA SERVICES.— 

11 Not later than 1 year after the date of the en12 actment of this section, the Secretary of Health 

13 and Human Services shall issue guidance for 

14 the States concerning options for Medicaid cov15 erage and payment for support services pro16 vided by doulas. 

17 (G) ENHANCED FMAP FOR RURAL OBSTET18 RIC AND GYNECOLOGICAL SERVICES.—Section 

19 1905 of the Social Security Act (42 U.S.C. 

20 1396d), as amended by title IV and subpara21 graphs (A) and (E), is further amended— 

22 (i) in subsection (b), by striking ‘‘and 

23 (oo)’’ and inserting ‘‘(oo), and (pp)’’; and 

24 (ii) by adding at the end the following 

25 new subsection: 


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1 ‘‘(pp) INCREASED FMAP FOR MEDICAL ASSISTANCE

2 FOR OBSTETRIC AND GYNECOLOGICAL SERVICES FUR3 NISHED AT RURAL HOSPITALS.— 

4 ‘‘(1) IN GENERAL.—Notwithstanding subsection 

5 (b), the Federal medical assistance percentage for a 

6 State, with respect to amounts expended by such 

7 State for medical assistance for obstetric or gyneco8 logical services that are furnished in a hospital that 

9 is located in a rural area (as defined for purposes 

10 of section 1886) shall be equal to 90 percent for 

11 each calendar quarter beginning with the first cal12 endar quarter during which this subsection is in ef13 fect. 

14 ‘‘(2) EXCLUSION FROM TERRITORIAL CAPS.— 

15 Any payment made to a territory for expenditures 

16 for medical assistance described in paragraph (1) 

17 that is subject to the Federal medical assistance per18 centage specified under paragraph (1) shall not be 

19 taken into account for purposes of applying payment 

20 limits under subsections (f) and (g) of section 

21 1108.’’. 

22 (H) EFFECTIVE DATES.— 

23 (i) IN GENERAL.—Subject to clauses 

24 (ii) and (iii)— 


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1 (I) the amendments made by 

2 subparagraphs (A), (B), and (E) shall 

3 take effect on the first day of the first 

4 calendar quarter that begins on or 

5 after the date that is 1 year after the 

6 date of enactment of this section; 

7 (II) the amendments made by 

8 subparagraph (C) shall take effect on 

9 the date of enactment of this section; 

10 and 

11 (III) the amendments made by 

12 subparagraph (G) shall take effect on 

13 the first day of the first calendar 

14 quarter that begins on or after the 

15 date of enactment of this section. 

16 (ii) EXCEPTION FOR STATE LEGISLA17 TION.—In the case of a State plan under 

18 title XIX of the Social Security Act or a 

19 State child health plan under title XXI of 

20 such Act that the Secretary of Health and 

21 Human Services determines requires State 

22 legislation in order for the respective plan 

23 to meet any requirement imposed by 

24 amendments made by this paragraph, the 

25 respective plan shall not be regarded as 


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1 failing to comply with the requirements of 

2 such title solely on the basis of its failure 

3 to meet such an additional requirement be4 fore the first day of the first calendar 

5 quarter beginning after the close of the 

6 first regular session of the State legislature 

7 that begins after the date of enactment of 

8 this section. For purposes of the previous 

9 sentence, in the case of a State that has a 

10 2-year legislative session, each year of the 

11 session shall be considered to be a separate 

12 regular session of the State legislature. 

13 (iii) STATE OPTION FOR EARLIER EF14 FECTIVE DATE.—A State may elect to have 

15 subsection (e)(16) of section 1902 of the 

16 Social Security Act (42 U.S.C. 1396a) and 

17 subparagraph (J) of section 2107(e)(1) of 

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

19 1397gg(e)(1)), as amended by subpara20 graph (B), and subsection (oo) of section 

21 1905 of the Social Security Act (42 U.S.C. 

22 1396d) and paragraph (13) of section 

23 2105(c) of the Social Security Act (42 

24 U.S.C. 1397ee(c)), as added by subpara25 graph (E), take effect with respect to the 


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1 State on the first day of any fiscal quarter 

2 that begins before the date described in 

3 clause (i) and apply to amounts payable to 

4 the State for expenditures for medical as5 sistance, child health assistance, or preg6 nancy-related assistance to pregnant or 

7 postpartum individuals furnished on or 

8 after such day. 

9 (3) REGIONAL CENTERS OF EXCELLENCE.— 

10 Part P of title III of the Public Health Service Act 

11 (42 U.S.C. 280g et seq.) (as amended by section 

12 5101) is amended by adding at the end the fol13 lowing: 

14 ‘‘SEC. 399V–9. REGIONAL CENTERS OF EXCELLENCE AD15 DRESSING IMPLICIT BIAS AND CULTURAL 

16 COMPETENCY IN PATIENT-PROVIDER INTER17 ACTIONS EDUCATION. 

18 ‘‘(a) IN GENERAL.—Not later than one year after the 

19 date of enactment of this section, the Secretary, in con20 sultation with such other agency heads as the Secretary 

21 determines appropriate, shall award cooperative agree22 ments for the establishment or support of regional centers 

23 of excellence addressing implicit bias, cultural competency, 

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1 proving how health care professionals are educated in im2 plicit bias and delivering culturally competent health care. 

3 ‘‘(b) ELIGIBILITY.—To be eligible to receive a cooper4 ative agreement under subsection (a), an entity shall— 

5 ‘‘(1) be a public or other nonprofit entity speci6 fied by the Secretary that provides educational and 

7 training opportunities for students and health care 

8 professionals, which may be a health system, teach9 ing hospital, community health center, medical 

10 school, school of public health, school of nursing, 

11 dental school, social work school, school of profes12 sional psychology, or any other health professional 

13 school or program at an institution of higher edu14 cation (as defined in section 101 of the Higher Edu15 cation Act of 1965) focused on the prevention, treat16 ment, or recovery of health conditions that con17 tribute to maternal mortality and the prevention of 

18 maternal mortality and severe maternal morbidity; 

19 ‘‘(2) demonstrate community engagement and 

20 participation, such as through partnerships with 

21 home visiting and case management programs and 

22 community-based organizations serving minority 

23 populations; 

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1 sional training in implicit bias and delivering cul2 turally competent care, such as departments of pub3 lic health, perinatal quality collaboratives, hospital 

4 systems, and health care professional groups, in 

5 order to obtain input on resources needed for effec6 tive implementation strategies; and 

7 ‘‘(4) provide to the Secretary such information, 

8 at such time and in such manner, as the Secretary 

9 may require. 

10 ‘‘(c) DIVERSITY.—In awarding a cooperative agree11 ment under subsection (a), the Secretary shall take into 

12 account any regional differences among eligible entities 

13 and make an effort to ensure geographic diversity among 

14 award recipients. 

15 ‘‘(d) DISSEMINATION OF INFORMATION.— 

16 ‘‘(1) PUBLIC AVAILABILITY.—The Secretary 

17 shall make publicly available on the internet website 

18 of the Department of Health and Human Services 

19 information submitted to the Secretary under sub20 section (b)(4). 

21 ‘‘(2) EVALUATION.—The Secretary shall evalu22 ate each regional center of excellence established or 

23 supported pursuant to subsection (a) and dissemi24 nate the findings resulting from each such evalua25 tion to the appropriate public and private entities. 


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1 ‘‘(3) DISTRIBUTION.—The Secretary shall share 

2 evaluations and overall findings with State depart3 ments of health and other relevant State level offices 

4 to inform State and local best practices. 

5 ‘‘(e) MATERNAL MORTALITY DEFINED.—In this sec6 tion, the term ‘maternal mortality’ means death of a 

7 woman that occurs during pregnancy or within the one8 year period following the end of such pregnancy. 

9 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—For 

10 purposes of carrying out this section, there is authorized 

11 to be appropriated $5,000,000 for each of fiscal years 

12 2025 through 2029.’’. 

13 (4) SPECIAL SUPPLEMENTAL NUTRITION PRO14 GRAM FOR WOMEN, INFANTS, AND CHILDREN.—Sec15 tion 17(d)(3)(A)(ii) of the Child Nutrition Act of 

16 1966 (42 U.S.C. 1786(d)(3)(A)(ii)) is amended— 

17 (A) by striking the clause designation and 

18 heading and all that follows through ‘‘A State’’ 

19 and inserting the following: 

20 ‘‘(ii) WOMEN.— 

21 ‘‘(I) BREASTFEEDING WOMEN.— 

22 A State’’; 

23 (B) in subclause (I) (as so designated), by 

24 striking ‘‘1 year’’ and all that follows through 


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1 ‘‘earlier’’ and inserting ‘‘2 years postpartum’’; 

2 and 

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

4 ‘‘(II) POSTPARTUM WOMEN.—A 

5 State may elect to certify a 

6 postpartum woman for a period of 2 

7 years.’’. 

8 (c) FULL SPECTRUM DOULA WORKFORCE.— 

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

10 Human Services shall establish and implement a 

11 program to award grants or contracts to health pro12 fessions schools, schools of public health, academic 

13 health centers, State or local governments, terri14 tories, Indian Tribes and Tribal organizations, 

15 Urban Indian organizations, Native Hawaiian orga16 nizations, or other appropriate public or private non17 profit entities or community-based organizations (or 

18 consortia of any such entities, including entities pro19 moting multidisciplinary approaches), to establish or 

20 expand programs to grow and diversify the doula 

21 workforce, including through improving the capacity 

22 and supply of health care providers. 

23 (2) USE OF FUNDS.—Amounts made available 

24 by paragraph (1) shall be used for the following ac25 tivities: 


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1 (A) Establishing programs that provide 

2 education and training to individuals seeking 

3 appropriate training or certification as full 

4 spectrum doulas. 

5 (B) Expanding the capacity of existing 

6 programs described in subparagraph (A), for 

7 the purpose of increasing the number of stu8 dents enrolled in such programs, including by 

9 awarding scholarships for students who agree to 

10 work in underserved communities after receiv11 ing such education and training. 

12 (C) Developing and implementing strate13 gies to recruit and retain students from under14 served communities, particularly from demo15 graphic groups experiencing high rates of ma16 ternal mortality and severe maternal morbidity, 

17 including racial and ethnic minority groups, 

18 into programs described in subparagraphs (A) 

19 and (B). 

20 (3) FUNDING.—In addition to amounts other21 wise available, there is appropriated to the Secretary 

22 of Health and Human Services for fiscal year 2025, 

23 out of any money in the Treasury not otherwise ap24 propriated, $50,000,000, to remain available until 

25 expended, for carrying out this subsection. 


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1 (d) GRANTS FOR RURAL OBSTETRIC MOBILE

2 HEALTH UNITS.—Part B of title III of the Public Health 

3 Service Act (42 U.S.C. 243 et seq.) is amended by adding 

4 at the end the following: 

5 ‘‘SEC. 320C. GRANTS FOR RURAL OBSTETRIC MOBILE 

6 HEALTH UNITS. 

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

8 the Administrator of the Health Resources and Services 

9 Administration (referred to in this section as the ‘Sec10 retary’), shall establish a pilot program under which the 

11 Secretary shall make grants to States— 

12 ‘‘(1) to purchase and equip rural mobile health 

13 units for the purpose of providing pre-conception, 

14 pregnancy, postpartum, and obstetric emergency 

15 services in rural and underserved communities; 

16 ‘‘(2) to train providers including obstetrician17 gynecologists, certified nurse-midwives, nurse practi18 tioners, nurses, and midwives to operate and provide 

19 obstetric services, including training and planning 

20 for obstetric emergencies, in such mobile health 

21 units; and 

22 ‘‘(3) to address access issues, including social 

23 determinants of health and wrap-around clinical and 

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1 tation services, and transportation support and re2 ferrals. 

3 ‘‘(b) NO SHARING OF DATA WITH LAW ENFORCE4 MENT.—As a condition of receiving a grant under this sec5 tion, a State shall submit to the Secretary an assurance 

6 that the State will not make available to Federal or State 

7 law enforcement any personally identifiable information 

8 regarding any pregnant or postpartum individual collected 

9 pursuant to such grant. 

10 ‘‘(c) GRANT DURATION.—The period of a grant 

11 under this section shall not exceed 5 years. 

12 ‘‘(d) IMPLEMENTING AND REPORTING.— 

13 ‘‘(1) IN GENERAL.—States that receive pilot 

14 grants under this section shall— 

15 ‘‘(A) implement the program funded by the 

16 pilot grants; and 

17 ‘‘(B) not later than 3 years after the date 

18 of enactment of this section, and not later than 

19 6 years after such date of enactment, submit to 

20 the Secretary a report that describes the results 

21 of such program, including— 

22 ‘‘(i) relevant information and relevant 

23 quantitative indicators of the programs’ 

24 success in improving the standard of care 

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1 uals in rural and underserved communities 

2 seen for pre-conception, pregnancy, or 

3 postpartum visits in the rural mobile 

4 health units, stratified by the categories of 

5 data specified in paragraph (2); 

6 ‘‘(ii) relevant qualitative evaluations 

7 from individuals receiving pre-conception, 

8 pregnant, or postpartum care from rural 

9 mobile health units, including measures of 

10 patient-reported experience of care and 

11 measures of patient-reported issues with 

12 access to care without the rural mobile 

13 health unit pilot; and 

14 ‘‘(iii) strategies to sustain such pro15 grams beyond the duration of the grant 

16 and expand such programs to other rural 

17 and underserved communities. 

18 ‘‘(2) CATEGORIES OF DATA.—The categories of 

19 data specified in this paragraph are the following: 

20 ‘‘(A) Race, ethnicity, sex, gender, gender 

21 identity, primary language, age, geography, in22 surance status, disability status. 

23 ‘‘(B) Number of visits provided for pre24 conception, prenatal, or postpartum care. 


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1 ‘‘(C) Number of repeat visits provided for 

2 preconception, prenatal, or postpartum care. 

3 ‘‘(D) Number of screenings or tests pro4 vided for smoking, substance use, hypertension, 

5 sexually-transmitted diseases, diabetes, HIV, 

6 depression, intimate partner violence, pap 

7 smears, and pregnancy. 

8 ‘‘(3) DATA PRIVACY PROTECTION.—The reports 

9 referred to in paragraph (1)(B) shall not contain 

10 any personally identifiable information regarding 

11 any pregnant or postpartum individual. 

12 ‘‘(e) EVALUATION.—The Secretary shall conduct an 

13 evaluation of the pilot program under this section to deter14 mine the impact of the pilot program with respect to— 

15 ‘‘(1) the effectiveness of the grants awarded 

16 under this section to improve maternal health out17 comes in rural and underserved communities, with 

18 data stratified by race, ethnicity, primary language, 

19 socioeconomic status, geography, insurance type, and 

20 other factors as the Secretary determines appro21 priate; 

22 ‘‘(2) spending on maternity care by States par23 ticipating in the pilot program; 

24 ‘‘(3) to the extent practicable, qualitative and 

25 quantitative measures of patient experience; and 


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1 ‘‘(4) any other areas of assessment that the 

2 Secretary determines relevant. 

3 ‘‘(f) REPORT.—Not later than one year after the 

4 completion of the pilot program under this section, the 

5 Secretary shall submit to Congress, and make publicly 

6 available, a report that describes— 

7 ‘‘(1) the results of the evaluation conducted 

8 under subsection (e); and 

9 ‘‘(2) a recommendation regarding whether the 

10 pilot program should be continued after fiscal year 

11 2029 and expanded on a national basis. 

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

13 is authorized to be appropriated to the Secretary to carry 

14 out this section $10,000,000 for each of fiscal years 2025 

15 through 2029.’’. 

16 (e) REQUIRING NOTIFICATION OF IMPENDING HOS17 PITAL OBSTETRIC UNIT CLOSURE.—Section 1866(a)(1) 

18 of the Social Security Act (42 U.S.C. 1395cc(a)(1)) is 

19 amended— 

20 (1) in subparagraph (X), by striking ‘‘and’’ at 

21 the end; 

22 (2) in subparagraph (Y)(ii)(V), by striking the 

23 period and inserting ‘‘, and’’; and 

24 (3) by inserting after subparagraph (Y) the fol25 lowing new subparagraph: 


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1 ‘‘(Z) beginning 180 days after the date of the 

2 enactment of this subparagraph, in the case of a 

3 hospital, not less than 90 days prior to the closure 

4 of any obstetric unit of the hospital, to submit to the 

5 Secretary a notification which shall include— 

6 ‘‘(i) a report analyzing the impact the clo7 sure will have on the community; 

8 ‘‘(ii) steps the hospital will take to identify 

9 other health care providers that can alleviate 

10 any service gaps as a result of the closure; and 

11 ‘‘(iii) any additional information as may be 

12 required by the Secretary.’’. 

13 (f) EVALUATION AND REPORT ON MATERNAL

14 HEALTH NEEDS.— 

15 (1) IN GENERAL.—Not later than 2 years after 

16 the date of enactment of this Act, the Secretary of 

17 Health and Human Services shall conduct, and sub18 mit to Congress a report that describes the results 

19 of, an evaluation of— 

20 (A) where the maternal health needs are 

21 greatest in the United States; and 

22 (B) the Federal expenditures made to ad23 dress such needs. 


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1 (2) PERIOD COVERED.—The evaluation under 

2 paragraph (1) shall cover the period of calendar 

3 years 2000 through 2023. 

4 (3) ANALYSIS.—The evaluation under para5 graph (1) shall include analysis of the following: 

6 (A) How Federal funds provided to States 

7 for maternal health were distributed across re8 gions, States, and localities or counties. 

9 (B) Barriers to applying for and receiving 

10 Federal funds for maternal health, including, 

11 with respect to initial applications— 

12 (i) requirements for submission in 

13 partnership with other entities; and 

14 (ii) stringent network requirements. 

15 (C) Why applicants did not receive fund16 ing, including limited availability of funds, the 

17 strength of the respective applications, and fail18 ure to adhere to requirements. 

19 (4) DISAGGREGATION OF DATA.—The report 

20 under paragraph (1) shall disaggregate data on 

21 mothers served by race, ethnicity, insurance status, 

22 and language spoken. 

23 (g) INCREASING EXCISE TAXES ON CIGARETTES AND

24 ESTABLISHING EXCISE TAX EQUITY AMONG ALL TO25 BACCO PRODUCT TAX RATES.— 


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1 (1) TAX PARITY FOR ROLL-YOUR-OWN TO2 BACCO.—Section 5701(g) of the Internal Revenue 

3 Code of 1986 is amended by striking ‘‘$24.78’’ and 

4 inserting ‘‘$49.56’’. 

5 (2) TAX PARITY FOR PIPE TOBACCO.—Section 

6 5701(f) of the Internal Revenue Code of 1986 is 

7 amended by striking ‘‘$2.8311 cents’’ and inserting 

8 ‘‘$49.56’’. 

9 (3) TAX PARITY FOR SMOKELESS TOBACCO.— 

10 (A) Section 5701(e) of the Internal Rev11 enue Code of 1986 is amended— 

12 (i) in paragraph (1), by striking 

13 ‘‘$1.51’’ and inserting ‘‘$26.84’’; 

14 (ii) in paragraph (2), by striking 

15 ‘‘50.33 cents’’ and inserting ‘‘$10.74’’; and 

16 (iii) by adding at the end the fol17 lowing: 

18 ‘‘(3) SMOKELESS TOBACCO SOLD IN DISCRETE

19 SINGLE-USE UNITS.—On discrete single-use units, 

20 $100.66 per thousand.’’. 

21 (B) Section 5702(m) of such Code is 

22 amended— 

23 (i) in paragraph (1), by striking ‘‘or 

24 chewing tobacco’’ and inserting ‘‘, chewing 

25 tobacco, or discrete single-use unit’’; 


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1 (ii) in paragraphs (2) and (3), by in2 serting ‘‘that is not a discrete single-use 

3 unit’’ before the period in each such para4 graph; and 

5 (iii) by adding at the end the fol6 lowing: 

7 ‘‘(4) DISCRETE SINGLE-USE UNIT.—The term 

8 ‘discrete single-use unit’ means any product con9 taining, made from, or derived from tobacco or nico10 tine that— 

11 ‘‘(A) is not intended to be smoked; and 

12 ‘‘(B) is in the form of a lozenge, tablet, 

13 pill, pouch, dissolvable strip, or other discrete 

14 single-use or single-dose unit.’’. 

15 (4) TAX PARITY FOR SMALL CIGARS.—Para16 graph (1) of section 5701(a) of the Internal Revenue 

17 Code of 1986 is amended by striking ‘‘$50.33’’ and 

18 inserting ‘‘$100.66’’. 

19 (5) TAX PARITY FOR LARGE CIGARS.— 

20 (A) IN GENERAL.—Paragraph (2) of sec21 tion 5701(a) of the Internal Revenue Code of 

22 1986 is amended by striking ‘‘52.75 percent’’ 

23 and all that follows through the period and in24 serting the following: ‘‘$49.56 per pound and a 

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1 tional parts of a pound but not less than 

2 10.066 cents per cigar.’’. 

3 (B) GUIDANCE.—The Secretary of the 

4 Treasury, or the Secretary’s delegate, may issue 

5 guidance regarding the appropriate method for 

6 determining the weight of large cigars for pur7 poses of calculating the applicable tax under 

8 section 5701(a)(2) of the Internal Revenue 

9 Code of 1986. 

10 (C) CONFORMING AMENDMENT.—Section 

11 5702 of such Code is amended by striking sub12 section (l). 

13 (6) TAX PARITY FOR ROLL-YOUR-OWN TOBACCO

14 AND CERTAIN PROCESSED TOBACCO.—Subsection (o) 

15 of section 5702 of the Internal Revenue Code of 

16 1986 is amended by inserting ‘‘, and includes proc17 essed tobacco that is removed for delivery or deliv18 ered to a person other than a person with a permit 

19 provided under section 5713, but does not include 

20 removals of processed tobacco for exportation’’ after 

21 ‘‘wrappers thereof’’. 

22 (7) CLARIFYING TAX RATE FOR OTHER TO23 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 graph (7), 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 2024, 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 2023’ 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 subparagraph (A) an amount equal 

11 to the lesser of $1,000 or the amount of such 

12 taxes. For purposes of the preceding sentence, 

13 all persons treated as a single employer under 

14 subsection (b), (c), (m), or (o) of section 414 of 

15 the Internal Revenue Code of 1986 shall be 

16 treated as 1 person for purposes of this sub17 paragraph. 

18 (C) LIABILITY FOR TAX AND METHOD OF

19 PAYMENT.— 

20 (i) LIABILITY FOR TAX.—A person 

21 holding tobacco products on any tax in22 crease date to which any tax imposed by 

23 subparagraph (A) applies shall be liable for 

24 such tax. 


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1 (ii) METHOD OF PAYMENT.—The tax 

2 imposed by subparagraph (A) shall be paid 

3 in such manner as the Secretary shall pre4 scribe by regulations. 

5 (iii) TIME FOR PAYMENT.—The tax 

6 imposed by subparagraph (A) shall be paid 

7 on or before the date that is 120 days 

8 after the effective date of the tax rate in9 crease. 

10 (D) ARTICLES IN FOREIGN TRADE

11 ZONES.—Notwithstanding the Act of June 18, 

12 1934 (commonly known as the Foreign Trade 

13 Zone Act, 48 Stat. 998, 19 U.S.C. 81a et seq.), 

14 or any other provision of law, any article which 

15 is located in a foreign trade zone on any tax in16 crease date shall be subject to the tax imposed 

17 by subparagraph (A) if— 

18 (i) internal revenue taxes have been 

19 determined, or customs duties liquidated, 

20 with respect to such article before such 

21 date pursuant to a request made under the 

22 first proviso of section 3(a) of such Act, or 

23 (ii) such article is held on such date 

24 under the supervision of an officer of the 

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1 tion of the Department of Homeland Secu2 rity pursuant to the second proviso of such 

3 section 3(a). 

4 (E) DEFINITIONS.—For purposes of this 

5 paragraph— 

6 (i) IN GENERAL.—Any term used in 

7 this paragraph which is also used in sec8 tion 5702 of such Code shall have the 

9 same meaning as such term has in such 

10 section. 

11 (ii) TAX INCREASE DATE.—The term 

12 ‘‘tax increase date’’ means the effective 

13 date of any increase in any tobacco prod14 uct excise tax rate pursuant to the amend15 ments made by this subsection (other than 

16 paragraph (10) thereof). 

17 (iii) SECRETARY.—The term ‘‘Sec18 retary’’ means the Secretary of the Treas19 ury or the Secretary’s delegate. 

20 (F) CONTROLLED GROUPS.—Rules similar 

21 to the rules of section 5061(e)(3) of such Code 

22 shall apply for purposes of this paragraph. 

23 (G) OTHER LAWS APPLICABLE.—All provi24 sions of law, including penalties, applicable with 

25 respect to the taxes imposed by section 5701 of 


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1 such Code shall, insofar as applicable and not 

2 inconsistent with the provisions of this para3 graph, apply to the floor stocks taxes imposed 

4 by subparagraph (A), to the same extent as if 

5 such taxes were imposed by such section 5701. 

6 The Secretary may treat any person who bore 

7 the ultimate burden of the tax imposed by sub8 paragraph (A) as the person to whom a credit 

9 or refund under such provisions may be allowed 

10 or made. 

11 (12) EFFECTIVE DATES.— 

12 (A) IN GENERAL.—Except as provided in 

13 subparagraphs (B) and (C), the amendments 

14 made by this subsection shall apply to articles 

15 removed (as defined in section 5702(j) of the 

16 Internal Revenue Code of 1986) after the last 

17 day of the month which includes the date of the 

18 enactment of this Act. 

19 (B) DISCRETE SINGLE-USE UNITS, LARGE

20 CIGARS, AND PROCESSED TOBACCO.—The 

21 amendments made by paragraphs (3)(A)(iii), 

22 (3)(B), (5), and (6) shall apply to articles re23 moved (as defined in section 5702(j) of the In24 ternal Revenue Code of 1986) after the date 


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1 that is 6 months after the date of the enact2 ment of this Act. 

3 (C) OTHER TOBACCO PRODUCTS.—The 

4 amendments made by paragraph (7)(A) shall 

5 apply to products removed after the last day of 

6 the month which includes the date that the Sec7 retary of the Treasury (or the Secretary of the 

8 Treasury’s delegate) issues final regulations es9 tablishing the level of tax for such product. 

10 SEC. 5202. MOMMIES. 

11 (a) GAO STUDY AND REPORT.— 

12 (1) IN GENERAL.—Not later than 1 year after 

13 the date of the enactment of this Act, the Comp14 troller General of the United States shall submit to 

15 Congress a report on the gaps in coverage with re16 spect to— 

17 (A) pregnant individuals enrolled under a 

18 State plan (or waiver of such plan) under title 

19 XIX of the Social Security Act (42 U.S.C. 1396 

20 et seq.) and the Children’s Health Insurance 

21 Program under title XXI of the Social Security 

22 Act (42 U.S.C. 1397aa et seq.); and 

23 (B) postpartum individuals enrolled under 

24 a State plan (or waiver of such plan) under title 

25 XIX of the Social Security Act (42 U.S.C. 1396 


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1 et seq.) and the Children’s Health Insurance 

2 Program under title XXI of the Social Security 

3 Act (42 U.S.C. 1397aa et seq.) who received as4 sistance under either such program during their 

5 pregnancy. 

6 (2) CONTENT OF REPORT.—The report re7 quired under this paragraph shall include the fol8 lowing: 

9 (A) Information about the abilities and 

10 successes of State Medicaid agencies in deter11 mining whether pregnant and postpartum indi12 viduals are eligible under another insurance af13 fordability program, and in transitioning any 

14 such individuals who are so eligible to coverage 

15 under such a program at the end of their period 

16 of eligibility for medical assistance, pursuant to 

17 section 435.1200 of the title 42, Code of Fed18 eral Regulations (as in effect on September 1, 

19 2018). 

20 (B) Information on factors contributing to 

21 gaps in coverage that disproportionately impact 

22 underserved populations, including low-income 

23 individuals, Black, Indigenous, and other indi24 viduals of color, individuals who reside in a 

25 health professional shortage area (as defined in 


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1 section 332(a)(1)(A) of the Public Health Serv2 ice Act (42 U.S.C. 254e(a)(1)(A))) or individ3 uals who are members of a medically under4 served population (as defined by section 

5 330(b)(3) of such Act (42 U.S.C. 

6 254b(b)(3)(A))). 

7 (C) Recommendations for addressing and 

8 reducing such gaps in coverage. 

9 (D) Such other information as the Comp10 troller General deems necessary. 

11 (3) DATA DISAGGREGATION.—To the greatest 

12 extent possible, the Comptroller General shall 

13 disaggregate data presented in the report, including 

14 by age, gender identity, race, ethnicity, income level, 

15 and other demographic factors. 

16 (b) MATERNITY CARE HOME DEMONSTRATION

17 PROJECT.—Title XIX of the Social Security Act (42 

18 U.S.C. 1396 et seq.) is amended by inserting the following 

19 new section after section 1947: 

20 ‘‘SEC. 1948. MATERNITY CARE HOME DEMONSTRATION 

21 PROJECT. 

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

23 date of the enactment of this section, the Secretary shall 

24 establish a demonstration project (in this section referred 

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1 retary shall provide grants to States to enter into arrange2 ments with eligible entities to implement or expand a ma3 ternity care home model for eligible individuals. 

4 ‘‘(b) GOALS OF DEMONSTRATION PROJECT.—The 

5 goals of the demonstration project are the following: 

6 ‘‘(1) To improve— 

7 ‘‘(A) maternity and infant care outcomes; 

8 ‘‘(B) birth equity; 

9 ‘‘(C) health equity for— 

10 ‘‘(i) Black, Indigenous, and other peo11 ple of color; 

12 ‘‘(ii) lesbian, gay, bisexual, 

13 transgender, queer, non-binary, and gender 

14 nonconfirming individuals; 

15 ‘‘(iii) people with disabilities; and 

16 ‘‘(iv) other underserved populations; 

17 ‘‘(D) communication by maternity, infant 

18 care, and social services providers; 

19 ‘‘(E) integration of perinatal support serv20 ices, including community health workers, 

21 doulas, social workers, public health nurses, 

22 peer lactation counselors, lactation consultants, 

23 childbirth educators, peer mental health work24 ers, and others, into health care entities and or25 ganizations; 


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1 ‘‘(F) care coordination between maternity, 

2 infant care, oral health services, and social serv3 ices providers within the community; 

4 ‘‘(G) the quality and safety of maternity 

5 and infant care; 

6 ‘‘(H) the experience of individuals receiv7 ing maternity care, including by increasing the 

8 ability of an individual to develop and follow 

9 their own birthing plans; and 

10 ‘‘(I) access to adequate prenatal and 

11 postpartum care, including— 

12 ‘‘(i) prenatal care that is initiated in 

13 a timely manner; 

14 ‘‘(ii) not fewer than 5 post-pregnancy 

15 visits to a maternity care provider; and 

16 ‘‘(iii) interpregnancy care. 

17 ‘‘(2) To provide coordinated, evidence-based, re18 spectful, culturally and linguistically appropriate, 

19 and person-centered maternity care management. 

20 ‘‘(3) To decrease— 

21 ‘‘(A) severe and preventable maternal mor22 bidity and maternal mortality; 

23 ‘‘(B) overall health care spending; 

24 ‘‘(C) unnecessary emergency department 

25 visits; 


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1 ‘‘(D) inequities in maternal and infant care 

2 outcomes, including racial, economic, disability, 

3 gender-based, and geographical inequities; 

4 ‘‘(E) racial, gender, economic, and other 

5 discrimination among health care professionals; 

6 ‘‘(F) racism, discrimination, disrespect, 

7 and abuse in maternity care settings; 

8 ‘‘(G) the rate of cesarean deliveries for 

9 low-risk pregnancies; 

10 ‘‘(H) the rate of pre-term births and in11 fants born with low birth weight; and 

12 ‘‘(I) the rate of avoidable maternal and 

13 newborn hospitalizations and admissions to in14 tensive care units. 

15 ‘‘(c) CONSULTATION.—In designing and imple16 menting the demonstration project the Secretary shall 

17 consult with stakeholders, including— 

18 ‘‘(1) States; 

19 ‘‘(2) organizations representing relevant health 

20 care professionals, including oral health services pro21 fessionals; 

22 ‘‘(3) organizations, particularly reproductive 

23 justice and birth justice organizations led by people 

24 of color, that represent consumers of maternal 

25 health care, including consumers of maternal health 


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1 care who are disproportionately impacted by poor 

2 maternal health outcomes; 

3 ‘‘(4) representatives with experience imple4 menting other maternity care home models, includ5 ing representatives from the Center for Medicare 

6 and Medicaid Innovation; 

7 ‘‘(5) community-based health care professionals, 

8 including doulas, lactation consultants, and other 

9 stakeholders; 

10 ‘‘(6) experts in promoting health equity and 

11 combating racial bias in health care settings; and 

12 ‘‘(7) Black, Indigenous, and other maternal 

13 health care consumers of color who have experienced 

14 severe maternal morbidity. 

15 ‘‘(d) APPLICATION AND SELECTION OF STATES.— 

16 ‘‘(1) IN GENERAL.—A State seeking to partici17 pate in the demonstration project shall submit an 

18 application to the Secretary at such time and in 

19 such manner as the Secretary shall require. 

20 ‘‘(2) SELECTION OF STATES.— 

21 ‘‘(A) IN GENERAL.—The Secretary shall 

22 select at least 10 States to participate in the 

23 demonstration project. 


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1 ‘‘(B) SELECTION REQUIREMENTS.—In se2 lecting States to participate in the demonstra3 tion project, the Secretary shall— 

4 ‘‘(i) ensure that there is geographic 

5 and regional diversity in the areas in which 

6 activities will be carried out under the 

7 project; 

8 ‘‘(ii) ensure that States with signifi9 cant inequities in maternal and infant 

10 health outcomes, including severe maternal 

11 morbidity, and other inequities based on 

12 race, income, or access to maternity care, 

13 are included; and 

14 ‘‘(iii) ensure that at least 1 territory 

15 is included. 

16 ‘‘(e) GRANTS.— 

17 ‘‘(1) IN GENERAL.—From amounts appro18 priated under subsection (l), the Secretary shall 

19 award 1 grant for each year of the demonstration 

20 project to each State that is selected to participate 

21 in the demonstration project. 

22 ‘‘(2) USE OF GRANT FUNDS.—A State may use 

23 funds received under this section to— 


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1 ‘‘(A) award grants or make payments to 

2 eligible entities as part of an arrangement de3 scribed in subsection (f)(2); 

4 ‘‘(B) provide financial incentives to health 

5 care professionals, including community-based 

6 health care workers and community-based 

7 doulas, who participate in the State’s maternity 

8 care home model; 

9 ‘‘(C) provide adequate training for health 

10 care professionals, including community-based 

11 health care workers, doulas, and care coordina12 tors, who participate in the State’s maternity 

13 care home model, which may include training 

14 for cultural humility and antiracism, racial bias, 

15 health equity, reproductive and birth justice, 

16 trauma-informed care, home visiting skills, and 

17 respectful communication and listening skills, 

18 particularly in regards to maternal health; 

19 ‘‘(D) pay for personnel and administrative 

20 expenses associated with designing, imple21 menting, and operating the State’s maternity 

22 care home model; 

23 ‘‘(E) pay for items and services that are 

24 furnished under the State’s maternity care 


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1 home model and for which payment is otherwise 

2 unavailable under this title; 

3 ‘‘(F) pay for services and materials to en4 sure culturally and linguistically appropriate 

5 communication, including— 

6 ‘‘(i) language services such as inter7 preters and translation of written mate8 rials; and 

9 ‘‘(ii) development of culturally and lin10 guistically appropriate materials; and aux11 iliary aids and services; and 

12 ‘‘(G) pay for other costs related to the 

13 State’s maternity care home model, as deter14 mined by the Secretary. 

15 ‘‘(3) GRANT FOR NATIONAL INDEPENDENT

16 EVALUATOR.— 

17 ‘‘(A) IN GENERAL.—From the amounts 

18 appropriated under subsection (l), prior to 

19 awarding any grants under paragraph (1), the 

20 Secretary shall enter into a contract with a na21 tional external entity to create a single, uniform 

22 process to— 

23 ‘‘(i) ensure that States that receive 

24 grants under paragraph (1) comply with 

25 the requirements of this section; and 


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1 ‘‘(ii) evaluate the outcomes of the 

2 demonstration project in each participating 

3 State. 

4 ‘‘(B) ANNUAL REPORT.—The contract de5 scribed in subparagraph (A) shall require the 

6 national external entity to submit to the Sec7 retary— 

8 ‘‘(i) a yearly evaluation report for 

9 each year of the demonstration project; 

10 and 

11 ‘‘(ii) a final impact report after the 

12 demonstration project has concluded. 

13 ‘‘(C) SECRETARY’S AUTHORITY.—Nothing 

14 in this paragraph shall prevent the Secretary 

15 from making a determination that a State is 

16 not in compliance with the requirements of this 

17 section without the national external entity 

18 making such a determination. 

19 ‘‘(f) PARTNERSHIP WITH ELIGIBLE ENTITIES.— 

20 ‘‘(1) IN GENERAL.—As a condition of receiving 

21 a grant under this section, a State shall enter into 

22 an arrangement with one or more eligible entities 

23 that meets the requirements of paragraph (2). 

24 ‘‘(2) ARRANGEMENTS WITH ELIGIBLE ENTI25 TIES.—Under an arrangement between a State and 


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1 an eligible entity under this subsection, the eligible 

2 entity shall perform the following functions, with re3 spect to eligible individuals enrolled with the entity 

4 under the State’s maternity care home model— 

5 ‘‘(A) provide culturally and linguistically 

6 appropriate congruent care, which may include 

7 prenatal care, family planning services, medical 

8 care, mental and behavioral care, postpartum 

9 care, and oral health services to such eligible in10 dividuals through a team of health care profes11 sionals, which may include obstetrician-gyne12 cologists, maternal-fetal medicine specialists, 

13 family physicians, primary care providers, oral 

14 health providers, physician assistants, advanced 

15 practice registered nurses such as nurse practi16 tioners and certified nurse midwives, certified 

17 midwives, certified professional midwives, phys18 ical therapists, social workers, traditional and 

19 community-based doulas, lactation consultants, 

20 childbirth educators, community health workers, 

21 peer mental health supporters, and other health 

22 care professionals; 

23 ‘‘(B) conduct a risk assessment of each 

24 such eligible individual to determine if their 

25 pregnancy is high or low risk, and establish a 


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1 tailored pregnancy care plan, which takes into 

2 consideration the individual’s own preferences 

3 and pregnancy care and birthing plans and de4 termines the appropriate support services to re5 duce the individual’s medical, social, and envi6 ronmental risk factors, for each such eligible in7 dividual based on the results of such risk as8 sessment; 

9 ‘‘(C) assign each such eligible individual to 

10 a culturally and linguistically appropriate care 

11 coordinator, which may be a nurse, social work12 er, traditional or community-based doula, com13 munity health worker, midwife, or other health 

14 care provider, who is responsible for ensuring 

15 that such eligible individual receives the nec16 essary medical care and connections to essential 

17 support services; 

18 ‘‘(D) provide, or arrange for the provision 

19 of, essential support services, such as services 

20 that address— 

21 ‘‘(i) food access, nutrition, and exer22 cise; 

23 ‘‘(ii) smoking cessation; 

24 ‘‘(iii) substance use disorder and ad25 diction treatment; 


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1 ‘‘(iv) anxiety, depression, trauma, and 

2 other mental and behavioral health issues; 

3 ‘‘(v) breastfeeding, chestfeeding, or 

4 other infant feeding options supports, initi5 ation, continuation, and duration; 

6 ‘‘(vi) stable, affordable, safe, and 

7 healthy housing; 

8 ‘‘(vii) transportation; 

9 ‘‘(viii) intimate partner violence; 

10 ‘‘(ix) community and police violence; 

11 ‘‘(x) home visiting services; 

12 ‘‘(xi) childbirth and newborn care edu13 cation; 

14 ‘‘(xii) oral health education; 

15 ‘‘(xiii) continuous labor support; 

16 ‘‘(xiv) group prenatal care; 

17 ‘‘(xv) family planning and contracep18 tive care and supplies; and 

19 ‘‘(xvi) affordable child care; 

20 ‘‘(E) as appropriate, facilitate connections 

21 to a usual primary care provider, which may be 

22 a reproductive health care provider; 

23 ‘‘(F) refer to guidelines and opinions of 

24 medical associations when determining whether 


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1 an elective delivery should be performed on an 

2 eligible individual before 39 weeks of gestation; 

3 ‘‘(G) provide such eligible individual with 

4 evidence-based and culturally and linguistically 

5 appropriate education and resources to identify 

6 potential warning signs of pregnancy and 

7 postpartum complications and when and how to 

8 obtain medical attention; 

9 ‘‘(H) provide, or arrange for the provision 

10 of, culturally and linguistically appropriate 

11 pregnancy and postpartum health services, in12 cluding family planning counseling and services, 

13 to eligible individuals; 

14 ‘‘(I) track and report postpartum health 

15 and birth outcomes of such eligible individuals 

16 and their children; 

17 ‘‘(J) ensure that care is person-centered, 

18 culturally and linguistically appropriate, and 

19 patient-led, including by engaging eligible indi20 viduals in their own care, including through 

21 communication and education; and 

22 ‘‘(K) ensure adequate training for appro23 priately serving the population of individuals el24 igible for medical assistance under the State 

25 plan (or waiver of such plan), including through 


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1 reproductive justice, birth justice, birth equity, 

2 and anti-racist frameworks, home visiting skills, 

3 and knowledge of social services. 

4 ‘‘(g) TERM OF DEMONSTRATION PROJECT.—The 

5 Secretary shall conduct the demonstration project for a 

6 period of 5 years. 

7 ‘‘(h) REPORT.—Not later than 18 months after the 

8 date of the enactment of this section and annually there9 after for each year of the demonstration project term, the 

10 Secretary shall submit a report to Congress on the results 

11 of the demonstration project, including— 

12 ‘‘(1) the results of the final report of the na13 tional external entity required under subsection 

14 (e)(3)(B)(ii); and 

15 ‘‘(2) recommendations on whether the model 

16 studied in the demonstration project should be con17 tinued or more widely adopted, including by private 

18 health plans. 

19 ‘‘(i) WAIVER AUTHORITY.—To the extent that the 

20 Secretary determines necessary in order to carry out the 

21 demonstration project, the Secretary may waive section 

22 1902(a)(1) (relating to statewideness) and section 

23 1902(a)(10)(B) (relating to comparability). 

24 ‘‘(j) TECHNICAL ASSISTANCE.—The Secretary shall 

25 establish a process to provide technical assistance to 


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1 States that are awarded grants under this section and to 

2 eligible entities and other providers participating in a 

3 State maternity care home model funded by such a grant. 

4 ‘‘(k) DEFINITIONS.—In this section: 

5 ‘‘(1) ELIGIBLE ENTITY.—The term ‘eligible en6 tity’ means an entity or organization that provides 

7 medically accurate, comprehensive maternity services 

8 to individuals who are eligible for medical assistance 

9 under a State plan under this title or a waiver of 

10 such a plan, and may include: 

11 ‘‘(A) A freestanding birth center. 

12 ‘‘(B) An entity or organization receiving 

13 assistance under section 330 of the Public 

14 Health Service Act. 

15 ‘‘(C) A federally qualified health center. 

16 ‘‘(D) A rural health clinic. 

17 ‘‘(E) A health facility operated by an In18 dian tribe or tribal organization (as those terms 

19 are defined in section 4 of the Indian Health 

20 Care Improvement Act). 

21 ‘‘(2) ELIGIBLE INDIVIDUAL.—The term ‘eligible 

22 individual’ means a pregnant individual or a for23 merly pregnant individual during the 1-year period 

24 beginning on the last day of the pregnancy, or such 


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1 longer period beginning on such day as a State may 

2 elect, who is— 

3 ‘‘(A) enrolled in a State plan under this 

4 title, a waiver of such a plan, or a State child 

5 health plan under title XXI; and 

6 ‘‘(B) a patient of an eligible entity which 

7 has entered into an arrangement with a State 

8 under subsection (g). 

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

10 are authorized to be appropriated to the Secretary, for 

11 each of fiscal years 2025 through 2032, such sums as may 

12 be necessary to carry out this section.’’. 

13 (c) REAPPLICATION OF MEDICARE PAYMENT RATE

14 FLOOR TO PRIMARY CARE SERVICES FURNISHED UNDER

15 MEDICAID AND INCLUSION OF ADDITIONAL PRO16 VIDERS.— 

17 (1) REAPPLICATION OF PAYMENT FLOOR; ADDI18 TIONAL PROVIDERS.— 

19 (A) IN GENERAL.—Section 1902(a)(13) of 

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

21 1396a(a)(13)) is amended— 

22 (i) in subparagraph (B), by striking ‘‘; 

23 and’’ and inserting a semicolon; 

24 (ii) in subparagraph (C), by striking 

25 the semicolon and inserting ‘‘; and’’; and 


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1 (iii) by adding at the end the fol2 lowing new subparagraph: 

3 ‘‘(D) payment for primary care services (as 

4 defined in subsection (jj)(1)) furnished in the 

5 period that begins on the first day of the first 

6 month that begins after the date of enactment 

7 of this subparagraph by a provider described in 

8 subsection (jj)(2)— 

9 ‘‘(i) at a rate that is not less than 100 

10 percent of the payment rate that applies to 

11 such services and the provider of such 

12 services under part B of title XVIII (or, if 

13 greater, the payment rate that would be 

14 applicable under such part if the conver15 sion factor under section 1848(d) for the 

16 year were the conversion factor under such 

17 section for 2009); 

18 ‘‘(ii) in the case of items and services 

19 that are not items and services provided 

20 under such part, at a rate to be established 

21 by the Secretary; and 

22 ‘‘(iii) in the case of items and services 

23 that are furnished in rural areas (as de24 fined in section 1886(d)(2)(D)), health 

25 professional shortage areas (as defined in 


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1 section 332(a)(1)(A) of the Public Health 

2 Service Act (42 U.S.C. 254e(a)(1)(A))), or 

3 medically underserved areas (according to 

4 a designation under section 330(b)(3)(A) 

5 of the Public Health Service Act (42 

6 U.S.C. 254b(b)(3)(A))), at the rate other7 wise applicable to such items or services 

8 under clause (i) or (ii) increased, at the 

9 Secretary’s discretion, by not more than 25 

10 percent;’’. 

11 (B) CONFORMING AMENDMENTS.— 

12 (i) Section 1902(a)(13)(C) of the So13 cial Security Act (42 U.S.C. 

14 1396a(a)(13)(C)) is amended by striking 

15 ‘‘subsection (jj)’’ and inserting ‘‘subsection 

16 (jj)(1)’’. 

17 (ii) Section 1905(dd) of the Social Se18 curity Act (42 U.S.C. 1396d(dd)) is 

19 amended— 

20 (I) by striking ‘‘Notwith21 standing’’ and inserting the following: 

22 ‘‘(1) IN GENERAL.—Notwithstanding’’; 

23 (II) by striking ‘‘section 

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1 paragraph (C) of section 

2 1902(a)(13)’’; 

3 (III) by inserting ‘‘or for services 

4 described in subparagraph (D) of sec5 tion 1902(a)(13) furnished during an 

6 additional period specified in para7 graph (2),’’ after ‘‘2015,’’; 

8 (IV) by striking ‘‘under such sec9 tion’’ and inserting ‘‘under subpara10 graph (C) or (D) of section 

11 1902(a)(13), as applicable’’; and 

12 (V) by adding at the end the fol13 lowing: 

14 ‘‘(2) ADDITIONAL PERIODS.—For purposes of 

15 paragraph (1), the following are additional periods: 

16 ‘‘(A) The period that begins on the first 

17 day of the first month that begins after the 

18 date of enactment of this paragraph.’’. 

19 (2) IMPROVED TARGETING OF PRIMARY

20 CARE.—Section 1902(jj) of the Social Security Act 

21 (42 U.S.C. 1396a(jj)) is amended— 

22 (A) by redesignating paragraphs (1) and 

23 (2) as clauses (i) and (ii), respectively, and re24 aligning the left margins accordingly; 


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1 (B) by striking ‘‘For purposes of sub2 section (a)(13)(C)’’ and inserting the following: 

3 ‘‘(1) IN GENERAL.— 

4 ‘‘(A) DEFINITION.—For purposes of sub5 paragraphs (C) and (D) of subsection (a)(13)’’; 

6 and 

7 (C) by inserting after clause (ii) (as so re8 designated) the following: 

9 ‘‘(B) EXCLUSIONS.—Such term does not 

10 include any services described in subparagraph 

11 (A) or (B) of paragraph (1) if such services are 

12 provided in an emergency department of a hos13 pital. 

14 ‘‘(2) ADDITIONAL PROVIDERS.—For purposes 

15 of subparagraph (D) of subsection (a)(13), a pro16 vider described in this paragraph is any of the fol17 lowing: 

18 ‘‘(A) A physician with a primary specialty 

19 designation of family medicine, general internal 

20 medicine, or pediatric medicine, or obstetrics 

21 and gynecology. 

22 ‘‘(B) An advanced practice clinician, as de23 fined by the Secretary, that works under the 

24 supervision of— 


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1 ‘‘(i) a physician that satisfies the cri2 teria specified in subparagraph (A); 

3 ‘‘(ii) a nurse practitioner or a physi4 cian assistant (as such terms are defined 

5 in section 1861(aa)(5)(A)) who is working 

6 in accordance with State law; or 

7 ‘‘(iii) or a certified nurse-midwife (as 

8 defined in section 1861(gg)) or a certified 

9 professional midwife who is working in ac10 cordance with State law. 

11 ‘‘(C) A rural health clinic, federally quali12 fied health center, health center that receives 

13 funding under title X of the Public Health 

14 Service Act, or other health clinic that receives 

15 reimbursement on a fee schedule applicable to 

16 a physician. 

17 ‘‘(D) An advanced practice clinician super18 vised by a physician described in subparagraph 

19 (A), another advanced practice clinician, or a 

20 certified nurse-midwife. 

21 ‘‘(E) A midwife who is working in accord22 ance with State law.’’. 

23 (3) ENSURING PAYMENT BY MANAGED CARE

24 ENTITIES.— 


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1 (A) IN GENERAL.—Section 1903(m)(2)(A) 

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

3 1396b(m)(2)(A)) is amended— 

4 (i) in clause (xii), by striking ‘‘and’’ 

5 after the semicolon; 

6 (ii) by realigning the left margin of 

7 clause (xiii) so as to align with the left 

8 margin of clause (xii) and by striking the 

9 period at the end of clause (xiii) and in10 serting ‘‘; and’’; and 

11 (iii) by inserting after clause (xiii) the 

12 following: 

13 ‘‘(xiv) such contract provides that (I) payments 

14 to providers specified in section 1902(a)(13)(D) for 

15 primary care services (as defined in section 1902(jj)) 

16 that are furnished during a year or period (as speci17 fied in section 1902(a)(13)(D) and section 

18 1905(dd)) are at least equal to the amounts set 

19 forth and required by the Secretary by regulation; 

20 (II) the entity shall, upon request, provide docu21 mentation to the State, sufficient to enable the State 

22 and the Secretary to ensure compliance with sub23 clause (I); and (III) the Secretary shall approve pay24 ments described in subclause (I) that are furnished 

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1 tion, or other value-based payment arrangement if 

2 the capitation, partial capitation, or other value3 based payment arrangement is based on a reason4 able methodology and the entity provides docu5 mentation to the State sufficient to enable the State 

6 and the Secretary to ensure compliance with sub7 clause (I).’’. 

8 (B) CONFORMING AMENDMENT.—Section 

9 1932(f) of the Social Security Act (42 U.S.C. 

10 1396u–2(f)) is amended— 

11 (i) by striking ‘‘section 

12 1902(a)(13)(C)’’ and inserting ‘‘sub13 sections (C) and (D) of section 

14 1902(a)(13)’’; and 

15 (ii) by inserting ‘‘, and clause (xiv) of 

16 section 1903(m)(2)(A)’’ before the period. 

17 (d) MACPAC REPORT AND CMS GUIDANCE ON IN18 CREASING ACCESS TO DOULA SERVICES FOR MEDICAID

19 BENEFICIARIES.— 

20 (1) MACPAC REPORT.— 

21 (A) IN GENERAL.—Not later than 1 year 

22 after the date of the enactment of this Act, the 

23 Medicaid and CHIP Payment and Access Com24 mission (referred to in this subsection as 

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1 erage of doula services under State Medicaid 

2 programs, which shall at a minimum include 

3 the following: 

4 (i) Information about coverage for 

5 doula services under State Medicaid pro6 grams that currently provide coverage for 

7 such care, including the type of doula serv8 ices offered (such as prenatal, labor and 

9 delivery, postpartum support, and also 

10 community-based and traditional doula 

11 services). 

12 (ii) An analysis of barriers to covering 

13 doula services under State Medicaid pro14 grams. 

15 (iii) An identification of effective 

16 strategies to increase the use of doula serv17 ices in order to provide better care and 

18 achieve better maternal and infant health 

19 outcomes, including strategies that States 

20 may use to recruit, train, and certify a di21 verse doula workforce, particularly from 

22 underserved communities, communities of 

23 color, and communities facing linguistic or 

24 cultural barriers. 


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1 (iv) Recommendations for legislative 

2 and administrative actions to increase ac3 cess to doula services in State Medicaid 

4 programs, including actions that ensure 

5 doulas may earn a living wage that ac6 counts for their time and costs associated 

7 with providing care and community-based 

8 doula program administration and oper9 ation. 

10 (B) STAKEHOLDER CONSULTATION.—In 

11 developing the report required under subpara12 graph (A), MACPAC shall consult with relevant 

13 stakeholders, including— 

14 (i) States; 

15 (ii) organizations, especially reproduc16 tive justice and birth justice organizations 

17 led by people of color, representing con18 sumers of maternal health care, including 

19 those that are disproportionately impacted 

20 by poor maternal health outcomes; 

21 (iii) organizations and individuals rep22 resenting doulas, including community23 based doula programs and those who serve 

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1 munities of color, and communities facing 

2 linguistic or cultural barriers; 

3 (iv) organizations representing health 

4 care providers; and 

5 (v) Black, Indigenous, and other ma6 ternal health care consumers of color who 

7 have experienced severe maternal mor8 bidity. 

9 (2) CMS GUIDANCE.— 

10 (A) IN GENERAL.—Not later than 1 year 

11 after the date that MACPAC publishes the re12 port required under paragraph (1)(A), the Ad13 ministrator of the Centers for Medicare & Med14 icaid Services shall issue guidance to States on 

15 increasing access to doula services under Med16 icaid. Such guidance shall at a minimum in17 clude— 

18 (i) options for States to provide med19 ical assistance for doula services under 

20 State Medicaid programs; 

21 (ii) best practices for ensuring that 

22 doulas, including community-based doulas, 

23 receive reimbursement for doula services 

24 provided under a State Medicaid program, 

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1 ing wage that accounts for their time and 

2 costs associated with providing care and 

3 community-based doula program adminis4 tration; and 

5 (iii) best practices for increasing ac6 cess to doula services, including services 

7 provided by community-based doulas, 

8 under State Medicaid programs. 

9 (B) STAKEHOLDER CONSULTATION.—In 

10 developing the guidance required under sub11 paragraph (A), the Administrator of the Cen12 ters for Medicare & Medicaid Services shall con13 sult with MACPAC and other relevant stake14 holders, including— 

15 (i) State Medicaid officials; 

16 (ii) organizations representing con17 sumers of maternal health care, including 

18 those that are disproportionately impacted 

19 by poor maternal health outcomes; 

20 (iii) organizations representing doulas, 

21 including community-based doulas and 

22 those who serve underserved communities, 

23 such as communities of color and commu24 nities facing linguistic or cultural barriers; 

25 and 


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1 (iv) organizations representing med2 ical professionals. 

3 (e) GAO REPORT ON STATE MEDICAID PROGRAMS’ 

4 USE OF TELEHEALTH TO INCREASE ACCESS TO MATER5 NITY CARE.—Not later than 1 year after the date of the 

6 enactment of this Act, the Comptroller General of the 

7 United States shall submit a report to Congress on State 

8 Medicaid programs’ use of telehealth to increase access to 

9 maternity care. Such report shall include the following: 

10 (1) The number of State Medicaid programs 

11 that utilize telehealth that increases access to mater12 nity care. 

13 (2) With respect to State Medicaid programs 

14 that utilize telehealth that increases access to mater15 nity care, information about— 

16 (A) common characteristics of such pro17 grams’ approaches to utilizing telehealth that 

18 increases access to maternity care; 

19 (B) differences in States’ approaches to 

20 utilizing telehealth to improve access to mater21 nity care, and the resulting differences in State 

22 maternal health outcomes, as determined by 

23 factors described in subsection (C); and 


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1 (C) when compared to patients who receive 

2 maternity care in person, what is known 

3 about— 

4 (i) the demographic characteristics, 

5 such as race, ethnicity, sex, sexual orienta6 tion, gender identity, disability status, age, 

7 and preferred language of the individuals 

8 enrolled in such programs who use tele9 health to access maternity care; 

10 (ii) health outcomes for such individ11 uals, including frequency of mortality and 

12 severe morbidity, as compared to individ13 uals with similar characteristics who did 

14 not use telehealth to access maternity care; 

15 (iii) the services provided to individ16 uals through telehealth, including family 

17 planning services, mental health care serv18 ices, and oral health services; 

19 (iv) the devices and equipment pro20 vided to individuals for remote patient 

21 monitoring and telehealth, including blood 

22 pressure monitors and blood glucose mon23 itors; 

24 (v) the quality of maternity care pro25 vided through telehealth, including whether 


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1 maternity care provided through telehealth 

2 is culturally and linguistically appropriate; 

3 (vi) the level of patient satisfaction 

4 with maternity care provided through tele5 health to individuals enrolled in State Med6 icaid programs; 

7 (vii) the impact of utilizing telehealth 

8 to increase access to maternity care on 

9 spending, cost savings, access to care, and 

10 utilization of care under State Medicaid 

11 programs; and 

12 (viii) the accessibility and effectiveness 

13 of telehealth for maternity care during the 

14 COVID–19 pandemic. 

15 (3) An identification and analysis of the bar16 riers to using telehealth to increase access to mater17 nity care under State Medicaid programs. 

18 (4) Recommendations for such legislative and 

19 administrative actions related to increasing access to 

20 telehealth maternity services under Medicaid as the 

21 Comptroller General deems appropriate. 

22 SEC. 5203. SOCIAL DETERMINANTS FOR MOMS. 

23 (a) TASK FORCE TO DEVELOP A STRATEGY TO AD24 DRESS SOCIAL DETERMINANTS OF MATERNAL

25 HEALTH.— 


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

2 Human Services shall convene a task force (in this 

3 subsection referred to as the ‘‘Task Force’’) to de4 velop a strategy to coordinate efforts between Fed5 eral agencies to address social determinants of ma6 ternal health with respect to pregnant and 

7 postpartum individuals. 

8 (2) EX OFFICIO MEMBERS.—The ex officio 

9 members of the Task Force shall consist of the fol10 lowing: 

11 (A) The Secretary of Health and Human 

12 Services (or a designee thereof). 

13 (B) The Secretary of Housing and Urban 

14 Development (or a designee thereof). 

15 (C) The Secretary of Transportation (or a 

16 designee thereof). 

17 (D) The Secretary of Agriculture (or a 

18 designee thereof). 

19 (E) The Secretary of Labor (or a designee 

20 thereof). 

21 (F) The Administrator of the Environ22 mental Protection Agency (or a designee there23 of). 


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1 (G) The Assistant Secretary for the Ad2 ministration for Children and Families (or a 

3 designee thereof). 

4 (H) The Administrator of the Centers for 

5 Medicare & Medicaid Services (or a designee 

6 thereof). 

7 (I) The Director of the Indian Health 

8 Service (or a designee thereof). 

9 (J) The Director of the National Institutes 

10 of Health (or a designee thereof). 

11 (K) The Administrator of the Health Re12 sources and Services Administration (or a des13 ignee thereof). 

14 (L) The Deputy Assistant Secretary for 

15 Minority Health of the Department of Health 

16 and Human Services (or a designee thereof). 

17 (M) The Deputy Assistant Secretary for 

18 Women’s Health of the Department of Health 

19 and Human Services (or a designee thereof). 

20 (N) The Director of the Centers for Dis21 ease Control and Prevention (or a designee 

22 thereof). 

23 (O) The Director of the Office on Violence 

24 Against Women of the Department of Justice 

25 (or a designee thereof). 


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1 (3) APPOINTED MEMBERS.—In addition to the 

2 ex officio members of the Task Force, the Secretary 

3 of Health and Human Services shall appoint the fol4 lowing members of the Task Force: 

5 (A) At least two representatives of pa6 tients, to include— 

7 (i) a representative of patients who 

8 have suffered from severe maternal mor9 bidity; or 

10 (ii) a representative of patients who is 

11 a family member of an individual who suf12 fered a pregnancy-related death. 

13 (B) At least two leaders of community14 based organizations that address maternal mor15 tality and severe maternal morbidity with a spe16 cific focus on racial and ethnic inequities. In 

17 appointing such leaders under this subpara18 graph, the Secretary of Health and Human 

19 Services shall give priority to individuals who 

20 are leaders of organizations led by individuals 

21 from racial and ethnic minority groups. 

22 (C) At least two perinatal health workers. 

23 (D) A professionally diverse panel of ma24 ternity care providers. 


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1 (4) CHAIR.—The Secretary of Health and 

2 Human Services shall select the chair of the Task 

3 Force from among the members of the Task Force. 

4 (5) REPORT.—Not later than 2 years after the 

5 date of enactment of this Act, the Task Force shall 

6 submit to Congress a report on— 

7 (A) the strategy developed under para8 graph (1); 

9 (B) recommendations on funding amounts 

10 with respect to implementing such strategy; and 

11 (C) recommendations for how to expand 

12 coverage of social services to address social de13 terminants of maternal health under Medicaid 

14 managed care organizations and State Medicaid 

15 programs. 

16 (6) TERMINATION.—Section 1013 of title 5, 

17 United States Code, shall not apply to the Task 

18 Force with respect to termination. 

19 (b) HOUSING FOR MOMS GRANT PROGRAM.— 

20 (1) DEFINITIONS.—In this subsection: 

21 (A) ELIGIBLE ENTITY.—The term ‘‘eligible 

22 entity’’ means— 

23 (i) a community-based organization; 


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1 (ii) a State or local governmental enti2 ty, including a State or local public health 

3 department; 

4 (iii) an Indian tribe or Tribal organi5 zation (as such terms are defined in sec6 tion 4 of the Indian Self-Determination 

7 and Education Assistance Act (25 U.S.C. 

8 5304)); or 

9 (iv) an Urban Indian organization (as 

10 such term is defined in section 4 of the In11 dian Health Care Improvement Act (25 

12 U.S.C. 1603)). 

13 (B) SECRETARY.—The term ‘‘Secretary’’ 

14 means the Secretary of Housing and Urban De15 velopment. 

16 (2) ESTABLISHMENT.—The Secretary shall es17 tablish a Housing for Moms grant program to make 

18 grants to eligible entities to increase access to safe, 

19 stable, affordable, and adequate housing for preg20 nant and postpartum individuals and their families. 

21 (3) APPLICATION.—To be eligible to receive a 

22 grant under this subsection, an eligible entity shall 

23 submit to the Secretary an application at such time, 

24 in such manner, and containing such information as 

25 the Secretary may provide. 


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1 (4) PRIORITY.—In awarding grants under this 

2 subsection, the Secretary shall give priority to an eli3 gible entity that— 

4 (A) is a community-based organization or 

5 will partner with a community-based organiza6 tion to implement initiatives to increase access 

7 to safe, stable, affordable, and adequate hous8 ing for pregnant and postpartum individuals 

9 and their families; 

10 (B) is operating in an area with high rates 

11 of adverse maternal health outcomes or signifi12 cant racial or ethnic inequities in maternal 

13 health outcomes, to the extent such data are 

14 available; and 

15 (C) is operating in an area with a high 

16 poverty rate or a significant number of individ17 uals who lack consistent access to safe, stable, 

18 affordable, and adequate housing. 

19 (5) USE OF FUNDS.—An eligible entity that re20 ceives a grant under this subsection shall use funds 

21 from the grant for the purposes of— 

22 (A) identifying and conducting outreach to 

23 pregnant and postpartum individuals who are 

24 low-income and lack consistent access to safe, 

25 stable, affordable, and adequate housing; 


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1 (B) providing safe, stable, affordable, and 

2 adequate housing options to such individuals; 

3 (C) connecting such individuals with local 

4 organizations offering safe, stable, affordable, 

5 and adequate housing options; 

6 (D) providing application assistance to 

7 such individuals seeking to enroll in programs 

8 offering safe, stable, affordable, and adequate 

9 housing options; 

10 (E) providing direct financial assistance to 

11 such individuals for the purposes of maintaining 

12 safe, stable, and adequate housing for the dura13 tion of the individual’s pregnancy and 

14 postpartum periods; and 

15 (F) working with relevant stakeholders to 

16 ensure that local housing and homeless shelter 

17 infrastructure is supportive to pregnant and 

18 postpartum individuals, including through— 

19 (i) health-promoting housing codes; 

20 (ii) enforcement of housing codes; 

21 (iii) proactive rental inspection pro22 grams; 

23 (iv) code enforcement officer training; 

24 and 


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1 (v) partnerships between regional of2 fices of the Department of Housing and 

3 Urban Development and community-based 

4 organizations to ensure housing laws are 

5 understood and violations are discovered. 

6 (6) REPORTING.— 

7 (A) ELIGIBLE ENTITIES.—The Secretary 

8 shall require each eligible entity receiving a 

9 grant under this subsection to annually submit 

10 to the Secretary and make publicly available a 

11 report on the status of activities conducted 

12 using the grant. 

13 (B) SECRETARY.—Not later than the end 

14 of each fiscal year in which grants are made 

15 under this subsection, the Secretary shall sub16 mit to Congress and make publicly available a 

17 report that— 

18 (i) summarizes the reports received 

19 under subparagraph (A); 

20 (ii) evaluates the effectiveness of 

21 grants awarded under this subsection in 

22 increasing access to safe, stable, afford23 able, and adequate housing for pregnant 

24 and postpartum individuals and their fami25 lies; and 


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1 (iii) makes recommendations with re2 spect to ensuring activities described in 

3 paragraph (5) continue after grant 

4 amounts made available under this sub5 section are expended. 

6 (7) AUTHORIZATION OF APPROPRIATIONS.— 

7 There is authorized to be appropriated to carry out 

8 this subsection $10,000,000 for fiscal year 2025, 

9 which shall remain available until expended. 

10 (c) DEPARTMENT OF TRANSPORTATION.— 

11 (1) REPORT.—Not later than 1 year after the 

12 date of enactment of this Act, the Secretary of 

13 Transportation shall submit to Congress and make 

14 publicly available a report containing— 

15 (A) an assessment of transportation bar16 riers preventing individuals from attending pre17 natal and postpartum appointments, accessing 

18 maternal health care services, or accessing serv19 ices and resources related to social deter20 minants of maternal health; 

21 (B) recommendations on how to overcome 

22 the barriers assessed under subparagraph (A); 

23 and 


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1 (C) an assessment of transportation safety 

2 risks for pregnant individuals and recommenda3 tions on how to mitigate those risks. 

4 (2) CONSIDERATIONS.—In carrying out para5 graph (1), the Secretary of Transportation shall give 

6 special consideration to solutions for— 

7 (A) pregnant and postpartum individuals 

8 living in a health professional shortage area 

9 designated under section 332 of the Public 

10 Health Service Act (42 U.S.C. 254e); 

11 (B) pregnant and postpartum individuals 

12 living in areas with high maternal mortality or 

13 severe morbidity rates or significant racial or 

14 ethnic inequities in maternal health outcomes; 

15 and 

16 (C) pregnant and postpartum individuals 

17 with a disability that impacts mobility. 

18 (d) DEPARTMENT OF AGRICULTURE.— 

19 (1) SPECIAL SUPPLEMENTAL NUTRITION PRO20 GRAM FOR WOMEN, INFANTS, AND CHILDREN.— 

21 (A) EXTENSION OF POSTPARTUM PE22 RIOD.—Section 17(b)(10) of the Child Nutri23 tion Act of 1966 (42 U.S.C. 1786(b)(10)) is 

24 amended by striking ‘‘six’’ and inserting ‘‘24’’. 


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1 (B) REPORT.—Not later than 2 years after 

2 the date of enactment of this Act, the Secretary 

3 shall submit to Congress a report that evaluates 

4 the effect of the amendment made by subpara5 graph (A) on— 

6 (i) maternal and infant health out7 comes, including racial and ethnic inequi8 ties with respect to those outcomes; 

9 (ii) breastfeeding rates among 

10 postpartum individuals; 

11 (iii) qualitative evaluations of family 

12 experiences under the special supplemental 

13 nutrition program for women, infants, and 

14 children established under section 17 of 

15 the Child Nutrition Act of 1966 (42 

16 U.S.C. 1786); and 

17 (iv) other relevant information as de18 termined by the Secretary. 

19 (2) GRANT PROGRAM FOR HEALTHY FOOD AND

20 CLEAN WATER FOR PREGNANT AND POSTPARTUM

21 INDIVIDUALS.— 

22 (A) IN GENERAL.—The Secretary shall es23 tablish a program (referred to in this paragraph 

24 as the ‘‘program’’) to award grants, on a comVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 00603 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 petitive basis, to eligible entities to carry out 

2 the activities described in subparagraph (D). 

3 (B) APPLICATION.—To be eligible for a 

4 grant under the program, an eligible entity 

5 shall submit to the Secretary an application at 

6 such time, in such manner, and containing such 

7 information as the Secretary determines appro8 priate. 

9 (C) PRIORITY.—In awarding grants under 

10 the program, the Secretary shall give priority to 

11 an eligible entity that— 

12 (i) is, or will partner with, an eligible 

13 entity described in paragraph (3)(A)(i); 

14 and 

15 (ii) is operating in an area with a high 

16 rate of— 

17 (I) adverse maternal health out18 comes; or 

19 (II) significant racial or ethnic 

20 inequities in maternal health out21 comes. 

22 (D) USE OF FUNDS.—An eligible entity 

23 shall use a grant awarded under the program to 

24 deliver healthy food, infant formula, clean 

25 water, or diapers to pregnant and postpartum 


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1 individuals located in areas that are food 

2 deserts, as determined by the Secretary using 

3 data from the Food Access Research Atlas of 

4 the Department of Agriculture. 

5 (E) REPORTS.— 

6 (i) ELIGIBLE ENTITIES.—Not later 

7 than 1 year after the date on which an eli8 gible entity receives a grant under the pro9 gram, and annually thereafter, the eligible 

10 entity shall submit to the Secretary a re11 port on the status of activities conducted 

12 using the grant, which shall contain such 

13 information as the Secretary may require. 

14 (ii) SECRETARY.— 

15 (I) IN GENERAL.—Not later than 

16 2 years after the date on which the 

17 first grant is awarded under the pro18 gram, the Secretary shall submit to 

19 Congress a report that includes— 

20 (aa) a summary of the re21 ports submitted by eligible enti22 ties under clause (i); 

23 (bb) an assessment of the 

24 extent to which food distributed 

25 using grants awarded under the 


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1 program was purchased from 

2 local and regional food systems; 

3 (cc) an evaluation of the ef4 fect of the program on maternal 

5 and infant health outcomes, in6 cluding racial and ethnic inequi7 ties with respect to those out8 comes; and 

9 (dd) recommendations with 

10 respect to ensuring the activities 

11 described in subparagraph (D) 

12 continue after the grant period 

13 funding those activities expires. 

14 (II) PUBLICATION.—The Sec15 retary shall make the report sub16 mitted under subclause (I) publicly 

17 available on the website of the De18 partment of Agriculture. 

19 (F) AUTHORIZATION OF APPROPRIA20 TIONS.—There is authorized to be appropriated 

21 to carry out the program $5,000,000 for the 

22 period of fiscal years 2025 through 2027. 

23 (3) DEFINITIONS.—In this subsection: 

24 (A) ELIGIBLE ENTITY.—The term ‘‘eligible 

25 entity’’ means— 


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1 (i) a community-based organization; 

2 (ii) a State or local governmental enti3 ty, including a State or local public health 

4 department; 

5 (iii) an Indian Tribe or Tribal organi6 zation (as those terms are defined in sec7 tion 4 of the Indian Self-Determination 

8 and Education Assistance Act (25 U.S.C. 

9 5304)); and 

10 (iv) an Urban Indian organization (as 

11 defined in section 4 of the Indian Health 

12 Care Improvement Act (25 U.S.C. 1603)). 

13 (B) SECRETARY.—The term ‘‘Secretary’’ 

14 means the Secretary of Agriculture. 

15 (e) ENVIRONMENTAL STUDY THROUGH NATIONAL

16 ACADEMIES.— 

17 (1) IN GENERAL.—Not later than 60 days after 

18 the date of enactment of this Act, the Administrator 

19 of the Environmental Protection Agency shall seek 

20 to enter into an agreement with the National Acad21 emies of Sciences, Engineering, and Medicine (re22 ferred to in this subsection as the ‘‘National Acad23 emies’’) under which the National Academies agree 

24 to conduct a study on the impacts of, with respect 

25 to maternal and infant health incomes, water and 


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1 air quality, exposure to extreme temperatures, envi2 ronmental chemicals, environmental risks in the 

3 workplace and the home, and pollution levels. 

4 (2) STUDY REQUIREMENTS.—The agreement 

5 under paragraph (1) shall direct the National Acad6 emies to make recommendations for— 

7 (A) improving environmental conditions to 

8 improve maternal and infant health outcomes; 

9 and 

10 (B) reducing or eliminating racial and eth11 nic inequities in those outcomes. 

12 (3) REPORT.—The agreement under paragraph 

13 (1) shall direct the National Academies to complete 

14 the study under this subsection, and submit to Con15 gress and make publicly available a report on the re16 sults of the study, not later than 1 year after the 

17 date of enactment of this Act. 

18 (f) CHILD CARE ACCESS.— 

19 (1) GRANT PROGRAM.—The Secretary of 

20 Health and Human Services (in this subsection re21 ferred to as the ‘‘Secretary’’) shall award grants to 

22 eligible organizations to carry out programs to pro23 vide pregnant and postpartum individuals with free 

24 and accessible drop-in child care services during pre25 natal and postpartum appointments. 


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1 (2) APPLICATION.—To be eligible to receive a 

2 grant under this subsection, an eligible entity shall 

3 submit to the Secretary an application at such time, 

4 in such manner, and containing such information as 

5 the Secretary may require. 

6 (3) ELIGIBLE ORGANIZATIONS.— 

7 (A) ELIGIBILITY.—To be eligible to receive 

8 a grant under this subsection, an organization 

9 shall be an organization that— 

10 (i) provides child care services; and 

11 (ii) can carry out a program providing 

12 pregnant and postpartum individuals with 

13 free and accessible drop-in child care serv14 ices during prenatal and postpartum ap15 pointments. 

16 (B) PRIORITIZATION.—In selecting grant 

17 recipients under this subsection, the Secretary 

18 shall give priority to eligible organizations that 

19 operate in an area that has, to the extent data 

20 with respect to such an area are available— 

21 (i) high rates of adverse maternal 

22 health outcomes; or 

23 (ii) significant racial or ethnic inequi24 ties in maternal health outcomes. 


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1 (4) TIMING.—The Secretary shall commence 

2 the grant program under paragraph (1) not later 

3 than 1 year after the date of enactment of this Act. 

4 (5) REPORTING.— 

5 (A) GRANTEES.—Each recipient of a grant 

6 under this subsection shall annually submit to 

7 the Secretary and make publicly available a re8 port on the status of activities conducted using 

9 the grant. Each such report shall include— 

10 (i) an analysis of the effect of the 

11 funded program on prenatal and 

12 postpartum appointment attendance rates; 

13 (ii) summaries of qualitative assess14 ments of the funded program from— 

15 (I) pregnant and postpartum in16 dividuals participating in the pro17 gram; and 

18 (II) the families of such individ19 uals; and 

20 (iii) such additional information as 

21 the Secretary may require. 

22 (B) SECRETARY.—Not later than the end 

23 of fiscal year 2027, the Secretary shall submit 

24 to the Congress, and make publicly available, a 

25 report containing each of the following: 


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1 (i) A summary of the reports received 

2 under subparagraph (A). 

3 (ii) An assessment of the effects, if 

4 any, of the funded programs on maternal 

5 health outcomes, with a specific focus on 

6 racial and ethnic inequities in such out7 comes. 

8 (iii) A description of actions the Sec9 retary can take to ensure that pregnant 

10 and postpartum individuals eligible for 

11 medical assistance under a State plan 

12 under title XIX of the Social Security Act 

13 (42 U.S.C. 1936 et seq.) have access to 

14 free and accessible drop-in child care serv15 ices during prenatal and postpartum ap16 pointments, including identification of the 

17 funding necessary to carry out such ac18 tions. 

19 (6) DROP-IN CHILD CARE SERVICES DE20 FINED.—In this subsection, the term ‘‘drop-in child 

21 care services’’ means child care (including early 

22 childhood education) services that are— 

23 (A) delivered at a facility that meets the 

24 requirements of all applicable laws and regula25 tions of the State or local government in which 


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1 it is located, including the requirements for li2 censing of the facility as a child care facility; 

3 and 

4 (B) provided in single encounters without 

5 requiring full-time enrollment of a person in a 

6 child care program. 

7 (7) AUTHORIZATION OF APPROPRIATIONS.—To 

8 carry out this subsection, there is authorized to be 

9 appropriated $5,000,000 for the period of fiscal 

10 years 2025 through 2027. 

11 (g) GRANTS TO LOCAL ENTITIES ADDRESSING SO12 CIAL DETERMINANTS OF MATERNAL HEALTH.— 

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

14 Human Services (in this subsection referred to as 

15 the ‘‘Secretary’’) shall award grants to eligible enti16 ties to— 

17 (A) address social determinants of mater18 nal health for pregnant and postpartum individ19 uals; and 

20 (B) eliminate racial and ethnic inequities 

21 in maternal health outcomes. 

22 (2) APPLICATION.—To be eligible to receive a 

23 grant under this subsection an eligible entity shall 

24 submit to the Secretary an application at such time, 


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1 in such manner, and containing such information as 

2 the Secretary may provide. 

3 (3) PRIORITIZATION.—In awarding grants 

4 under paragraph (1), the Secretary shall give pri5 ority to an eligible entity that— 

6 (A) is a community-based organization, or 

7 will partner with a community-based organiza8 tion to carry out the activities under paragraph 

9 (4); 

10 (B) is operating in an area with high rates 

11 of adverse maternal health outcomes or signifi12 cant racial or ethnic inequities in maternal 

13 health outcomes; and 

14 (C) is operating in an area with a high 

15 poverty rate. 

16 (4) ACTIVITIES.—An eligible entity that re17 ceives a grant under this subsection may use funds 

18 received through the grant to— 

19 (A) hire and retain staff; 

20 (B) develop and distribute a list of avail21 able resources with respect to social service pro22 grams in a community; 

23 (C) establish a resource center that pro24 vides multiple social service programs in a sin25 gle location; 


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1 (D) offer programs and resources in the 

2 communities in which the respective eligible en3 tities are located to address social determinants 

4 of health for pregnant and postpartum individ5 uals; and 

6 (E) consult with such pregnant and 

7 postpartum individuals to conduct an assess8 ment of the activities under this paragraph. 

9 (5) TECHNICAL ASSISTANCE.—The Secretary 

10 shall provide to grant recipients under this sub11 section technical assistance to plan for sustaining 

12 programs to address social determinants of maternal 

13 health among pregnant and postpartum individuals 

14 after the period of the grant. 

15 (6) REPORTING.— 

16 (A) GRANTEES.—Not later than 1 year 

17 after the date on which an eligible entity first 

18 receives a grant under this subsection, and an19 nually thereafter, an eligible entity shall submit 

20 to the Secretary, and make publicly available, a 

21 report on the status of activities conducted 

22 using the grant. Each such report shall include 

23 data on the effects of such activities, 

24 disaggregated by race, ethnicity, gender, and 

25 other relevant factors. 


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1 (B) SECRETARY.—Not later than the end 

2 of fiscal year 2029, the Secretary shall submit 

3 to Congress a report that includes— 

4 (i) a summary of the reports received 

5 under subparagraph (A); and 

6 (ii) recommendations for— 

7 (I) improving maternal health 

8 outcomes; and 

9 (II) reducing or eliminating ra10 cial and ethnic inequities in maternal 

11 health outcomes. 

12 (7) AUTHORIZATION OF APPROPRIATIONS.— 

13 There is authorized to be appropriated to carry out 

14 this subsection $15,000,000 for each of fiscal years 

15 2025 through 2029. 

16 (h) DEFINITIONS.—In this section: 

17 (1) CULTURALLY CONGRUENT.—The term ‘‘cul18 turally congruent’’, with respect to care or maternity 

19 care provided to a health care consumer, means care 

20 that is in agreement with the preferred cultural val21 ues, beliefs, worldview, language, and practices of 

22 the health care consumer and other relevant stake23 holders. 


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1 (2) MATERNITY CARE PROVIDER.—The term 

2 ‘‘maternity care provider’’ means a health care pro3 vider who— 

4 (A) is a physician, physician assistant, 

5 midwife who meets at a minimum the inter6 national definition of the midwife and global 

7 standards for midwifery education as estab8 lished by the International Confederation of 

9 Midwives, nurse practitioner, or clinical nurse 

10 specialist; and 

11 (B) has a focus on maternal or perinatal 

12 health. 

13 (3) MATERNAL MORTALITY.—The term ‘‘mater14 nal mortality’’ means a death occurring during or 

15 within a one-year period after pregnancy, caused by 

16 pregnancy-related or childbirth complications, in17 cluding a suicide, overdose, or other death resulting 

18 from a mental health or substance use disorder at19 tributed to or aggravated by pregnancy-related or 

20 childbirth complications. 

21 (4) PERINATAL HEALTH WORKER.—The term 

22 ‘‘perinatal health worker’’ means a doula, commu23 nity health worker, peer supporter, breastfeeding 

24 and lactation educator or counselor, nutritionist or 


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1 dietitian, childbirth educator, social worker, home 

2 visitor, language interpreter, or navigator. 

3 (5) POSTPARTUM AND POSTPARTUM PERIOD.— 

4 The terms ‘‘postpartum’’ and ‘‘postpartum period’’ 

5 refer to the 1-year period beginning on the last day 

6 of the pregnancy of an individual. 

7 (6) RACIAL AND ETHNIC MINORITY GROUP.— 

8 The term ‘‘racial and ethnic minority group’’ has the 

9 meaning given such term in section 1707(g)(1) of 

10 the Public Health Service Act (42 U.S.C. 300u– 

11 6(g)(1)). 

12 (7) SEVERE MATERNAL MORBIDITY.—The term 

13 ‘‘severe maternal morbidity’’ means a health condi14 tion, including mental health conditions and sub15 stance use disorders, attributed to or aggravated by 

16 pregnancy or childbirth that results in significant 

17 short-term or long-term consequences to the health 

18 of the individual who was pregnant. 

19 (8) SOCIAL DETERMINANTS OF MATERNAL

20 HEALTH DEFINED.—The term ‘‘social determinants 

21 of maternal health’’ means non-clinical factors that 

22 impact maternal health outcomes, including— 

23 (A) economic factors, which may include 

24 poverty, employment, food security, support for 


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1 and access to lactation and other infant feeding 

2 options, housing stability, and related factors; 

3 (B) neighborhood factors, which may in4 clude quality of housing, access to transpor5 tation, access to child care, availability of 

6 healthy foods and nutrition counseling, avail7 ability of clean water, air and water quality, 

8 ambient temperatures, neighborhood crime and 

9 violence, access to broadband, and related fac10 tors; 

11 (C) social and community factors, which 

12 may include systemic racism, gender discrimi13 nation or discrimination based on other pro14 tected classes, workplace conditions, incarcer15 ation, and related factors; 

16 (D) household factors, which may include 

17 ability to conduct lead testing and abatement, 

18 car seat installation, indoor air temperatures, 

19 and related factors; 

20 (E) education access and quality factors, 

21 which may include educational attainment, lan22 guage and literacy, and related factors; and 

23 (F) health care access factors, including 

24 health insurance coverage, access to culturally 

25 congruent health care services, providers, and 


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1 non-clinical support, access to home visiting 

2 services, access to wellness and stress manage3 ment programs, health literacy, access to tele4 health and items required to receive telehealth 

5 services, and related factors. 

6 SEC. 5204. KIRA JOHNSON ACT. 

7 (a) INVESTMENTS IN COMMUNITY-BASED ORGANIZA8 TIONS TO IMPROVE BLACK MATERNAL HEALTH OUT9 COMES.— 

10 (1) AWARDS.—Following the 1-year period de11 scribed in paragraph (3), the Secretary of Health 

12 and Human Services (in this subsection referred to 

13 as the ‘‘Secretary’’) shall award grants to eligible 

14 entities to establish or expand programs to prevent 

15 maternal mortality and severe maternal morbidity 

16 among Black pregnant and postpartum individuals. 

17 (2) ELIGIBILITY.—To be eligible to seek a 

18 grant under this subsection, an entity shall be a 

19 community-based organization offering programs 

20 and resources aligned with evidence-based practices 

21 for improving maternal health outcomes for Black 

22 pregnant and postpartum individuals. 

23 (3) OUTREACH AND TECHNICAL ASSISTANCE

24 PERIOD.—During the 1-year period beginning on the 

25 date of enactment of this Act, the Secretary shall— 


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1 (A) conduct outreach to encourage eligible 

2 entities to apply for grants under this sub3 section; and 

4 (B) provide technical assistance to eligible 

5 entities on best practices for applying for grants 

6 under this subsection. 

7 (4) SPECIAL CONSIDERATION.— 

8 (A) OUTREACH.—In conducting outreach 

9 under paragraph (3), the Secretary shall give 

10 special consideration to eligible entities that— 

11 (i) are based in, and provide support 

12 for, communities with high rates of adverse 

13 maternal health outcomes or significant ra14 cial and ethnic inequities in maternal 

15 health outcomes, to the extent such data 

16 are available; 

17 (ii) are led by Black people; and 

18 (iii) offer programs and resources that 

19 are aligned with evidence-based practices 

20 for improving maternal health outcomes 

21 for Black pregnant and postpartum indi22 viduals. 

23 (B) AWARDS.—In awarding grants under 

24 this subsection, the Secretary shall give special 

25 consideration to eligible entities that— 


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1 (i) are described in clauses (i), (ii), 

2 and (iii) of subparagraph (A); 

3 (ii) offer programs and resources de4 signed in consultation with and intended 

5 for Black pregnant and postpartum indi6 viduals; and 

7 (iii) offer programs and resources in 

8 the communities in which the respective el9 igible entities are located that— 

10 (I) promote maternal mental 

11 health and maternal substance use 

12 disorder treatments and supports that 

13 are aligned with evidence-based prac14 tices for improving maternal mental 

15 and behavioral health outcomes for 

16 Black pregnant and postpartum indi17 viduals; 

18 (II) address social determinants 

19 of maternal health for pregnant and 

20 postpartum individuals; 

21 (III) promote evidence-based 

22 health literacy and pregnancy, child23 birth, and parenting education for 

24 pregnant and postpartum individuals; 


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1 (IV) provide support from 

2 perinatal health workers to pregnant 

3 and postpartum individuals; 

4 (V) provide culturally congruent 

5 training to perinatal health workers; 

6 (VI) conduct or support research 

7 on maternal health issues dispropor8 tionately impacting Black pregnant 

9 and postpartum individuals; 

10 (VII) provide support to family 

11 members of individuals who suffered a 

12 pregnancy-associated death or preg13 nancy-related death; 

14 (VIII) operate midwifery prac15 tices that provide culturally congruent 

16 maternal health care and support, in17 cluding for the purposes of— 

18 (aa) supporting additional 

19 education, training, and certifi20 cation programs, including sup21 port for distance learning; 

22 (bb) providing financial sup23 port to current and future mid24 wives to address education costs, 

25 debts, and other needs; 


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1 (cc) clinical site investments; 

2 (dd) supporting preceptor 

3 development trainings; 

4 (ee) expanding the mid5 wifery practice; or 

6 (ff) related needs identified 

7 by the midwifery practice and de8 scribed in the practice’s applica9 tion; or 

10 (IX) have developed other pro11 grams and resources that address 

12 community-specific needs for pregnant 

13 and postpartum individuals and are 

14 aligned with evidence-based practices 

15 for improving maternal health out16 comes for Black pregnant and 

17 postpartum individuals. 

18 (5) TECHNICAL ASSISTANCE.—The Secretary 

19 shall provide to grant recipients under this sub20 section technical assistance on— 

21 (A) capacity building to establish or ex22 pand programs to prevent adverse maternal 

23 health outcomes among Black pregnant and 

24 postpartum individuals; 


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1 (B) best practices in data collection, meas2 urement, evaluation, and reporting; and 

3 (C) planning for sustaining programs to 

4 prevent maternal mortality and severe maternal 

5 morbidity among Black pregnant and 

6 postpartum individuals after the period of the 

7 grant. 

8 (6) EVALUATION.—Not later than the end of 

9 fiscal year 2029, the Secretary shall submit to the 

10 Congress an evaluation of the grant program under 

11 this subsection that— 

12 (A) assesses the effectiveness of outreach 

13 efforts during the application process in diversi14 fying the pool of grant recipients; 

15 (B) makes recommendations for future 

16 outreach efforts to diversify the pool of grant 

17 recipients for Department of Health and 

18 Human Services grant programs and funding 

19 opportunities related to maternal health; 

20 (C) assesses the effectiveness of programs 

21 funded by grants under this subsection in im22 proving maternal health outcomes for Black 

23 pregnant and postpartum individuals, to the ex24 tent practicable; and 


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1 (D) makes recommendations for future 

2 Department of Health and Human Services 

3 grant programs and funding opportunities that 

4 deliver funding to community-based organiza5 tions that provide programs and resources that 

6 are aligned with evidence-based practices for 

7 improving maternal health outcomes for Black 

8 pregnant and postpartum individuals. 

9 (7) AUTHORIZATION OF APPROPRIATIONS.—To 

10 carry out this subsection, there is authorized to be 

11 appropriated $10,000,000 for each of fiscal years 

12 2025 through 2029. 

13 (b) INVESTMENTS IN COMMUNITY-BASED ORGANIZA14 TIONS TO IMPROVE MATERNAL HEALTH OUTCOMES IN

15 UNDERSERVED COMMUNITIES.— 

16 (1) AWARDS.—Following the 1-year period de17 scribed in paragraph (3), the Secretary of Health 

18 and Human Services (in this subsection referred to 

19 as the ‘‘Secretary’’) shall award grants to eligible 

20 entities to establish or expand programs to prevent 

21 maternal mortality and severe maternal morbidity 

22 among underserved groups. 

23 (2) ELIGIBILITY.—To be eligible to seek a 

24 grant under this subsection, an entity shall be a 

25 community-based organization offering programs 


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1 and resources aligned with evidence-based practices 

2 for improving maternal health outcomes for preg3 nant and postpartum individuals. 

4 (3) OUTREACH AND TECHNICAL ASSISTANCE

5 PERIOD.—During the 1-year period beginning on the 

6 date of enactment of this Act, the Secretary shall— 

7 (A) conduct outreach to encourage eligible 

8 entities to apply for grants under this sub9 section; and 

10 (B) provide technical assistance to eligible 

11 entities on best practices for applying for grants 

12 under this subsection. 

13 (4) SPECIAL CONSIDERATION.— 

14 (A) OUTREACH.—In conducting outreach 

15 under paragraph (3), the Secretary shall give 

16 special consideration to eligible entities that— 

17 (i) are based in, and provide support 

18 for, communities with high rates of adverse 

19 maternal health outcomes or significant ra20 cial and ethnic inequities in maternal 

21 health outcomes, to the extent such data 

22 are available; 

23 (ii) are led by individuals from ra24 cially, ethnically, and geographically di25 verse backgrounds; and 


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1 (iii) offer programs and resources that 

2 are aligned with evidence-based practices 

3 for improving maternal health outcomes 

4 for pregnant and postpartum individuals. 

5 (B) AWARDS.—In awarding grants under 

6 this subsection, the Secretary shall give special 

7 consideration to eligible entities that— 

8 (i) are described in clauses (i), (ii), 

9 and (iii) of subparagraph (A); 

10 (ii) offer programs and resources de11 signed in consultation with and intended 

12 for pregnant and postpartum individuals 

13 from underserved groups; 

14 (iii) offer programs and resources in 

15 the communities in which the respective el16 igible entities are located that— 

17 (I) promote maternal mental 

18 health and maternal substance use 

19 disorder treatments and support that 

20 are aligned with evidence-based prac21 tices for improving maternal mental 

22 and behavioral health outcomes for 

23 pregnant and postpartum individuals; 


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1 (II) address social determinants 

2 of maternal health for pregnant and 

3 postpartum individuals; 

4 (III) promote evidence-based 

5 health literacy and pregnancy, child6 birth, and parenting education for 

7 pregnant and postpartum individuals; 

8 (IV) provide support from 

9 perinatal health workers to pregnant 

10 and postpartum individuals; 

11 (V) provide culturally congruent 

12 training to perinatal health workers; 

13 (VI) conduct or support research 

14 on maternal health outcomes and in15 equities; 

16 (VII) provide support to family 

17 members of individuals who suffered a 

18 pregnancy-associated death or preg19 nancy-related death; or 

20 (VIII) operate midwifery prac21 tices that provide culturally congruent 

22 maternal health care and support, in23 cluding for the purposes of— 

24 (aa) supporting additional 

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1 cation programs, including sup2 port for distance learning; 

3 (bb) providing financial sup4 port to current and future mid5 wives to address education costs, 

6 debts, and other needs; 

7 (cc) clinical site investments; 

8 (dd) supporting preceptor 

9 development trainings; 

10 (ee) expanding the mid11 wifery practice; or 

12 (ff) related needs identified 

13 by the midwifery practice and de14 scribed in the practice’s applica15 tion; or 

16 (iv) have developed other programs 

17 and resources that address community-spe18 cific needs for pregnant and postpartum 

19 individuals and are aligned with evidence20 based practices for improving maternal 

21 health outcomes for pregnant and 

22 postpartum individuals. 

23 (5) TECHNICAL ASSISTANCE.—The Secretary 

24 shall provide to grant recipients under this sub25 section technical assistance on— 


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1 (A) capacity building to establish or ex2 pand programs to prevent adverse maternal 

3 health outcomes among pregnant and 

4 postpartum individuals from underserved 

5 groups; 

6 (B) best practices in data collection, meas7 urement, evaluation, and reporting; and 

8 (C) planning for sustaining programs to 

9 prevent maternal mortality and severe maternal 

10 morbidity among pregnant and postpartum in11 dividuals from underserved groups after the pe12 riod of the grant. 

13 (6) EVALUATION.—Not later than the end of 

14 fiscal year 2029, the Secretary shall submit to the 

15 Congress an evaluation of the grant program under 

16 this subsection that— 

17 (A) assesses the effectiveness of outreach 

18 efforts during the application process in diversi19 fying the pool of grant recipients; 

20 (B) makes recommendations for future 

21 outreach efforts to diversify the pool of grant 

22 recipients for Department of Health and 

23 Human Services grant programs and funding 

24 opportunities related to maternal health; 


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1 (C) assesses the effectiveness of programs 

2 funded by grants under this subsection in im3 proving maternal health outcomes for pregnant 

4 and postpartum individuals from underserved 

5 groups, to the extent practicable; and 

6 (D) makes recommendations for future 

7 Department of Health and Human Services 

8 grant programs and funding opportunities that 

9 deliver funding to community-based organiza10 tions that provide programs and resources that 

11 are aligned with evidence-based practices for 

12 improving maternal health outcomes for preg13 nant and postpartum individuals. 

14 (7) DEFINITION.—In this subsection, the term 

15 ‘‘underserved groups’’ refers to pregnant and 

16 postpartum individuals— 

17 (A) from racial and ethnic minority 

18 groups; 

19 (B) whose household income is equal to or 

20 less than 150 percent of the Federal poverty 

21 line; 

22 (C) who live in health professional shortage 

23 areas (as such term is defined in section 332 of 

24 the Public Health Service Act (42 U.S.C. 

25 254e)); 


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1 (D) who live in counties with no hospital 

2 offering obstetric care, no birth center, and no 

3 obstetric provider; or 

4 (E) who live in counties with a level of vul5 nerability of moderate-to-high or higher, accord6 ing to the Social Vulnerability Index of the Cen7 ters for Disease Control and Prevention. 

8 (8) AUTHORIZATION OF APPROPRIATIONS.—To 

9 carry out this subsection, there is authorized to be 

10 appropriated $10,000,000 for each of fiscal years 

11 2025 through 2029. 

12 (c) RESPECTFUL MATERNITY CARE TRAINING FOR

13 ALL EMPLOYEES IN MATERNITY CARE SETTINGS.—Part 

14 B of title VII of the Public Health Service Act (42 U.S.C. 

15 293 et seq.) (as amended by section 3002), is amended 

16 by adding at the end the following: 

17 ‘‘SEC. 743. RESPECTFUL MATERNITY CARE TRAINING FOR 

18 ALL EMPLOYEES IN MATERNITY CARE SET19 TINGS. 

20 ‘‘(a) GRANTS.—The Secretary shall award grants for 

21 programs to reduce and prevent bias, racism, and dis22 crimination in maternity care settings and to advance re23 spectful, culturally congruent, trauma-informed care. 


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1 ‘‘(b) SPECIAL CONSIDERATION.—In awarding grants 

2 under subsection (a), the Secretary shall give special con3 sideration to applications for programs that would— 

4 ‘‘(1) apply to all maternity care providers and 

5 any employees who interact with pregnant and 

6 postpartum individuals in the provider setting, in7 cluding front desk employees, sonographers, sched8 ulers, health care professionals, hospital or health 

9 system administrators, security staff, and other em10 ployees; 

11 ‘‘(2) emphasize periodic, as opposed to one12 time, trainings for all birthing professionals and em13 ployees described in paragraph (1); 

14 ‘‘(3) address implicit bias, racism, and cultural 

15 humility; 

16 ‘‘(4) be delivered in ongoing education settings 

17 for providers maintaining their licenses, with a pref18 erence for trainings that provide continuing edu19 cation units; 

20 ‘‘(5) include trauma-informed care best prac21 tices and an emphasis on shared decision making be22 tween providers and patients; 

23 ‘‘(6) include antiracism training and programs; 

24 ‘‘(7) be delivered in undergraduate programs 

25 that funnel into health professions schools; 


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1 ‘‘(8) be delivered in settings that apply to pro2 viders of the special supplemental nutrition program 

3 for women, infants, and children under section 17 of 

4 the Child Nutrition Act of 1966; 

5 ‘‘(9) integrate bias training in obstetric emer6 gency simulation trainings or related trainings; 

7 ‘‘(10) include training for emergency depart8 ment employees and emergency medical technicians 

9 on recognizing warning signs for severe pregnancy10 related complications; 

11 ‘‘(11) offer training to all maternity care pro12 viders on the value of racially, ethnically, and profes13 sionally diverse maternity care teams to provide cul14 turally congruent care; or 

15 ‘‘(12) be based on one or more programs de16 signed by a historically Black college or university or 

17 other minority-serving institution. 

18 ‘‘(c) APPLICATION.—To seek a grant under sub19 section (a), an entity shall submit an application at such 

20 time, in such manner, and containing such information as 

21 the Secretary may require. 

22 ‘‘(d) REPORTING TO SECRETARY.—Each recipient of 

23 a grant under this section shall annually submit to the 

24 Secretary a report on the status of activities conducted 

25 using the grant, including, as applicable, a description of 


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1 the impact of training provided through the grant on pa2 tient outcomes and patient experience for pregnant and 

3 postpartum individuals from racial and ethnic minority 

4 groups and their families. 

5 ‘‘(e) DISSEMINATION OF FINDINGS.—Based on the 

6 annual reports submitted pursuant to subsection (d), the 

7 Secretary— 

8 ‘‘(1) shall produce an annual report on the find9 ings resulting from programs funded through this 

10 section; 

11 ‘‘(2) shall disseminate such report to all recipi12 ents of grants under this section and to the public; 

13 and 

14 ‘‘(3) may include in such report findings on 

15 best practices for improving patient outcomes and 

16 patient experience for pregnant and postpartum in17 dividuals from racial and ethnic minority groups and 

18 their families in maternity care settings. 

19 ‘‘(f) DEFINITIONS.—In this section: 

20 ‘‘(1) The term ‘postpartum’ means the one-year 

21 period beginning on the last day of an individual’s 

22 pregnancy. 

23 ‘‘(2) The term ‘culturally congruent’ means in 

24 agreement with the preferred cultural values, beliefs, 


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1 world view, language, and practices of the health 

2 care consumer and other stakeholders. 

3 ‘‘(3) The term ‘maternity care provider’ means 

4 a health care provider who— 

5 ‘‘(A) is a physician, physician assistant, 

6 midwife who meets at a minimum the inter7 national definition of the midwife and global 

8 standards for midwifery education as estab9 lished by the International Confederation of 

10 Midwives, nurse practitioner, or clinical nurse 

11 specialist; and 

12 ‘‘(B) has a focus on maternal or perinatal 

13 health. 

14 ‘‘(4) The term ‘racial and ethnic minority 

15 group’ has the meaning given such term in section 

16 1707(g)(1). 

17 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—To 

18 carry out this section, there is authorized to be appro19 priated $5,000,000 for each of fiscal years 2025 through 

20 2029.’’. 

21 (d) STUDY ON REDUCING AND PREVENTING BIAS, 

22 RACISM, AND DISCRIMINATION IN MATERNITY CARE SET23 TINGS.— 

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

25 Human Services shall seek to enter into an agreeVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 00636 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 ment, not later than 90 days after the date of enact2 ment of this Act, with the National Academies of 

3 Sciences, Engineering, and Medicine (referred to in 

4 this subsection as the ‘‘National Academies’’) under 

5 which the National Academies agree to— 

6 (A) conduct a study on the design and im7 plementation of programs to reduce and prevent 

8 bias, racism, and discrimination in maternity 

9 care settings and to advance respectful, cul10 turally congruent, trauma-informed care; and 

11 (B) not later than 2 years after the date 

12 of enactment of this Act— 

13 (i) complete the study; and 

14 (ii) transmit a report on the results of 

15 the study to the Congress. 

16 (2) POSSIBLE TOPICS.—The agreement entered 

17 into pursuant to paragraph (1) may provide for the 

18 study of any of the following: 

19 (A) The development of a scorecard or 

20 other evaluation standards for programs de21 signed to reduce and prevent bias, racism, and 

22 discrimination in maternity care settings to as23 sess the effectiveness of such programs in im24 proving patient outcomes and patient experi25 ence for pregnant and postpartum individuals 


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1 from racial and ethnic minority groups and 

2 their families. 

3 (B) Determination of the types and fre4 quency of training to reduce and prevent bias, 

5 racism, and discrimination in maternity care 

6 settings that are demonstrated to improve pa7 tient outcomes or patient experience for preg8 nant and postpartum individuals from racial 

9 and ethnic minority groups and their families. 

10 (e) RESPECTFUL MATERNITY CARE COMPLIANCE

11 PROGRAM.— 

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

13 Human Services (referred to in this subsection as 

14 the ‘‘Secretary’’) shall award grants to accredited 

15 hospitals, health systems, and other maternity care 

16 settings to establish as an integral part of quality 

17 implementation initiatives within one or more hos18 pitals or other birth settings a respectful maternity 

19 care compliance program. 

20 (2) PROGRAM REQUIREMENTS.—A respectful 

21 maternity care compliance program funded through 

22 a grant under this subsection shall— 

23 (A) institutionalize mechanisms to allow 

24 patients receiving maternity care services, the 

25 families of such patients, or perinatal health 


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1 workers supporting such patients to report in2 stances of racism or evidence of bias on the 

3 basis of race, ethnicity, or another protected 

4 class; 

5 (B) institutionalize response mechanisms 

6 through which representatives of the program 

7 can directly follow up with the patient, if pos8 sible, and the patient’s family in a timely man9 ner; 

10 (C) prepare, and make publicly available, a 

11 hospital- or health system-wide strategy to re12 duce bias on the basis of race, ethnicity, or an13 other protected class in the delivery of mater14 nity care that includes— 

15 (i) information on the training pro16 grams to reduce and prevent bias, racism, 

17 and discrimination on the basis of race, 

18 ethnicity, or another protected class for all 

19 employees in maternity care settings; 

20 (ii) information on the number of 

21 cases reported to the compliance program; 

22 and 

23 (iii) the development of methods to 

24 routinely assess the extent to which bias, 

25 racism, or discrimination on the basis of 


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1 race, ethnicity, or another protected class 

2 are present in the delivery of maternity 

3 care to patients from racial and ethnic mi4 nority groups; 

5 (D) develop mechanisms to routinely col6 lect and publicly report hospital-level data re7 lated to patient-reported experience of care; and 

8 (E) provide annual reports to the Sec9 retary with information about each case re10 ported to the compliance program over the 

11 course of the year containing such information 

12 as the Secretary may require, such as— 

13 (i) de-identified demographic informa14 tion on the patient in the case, such as 

15 race, ethnicity, gender identity, and pri16 mary language; 

17 (ii) the content of the report from the 

18 patient or the family of the patient to the 

19 compliance program; 

20 (iii) the response from the compliance 

21 program; and 

22 (iv) to the extent applicable, institu23 tional changes made as a result of the 

24 case. 

25 (3) SECRETARY REQUIREMENTS.— 


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1 (A) PROCESSES.—Not later than 180 days 

2 after the date of enactment of this Act, the Sec3 retary shall establish processes for— 

4 (i) disseminating best practices for es5 tablishing and implementing a respectful 

6 maternity care compliance program within 

7 a hospital or other birth setting; 

8 (ii) promoting coordination and col9 laboration between hospitals, health sys10 tems, and other maternity care delivery 

11 settings on the establishment and imple12 mentation of respectful maternity care 

13 compliance programs; and 

14 (iii) evaluating the effectiveness of re15 spectful maternity care compliance pro16 grams on maternal health outcomes and 

17 patient and family experiences, especially 

18 for patients from racial and ethnic minor19 ity groups and their families. 

20 (B) STUDY.— 

21 (i) IN GENERAL.—Not later than 2 

22 years after the date of enactment of this 

23 Act, the Secretary shall, through a con24 tract with an independent research organiVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 00641 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 zation, conduct a study on strategies to ad2 dress— 

3 (I) racism or bias on the basis of 

4 race, ethnicity, or another protected 

5 class in the delivery of maternity care 

6 services; and 

7 (II) successful implementation of 

8 respectful care initiatives. 

9 (ii) COMPONENTS OF STUDY.—The 

10 study shall include the following: 

11 (I) An assessment of the reports 

12 submitted to the Secretary from the 

13 respectful maternity care compliance 

14 programs pursuant to paragraph 

15 (2)(E). 

16 (II) Based on such assessment, 

17 recommendations for potential ac18 countability mechanisms related to 

19 cases of racism or bias on the basis of 

20 race, ethnicity, or another protected 

21 class in the delivery of maternity care 

22 services at hospitals and other birth 

23 settings. Such recommendations shall 

24 take into consideration medical and 

25 non-medical factors that contribute to 


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1 adverse patient experiences and ma2 ternal health outcomes. 

3 (iii) REPORT.—The Secretary shall 

4 submit to the Congress, and make publicly 

5 available, a report on the results of the 

6 study under this subparagraph. 

7 (4) AUTHORIZATION OF APPROPRIATIONS.—To 

8 carry out this subsection, there is authorized to be 

9 appropriated such sums as may be necessary for fis10 cal years 2025 through 2030. 

11 (f) GAO REPORT.— 

12 (1) IN GENERAL.—Not later than 2 years after 

13 the date of enactment of this Act and annually 

14 thereafter, the Comptroller General of the United 

15 States shall submit to the Congress, and make pub16 licly available, a report on the establishment of re17 spectful maternity care compliance programs within 

18 hospitals, health systems, and other maternity care 

19 settings. 

20 (2) MATTERS INCLUDED.—The report under 

21 paragraph (1) shall include the following: 

22 (A) Information regarding the extent to 

23 which hospitals, health systems, and other ma24 ternity care settings have elected to establish 


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1 respectful maternity care compliance programs, 

2 including— 

3 (i) which hospitals and other birth 

4 settings elect to establish compliance pro5 grams and when such programs are estab6 lished; 

7 (ii) to the extent practicable, impacts 

8 of the establishment of such programs on 

9 maternal health outcomes and patient and 

10 family experiences in the hospitals and 

11 other birth settings that have established 

12 such programs, especially for patients from 

13 racial and ethnic minority groups and their 

14 families; 

15 (iii) information on geographic areas, 

16 and types of hospitals or other birth set17 tings, where respectful maternity care com18 pliance programs are not being established 

19 and information on factors contributing to 

20 decisions to not establish such programs; 

21 and 

22 (iv) recommendations for establishing 

23 respectful maternity care compliance pro24 grams in geographic areas, and types of 


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1 hospitals or other birth settings, where 

2 such programs are not being established. 

3 (B) Whether the funding made available to 

4 carry out this subsection has been sufficient 

5 and, if applicable, recommendations for addi6 tional appropriations to carry out this sub7 section. 

8 (C) Such other information as the Comp9 troller General determines appropriate. 

10 (g) DEFINITIONS.—In this section: 

11 (1) CULTURALLY CONGRUENT.—The term ‘‘cul12 turally congruent’’, with respect to care or maternity 

13 care, means care that is in agreement with the pre14 ferred cultural values, beliefs, worldview, language, 

15 and practices of the health care consumer and other 

16 stakeholders. 

17 (2) MATERNITY CARE PROVIDER.—The term 

18 ‘‘maternity care provider’’ means a health care pro19 vider who— 

20 (A) is a physician, physician assistant, 

21 midwife who meets at a minimum the inter22 national definition of the midwife and global 

23 standards for midwifery education as estab24 lished by the International Confederation of 


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1 Midwives, nurse practitioner, or clinical nurse 

2 specialist; and 

3 (B) has a focus on maternal or perinatal 

4 health. 

5 (3) MATERNAL MORTALITY.—The term ‘‘mater6 nal mortality’’ means a death occurring during or 

7 within a one-year period after pregnancy, caused by 

8 pregnancy-related or childbirth complications, in9 cluding a suicide, overdose, or other death resulting 

10 from a mental health or substance use disorder at11 tributed to or aggravated by pregnancy-related or 

12 childbirth complications. 

13 (4) PERINATAL HEALTH WORKER.—The term 

14 ‘‘perinatal health worker’’ means a doula, commu15 nity health worker, peer supporter, breastfeeding 

16 and lactation educator or counselor, nutritionist or 

17 dietitian, childbirth educator, social worker, home 

18 visitor, language interpreter, or navigator. 

19 (5) POSTPARTUM AND POSTPARTUM PERIOD.— 

20 The terms ‘‘postpartum’’ and ‘‘postpartum period’’ 

21 refer to the 1-year period beginning on the last day 

22 of the pregnancy of an individual. 

23 (6) PREGNANCY-ASSOCIATED DEATH.—The 

24 term ‘‘pregnancy-associated death’’ means a death of 

25 a pregnant or postpartum individual, by any cause, 


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1 that occurs during, or within 1 year following, the 

2 individual’s pregnancy, regardless of the outcome, 

3 duration, or site of the pregnancy. 

4 (7) PREGNANCY-RELATED DEATH.—The term 

5 ‘‘pregnancy-related death’’ means a death of a preg6 nant or postpartum individual that occurs during, or 

7 within 1 year following, the individual’s pregnancy, 

8 from a pregnancy complication, a chain of events 

9 initiated by pregnancy, or the aggravation of an un10 related condition by the physiologic effects of preg11 nancy. 

12 (8) RACIAL AND ETHNIC MINORITY GROUP.— 

13 The term ‘‘racial and ethnic minority group’’ has the 

14 meaning given such term in section 1707(g)(1) of 

15 the Public Health Service Act (42 U.S.C. 300u– 

16 6(g)(1)). 

17 (9) SEVERE MATERNAL MORBIDITY.—The term 

18 ‘‘severe maternal morbidity’’ means a health condi19 tion, including mental health conditions and sub20 stance use disorders, attributed to or aggravated by 

21 pregnancy or childbirth that results in significant 

22 short-term or long-term consequences to the health 

23 of the individual who was pregnant. 

24 (10) SOCIAL DETERMINANTS OF MATERNAL

25 HEALTH DEFINED.—The term ‘‘social determinants 


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1 of maternal health’’ means non-clinical factors that 

2 impact maternal health outcomes, including— 

3 (A) economic factors, which may include 

4 poverty, employment, food security, support for 

5 and access to lactation and other infant feeding 

6 options, housing stability, and related factors; 

7 (B) neighborhood factors, which may in8 clude quality of housing, access to transpor9 tation, access to child care, availability of 

10 healthy foods and nutrition counseling, avail11 ability of clean water, air and water quality, 

12 ambient temperatures, neighborhood crime and 

13 violence, access to broadband, and related fac14 tors; 

15 (C) social and community factors, which 

16 may include systemic racism, gender discrimi17 nation or discrimination based on other pro18 tected classes, workplace conditions, incarcer19 ation, and related factors; 

20 (D) household factors, which may include 

21 ability to conduct lead testing and abatement, 

22 car seat installation, indoor air temperatures, 

23 and related factors; 


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1 (E) education access and quality factors, 

2 which may include educational attainment, lan3 guage and literacy, and related factors; and 

4 (F) health care access factors, including 

5 health insurance coverage, access to culturally 

6 congruent health care services, providers, and 

7 non-clinical support, access to home visiting 

8 services, access to wellness and stress manage9 ment programs, health literacy, access to tele10 health and items required to receive telehealth 

11 services, and related factors. 

12 SEC. 5205. PERINATAL WORKFORCE. 

13 (a) HHS AGENCY DIRECTIVES.— 

14 (1) GUIDANCE TO STATES.— 

15 (A) IN GENERAL.—Not later than 2 years 

16 after the date of enactment of this Act, the Sec17 retary of Health and Human Services shall 

18 issue and disseminate guidance to States to 

19 educate providers, managed care entities, and 

20 other insurers about the value and process of 

21 delivering respectful maternal health care 

22 through diverse and multidisciplinary care pro23 vider models. 

24 (B) CONTENTS.—The guidance required 

25 by subparagraph (A) shall address how States 


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1 can encourage and incentivize hospitals, health 

2 systems, midwifery practices, freestanding birth 

3 centers, other maternity care provider groups, 

4 managed care entities, and other insurers— 

5 (i) to recruit and retain maternity 

6 care providers, mental and behavioral 

7 health care providers acting in accordance 

8 with State law, registered dietitians or nu9 trition professionals (as such term is de10 fined in section 1861(vv)(2) of the Social 

11 Security Act (42 U.S.C. 1395x(vv)(2))), 

12 and lactation consultants certified by the 

13 International Board of Lactation Consult14 ants Examiners— 

15 (I) from racially, ethnically, and 

16 linguistically diverse backgrounds; 

17 (II) with experience practicing in 

18 racially and ethnically diverse commu19 nities; and 

20 (III) who have undergone train21 ing on implicit bias and racism; 

22 (ii) to incorporate into maternity care 

23 teams— 

24 (I) midwives who meet, at a min25 imum, the international definition of 


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1 the midwife and global standards for 

2 midwifery education, as established by 

3 the International Confederation of 

4 Midwives; and 

5 (II) perinatal health workers; 

6 (iii) to provide collaborative, culturally 

7 congruent care; and 

8 (iv) to provide opportunities for indi9 viduals enrolled in accredited midwifery 

10 education programs to participate in job 

11 shadowing with maternity care teams in 

12 hospitals, health systems, midwifery prac13 tices, and freestanding birth centers. 

14 (2) STUDY ON RESPECTFUL AND CULTURALLY

15 CONGRUENT MATERNITY CARE.— 

16 (A) STUDY.—The Secretary of Health and 

17 Human Services, acting through the Director of 

18 the National Institutes of Health (in this para19 graph referred to as the ‘‘Secretary’’), shall 

20 conduct a study on best practices in respectful 

21 and culturally congruent maternity care. 

22 (B) REPORT.—Not later than 2 years after 

23 the date of enactment of this Act, the Secretary 

24 shall— 


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1 (i) complete the study required by 

2 subparagraph (A); 

3 (ii) submit to the Congress, and make 

4 publicly available, a report on the results 

5 of such study; and 

6 (iii) include in such report— 

7 (I) a compendium of examples of 

8 hospitals, health systems, midwifery 

9 practices, freestanding birth centers, 

10 other maternity care provider groups, 

11 managed care entities, and other in12 surers that are delivering respectful 

13 and culturally congruent maternal 

14 health care; 

15 (II) a compendium of examples 

16 of hospitals, health systems, midwifery 

17 practices, freestanding birth centers, 

18 other maternity care provider groups, 

19 managed care entities, and other in20 surers that have made progress in re21 ducing inequities in maternal health 

22 outcomes and improving birthing ex23 periences for pregnant and 

24 postpartum individuals from racial 

25 and ethnic minority groups; and 


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1 (III) recommendations to hos2 pitals, health systems, midwifery prac3 tices, freestanding birth centers, other 

4 maternity care provider groups, man5 aged care entities, and other insurers, 

6 for best practices in respectful and 

7 culturally congruent maternity care. 

8 (b) GRANTS TO GROW AND DIVERSIFY THE

9 PERINATAL WORKFORCE.—Title VII of the Public Health 

10 Service Act is amended by inserting after section 757 (42 

11 U.S.C. 294f) the following: 

12 ‘‘SEC. 758. PERINATAL WORKFORCE GRANTS. 

13 ‘‘(a) IN GENERAL.—The Secretary shall award 

14 grants to entities to establish or expand programs de15 scribed in subsection (b) to grow and diversify the 

16 perinatal workforce. 

17 ‘‘(b) USE OF FUNDS.—Recipients of grants under 

18 this section shall use the grants to grow and diversify the 

19 perinatal workforce by— 

20 ‘‘(1) establishing schools or programs that pro21 vide education and training to individuals seeking 

22 appropriate licensing or certification as— 

23 ‘‘(A) physician assistants who will complete 

24 clinical training in the field of maternal and 

25 perinatal health; or 


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1 ‘‘(B) perinatal health workers; and 

2 ‘‘(2) expanding the capacity of existing schools 

3 or programs described in paragraph (1), for the pur4 poses of increasing the number of students enrolled 

5 in such schools or programs, including by awarding 

6 scholarships for students. 

7 ‘‘(c) PRIORITIZATION.—In awarding grants under 

8 this section, the Secretary shall give priority to any entity 

9 that— 

10 ‘‘(1) has demonstrated a commitment to re11 cruiting and retaining students and faculty from ra12 cial and ethnic minority groups; 

13 ‘‘(2) has developed a strategy to recruit and re14 tain a diverse pool of students into the perinatal 

15 workforce program or school supported by funds re16 ceived through the grant, particularly from racial 

17 and ethnic minority groups and other underserved 

18 populations; 

19 ‘‘(3) has developed a strategy to recruit and re20 tain students who plan to practice in a health pro21 fessional shortage area designated under section 

22 332; 

23 ‘‘(4) has developed a strategy to recruit and re24 tain students who plan to practice in an area with 


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1 significant racial and ethnic inequities in maternal 

2 health outcomes, to the extent practicable; and 

3 ‘‘(5) includes in the standard curriculum for all 

4 students within the perinatal workforce program or 

5 school a bias, racism, or discrimination training pro6 gram that includes training on implicit bias and rac7 ism. 

8 ‘‘(d) REPORTING.—As a condition on receipt of a 

9 grant under this section for a perinatal workforce program 

10 or school, an entity shall agree to submit to the Secretary 

11 an annual report on the activities conducted through the 

12 grant, including— 

13 ‘‘(1) the number and demographics of students 

14 participating in the program or school; 

15 ‘‘(2) the extent to which students in the pro16 gram or school are entering careers in— 

17 ‘‘(A) health professional shortage areas 

18 designated under section 332; and 

19 ‘‘(B) areas with significant racial and eth20 nic inequities in maternal health outcomes, to 

21 the extent such data are available; and 

22 ‘‘(3) whether the program or school has in23 cluded in the standard curriculum for all students a 

24 bias, racism, or discrimination training program that 


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1 includes explicit and implicit bias, and if so the ef2 fectiveness of such training program. 

3 ‘‘(e) PERIOD OF GRANTS.—The period of a grant 

4 under this section shall not exceed 5 years. 

5 ‘‘(f) APPLICATION.—To seek a grant under this sec6 tion, an entity shall submit to the Secretary an application 

7 at such time, in such manner, and containing such infor8 mation as the Secretary may require, including any infor9 mation necessary for prioritization under subsection (c). 

10 ‘‘(g) TECHNICAL ASSISTANCE.—The Secretary shall 

11 provide, directly or by contract, technical assistance to en12 tities seeking or receiving a grant under this section on 

13 the development, use, evaluation, and post-grant period 

14 sustainability of the perinatal workforce programs or 

15 schools proposed to be, or being, established or expanded 

16 through the grant. 

17 ‘‘(h) REPORT BY THE SECRETARY.—Not later than 

18 4 years after the date of enactment of this section, the 

19 Secretary shall prepare and submit to the Congress, and 

20 post on the internet website of the Department of Health 

21 and Human Services, a report on the effectiveness of the 

22 grant program under this section at— 

23 ‘‘(1) recruiting students from racial and ethnic 

24 minority groups; 


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1 ‘‘(2) increasing the number of physician assist2 ants who will complete clinical training in the field 

3 of maternal and perinatal health, and perinatal 

4 health workers, from racial and ethnic minority 

5 groups and other underserved populations; 

6 ‘‘(3) increasing the number of physician assist7 ants who will complete clinical training in the field 

8 of maternal and perinatal health, and perinatal 

9 health workers, working in health professional short10 age areas designated under section 332; and 

11 ‘‘(4) increasing the number of physician assist12 ants who will complete clinical training in the field 

13 of maternal and perinatal health, and perinatal 

14 health workers, working in areas with significant ra15 cial and ethnic inequities in maternal health out16 comes, to the extent such data are available. 

17 ‘‘(i) DEFINITION.—In this section, the term ‘racial 

18 and ethnic minority group’ has the meaning given such 

19 term in section 1707(g). 

20 ‘‘(j) AUTHORIZATION OF APPROPRIATIONS.—To 

21 carry out this section, there is authorized to be appro22 priated $15,000,000 for each of fiscal years 2025 through 

23 2029.’’. 

24 (c) GRANTS TO GROW AND DIVERSIFY THE NURSING

25 WORKFORCE IN MATERNAL AND PERINATAL HEALTH.— 


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1 Title VIII of the Public Health Service Act is amended 

2 by inserting after section 811 (42 U.S.C. 296j) the fol3 lowing: 

4 ‘‘SEC. 812. PERINATAL NURSING WORKFORCE GRANTS. 

5 ‘‘(a) IN GENERAL.—The Secretary shall award 

6 grants to schools of nursing to grow and diversify the 

7 perinatal nursing workforce. 

8 ‘‘(b) USE OF FUNDS.—Recipients of grants under 

9 this section shall use the grants to grow and diversify the 

10 perinatal nursing workforce by providing scholarships to 

11 students seeking to become— 

12 ‘‘(1) nurse practitioners whose education in13 cludes a focus on maternal and perinatal health; or 

14 ‘‘(2) clinical nurse specialists whose education 

15 includes a focus on maternal and perinatal health. 

16 ‘‘(c) PRIORITIZATION.—In awarding grants under 

17 this section, the Secretary shall give priority to any school 

18 of nursing that— 

19 ‘‘(1) has developed a strategy to recruit and re20 tain a diverse pool of students seeking to enter ca21 reers focused on maternal and perinatal health, par22 ticularly students from racial and ethnic minority 

23 groups and other underserved populations; 

24 ‘‘(2) has developed a partnership with a prac25 tice setting in a health professional shortage area 


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1 designated under section 332 for the clinical place2 ments of the school’s students; 

3 ‘‘(3) has developed a strategy to recruit and re4 tain students who plan to practice in an area with 

5 significant racial and ethnic inequities in maternal 

6 health outcomes, to the extent practicable; and 

7 ‘‘(4) includes in the standard curriculum for all 

8 students seeking to enter careers focused on mater9 nal and perinatal health a bias, racism, or discrimi10 nation training program that includes education on 

11 implicit bias and racism. 

12 ‘‘(d) REPORTING.—As a condition on receipt of a 

13 grant under this section, a school of nursing shall agree 

14 to submit to the Secretary an annual report on the activi15 ties conducted through the grant, including, to the extent 

16 practicable— 

17 ‘‘(1) the number and demographics of students 

18 in the school of nursing seeking to enter careers fo19 cused on maternal and perinatal health; 

20 ‘‘(2) the extent to which such students are pre21 paring to enter careers in— 

22 ‘‘(A) health professional shortage areas 

23 designated under section 332; and 


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1 ‘‘(B) areas with significant racial and eth2 nic inequities in maternal health outcomes, to 

3 the extent such data are available; and 

4 ‘‘(3) whether the standard curriculum for all 

5 students seeking to enter careers focused on mater6 nal and perinatal health includes a bias, racism, or 

7 discrimination training program that includes edu8 cation on implicit bias and racism. 

9 ‘‘(e) PERIOD OF GRANTS.—The period of a grant 

10 under this section shall be up to 5 years. 

11 ‘‘(f) APPLICATION.—To seek a grant under this sec12 tion, an entity shall submit to the Secretary an applica13 tion, at such time, in such manner, and containing such 

14 information as the Secretary may require, including any 

15 information necessary for prioritization under subsection 

16 (c). 

17 ‘‘(g) TECHNICAL ASSISTANCE.—The Secretary shall 

18 provide, directly or by contract, technical assistance to 

19 schools of nursing seeking or receiving a grant under this 

20 section on the processes of awarding and evaluating schol21 arships through the grant. 

22 ‘‘(h) REPORT BY THE SECRETARY.—Not later than 

23 4 years after the date of enactment of this section, the 

24 Secretary shall prepare and submit to the Congress, and 

25 post on the internet website of the Department of Health 


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1 and Human Services, a report on the effectiveness of the 

2 grant program under this section at— 

3 ‘‘(1) recruiting students from racial and ethnic 

4 minority groups and other underserved populations; 

5 ‘‘(2) increasing the number of nurse practi6 tioners and clinical nurse specialists entering careers 

7 focused on maternal and perinatal health from racial 

8 and ethnic minority groups and other underserved 

9 populations; 

10 ‘‘(3) increasing the number of nurse practi11 tioners and clinical nurse specialists entering careers 

12 focused on maternal and perinatal health working in 

13 health professional shortage areas designated under 

14 section 332; and 

15 ‘‘(4) increasing the number of nurse practi16 tioners and clinical nurse specialists entering careers 

17 focused on maternal and perinatal health working in 

18 areas with significant racial and ethnic inequities in 

19 maternal health outcomes, to the extent such data 

20 are available. 

21 ‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—To 

22 carry out this section, there is authorized to be appro23 priated $15,000,000 for each of fiscal years 2025 through 

24 2029.’’. 

25 (d) GAO REPORT.— 


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1 (1) IN GENERAL.—Not later than 2 years after 

2 the date of enactment of this Act, and every 5 years 

3 thereafter, the Comptroller General of the United 

4 States shall submit to Congress a report on barriers 

5 to maternal health education and access to care in 

6 the United States. Such report shall include the in7 formation and recommendations described in para8 graph (2). 

9 (2) CONTENT OF REPORT.—The report under 

10 paragraph (1) shall include— 

11 (A) an assessment of current barriers to 

12 entering accredited midwifery education pro13 grams, and recommendations for addressing 

14 such barriers, particularly for low-income people 

15 and people from racial and ethnic minority 

16 groups; 

17 (B) an assessment of current barriers to 

18 entering and successfully completing accredited 

19 education programs for other health profes20 sional careers related to maternity care, includ21 ing maternity care providers, mental and behav22 ioral health care providers acting in accordance 

23 with State law, registered dietitians or nutrition 

24 professionals (as such term is defined in section 

25 1861(vv)(2) of the Social Security Act (42 


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1 U.S.C. 1395x(vv)(2))), and lactation consult2 ants certified by the International Board of 

3 Lactation Consultants Examiners, particularly 

4 for low-income people and people from racial 

5 and ethnic minority groups; 

6 (C) an assessment of current barriers that 

7 prevent midwives from meeting the inter8 national definition of the midwife and global 

9 standards for midwifery education as estab10 lished by the International Confederation of 

11 Midwives, and recommendations for addressing 

12 such barriers, particularly for low-income people 

13 and people from racial and ethnic minority 

14 groups; 

15 (D) an assessment of inequities in access 

16 to maternity care providers, mental or behav17 ioral health care providers acting in accordance 

18 with State law, registered dietitians or nutrition 

19 professionals (as such term is defined in section 

20 1861(vv)(2) of the Social Security Act (42 

21 U.S.C. 1395x(vv)(2))), lactation consultants 

22 certified by the International Board of Lacta23 tion Consultants Examiners, and perinatal 

24 health workers, stratified by race, ethnicity, 

25 gender identity, geographic location, and insurVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 00663 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 ance type and recommendations to promote 

2 greater access equity; and 

3 (E) recommendations to promote greater 

4 equity in compensation for perinatal health 

5 workers under public and private insurers, par6 ticularly for such individuals from racially and 

7 ethnically diverse backgrounds. 

8 (e) DEFINITIONS.—In this section: 

9 (1) CULTURALLY CONGRUENT.—The term ‘‘cul10 turally congruent’’, with respect to care or maternity 

11 care, means care that is in agreement with the pre12 ferred cultural values, beliefs, worldview, language, 

13 and practices of the health care consumer and other 

14 stakeholders. 

15 (2) MATERNITY CARE PROVIDER.—The term 

16 ‘‘maternity care provider’’ means a health care pro17 vider who— 

18 (A) is a physician, physician assistant, 

19 midwife who meets at a minimum the inter20 national definition of the midwife and global 

21 standards for midwifery education as estab22 lished by the International Confederation of 

23 Midwives, nurse practitioner, or clinical nurse 

24 specialist; and 


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1 (B) has a focus on maternal or perinatal 

2 health. 

3 (3) PERINATAL HEALTH WORKER.—The term 

4 ‘‘perinatal health worker’’ means a doula, commu5 nity health worker, peer supporter, breastfeeding 

6 and lactation educator or counselor, nutritionist or 

7 dietitian, childbirth educator, social worker, home 

8 visitor, language interpreter, or navigator. 

9 (4) POSTPARTUM.—The terms ‘‘postpartum’’ 

10 refers to the 1-year period beginning on the last day 

11 of the pregnancy of an individual. 

12 (5) RACIAL AND ETHNIC MINORITY GROUP.— 

13 The term ‘‘racial and ethnic minority group’’ has the 

14 meaning given such term in section 1707(g)(1) of 

15 the Public Health Service Act (42 U.S.C. 300u– 

16 6(g)(1)). 

17 SEC. 5206. DATA TO SAVE MOMS ACT. 

18 (a) SHORT TITLE.—This section may be cited as the 

19 ‘‘Data To Save Moms Act’’. 

20 (b) FUNDING FOR MATERNAL MORTALITY REVIEW

21 COMMITTEES TO PROMOTE REPRESENTATIVE COMMU22 NITY ENGAGEMENT.— 

23 (1) IN GENERAL.—Section 317K(d) of the Pub24 lic Health Service Act (42 U.S.C. 247b–12(d)) is 

25 amended by adding at the end the following: 


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1 ‘‘(9) GRANTS TO PROMOTE REPRESENTATIVE

2 COMMUNITY ENGAGEMENT IN MATERNAL MOR3 TALITY REVIEW COMMITTEES.— 

4 ‘‘(A) IN GENERAL.—The Secretary may, 

5 using funds made available pursuant to sub6 paragraph (C), provide assistance to an applica7 ble maternal mortality review committee of a 

8 State, Indian tribe, tribal organization, or 

9 Urban Indian organization (as such terms are 

10 defined in section 4 of the Indian Health Care 

11 Improvement Act)— 

12 ‘‘(i) to select for inclusion in the mem13 bership of such a committee community 

14 members from the State, Indian tribe, trib15 al organization, or Urban Indian organiza16 tion by— 

17 ‘‘(I) prioritizing community mem18 bers who can increase the diversity of 

19 the committee’s membership with re20 spect to race and ethnicity, location, 

21 and professional background, includ22 ing members with non-clinical experi23 ences; and 

24 ‘‘(II) to the extent applicable, 

25 using funds reserved under subsection 


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1 (f), to address barriers to maternal 

2 mortality review committee participa3 tion for community members, includ4 ing through providing required train5 ing, reducing transportation barriers, 

6 providing compensation, and providing 

7 other supports as may be necessary; 

8 ‘‘(ii) to establish initiatives to conduct 

9 outreach and community engagement ef10 forts within communities throughout the 

11 State or Indian tribe to seek input from 

12 community members on the work of such 

13 maternal mortality review committee, with 

14 a particular focus on outreach to people 

15 who are members of minority groups; and 

16 ‘‘(iii) to release public reports assess17 ing— 

18 ‘‘(I) the pregnancy-related death 

19 and pregnancy-associated death review 

20 processes of the maternal mortality 

21 review committee, with a particular 

22 focus on the maternal mortality re23 view committee’s sensitivity to the 

24 unique circumstances of pregnant and 

25 postpartum individuals from racial 


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1 and ethnic minority groups (as such 

2 term is defined in section 1707(g)(1)) 

3 who have suffered pregnancy-related 

4 deaths; and 

5 ‘‘(II) the impact of the use of 

6 funds made available pursuant to 

7 paragraph (C) on increasing the diver8 sity of the maternal mortality review 

9 committee membership and promoting 

10 community engagement efforts 

11 throughout the State or Indian tribe. 

12 ‘‘(B) TECHNICAL ASSISTANCE.—The Sec13 retary shall provide (either directly through the 

14 Department of Health and Human Services or 

15 by contract) technical assistance to any mater16 nal mortality review committee receiving a 

17 grant under this paragraph on best practices 

18 for increasing the diversity of the maternal 

19 mortality review committee’s membership and 

20 for conducting effective community engagement 

21 throughout the State or Indian tribe. 

22 ‘‘(C) AUTHORIZATION OF APPROPRIA23 TIONS.—In addition to any funds made avail24 able under subsection (f), there are authorized 

25 to be appropriated to carry out this paragraph 


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1 $10,000,000 for each of fiscal years 2025 

2 through 2029.’’. 

3 (2) RESERVATION OF FUNDS.—Section 317K(f) 

4 of the Public Health Service Act (42 U.S.C. 247b– 

5 12(f)) is amended by adding at the end the fol6 lowing: ‘‘Of the amount made available under the 

7 preceding sentence for a fiscal year, not less than 

8 $1,500,000 shall be reserved for grants awarded 

9 under subsection (d)(9) to Indian tribes, tribal orga10 nizations, or Urban Indian organizations (as such 

11 terms are defined in section 4 of the Indian Health 

12 Care Improvement Act).’’. 

13 (c) DATA COLLECTION AND REVIEW.—Section 

14 317K(d)(3)(A)(i) of the Public Health Service Act (42 

15 U.S.C. 247b–12(d)(3)(A)(i)) is amended— 

16 (1) by redesignating subclauses (II) and (III) 

17 as subclauses (V) and (VI), respectively; and 

18 (2) by inserting after subclause (I) the fol19 lowing: 

20 ‘‘(II) to the extent practicable, 

21 reviewing cases of severe maternal 

22 morbidity, according to the most up23 to-date indicators; 

24 ‘‘(III) to the extent practicable, 

25 reviewing deaths during pregnancy or 


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1 up to 1 year after the end of a preg2 nancy from suicide, overdose, or other 

3 death from a mental health condition 

4 or substance use disorder attributed 

5 to, or aggravated by, pregnancy or 

6 childbirth complications; 

7 ‘‘(IV) to the extent practicable, 

8 consulting with local community-based 

9 organizations representing pregnant 

10 and postpartum individuals from de11 mographic groups disproportionately 

12 impacted by poor maternal health out13 comes to ensure that, in addition to 

14 clinical factors, non-clinical factors 

15 that might have contributed to a preg16 nancy-related death are appropriately 

17 considered;’’. 

18 (d) REVIEW OF MATERNAL HEALTH DATA COLLEC19 TION PROCESSES AND QUALITY MEASURES.— 

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

21 Human Services, acting through the Administrator 

22 for the Centers for Medicare & Medicaid Services 

23 and the Director of the Agency for Healthcare Re24 search and Quality (referred to in this subsection as 


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1 the ‘‘Secretary’’), shall consult with relevant stake2 holders— 

3 (A) to review existing maternal health data 

4 collection processes and quality measures; and 

5 (B) to make recommendations to improve 

6 such processes and measures, including topics 

7 described in paragraph (3). 

8 (2) COLLABORATION.—In carrying out this sub9 section, the Secretary shall consult with a diverse 

10 group of maternal health stakeholders, which may 

11 include— 

12 (A) pregnant and postpartum individuals 

13 and their family members, and nonprofit orga14 nizations representing such individuals, with a 

15 particular focus on patients from racial and 

16 ethnic minority groups; 

17 (B) community-based organizations that 

18 provide support for pregnant and postpartum 

19 individuals, with a particular focus on patients 

20 from racial and ethnic minority groups; 

21 (C) membership organizations for mater22 nity care providers; 

23 (D) organizations representing perinatal 

24 health workers; 


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1 (E) organizations that focus on maternal 

2 mental or behavioral health; 

3 (F) organizations that focus on intimate 

4 partner violence; 

5 (G) institutions of higher education, with a 

6 particular focus on minority-serving institu7 tions; 

8 (H) licensed and accredited hospitals, birth 

9 centers, midwifery practices, or other medical 

10 practices that provide maternal health care 

11 services to pregnant and postpartum patients; 

12 (I) relevant State and local public agencies, 

13 including State maternal mortality review com14 mittees; and 

15 (J) the National Quality Forum, or such 

16 other standard-setting organizations specified 

17 by the Secretary. 

18 (3) TOPICS.—The review of maternal health 

19 data collection processes and recommendations to 

20 improve such processes and measures required under 

21 paragraph (1) shall assess all available relevant in22 formation, including information from State-level 

23 sources, and shall consider at least the following: 

24 (A) Current State and Tribal practices for 

25 maternal health, maternal mortality, and severe 


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1 maternal morbidity data collection and dissemi2 nation, including consideration of— 

3 (i) the timeliness of processes for 

4 amending a death certificate when new in5 formation pertaining to the death becomes 

6 available to reflect whether the death was 

7 a pregnancy-related death; 

8 (ii) relevant data collected with elec9 tronic health records, including data on 

10 race, ethnicity, socioeconomic status, insur11 ance type, and other relevant demographic 

12 information; 

13 (iii) maternal health data collected 

14 and publicly reported by hospitals, health 

15 systems, midwifery practices, and birth 

16 centers; 

17 (iv) the barriers preventing States 

18 from correlating maternal outcome data 

19 with race and ethnicity data; 

20 (v) processes for determining the 

21 cause of a pregnancy-associated death in 

22 States that do not have a maternal mor23 tality review committee; 

24 (vi) whether maternal mortality review 

25 committees include multidisciplinary and 


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1 diverse membership (as described in sec2 tion 317K(d)(1)(A) of the Public Health 

3 Service Act (42 U.S.C. 247b– 

4 12(d)(1)(A))); 

5 (vii) whether members of maternal 

6 mortality review committees participate in 

7 trainings on bias, racism, or discrimina8 tion, and the quality of such trainings; 

9 (viii) the extent to which States have 

10 implemented systematic processes of listen11 ing to the stories of pregnant and 

12 postpartum individuals and their family 

13 members, with a particular focus on preg14 nant and postpartum individuals from ra15 cial and ethnic minority groups and their 

16 family members, to fully understand the 

17 causes of, and inform potential solutions 

18 to, the maternal mortality and severe ma19 ternal morbidity crisis within their respec20 tive States; 

21 (ix) the extent to which maternal mor22 tality review committees are considering 

23 social determinants of maternal health 

24 when examining the causes of pregnancy25 associated and pregnancy-related deaths; 


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1 (x) the extent to which maternal mor2 tality review committees are making ac3 tionable recommendations based on their 

4 reviews of adverse maternal health out5 comes and the extent to which such rec6 ommendations are being implemented by 

7 appropriate stakeholders; 

8 (xi) the legal and administrative bar9 riers preventing the collection, collation, 

10 and dissemination of State maternity care 

11 data; 

12 (xii) the effectiveness of data collec13 tion and reporting processes in separating 

14 pregnancy-associated deaths from preg15 nancy-related deaths; and 

16 (xiii) the current Federal, State, local, 

17 and Tribal funding support for the activi18 ties referred to in clauses (i) through (xii). 

19 (B) Whether the funding support referred 

20 to in subparagraph (A)(xiii) is adequate for 

21 States to carry out optimal data collection and 

22 dissemination processes with respect to mater23 nal health, maternal mortality, and severe ma24 ternal morbidity. 


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1 (C) Current quality measures for mater2 nity care, including prenatal measures, labor 

3 and delivery measures, and postpartum meas4 ures, including topics such as— 

5 (i) effective quality measures for ma6 ternity care used by hospitals, health sys7 tems, midwifery practices, birth centers, 

8 health plans, and other relevant entities; 

9 (ii) the sufficiency of current outcome 

10 measures used to evaluate maternity care 

11 for driving improved care, experiences, and 

12 outcomes in maternity care payment and 

13 delivery system models; 

14 (iii) maternal health quality measures 

15 that other countries effectively use; 

16 (iv) validated measures that have been 

17 used for research purposes that could be 

18 tested, refined, and submitted for national 

19 endorsement; 

20 (v) barriers preventing maternity care 

21 providers and insurers from implementing 

22 quality measures that are aligned with best 

23 practices; 


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1 (vi) the frequency with which mater2 nity care quality measures are reviewed 

3 and revised; 

4 (vii) the strengths and weaknesses of 

5 the Prenatal and Postpartum Care meas6 ures of the Health Plan Employer Data 

7 and Information Set measures established 

8 by the National Committee for Quality As9 surance; 

10 (viii) the strengths and weaknesses of 

11 maternity care quality measures under the 

12 Medicaid program under title XIX of the 

13 Social Security Act (42 U.S.C. 1396 et 

14 seq.) and the Children’s Health Insurance 

15 Program under title XXI of such Act (42 

16 U.S.C. 1397aa et seq.), including the ex17 tent to which States voluntarily report rel18 evant measures; 

19 (ix) the extent to which maternity 

20 care quality measures are informed by pa21 tient experiences that include measures of 

22 patient-reported experience of care; 

23 (x) the current processes for collecting 

24 stratified data on the race and ethnicity of 

25 pregnant and postpartum individuals in 


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1 hospitals, health systems, midwifery prac2 tices, and birth centers, and for incor3 porating such racially and ethnically strati4 fied data in maternity care quality meas5 ures; 

6 (xi) the extent to which maternity 

7 care quality measures account for the 

8 unique experiences of pregnant and 

9 postpartum individuals from racial and 

10 ethnic minority groups; and 

11 (xii) the extent to which hospitals, 

12 health systems, midwifery practices, and 

13 birth centers are implementing existing 

14 maternity care quality measures. 

15 (D) Recommendations on authorizing addi16 tional funds and providing additional technical 

17 assistance to improve maternal mortality review 

18 committees and State and Tribal maternal 

19 health data collection and reporting processes. 

20 (E) Recommendations for new authorities 

21 that may be granted to maternal mortality re22 view committees to be able to— 

23 (i) access records from other Federal 

24 and State agencies and departments that 

25 may be necessary to identify causes of 


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1 pregnancy-associated and pregnancy-re2 lated deaths that are unique to pregnant 

3 and postpartum individuals from specific 

4 populations, such as veterans and individ5 uals who are incarcerated; and 

6 (ii) work with relevant experts who 

7 are not members of the maternal mortality 

8 review committee to assist in the review of 

9 pregnancy-associated deaths of pregnant 

10 and postpartum individuals from specific 

11 populations, such as veterans and individ12 uals who are incarcerated. 

13 (F) Recommendations to improve and 

14 standardize current quality measures for mater15 nity care, with a particular focus on racial and 

16 ethnic inequities in maternal health outcomes. 

17 (G) Recommendations to improve the co18 ordination by the Department of Health and 

19 Human Services of the efforts undertaken by 

20 the agencies and organizations within the De21 partment related to maternal health data and 

22 quality measures. 

23 (4) REPORT.—Not later than 1 year after the 

24 date of enactment of this Act, the Secretary shall 

25 submit to Congress, and make publicly available, a 


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1 report on the results of the review of maternal 

2 health data collection processes and quality meas3 ures and recommendations to improve such proc4 esses and measures required under paragraph (1). 

5 (5) DEFINITION OF MATERNAL MORTALITY RE6 VIEW COMMITTEE.—In this subsection, the term 

7 ‘‘maternal mortality review committee’’ means a ma8 ternal mortality review committee duly authorized by 

9 a State and receiving funding under section 

10 317K(a)(2)(D) of the Public Health Service Act (42 

11 U.S.C. 247b–12(a)(2)(D)). 

12 (6) AUTHORIZATION OF APPROPRIATIONS.— 

13 There are authorized to be appropriated such sums 

14 as may be necessary to carry out this subsection for 

15 each of fiscal years 2025 through 2029. 

16 (e) INDIAN HEALTH SERVICE STUDY ON MATERNAL

17 MORTALITY AND SEVERE MATERNAL MORBIDITY.— 

18 (1) IN GENERAL.—The Director of the Indian 

19 Health Service (referred to in this subsection as the 

20 ‘‘Director’’) shall, in coordination with entities de21 scribed in paragraph (2)— 

22 (A) not later than 90 days after the date 

23 of enactment of this Act, enter into a contract 

24 with an independent research organization or 

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1 prehensive study on maternal mortality and se2 vere maternal morbidity in the populations of 

3 American Indian and Alaska Native individuals; 

4 and 

5 (B) not later than 3 years after the date 

6 of enactment of this Act, submit to Congress a 

7 report on that study that contains recommenda8 tions for policies and practices that can be 

9 adopted to improve maternal health outcomes 

10 for pregnant and postpartum American Indian 

11 and Alaska Native individuals. 

12 (2) PARTICIPATING ENTITIES.— 

13 (A) IN GENERAL.—The entities referred to 

14 in paragraph (1) shall consist of 12 members, 

15 selected by the Director from among individuals 

16 nominated by Indian Tribes and Tribal organi17 zations (as those terms are defined in section 4 

18 of the Indian Self-Determination and Education 

19 Assistance Act (25 U.S.C. 5304)) and Urban 

20 Indian organizations (as defined in section 4 of 

21 the Indian Health Care Improvement Act (25 

22 U.S.C. 1603)). 

23 (B) REQUIREMENT.—In selecting members 

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1 sure that each of the 12 service areas of the In2 dian Health Service are represented. 

3 (3) CONTENTS OF STUDY.—The study con4 ducted pursuant to paragraph (1)(A) shall— 

5 (A) examine the causes of maternal mor6 tality and severe maternal morbidity that are 

7 unique to American Indian and Alaska Native 

8 individuals; 

9 (B) include a systematic process of listen10 ing to the stories of American Indian and Alas11 ka Native pregnant and postpartum individuals 

12 to fully understand the causes of, and inform 

13 potential solutions to, the maternal mortality 

14 and severe maternal morbidity crisis within the 

15 communities of those individuals; 

16 (C) distinguish between the causes of, 

17 landscape of maternity care at, and rec18 ommendations to improve maternal health out19 comes within the different settings in which 

20 American Indian and Alaska Native pregnant 

21 and postpartum individuals receive maternity 

22 care, including— 

23 (i) facilities operated by the Indian 

24 Health Service; 


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1 (ii) an Indian health program oper2 ated by an Indian Tribe or a Tribal orga3 nization (as those terms are defined in sec4 tion 4 of the Indian Self-Determination 

5 and Education Assistance Act (25 U.S.C. 

6 5304)) pursuant to a contract, grant, coop7 erative agreement, or compact with the In8 dian Health Service pursuant to the Indian 

9 Self-Determination and Education Assist10 ance Act (25 U.S.C. 5301 et seq.); and 

11 (iii) an Urban Indian health program 

12 operated by an Urban Indian organization 

13 (as defined in section 4 of the Indian 

14 Health Care Improvement Act (25 U.S.C. 

15 1603)) pursuant to a grant or contract 

16 with the Indian Health Service pursuant to 

17 title V of the Indian Health Care Improve18 ment Act (25 U.S.C. 1651 et seq.); 

19 (D) review processes for coordinating pro20 grams of the Indian Health Service with social 

21 services provided through other programs ad22 ministered by the Secretary of Health and 

23 Human Services (other than the Medicare pro24 gram under title XVIII of the Social Security 

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1 gram under title XIX of that Act (42 U.S.C. 

2 1396 et seq.), and the State Children’s Health 

3 Insurance Program under title XXI of that Act 

4 (42 U.S.C. 1397aa et seq.)); 

5 (E) review current data collection and 

6 quality measurement processes and practices; 

7 (F) assess causes and frequency of mater8 nal mental health conditions and substance use 

9 disorders; 

10 (G) consider social determinants of health, 

11 including poverty, lack of health insurance, un12 employment, sexual violence, and environmental 

13 conditions in Tribal areas; 

14 (H) consider the role that historical mis15 treatment of American Indian and Alaska Na16 tive people has played in causing currently high 

17 rates of maternal mortality and severe maternal 

18 morbidity; 

19 (I) consider how current funding of the In20 dian Health Service affects the ability of the In21 dian Health Service to deliver quality maternity 

22 care; 

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1 propriate for American Indian and Alaska Na2 tive pregnant and postpartum individuals; 

3 (K) make recommendations to reduce 

4 misclassification of American Indian and Alaska 

5 Native pregnant and postpartum individuals, 

6 including consideration of best practices in 

7 training for maternal mortality review com8 mittee members to be able to correctly classify 

9 American Indian and Alaska Native individuals; 

10 and 

11 (L) make recommendations informed by 

12 the stories shared by American Indian and 

13 Alaska Native pregnant and postpartum indi14 viduals pursuant to subparagraph (B) to im15 prove maternal health outcomes for those indi16 viduals. 

17 (4) REPORT.—The agreement entered into 

18 under paragraph (1)(A) with an independent re19 search organization or Tribal Epidemiology Center 

20 shall require that the independent research organiza21 tion or Tribal Epidemiology Center, as applicable, 

22 submit to Congress a report on the results of the 

23 study conducted pursuant to that agreement not 

24 later than 36 months after the date of enactment of 

25 this Act. 


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1 (5) AUTHORIZATION OF APPROPRIATIONS.— 

2 There is authorized to be appropriated to carry out 

3 this subsection $2,000,000 for each of fiscal years 

4 2025 through 2027. 

5 (f) GRANTS TO MINORITY-SERVING INSTITUTIONS TO

6 STUDY MATERNAL MORTALITY, SEVERE MATERNAL

7 MORBIDITY, AND OTHER ADVERSE MATERNAL HEALTH

8 OUTCOMES.— 

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

10 Human Services (referred to in this subsection as 

11 the ‘‘Secretary’’) shall establish a program under 

12 which the Secretary shall award grants to research 

13 centers, health professions schools and programs, 

14 and other entities at minority-serving institutions to 

15 study specific aspects of the maternal health crisis 

16 among pregnant and postpartum individuals from 

17 racial and ethnic minority groups. Such research 

18 may— 

19 (A) include the development and imple20 mentation of systematic processes of listening 

21 to the stories of pregnant and postpartum indi22 viduals from racial and ethnic minority groups, 

23 and perinatal health workers supporting such 

24 individuals, to fully understand the causes of, 

25 and inform potential solutions to, the maternal 


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1 mortality and severe maternal morbidity crisis 

2 within their respective communities; 

3 (B) assess the potential causes of relatively 

4 low rates of maternal mortality among Hispanic 

5 individuals, including potential racial 

6 misclassification and other data collection and 

7 reporting issues that might be misrepresenting 

8 maternal mortality rates among Hispanic indi9 viduals in the United States; and 

10 (C) assess differences in rates of adverse 

11 maternal health outcomes among subgroups 

12 identifying as Hispanic. 

13 (2) APPLICATION.—To be eligible to receive a 

14 grant under paragraph (1), an entity described in 

15 such paragraph shall submit to the Secretary an ap16 plication at such time, in such manner, and con17 taining such information as the Secretary may re18 quire. 

19 (3) TECHNICAL ASSISTANCE.—The Secretary 

20 may use not more than 10 percent of the funds 

21 made available under paragraph (7)— 

22 (A) to conduct outreach to minority-serv23 ing institutions to raise awareness of the avail24 ability of grants under paragraph (1); 


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1 (B) to provide technical assistance in the 

2 application process for such a grant; and 

3 (C) to promote capacity building, as need4 ed to enable entities described in such para5 graph to submit such an application. 

6 (4) REPORTING REQUIREMENT.—Each entity 

7 awarded a grant under this subsection shall periodi8 cally submit to the Secretary a report on the status 

9 of activities conducted using the grant. 

10 (5) EVALUATION.—Beginning one year after 

11 the date on which the first grant is awarded under 

12 this subsection, the Secretary shall submit to Con13 gress an annual report summarizing the findings of 

14 research conducted using funds made available 

15 under this subsection. 

16 (6) MINORITY-SERVING INSTITUTIONS DE17 FINED.—In this subsection, the term ‘‘minority-serv18 ing institution’’ means an eligible institution de19 scribed in section 371(a) of the Higher Education 

20 Act of 1965 (20 U.S.C. 1067q(a)). 

21 (7) AUTHORIZATION OF APPROPRIATIONS.— 

22 There are authorized to be appropriated to carry out 

23 this subsection $10,000,000 for each of fiscal years 

24 2025 through 2029. 

25 (g) DEFINITIONS.—In this section: 


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1 (1) CULTURALLY CONGRUENT.—The term ‘‘cul2 turally congruent’’, with respect to care or maternity 

3 care, means care that is in agreement with the pre4 ferred cultural values, beliefs, worldview, language, 

5 and practices of the health care consumer and other 

6 stakeholders. 

7 (2) MATERNITY CARE PROVIDER.—The term 

8 ‘‘maternity care provider’’ means a health care pro9 vider who— 

10 (A) is a physician, physician assistant, 

11 midwife who meets at a minimum the inter12 national definition of the midwife and global 

13 standards for midwifery education as estab14 lished by the International Confederation of 

15 Midwives, nurse practitioner, or clinical nurse 

16 specialist; and 

17 (B) has a focus on maternal or perinatal 

18 health. 

19 (3) MATERNAL MORTALITY.—The term ‘‘mater20 nal mortality’’ means a death occurring during or 

21 within a one-year period after pregnancy, caused by 

22 pregnancy-related or childbirth complications, in23 cluding a suicide, overdose, or other death resulting 

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1 tributed to or aggravated by pregnancy-related or 

2 childbirth complications. 

3 (4) PERINATAL HEALTH WORKER.—The term 

4 ‘‘perinatal health worker’’ means a doula, commu5 nity health worker, peer supporter, breastfeeding 

6 and lactation educator or counselor, nutritionist or 

7 dietitian, childbirth educator, social worker, home 

8 visitor, language interpreter, or navigator. 

9 (5) POSTPARTUM AND POSTPARTUM PERIOD.— 

10 The terms ‘‘postpartum’’ and ‘‘postpartum period’’ 

11 refer to the 1-year period beginning on the last day 

12 of the pregnancy of an individual. 

13 (6) PREGNANCY-ASSOCIATED.—The term 

14 ‘‘pregnancy-associated’’, with respect to a death, 

15 means a death of a pregnant or postpartum indi16 vidual, by any cause, that occurs during, or within 

17 1 year following, the individual’s pregnancy, regard18 less of the outcome, duration, or site of the preg19 nancy. 

20 (7) PREGNANCY-RELATED.—The term ‘‘preg21 nancy-related’’, with respect to a death, means a 

22 death of a pregnant or postpartum individual that 

23 occurs during, or within 1 year following, the indi24 vidual’s pregnancy, from a pregnancy complication, 

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1 gravation of an unrelated condition by the physio2 logic effects of pregnancy. 

3 (8) RACIAL AND ETHNIC MINORITY GROUP.— 

4 The term ‘‘racial and ethnic minority group’’ has the 

5 meaning given such term in section 1707(g)(1) of 

6 the Public Health Service Act (42 U.S.C. 300u– 

7 6(g)(1)). 

8 (9) SEVERE MATERNAL MORBIDITY.—The term 

9 ‘‘severe maternal morbidity’’ means a health condi10 tion, including mental health conditions and sub11 stance use disorders, attributed to or aggravated by 

12 pregnancy or childbirth that results in significant 

13 short-term or long-term consequences to the health 

14 of the individual who was pregnant. 

15 (10) SOCIAL DETERMINANTS OF MATERNAL

16 HEALTH.—The term ‘‘social determinants of mater17 nal health’’ means non-clinical factors that impact 

18 maternal health outcomes, including— 

19 (A) economic factors, which may include 

20 poverty, employment, food security, support for 

21 and access to lactation and other infant feeding 

22 options, housing stability, and related factors; 

23 (B) neighborhood factors, which may in24 clude quality of housing, access to transpor25 tation, access to child care, availability of 


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1 healthy foods and nutrition counseling, avail2 ability of clean water, air and water quality, 

3 ambient temperatures, neighborhood crime and 

4 violence, access to broadband, and related fac5 tors; 

6 (C) social and community factors, which 

7 may include systemic racism, gender discrimi8 nation or discrimination based on other pro9 tected classes, workplace conditions, incarcer10 ation, and related factors; 

11 (D) household factors, which may include 

12 ability to conduct lead testing and abatement, 

13 car seat installation, indoor air temperatures, 

14 and related factors; 

15 (E) education access and quality factors, 

16 which may include educational attainment, lan17 guage and literacy, and related factors; and 

18 (F) health care access factors, including 

19 health insurance coverage, access to culturally 

20 congruent health care services, providers, and 

21 non-clinical support, access to home visiting 

22 services, access to wellness and stress manage23 ment programs, health literacy, access to tele24 health and items required to receive telehealth 

25 services, and related factors. 


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1 SEC. 5207. MOMS MATTER. 

2 (a) MATERNAL MENTAL HEALTH EQUITY GRANT

3 PROGRAM.— 

4 (1) IN GENERAL.—The Secretary shall establish 

5 a program to award grants to eligible entities to ad6 dress maternal mental health conditions and sub7 stance use disorders with respect to pregnant and 

8 postpartum individuals, with a focus on racial and 

9 ethnic minority groups. 

10 (2) APPLICATION.—To be eligible to receive a 

11 grant under this subsection, an eligible entity shall 

12 submit to the Secretary an application at such time, 

13 in such manner, and containing such information as 

14 the Secretary may provide, including how such entity 

15 will use funds for activities described in paragraph 

16 (4) that are culturally congruent. 

17 (3) PRIORITY.—In awarding grants under this 

18 subsection, the Secretary shall give priority to an eli19 gible entity that— 

20 (A) is, or will partner with, a community21 based organization to address maternal mental 

22 health conditions and substance use disorders 

23 described in paragraph (1); 

24 (B) is operating in an area with high rates 

25 of— 


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1 (i) adverse maternal health outcomes; 

2 or 

3 (ii) significant racial or ethnic inequi4 ties in maternal health outcomes; and 

5 (C) is operating in a health professional 

6 shortage area designated under section 332 of 

7 the Public Health Service Act (42 U.S.C. 

8 254e). 

9 (4) USE OF FUNDS.—An eligible entity that re10 ceives a grant under this subsection shall use funds 

11 for the following: 

12 (A) Establishing or expanding maternity 

13 care programs to improve the integration of 

14 maternal health and behavioral health care 

15 services into primary care settings where preg16 nant individuals regularly receive health care 

17 services. 

18 (B) Establishing or expanding group pre19 natal care programs or postpartum care pro20 grams. 

21 (C) Expanding existing programs that im22 prove maternal mental and behavioral health 

23 during the prenatal and postpartum periods, 

24 with a focus on individuals from racial and eth25 nic minority groups. 


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1 (D) Providing services and support for 

2 pregnant and postpartum individuals with ma3 ternal mental health conditions and substance 

4 use disorders, including referrals to addiction 

5 treatment centers that offer evidence-based 

6 treatment options. 

7 (E) Addressing stigma associated with ma8 ternal mental health conditions and substance 

9 use disorders, with a focus on racial and ethnic 

10 minority groups. 

11 (F) Raising awareness of warning signs of 

12 maternal mental health conditions and sub13 stance use disorders, with a focus on pregnant 

14 and postpartum individuals from racial and eth15 nic minority groups. 

16 (G) Establishing or expanding programs to 

17 prevent suicide or self-harm among pregnant 

18 and postpartum individuals. 

19 (H) Offering evidence-aligned programs at 

20 freestanding birth centers that provide maternal 

21 mental and behavioral health care education, 

22 treatments, and services, and other services for 

23 individuals throughout the prenatal and 

24 postpartum period. 


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1 (I) Establishing or expanding programs to 

2 provide education and training to maternity 

3 care providers with respect to— 

4 (i) identifying potential warning signs 

5 for maternal mental health conditions or 

6 substance use disorders in pregnant and 

7 postpartum individuals, with a focus on in8 dividuals from racial and ethnic minority 

9 groups; and 

10 (ii) in the case where such providers 

11 identify such warning signs, offering refer12 rals to mental and behavioral health care 

13 professionals. 

14 (J) Developing a website, or other source, 

15 that includes information on health care pro16 viders who treat maternal mental health condi17 tions and substance use disorders. 

18 (K) Establishing or expanding programs in 

19 communities to improve coordination between 

20 maternity care providers and mental and behav21 ioral health care providers who treat maternal 

22 mental health conditions and substance use dis23 orders, including through the use of toll-free 

24 hotlines. 


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1 (L) Carrying out other programs aligned 

2 with evidence-based practices for addressing 

3 maternal mental health conditions and sub4 stance use disorders for pregnant and 

5 postpartum individuals from racial and ethnic 

6 minority groups. 

7 (5) REPORTING.— 

8 (A) ELIGIBLE ENTITIES.—An eligible enti9 ty that receives a grant under paragraph (1) 

10 shall submit annually to the Secretary, and 

11 make publicly available, a report on the activi12 ties conducted using funds received through a 

13 grant under this subsection. Such reports shall 

14 include quantitative and qualitative evaluations 

15 of such activities, including the experience of in16 dividuals who received health care through such 

17 grant. 

18 (B) SECRETARY.—Not later than the end 

19 of fiscal year 2026, the Secretary shall submit 

20 to Congress a report that includes— 

21 (i) a summary of the reports received 

22 under subparagraph (A); 

23 (ii) an evaluation of the effectiveness 

24 of grants awarded under this subsection; 


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1 (iii) recommendations with respect to 

2 expanding coverage of evidence-based 

3 screenings and treatments for maternal 

4 mental health conditions and substance use 

5 disorders; and 

6 (iv) recommendations with respect to 

7 ensuring activities described under para8 graph (4) continue after the end of a grant 

9 period. 

10 (6) DEFINITIONS.—In this subsection: 

11 (A) CULTURALLY CONGRUENT.—The term 

12 ‘‘culturally congruent’’, with respect to care or 

13 maternity care, means care that is in agreement 

14 with the preferred cultural values, beliefs, 

15 worldview, language, and practices of the health 

16 care consumer and other stakeholders. 

17 (B) ELIGIBLE ENTITY.—The term ‘‘eligible 

18 entity’’ means— 

19 (i) a community-based organization 

20 serving pregnant and postpartum individ21 uals, including such organizations serving 

22 individuals from racial and ethnic minority 

23 groups and other underserved populations; 


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1 (ii) a nonprofit or patient advocacy 

2 organization with expertise in maternal 

3 mental and behavioral health; 

4 (iii) a maternity care provider; 

5 (iv) a mental or behavioral health care 

6 provider who treats maternal mental health 

7 conditions or substance use disorders; 

8 (v) a State or local governmental enti9 ty, including a State or local public health 

10 department; 

11 (vi) an Indian Tribe or Tribal organi12 zation (as such terms are defined in sec13 tion 4 of the Indian Self-Determination 

14 and Education Assistance Act (25 U.S.C. 

15 5304)); and 

16 (vii) an Urban Indian organization (as 

17 such term is defined in section 4 of the In18 dian Health Care Improvement Act (25 

19 U.S.C. 1603)). 

20 (C) FREESTANDING BIRTH CENTER.—The 

21 term ‘‘freestanding birth center’’ has the mean22 ing given that term under section 1905(l) of the 

23 Social Security Act (42 U.S.C. 1396d(1)). 


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1 (D) MATERNITY CARE PROVIDER.—The 

2 term ‘‘maternity care provider’’ means a health 

3 care provider who— 

4 (i) is a physician, physician assistant, 

5 midwife who meets at a minimum the 

6 international definition of the midwife and 

7 global standards for midwifery education 

8 as established by the International Confed9 eration of Midwives, nurse practitioner, or 

10 clinical nurse specialist; and 

11 (ii) has a focus on maternal or 

12 perinatal health. 

13 (E) SECRETARY.—The term ‘‘Secretary’’ 

14 means the Secretary of Health and Human 

15 Services, acting through the Assistant Secretary 

16 for Mental Health and Substance Use. 

17 (7) AUTHORIZATION OF APPROPRIATIONS.—To 

18 carry out this subsection, there is authorized to be 

19 appropriated $25,000,000 for each of fiscal years 

20 2025 through 2028. 

21 (b) GRANTS TO GROW AND DIVERSIFY THE MATER22 NAL MENTAL AND BEHAVIORAL HEALTH CARE WORK23 FORCE.—Title VII of the Public Health Service Act is 

24 amended by inserting after section 758 (as added by sec25 tion 5205(b)) the following: 


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1 ‘‘SEC. 758A. MATERNAL MENTAL AND BEHAVIORAL HEALTH 

2 CARE WORKFORCE GRANTS. 

3 ‘‘(a) IN GENERAL.—The Secretary may award grants 

4 to entities to establish or expand programs described in 

5 subsection (b) to grow and diversify the maternal mental 

6 and behavioral health care workforce. 

7 ‘‘(b) USE OF FUNDS.—Recipients of grants under 

8 this section shall use the grants to grow and diversify the 

9 maternal mental and behavioral health care workforce 

10 by— 

11 ‘‘(1) establishing schools or programs that pro12 vide education and training to individuals seeking 

13 appropriate licensing or certification as mental or 

14 behavioral health care providers who will specialize 

15 in maternal mental health conditions or substance 

16 use disorders; or 

17 ‘‘(2) expanding the capacity of existing schools 

18 or programs described in paragraph (1), for the pur19 poses of increasing the number of students enrolled 

20 in such schools or programs, including by awarding 

21 scholarships for students. 

22 ‘‘(c) PRIORITIZATION.—In awarding grants under 

23 this section, the Secretary shall give priority to any entity 

24 that— 


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1 ‘‘(1) has demonstrated a commitment to re2 cruiting and retaining students and faculty from ra3 cial and ethnic minority groups; 

4 ‘‘(2) has developed a strategy to recruit and re5 tain a diverse pool of students into the maternal 

6 mental or behavioral health care workforce program 

7 or school supported by funds received through the 

8 grant, particularly from racial and ethnic minority 

9 groups and other underserved populations; 

10 ‘‘(3) has developed a strategy to recruit and re11 tain students who plan to practice in a health pro12 fessional shortage area designated under section 

13 332; 

14 ‘‘(4) has developed a strategy to recruit and re15 tain students who plan to practice in an area with 

16 significant racial and ethnic inequities in maternal 

17 health outcomes, to the extent practicable; and 

18 ‘‘(5) includes in the standard curriculum for all 

19 students within the maternal mental or behavioral 

20 health care workforce program or school a bias, rac21 ism, or discrimination training program that in22 cludes training on implicit bias and racism. 

23 ‘‘(d) REPORTING.—As a condition on receipt of a 

24 grant under this section for a maternal mental or behav25 ioral health care workforce program or school, an entity 


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1 shall agree to submit to the Secretary an annual report 

2 on the activities conducted through the grant, including— 

3 ‘‘(1) the number and demographics of students 

4 participating in the program or school; 

5 ‘‘(2) the extent to which students in the pro6 gram or school are entering careers in— 

7 ‘‘(A) health professional shortage areas 

8 designated under section 332; and 

9 ‘‘(B) areas with significant racial and eth10 nic inequities in maternal health outcomes, to 

11 the extent such data are available; and 

12 ‘‘(3) whether the program or school has in13 cluded in the standard curriculum for all students a 

14 bias, racism, or discrimination training program that 

15 includes training on implicit bias and racism, and if 

16 so the effectiveness of such training program. 

17 ‘‘(e) PERIOD OF GRANTS.—The period of a grant 

18 under this section shall be up to 5 years. 

19 ‘‘(f) APPLICATION.—To seek a grant under this sec20 tion, an entity shall submit to the Secretary an application 

21 at such time, in such manner, and containing such infor22 mation as the Secretary may require, including any infor23 mation necessary for prioritization under subsection (c). 

24 ‘‘(g) TECHNICAL ASSISTANCE.—The Secretary shall 

25 provide, directly or by contract, technical assistance to enVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 00703 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 tities seeking or receiving a grant under this section on 

2 the development, use, evaluation, and post-grant period 

3 sustainability of the maternal mental or behavioral health 

4 care workforce programs or schools proposed to be, or 

5 being, established or expanded through the grant. 

6 ‘‘(h) REPORT BY THE SECRETARY.—Not later than 

7 4 years after the date of enactment of this section, the 

8 Secretary shall prepare and submit to the Congress, and 

9 post on the internet website of the Department of Health 

10 and Human Services, a report on the effectiveness of the 

11 grant program under this section at— 

12 ‘‘(1) recruiting students from racial and ethnic 

13 minority groups and other underserved populations; 

14 ‘‘(2) increasing the number of mental or behav15 ioral health care providers specializing in maternal 

16 mental health conditions or substance use disorders 

17 from racial and ethnic minority groups and other 

18 underserved populations; 

19 ‘‘(3) increasing the number of mental or behav20 ioral health care providers specializing in maternal 

21 mental health conditions or substance use disorders 

22 working in health professional shortage areas des23 ignated under section 332; and 

24 ‘‘(4) increasing the number of mental or behav25 ioral health care providers specializing in maternal 


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1 mental health conditions or substance use disorders 

2 working in areas with significant racial and ethnic 

3 inequities in maternal health outcomes, to the extent 

4 such data are available. 

5 ‘‘(i) DEFINITIONS.—In this section: 

6 ‘‘(1) RACIAL AND ETHNIC MINORITY GROUP.— 

7 The term ‘racial and ethnic minority group’ has the 

8 meaning given such term in section 1707(g)(1). 

9 ‘‘(2) MENTAL OR BEHAVIORAL HEALTH CARE

10 PROVIDER.—The term ‘mental or behavioral health 

11 care provider’ refers to a health care provider in the 

12 field of mental and behavioral health, including sub13 stance use disorders, acting in accordance with State 

14 law. 

15 ‘‘(j) AUTHORIZATION OF APPROPRIATIONS.—To 

16 carry out this section, there is authorized to be appro17 priated $15,000,000 for each of fiscal years 2025 through 

18 2029.’’. 

19 SEC. 5208. JUSTICE FOR INCARCERATED MOMS. 

20 (a) ENDING THE SHACKLING OF PREGNANT INDI21 VIDUALS.— 

22 (1) IN GENERAL.—Beginning on the date that 

23 is 6 months after the date of enactment of this Act, 

24 and annually thereafter, in each State that receives 

25 a grant under subpart 1 of part E of title I of the 


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1 Omnibus Crime Control and Safe Streets Act of 

2 1968 (34 U.S.C. 10151 et seq.) (commonly referred 

3 to as the ‘‘Edward Byrne Memorial Justice Assist4 ance Grant Program’’) and that does not have in ef5 fect throughout the State for such fiscal year laws 

6 restricting the use of restraints on pregnant individ7 uals in prison that are substantially similar to the 

8 rights, procedures, requirements, effects, and pen9 alties set forth in section 4322 of title 18, United 

10 States Code, the amount of such grant that would 

11 otherwise be allocated to such State under such sub12 part for the fiscal year shall be decreased by 25 per13 cent. 

14 (2) REALLOCATION.—Amounts not allocated to 

15 a State for failure to comply with paragraph (1) 

16 shall be reallocated in accordance with subpart 1 of 

17 part E of title I of the Omnibus Crime Control and 

18 Safe Streets Act of 1968 (34 U.S.C. 10151 et seq.) 

19 to States that have complied with such paragraph. 

20 (b) CREATING MODEL PROGRAMS FOR THE CARE OF

21 INCARCERATED INDIVIDUALS IN THE PRENATAL AND

22 POSTPARTUM PERIODS.— 

23 (1) IN GENERAL.—Not later than 1 year after 

24 the date of enactment of this Act, the Attorney Gen25 eral, acting through the Director of the Bureau of 


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1 Prisons, shall establish, in not fewer than 6 Bureau 

2 of Prisons facilities, programs to optimize maternal 

3 health outcomes for pregnant and postpartum indi4 viduals incarcerated in such facilities. The Attorney 

5 General shall establish such programs in consulta6 tion with stakeholders such as— 

7 (A) relevant community-based organiza8 tions, particularly organizations that represent 

9 incarcerated and formerly incarcerated individ10 uals and organizations that seek to improve ma11 ternal health outcomes for pregnant and 

12 postpartum individuals from demographic 

13 groups with elevated rates of maternal mor14 tality, severe maternal morbidity, maternal 

15 health disparities, or other adverse perinatal or 

16 childbirth outcomes; 

17 (B) relevant organizations representing pa18 tients, with a particular focus on patients from 

19 demographic groups with elevated rates of ma20 ternal mortality, severe maternal morbidity, ma21 ternal health disparities, or other adverse 

22 perinatal or childbirth outcomes; 

23 (C) organizations representing maternity 

24 care providers and maternal health care edu25 cation programs; 


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1 (D) perinatal health workers; and 

2 (E) researchers and policy experts in fields 

3 related to maternal health care for incarcerated 

4 individuals. 

5 (2) START DATE.—Each selected facility shall 

6 begin facility programs not later than 18 months 

7 after the date of enactment of this Act. 

8 (3) FACILITY PRIORITY.—In carrying out para9 graph (1), the Director shall give priority to a facil10 ity based on— 

11 (A) the number of pregnant and 

12 postpartum individuals incarcerated in such fa13 cility and, among such individuals, the number 

14 of pregnant and postpartum individuals from 

15 demographic groups with elevated rates of ma16 ternal mortality, severe maternal morbidity, ma17 ternal health disparities, or other adverse 

18 perinatal or childbirth outcomes; and 

19 (B) the extent to which the leaders of such 

20 facility have demonstrated a commitment to de21 veloping exemplary programs for pregnant and 

22 postpartum individuals incarcerated in such fa23 cility. 


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1 (4) PROGRAM DURATION.—The programs es2 tablished under this subsection shall be for a 5-year 

3 period. 

4 (5) PROGRAMS.—Bureau of Prisons facilities 

5 selected by the Director shall establish programs for 

6 pregnant and postpartum incarcerated individuals, 

7 and such programs may— 

8 (A) provide access to perinatal health 

9 workers from pregnancy through the 

10 postpartum period; 

11 (B) provide access to healthy foods and 

12 counseling on nutrition, recommended activity 

13 levels, and safety measures throughout preg14 nancy; 

15 (C) train correctional officers to ensure 

16 that pregnant incarcerated individuals receive 

17 safe and respectful treatment; 

18 (D) train medical personnel to ensure that 

19 pregnant incarcerated individuals receive trau20 ma-informed, culturally and linguistically con21 gruent care that promotes the health and safety 

22 of the pregnant individuals; 

23 (E) provide counseling and treatment for 

24 individuals who have suffered from— 


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1 (i) diagnosed mental or behavioral 

2 health conditions, including trauma and 

3 substance use disorders; 

4 (ii) trauma or violence, including do5 mestic violence; 

6 (iii) human immunodeficiency virus; 

7 (iv) sexual abuse; 

8 (v) pregnancy or infant loss; or 

9 (vi) chronic conditions; 

10 (F) provide evidence-based pregnancy and 

11 childbirth education, parenting support, and 

12 other relevant forms of health literacy; 

13 (G) provide clinical education opportunities 

14 to maternity care providers in training to ex15 pand pathways into maternal health care ca16 reers serving incarcerated individuals; 

17 (H) offer opportunities for postpartum in18 dividuals to maintain contact with the individ19 ual’s newborn child to promote bonding, includ20 ing enhanced visitation policies, access to prison 

21 nursery programs, or breastfeeding support; 

22 (I) provide reentry assistance, particularly 

23 to— 

24 (i) ensure access to health insurance 

25 coverage and transfer of health records to 


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1 community providers if an incarcerated in2 dividual exits the criminal justice system 

3 during such individual’s pregnancy or in 

4 the postpartum period; and 

5 (ii) connect individuals exiting the 

6 criminal justice system during pregnancy 

7 or in the postpartum period to community8 based resources, such as referrals to health 

9 care providers, substance use disorder 

10 treatments, and social services that ad11 dress social determinants of maternal 

12 health; or 

13 (J) establish partnerships with local public 

14 entities, private community entities, community15 based organizations, Indian Tribes and Tribal 

16 organizations (as such terms are defined in sec17 tion 4 of the Indian Self-Determination and 

18 Education Assistance Act (25 U.S.C. 5304)), 

19 and Urban Indian organizations (as such term 

20 is defined in section 4 of the Indian Health 

21 Care Improvement Act (25 U.S.C. 1603)) to es22 tablish or expand pretrial diversion programs as 

23 an alternative to incarceration for pregnant and 

24 postpartum individuals. Such programs may in25 clude— 


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1 (i) evidence-based childbirth education 

2 or parenting classes; 

3 (ii) prenatal health coordination; 

4 (iii) family and individual counseling; 

5 (iv) evidence-based screenings, edu6 cation, and, as needed, treatment for men7 tal and behavioral health conditions, in8 cluding drug and alcohol treatments; 

9 (v) family case management services; 

10 (vi) domestic violence education and 

11 prevention; 

12 (vii) physical and sexual abuse coun13 seling; and 

14 (viii) programs to address social de15 terminants of health such as employment, 

16 housing, education, transportation, and nu17 trition. 

18 (6) IMPLEMENTATION AND REPORTING.—A se19 lected facility shall be responsible for— 

20 (A) implementing programs, which may in21 clude the programs described in paragraph (5); 

22 and 

23 (B) not later than 3 years after the date 

24 of enactment of this Act, and 6 years after the 

25 date of enactment of this Act, reporting results 


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1 of the programs to the Director, including in2 formation describing— 

3 (i) relevant quantitative indicators of 

4 success in improving the standard of care 

5 and health outcomes for pregnant and 

6 postpartum incarcerated individuals in the 

7 facility, including data stratified by race, 

8 ethnicity, sex, gender, primary language, 

9 age, geography, disability status, the cat10 egory of the criminal charge against such 

11 individual, rates of pregnancy-related 

12 deaths, pregnancy-associated deaths, cases 

13 of infant mortality and morbidity, rates of 

14 preterm births and low-birthweight births, 

15 cases of severe maternal morbidity, cases 

16 of violence against pregnant or postpartum 

17 individuals, diagnoses of maternal mental 

18 or behavioral health conditions, and other 

19 such information as appropriate; 

20 (ii) relevant qualitative and quan21 titative evaluations from pregnant and 

22 postpartum incarcerated individuals who 

23 participated in such programs, including 

24 measures of patient-reported experience of 

25 care; and 


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1 (iii) strategies to sustain such pro2 grams after fiscal year 2029 and expand 

3 such programs to other facilities. 

4 (7) REPORT.—Not later than 6 years after the 

5 date of enactment of this Act, the Director shall 

6 submit to the Attorney General and to Congress a 

7 report describing the results of the programs funded 

8 under this subsection. 

9 (8) OVERSIGHT.—Not later than 1 year after 

10 the date of enactment of this Act, the Attorney Gen11 eral shall award a contract to an independent orga12 nization or independent organizations to conduct 

13 oversight of the programs described in paragraph 

14 (5). 

15 (9) AUTHORIZATION OF APPROPRIATIONS.— 

16 There is authorized to be appropriated to carry out 

17 this subsection $10,000,000 for each of fiscal years 

18 2025 through 2029. 

19 (c) GRANT PROGRAM TO IMPROVE MATERNAL

20 HEALTH OUTCOMES FOR INDIVIDUALS IN STATE AND

21 LOCAL PRISONS AND JAILS.— 

22 (1) ESTABLISHMENT.—Not later than 1 year 

23 after the date of enactment of this Act, the Attorney 

24 General, acting through the Director of the Bureau 

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1 cerated Moms grants to States to establish or ex2 pand programs in State and local prisons and jails 

3 for pregnant and postpartum incarcerated individ4 uals. The Attorney General shall award such grants 

5 in consultation with stakeholders such as— 

6 (A) relevant community-based organiza7 tions, particularly organizations that represent 

8 incarcerated and formerly incarcerated individ9 uals and organizations that seek to improve ma10 ternal health outcomes for pregnant and 

11 postpartum individuals from demographic 

12 groups with elevated rates of maternal mor13 tality, severe maternal morbidity, maternal 

14 health disparities, or other adverse perinatal or 

15 childbirth outcomes; 

16 (B) relevant organizations representing pa17 tients, with a particular focus on patients from 

18 demographic groups with elevated rates of ma19 ternal mortality, severe maternal morbidity, ma20 ternal health disparities, or other adverse 

21 perinatal or childbirth outcomes; 

22 (C) organizations representing maternity 

23 care providers and maternal health care edu24 cation programs; 

25 (D) perinatal health workers; and 


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1 (E) researchers and policy experts in fields 

2 related to maternal health care for incarcerated 

3 individuals. 

4 (2) APPLICATIONS.—Each applicant for a grant 

5 under this subsection shall submit to the Director of 

6 the Bureau of Justice Assistance an application at 

7 such time, in such manner, and containing such in8 formation as the Director may require. 

9 (3) USE OF FUNDS.—A State that is awarded 

10 a grant under this subsection shall use such grant 

11 to establish or expand programs for pregnant and 

12 postpartum incarcerated individuals, and such pro13 grams may— 

14 (A) provide access to perinatal health 

15 workers from pregnancy through the 

16 postpartum period; 

17 (B) provide access to healthy foods and 

18 counseling on nutrition, recommended activity 

19 levels, and safety measures throughout preg20 nancy; 

21 (C) train correctional officers to ensure 

22 that pregnant incarcerated individuals receive 

23 safe and respectful treatment; 

24 (D) train medical personnel to ensure that 

25 pregnant incarcerated individuals receive trauVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 00716 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 ma-informed, culturally and linguistically con2 gruent care that promotes the health and safety 

3 of the pregnant individuals; 

4 (E) provide counseling and treatment for 

5 individuals who have suffered from— 

6 (i) diagnosed mental or behavioral 

7 health conditions, including trauma and 

8 substance use disorders; 

9 (ii) trauma or violence, including do10 mestic violence; 

11 (iii) human immunodeficiency virus; 

12 (iv) sexual abuse; 

13 (v) pregnancy or infant loss; or 

14 (vi) chronic conditions; 

15 (F) provide evidence-based pregnancy and 

16 childbirth education, parenting support, and 

17 other relevant forms of health literacy; 

18 (G) provide clinical education opportunities 

19 to maternity care providers in training to ex20 pand pathways into maternal health care ca21 reers serving incarcerated individuals; 

22 (H) offer opportunities for postpartum in23 dividuals to maintain contact with the individ24 ual’s newborn child to promote bonding, includVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 00717 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 ing enhanced visitation policies, access to prison 

2 nursery programs, or breastfeeding support; 

3 (I) provide reentry assistance, particularly 

4 to— 

5 (i) ensure access to health insurance 

6 coverage and transfer of health records to 

7 community providers if an incarcerated in8 dividual exits the criminal justice system 

9 during such individual’s pregnancy or in 

10 the postpartum period; and 

11 (ii) connect individuals exiting the 

12 criminal justice system during pregnancy 

13 or in the postpartum period to community14 based resources, such as referrals to health 

15 care providers, substance use disorder 

16 treatments, and social services that ad17 dress social determinants of maternal 

18 health; or 

19 (J) establish partnerships with local public 

20 entities, private community entities, community21 based organizations, Indian Tribes and Tribal 

22 organizations (as such terms are defined in sec23 tion 4 of the Indian Self-Determination and 

24 Education Assistance Act (25 U.S.C. 5304)), 

25 and Urban Indian organizations (as such term 


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1 is defined in section 4 of the Indian Health 

2 Care Improvement Act (25 U.S.C. 1603)) to es3 tablish or expand pretrial diversion programs as 

4 an alternative to incarceration for pregnant and 

5 postpartum individuals. Such programs may in6 clude— 

7 (i) evidence-based childbirth education 

8 or parenting classes; 

9 (ii) prenatal health coordination; 

10 (iii) family and individual counseling; 

11 (iv) evidence-based screenings, edu12 cation, and, as needed, treatment for men13 tal and behavioral health conditions, in14 cluding drug and alcohol treatments; 

15 (v) family case management services; 

16 (vi) domestic violence education and 

17 prevention; 

18 (vii) physical and sexual abuse coun19 seling; and 

20 (viii) programs to address social de21 terminants of health such as employment, 

22 housing, education, transportation, and nu23 trition. 

24 (4) PRIORITY.—In awarding grants under this 

25 subsection, the Director of the Bureau of Justice 


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1 Assistance shall give priority to applicants based 

2 on— 

3 (A) the number of pregnant and 

4 postpartum individuals incarcerated in the 

5 State and, among such individuals, the number 

6 of pregnant and postpartum individuals from 

7 demographic groups with elevated rates of ma8 ternal mortality, severe maternal morbidity, ma9 ternal health disparities, or other adverse 

10 perinatal or childbirth outcomes; and 

11 (B) the extent to which the State has dem12 onstrated a commitment to developing exem13 plary programs for pregnant and postpartum 

14 individuals incarcerated in the prisons and jails 

15 in the State. 

16 (5) GRANT DURATION.—A grant awarded under 

17 this subsection shall be for a 5-year period. 

18 (6) IMPLEMENTING AND REPORTING.—A State 

19 that receives a grant under this subsection shall be 

20 responsible for— 

21 (A) implementing the program funded by 

22 the grant; and 

23 (B) not later than 3 years after the date 

24 of enactment of this Act, and 6 years after the 

25 date of enactment of this Act, reporting results 


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1 of such program to the Attorney General, in2 cluding information describing— 

3 (i) relevant quantitative indicators of 

4 the program’s success in improving the 

5 standard of care and health outcomes for 

6 pregnant and postpartum incarcerated in7 dividuals in the facility, including data 

8 stratified by race, ethnicity, sex, gender, 

9 primary language, age, geography, dis10 ability status, category of the criminal 

11 charge against such individual, incidence 

12 rates of pregnancy-related deaths, preg13 nancy-associated deaths, cases of infant 

14 mortality and morbidity, rates of preterm 

15 births and low-birthweight births, cases of 

16 severe maternal morbidity, cases of vio17 lence against pregnant or postpartum indi18 viduals, diagnoses of maternal mental or 

19 behavioral health conditions, and other 

20 such information as appropriate; 

21 (ii) relevant qualitative and quan22 titative evaluations from pregnant and 

23 postpartum incarcerated individuals who 

24 participated in such programs, including 


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1 measures of patient-reported experience of 

2 care; and 

3 (iii) strategies to sustain such pro4 grams beyond the duration of the grant 

5 and expand such programs to other facili6 ties. 

7 (7) REPORT.—Not later than 6 years after the 

8 date of enactment of this Act, the Attorney General 

9 shall submit to Congress a report describing the re10 sults of such grant programs. 

11 (8) OVERSIGHT.—Not later than 1 year after 

12 the date of enactment of this Act, the Attorney Gen13 eral shall award a contract to an independent orga14 nization or independent organizations to conduct 

15 oversight of the programs described in paragraph 

16 (3). 

17 (9) AUTHORIZATION OF APPROPRIATIONS.— 

18 There is authorized to be appropriated to carry out 

19 this subsection $10,000,000 for each of fiscal years 

20 2025 through 2029. 

21 (d) GAO REPORT.— 

22 (1) IN GENERAL.—Not later than 2 years after 

23 the date of enactment of this Act, the Comptroller 

24 General of the United States shall submit to Con25 gress a report on adverse maternal and infant health 


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1 outcomes among incarcerated individuals and infants 

2 born to such individuals, with a particular focus on 

3 racial and ethnic disparities in maternal and infant 

4 health outcomes for incarcerated individuals. 

5 (2) CONTENTS OF REPORT.—The report de6 scribed in this subsection shall include— 

7 (A) to the extent practicable— 

8 (i) the number of pregnant individuals 

9 who are incarcerated in Bureau of Prisons 

10 facilities; 

11 (ii) the number of incarcerated indi12 viduals, including those incarcerated in 

13 Federal, State, and local correctional facili14 ties, who have experienced a pregnancy-re15 lated death, pregnancy-associated death, or 

16 the death of an infant in the most recent 

17 10 years of available data; 

18 (iii) the number of cases of severe ma19 ternal morbidity among incarcerated indi20 viduals, including those incarcerated in 

21 Federal, State, and local detention facili22 ties, in the most recent 10 years of avail23 able data; 

24 (iv) the number of preterm and low25 birthweight births of infants born to incarVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 00723 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 cerated individuals, including those incar2 cerated in Federal, State, and local correc3 tional facilities, in the most recent 10 

4 years of available data; and 

5 (v) statistics on the racial and ethnic 

6 disparities in maternal and infant health 

7 outcomes and severe maternal morbidity 

8 rates among incarcerated individuals, in9 cluding those incarcerated in Federal, 

10 State, and local detention facilities; 

11 (B) in the case that the Comptroller Gen12 eral of the United States is unable determine 

13 the information required in clauses (i) through 

14 (iii) of subparagraph (A), an assessment of the 

15 barriers to determining such information and 

16 recommendations for improvements in tracking 

17 maternal health outcomes among incarcerated 

18 individuals, including those incarcerated in Fed19 eral, State, and local detention facilities; 

20 (C) the implications of pregnant and 

21 postpartum incarcerated individuals being ineli22 gible for medical assistance under a State plan 

23 under title XIX of the Social Security Act (42 

24 U.S.C. 1396 et seq.) including information 

25 about— 


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1 (i) the effects of such ineligibility on 

2 maternal health outcomes for pregnant and 

3 postpartum incarcerated individuals, with 

4 emphasis given to such effects for preg5 nant and postpartum individuals from ra6 cial and ethnic minority groups; and 

7 (ii) potential implications on maternal 

8 health outcomes resulting from temporarily 

9 suspending, rather than permanently ter10 minating, such eligibility when a pregnant 

11 or postpartum individual is incarcerated; 

12 (D) the extent to which Federal, State, 

13 and local correctional facilities are holding preg14 nant and postpartum individuals who test posi15 tive for illicit drug use in detention with special 

16 conditions, such as additional bond require17 ments, due to the individual’s drug use, and the 

18 effect of such detention policies on maternal 

19 and infant health outcomes; 

20 (E) causes of adverse maternal health out21 comes that are unique to incarcerated individ22 uals, including those incarcerated in Federal, 

23 State, and local detention facilities; 

24 (F) causes of adverse maternal health out25 comes and severe maternal morbidity that are 


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1 unique to incarcerated individuals from racial 

2 and ethnic minority groups; 

3 (G) recommendations to reduce maternal 

4 mortality and severe maternal morbidity among 

5 incarcerated individuals and to address racial 

6 and ethnic disparities in maternal health out7 comes for incarcerated individuals in Bureau of 

8 Prisons facilities and State and local prisons 

9 and jails; and 

10 (H) such other information as may be ap11 propriate to reduce the occurrence of adverse 

12 maternal health outcomes among incarcerated 

13 individuals and to address racial and ethnic dis14 parities in maternal health outcomes for such 

15 individuals. 

16 (e) DEFINITIONS.—In this section: 

17 (1) CULTURALLY AND LINGUISTICALLY CON18 GRUENT.—The term ‘‘culturally and linguistically 

19 congruent’’, with respect to care or maternity care, 

20 means care that is in agreement with the preferred 

21 cultural values, beliefs, worldview, language, and 

22 practices of the health care consumer and other 

23 stakeholders. 

24 (2) MATERNAL MORTALITY.—The term ‘‘mater25 nal mortality’’ means a death occurring during or 


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1 within a 1-year period after pregnancy, caused by 

2 pregnancy-related or childbirth complications, in3 cluding a suicide, overdose, or other death resulting 

4 from a mental health or substance use disorder at5 tributed to or aggravated by pregnancy-related or 

6 childbirth complications. 

7 (3) MATERNITY CARE PROVIDER.—The term 

8 ‘‘maternity care provider’’ means a health care pro9 vider who— 

10 (A) is a physician, a physician assistant, a 

11 midwife who meets, at a minimum, the inter12 national definition of a midwife and global 

13 standards for midwifery education as estab14 lished by the International Confederation of 

15 Midwives, an advanced practice registered 

16 nurse, or a lactation consultant certified by the 

17 International Board of Lactation Consultant 

18 Examiners; and 

19 (B) has a focus on maternal or perinatal 

20 health. 

21 (4) PERINATAL HEALTH WORKER.—The term 

22 ‘‘perinatal health worker’’ means a nonclinical health 

23 worker focused on maternal or perinatal health, such 

24 as a doula, community health worker, peer sup25 porter, lactation educator or counselor, nutritionist 


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1 or dietitian, childbirth educator, social worker, home 

2 visitor, patient navigator or coordinator, or language 

3 interpreter. 

4 (5) POSTPARTUM AND POSTPARTUM PERIOD.— 

5 The terms ‘‘postpartum’’ and ‘‘postpartum period’’ 

6 refer to the 1-year period beginning on the last day 

7 of the pregnancy of an individual. 

8 (6) PREGNANCY-ASSOCIATED DEATH.—The 

9 term ‘‘pregnancy-associated death’’ means a death of 

10 a pregnant or postpartum individual, by any cause, 

11 that occurs during, or within 1 year following, the 

12 individual’s pregnancy, regardless of the outcome, 

13 duration, or site of the pregnancy. 

14 (7) PREGNANCY-RELATED DEATH.—The term 

15 ‘‘pregnancy-related death’’ means a death of a preg16 nant or postpartum individual that occurs during, or 

17 within 1 year following, the individual’s pregnancy, 

18 from a pregnancy complication, a chain of events 

19 initiated by pregnancy, or the aggravation of an un20 related condition by the physiologic effects of preg21 nancy. 

22 (8) RACIAL AND ETHNIC MINORITY GROUP.— 

23 The term ‘‘racial and ethnic minority group’’ has the 

24 meaning given such term in section 1707(g)(1) of 


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1 the Public Health Service Act (42 U.S.C. 300u– 

2 6(g)(1)). 

3 (9) SEVERE MATERNAL MORBIDITY.—The term 

4 ‘‘severe maternal morbidity’’ means a health condi5 tion, including mental health conditions and sub6 stance use disorders, attributed to or aggravated by 

7 pregnancy or childbirth that results in significant 

8 short-term or long-term consequences to the health 

9 of the individual who was pregnant. 

10 (10) SOCIAL DETERMINANTS OF MATERNAL

11 HEALTH.—The term ‘‘social determinants of mater12 nal health’’ means nonclinical factors that impact 

13 maternal health outcomes. 

14 SEC. 5209. TECH TO SAVE MOMS. 

15 (a) DEFINITIONS.—In this section: 

16 (1) POSTPARTUM AND POSTPARTUM PERIOD.— 

17 The terms ‘‘postpartum’’ and ‘‘postpartum period’’ 

18 refer to the 1-year period beginning on the last day 

19 of the pregnancy of an individual. 

20 (2) RACIAL AND ETHNIC MINORITY GROUP.— 

21 The term ‘‘racial and ethnic minority group’’ has the 

22 meaning given such term in section 1707(g)(1) of 

23 the Public Health Service Act (42 U.S.C. 300u– 

24 6(g)(1)). 


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1 (3) SEVERE MATERNAL MORBIDITY.—The term 

2 ‘‘severe maternal morbidity’’ means a health condi3 tion, including mental health conditions and sub4 stance use disorders, attributed to or aggravated by 

5 pregnancy or childbirth that results in significant 

6 short-term or long-term consequences to the health 

7 of the individual who was pregnant. 

8 (4) SOCIAL DETERMINANTS OF MATERNAL

9 HEALTH.—The term ‘‘social determinants of mater10 nal health’’ means non-clinical factors that impact 

11 maternal health outcomes, including— 

12 (A) economic factors, which may include 

13 poverty, employment, food security, support for 

14 and access to lactation and other infant feeding 

15 options, housing stability, and related factors; 

16 (B) neighborhood factors, which may in17 clude quality of housing, access to transpor18 tation, access to child care, availability of 

19 healthy foods and nutrition counseling, avail20 ability of clean water, air and water quality, 

21 ambient temperatures, neighborhood crime and 

22 violence, access to broadband, and related fac23 tors; 

24 (C) social and community factors, which 

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1 nation or discrimination based on other pro2 tected classes, workplace conditions, incarcer3 ation, and related factors; 

4 (D) household factors, which may include 

5 ability to conduct lead testing and abatement, 

6 car seat installation, indoor air temperatures, 

7 and related factors; 

8 (E) education access and quality factors, 

9 which may include educational attainment, lan10 guage and literacy, and related factors; and 

11 (F) health care access factors, including 

12 health insurance coverage, access to culturally 

13 congruent health care services, providers, and 

14 non-clinical support, access to home visiting 

15 services, access to wellness and stress manage16 ment programs, health literacy, access to tele17 health and items required to receive telehealth 

18 services, and related factors. 

19 (b) INTEGRATED TELEHEALTH MODELS IN MATER20 NITY CARE SERVICES.— 

21 (1) IN GENERAL.—Section 1115A(b)(2)(B) of 

22 the Social Security Act (42 U.S.C. 1315a(b)(2)(B)) 

23 is amended by adding at the end the following: 

24 ‘‘(xxviii) Focusing on title XIX, pro25 viding for the adoption of and use of teleVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 00731 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 health tools that allow for screening, moni2 toring, and management of common health 

3 complications with respect to an individual 

4 receiving medical assistance during such 

5 individual’s pregnancy and for not more 

6 than a 1-year period beginning on the last 

7 day of the pregnancy.’’. 

8 (2) EFFECTIVE DATE.—The amendment made 

9 by paragraph (1) shall take effect 1 year after the 

10 date of the enactment of this section. 

11 (c) GRANTS TO EXPAND THE USE OF TECHNOLOGY12 ENABLED COLLABORATIVE LEARNING AND CAPACITY

13 MODELS FOR PREGNANT AND POSTPARTUM INDIVID14 UALS.—Title III of the Public Health Service Act is 

15 amended by inserting after section 330N (42 U.S.C. 

16 254c–20) the following: 

17 ‘‘SEC. 330N–1. EXPANDING CAPACITY FOR MATERNAL 

18 HEALTH OUTCOMES. 

19 ‘‘(a) ESTABLISHMENT.—Beginning not later than 1 

20 year after the date of enactment of this section, the Sec21 retary shall award grants to eligible entities to evaluate, 

22 develop, and expand the use of technology-enabled collabo23 rative learning and capacity building models and improve 

24 maternal health outcomes— 

25 ‘‘(1) in health professional shortage areas; 


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1 ‘‘(2) in areas with high rates of maternal mor2 tality and severe maternal morbidity; 

3 ‘‘(3) in areas with significant racial and ethnic 

4 inequities in maternal health outcomes; and 

5 ‘‘(4) for medically underserved populations and 

6 American Indians and Alaska Natives, including In7 dian Tribes, Tribal organizations, and Urban Indian 

8 organizations. 

9 ‘‘(b) USE OF FUNDS.— 

10 ‘‘(1) REQUIRED USES.—Recipients of grants 

11 under this section shall use the grants to— 

12 ‘‘(A) train maternal health care providers, 

13 students, and other similar professionals 

14 through models that include— 

15 ‘‘(i) methods to increase safety and 

16 health care quality; 

17 ‘‘(ii) training to increase awareness of, 

18 and eliminate implicit bias, racism, and 

19 discrimination in, the provision of health 

20 care; 

21 ‘‘(iii) best practices in screening for 

22 and, as needed, evaluating and treating 

23 maternal mental health conditions and 

24 substance use disorders; 


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1 ‘‘(iv) training on best practices in ma2 ternity care for pregnant and postpartum 

3 individuals during the COVID–19 public 

4 health emergency or future public health 

5 emergencies; 

6 ‘‘(v) methods to screen for social de7 terminants of maternal health risks in the 

8 prenatal and postpartum periods; and 

9 ‘‘(vi) the use of remote patient moni10 toring tools for pregnancy-related com11 plications described in section 

12 1115A(b)(2)(B)(xxviii) of the Social Secu13 rity Act; 

14 ‘‘(B) evaluate and collect information on 

15 the effect of such models on— 

16 ‘‘(i) access to, and quality of, care; 

17 ‘‘(ii) outcomes with respect to the 

18 health of an individual; and 

19 ‘‘(iii) the experience of individuals who 

20 receive pregnancy-related health care; 

21 ‘‘(C) develop qualitative and quantitative 

22 measures to identify best practices for the ex23 pansion and use of such models; 


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1 ‘‘(D) study the effect of such models on 

2 patient outcomes and maternity care providers; 

3 and 

4 ‘‘(E) conduct any other activity, as deter5 mined by the Secretary. 

6 ‘‘(2) PERMISSIBLE USES.—Recipients of grants 

7 under this section may use grants to support— 

8 ‘‘(A) the use and expansion of technology9 enabled collaborative learning and capacity 

10 building models, including hardware and soft11 ware that— 

12 ‘‘(i) enable distance learning and tech13 nical support; and 

14 ‘‘(ii) support the secure exchange of 

15 electronic health information; and 

16 ‘‘(B) maternity care providers, students, 

17 and other similar professionals in the provision 

18 of maternity care through such models. 

19 ‘‘(c) APPLICATION.— 

20 ‘‘(1) IN GENERAL.—An eligible entity seeking a 

21 grant under subsection (a) shall submit to the Sec22 retary an application, at such time, in such manner, 

23 and containing such information as the Secretary 

24 may require. 


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1 ‘‘(2) ASSURANCE.—An application under para2 graph (1) shall include an assurance that such entity 

3 shall collect information on, and assess the effect of, 

4 the use of technology-enabled collaborative learning 

5 and capacity building models, including with respect 

6 to— 

7 ‘‘(A) maternal health outcomes; 

8 ‘‘(B) access to maternal health care serv9 ices; 

10 ‘‘(C) quality of maternal health care; and 

11 ‘‘(D) retention of maternity care providers 

12 serving areas and populations described in sub13 section (a). 

14 ‘‘(d) LIMITATIONS.— 

15 ‘‘(1) NUMBER.—The Secretary may not award 

16 more than 1 grant under this section to an eligible 

17 entity. 

18 ‘‘(2) DURATION.—A grant awarded under this 

19 section shall be for a 5-year period. 

20 ‘‘(e) ACCESS TO BROADBAND.—In administering 

21 grants under this section, the Secretary may coordinate 

22 with other agencies to ensure that funding opportunities 

23 are available to support access to reliable, high-speed 

24 internet for grantees. 


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1 ‘‘(f) TECHNICAL ASSISTANCE.—The Secretary shall 

2 provide (either directly or by contract) technical assistance 

3 to eligible entities, including recipients of grants under 

4 subsection (a), on the development, use, and sustainability 

5 of technology-enabled collaborative learning and capacity 

6 building models to expand access to maternal health care 

7 services provided by such entities, including— 

8 ‘‘(1) in health professional shortage areas; 

9 ‘‘(2) in areas with high rates of maternal mor10 tality and severe maternal morbidity or significant 

11 racial and ethnic inequities in maternal health out12 comes; and 

13 ‘‘(3) for medically underserved populations or 

14 American Indians and Alaska Natives. 

15 ‘‘(g) RESEARCH AND EVALUATION.—The Secretary, 

16 in consultation with experts, shall develop a strategic plan 

17 to research and evaluate the evidence for such models. 

18 ‘‘(h) REPORTING.— 

19 ‘‘(1) ELIGIBLE ENTITIES.—An eligible entity 

20 that receives a grant under subsection (a) shall sub21 mit to the Secretary a report, at such time, in such 

22 manner, and containing such information as the Sec23 retary may require. 

24 ‘‘(2) SECRETARY.—Not later than 4 years after 

25 the date of enactment of this section, the Secretary 


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1 shall submit to the Congress, and make available on 

2 the website of the Department of Health and 

3 Human Services, a report that includes— 

4 ‘‘(A) a description of grants awarded 

5 under subsection (a) and the purpose and 

6 amounts of such grants; 

7 ‘‘(B) a summary of— 

8 ‘‘(i) the evaluations conducted under 

9 subsection (b)(1)(B); 

10 ‘‘(ii) any technical assistance provided 

11 under subsection (f); and 

12 ‘‘(iii) the activities conducted under 

13 subsection (a); and 

14 ‘‘(C) a description of any significant find15 ings with respect to— 

16 ‘‘(i) patient outcomes; and 

17 ‘‘(ii) best practices for expanding, 

18 using, or evaluating technology-enabled col19 laborative learning and capacity building 

20 models. 

21 ‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—There is 

22 authorized to be appropriated to carry out this section, 

23 $6,000,000 for each of fiscal years 2025 through 2029. 

24 ‘‘(j) DEFINITIONS.—In this section: 

25 ‘‘(1) ELIGIBLE ENTITY.— 


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1 ‘‘(A) IN GENERAL.—The term ‘eligible en2 tity’ means an entity that provides, or supports 

3 the provision of, maternal health care services 

4 or other evidence-based services for pregnant 

5 and postpartum individuals— 

6 ‘‘(i) in health professional shortage 

7 areas; 

8 ‘‘(ii) in areas with high rates of ad9 verse maternal health outcomes or signifi10 cant racial and ethnic inequities in mater11 nal health outcomes; or 

12 ‘‘(iii) who are— 

13 ‘‘(I) members of medically under14 served populations; or 

15 ‘‘(II) American Indians and Alas16 ka Natives, including Indian Tribes, 

17 Tribal organizations, and Urban In18 dian organizations. 

19 ‘‘(B) INCLUSIONS.—An eligible entity may 

20 include entities that lead, or are capable of 

21 leading, a technology-enabled collaborative 

22 learning and capacity building model. 

23 ‘‘(2) HEALTH PROFESSIONAL SHORTAGE

24 AREA.—The term ‘health professional shortage area’ 


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1 means a health professional shortage area des2 ignated under section 332. 

3 ‘‘(3) INDIAN TRIBE.—The term ‘Indian Tribe’ 

4 has the meaning given such term in section 4 of the 

5 Indian Self-Determination and Education Assistance 

6 Act. 

7 ‘‘(4) MATERNAL MORTALITY.—The term ‘ma8 ternal mortality’ means a death occurring during or 

9 within the 1-year period after pregnancy caused by 

10 pregnancy-related or childbirth complications, in11 cluding a suicide, overdose, or other death resulting 

12 from a mental health or substance use disorder at13 tributed to or aggravated by pregnancy or childbirth 

14 complications. 

15 ‘‘(5) MEDICALLY UNDERSERVED POPU16 LATION.—The term ‘medically underserved popu17 lation’ has the meaning given such term in section 

18 330(b)(3). 

19 ‘‘(6) POSTPARTUM.—The term ‘postpartum’ 

20 means the 1-year period beginning on the last date 

21 of an individual’s pregnancy. 

22 ‘‘(7) SEVERE MATERNAL MORBIDITY.—The 

23 term ‘severe maternal morbidity’ means a health 

24 condition, including a mental health or substance 

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1 nancy or childbirth that results in significant short2 term or long-term consequences to the health of the 

3 individual who was pregnant. 

4 ‘‘(8) TECHNOLOGY-ENABLED COLLABORATIVE

5 LEARNING AND CAPACITY BUILDING MODEL.—The 

6 term ‘technology-enabled collaborative learning and 

7 capacity building model’ means a distance health 

8 education model that connects health care profes9 sionals, and other specialists, through simultaneous 

10 interactive videoconferencing for the purpose of fa11 cilitating case-based learning, disseminating best 

12 practices, and evaluating outcomes in the context of 

13 maternal health care. 

14 ‘‘(9) TRIBAL ORGANIZATION.—The term ‘Tribal 

15 organization’ has the meaning given such term in 

16 section 4 of the Indian Self-Determination and Edu17 cation Assistance Act. 

18 ‘‘(10) URBAN INDIAN ORGANIZATION.—The 

19 term ‘Urban Indian organization’ has the meaning 

20 given such term in section 4 of the Indian Health 

21 Care Improvement Act.’’. 

22 (d) GRANTS TO PROMOTE EQUITY IN MATERNAL

23 HEALTH OUTCOMES THROUGH DIGITAL TOOLS.— 

24 (1) IN GENERAL.—Beginning not later than 1 

25 year after the date of enactment of this Act, the 


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1 Secretary of Health and Human Services (referred 

2 to in this subsection as the ‘‘Secretary’’) shall make 

3 grants to eligible entities to reduce racial and ethnic 

4 inequities in maternal health outcomes by increasing 

5 access to digital tools related to maternal health 

6 care. 

7 (2) APPLICATIONS.—To be eligible to receive a 

8 grant under this subsection, an eligible entity shall 

9 submit to the Secretary an application at such time, 

10 in such manner, and containing such information as 

11 the Secretary may require. 

12 (3) PRIORITIZATION.—In awarding grants 

13 under this subsection, the Secretary shall prioritize 

14 an eligible entity— 

15 (A) in an area with high rates of adverse 

16 maternal health outcomes or significant racial 

17 and ethnic inequities in maternal health out18 comes; 

19 (B) in a health professional shortage area 

20 designated under section 332 of the Public 

21 Health Service Act (42 U.S.C. 254e); and 

22 (C) that promotes technology that address23 es racial and ethnic inequities in maternal 

24 health outcomes. 

25 (4) LIMITATIONS.— 


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1 (A) NUMBER.—The Secretary may award 

2 not more than 1 grant under this subsection to 

3 an eligible entity. 

4 (B) DURATION.—A grant awarded under 

5 this subsection shall be for a 5-year period. 

6 (5) TECHNICAL ASSISTANCE.—The Secretary 

7 shall provide technical assistance to an eligible entity 

8 on the development, use, evaluation, and post-grant 

9 sustainability of digital tools for purposes of pro10 moting equity in maternal health outcomes. 

11 (6) REPORTING.— 

12 (A) ELIGIBLE ENTITIES.—An eligible enti13 ty that receives a grant under paragraph (1) 

14 shall submit to the Secretary a report, at such 

15 time, in such manner, and containing such in16 formation as the Secretary may require. 

17 (B) SECRETARY.—Not later than 4 years 

18 after the date of enactment of this Act, the Sec19 retary shall submit to Congress a report that 

20 includes— 

21 (i) an evaluation on the effectiveness 

22 of grants awarded under this subsection to 

23 improve health outcomes for pregnant and 

24 postpartum individuals from racial and 

25 ethnic minority groups; 


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1 (ii) recommendations on new grant 

2 programs that promote the use of tech3 nology to improve such maternal health 

4 outcomes; and 

5 (iii) recommendations with respect 

6 to— 

7 (I) technology-based privacy and 

8 security safeguards in maternal health 

9 care; 

10 (II) reimbursement rates for ma11 ternal telehealth services; 

12 (III) the use of digital tools to 

13 analyze large data sets to identify po14 tential pregnancy-related complica15 tions; 

16 (IV) barriers that prevent mater17 nity care providers from providing 

18 telehealth services across States; 

19 (V) the use of consumer digital 

20 tools such as mobile phone applica21 tions, patient portals, and wearable 

22 technologies to improve maternal 

23 health outcomes; 

24 (VI) barriers that prevent access 

25 to telehealth services, including a lack 


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1 of access to reliable, high-speed inter2 net or electronic devices; 

3 (VII) barriers to data sharing be4 tween the Special Supplemental Nu5 trition Program for Women, Infants, 

6 and Children program and maternity 

7 care providers, and recommendations 

8 for addressing such barriers; and 

9 (VIII) lessons learned from ex10 panded access to telehealth related to 

11 maternity care during the COVID–19 

12 public health emergency. 

13 (7) AUTHORIZATION OF APPROPRIATIONS.— 

14 There is authorized to be appropriated to carry out 

15 this subsection $6,000,000 for each of fiscal years 

16 2025 through 2029. 

17 (e) REPORT ON THE USE OF TECHNOLOGY IN MA18 TERNITY CARE.— 

19 (1) IN GENERAL.—Not later than 60 days after 

20 the date of enactment of this Act, the Secretary of 

21 Health and Human Services shall enter into an 

22 agreement with the National Academies of Sciences, 

23 Engineering, and Medicine (referred to in this sec24 tion as the ‘‘National Academies’’) under which the 

25 National Academies shall conduct a study on the use 


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1 of technology and patient monitoring devices in ma2 ternity care. 

3 (2) CONTENT.—The agreement entered into 

4 pursuant to paragraph (1) shall provide for the 

5 study of the following: 

6 (A) The use of innovative technology (in7 cluding artificial intelligence) in maternal 

8 health care, including the extent to which such 

9 technology has affected racial or ethnic biases 

10 in maternal health care. 

11 (B) The use of patient monitoring devices 

12 (including pulse oximeter devices) in maternal 

13 health care, including the extent to which such 

14 devices have affected racial or ethnic biases in 

15 maternal health care. 

16 (C) Best practices for reducing and pre17 venting racial or ethnic biases in the use of in18 novative technology and patient monitoring de19 vices in maternity care. 

20 (D) Best practices in the use of innovative 

21 technology and patient monitoring devices for 

22 pregnant and postpartum individuals from ra23 cial and ethnic minority groups. 

24 (E) Best practices with respect to privacy 

25 and security safeguards in such use. 


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1 (3) REPORT.—Not later than 2 years after the 

2 date of enactment of this Act, the National Acad3 emies shall complete the study under this subsection, 

4 and transmit a report of the results of such study 

5 to Congress. 

6 SEC. 5210. IMPACT TO SAVE MOMS ACT. 

7 (a) PERINATAL CARE ALTERNATIVE PAYMENT

8 MODEL DEMONSTRATION PROJECT.— 

9 (1) IN GENERAL.—For the period of fiscal 

10 years 2025 through 2028, the Secretary of Health 

11 and Human Services (referred to in this subsection 

12 as the ‘‘Secretary’’), acting through the Adminis13 trator of the Centers for Medicare & Medicaid Serv14 ices, shall establish and implement, in accordance 

15 with the requirements of this subsection, a dem16 onstration project, to be known as the Perinatal 

17 Care Alternative Payment Model Demonstration 

18 Project (referred to in this subsection as the ‘‘Dem19 onstration Project’’), for purposes of allowing States 

20 to test payment models under their State plans 

21 under title XIX of the Social Security Act (42 

22 U.S.C. 1396 et seq.) and State child health plans 

23 under title XXI of such Act (42 U.S.C. 1397aa et 

24 seq.) with respect to maternity care provided to 


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1 pregnant and postpartum individuals enrolled in 

2 such State plans and State child health plans. 

3 (2) COORDINATION.—In establishing the Dem4 onstration Project, the Secretary shall coordinate 

5 with stakeholders such as— 

6 (A) State Medicaid programs; 

7 (B) relevant organizations representing 

8 maternal health care providers; 

9 (C) relevant organizations representing pa10 tients, with a particular focus on individuals 

11 from demographic groups with disproportionate 

12 rates of adverse maternal health outcomes; 

13 (D) relevant community-based organiza14 tions, particularly organizations that seek to 

15 improve maternal health outcomes for individ16 uals from demographic groups with dispropor17 tionate rates of adverse maternal health out18 comes; 

19 (E) non-clinical perinatal health workers 

20 such as doulas, community health workers, peer 

21 supporters, certified lactation consultants, nu22 tritionists and dieticians, social workers, home 

23 visitors, and navigators; 

24 (F) relevant health insurance issuers; 


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1 (G) hospitals, health systems, freestanding 

2 birth centers (as such term is defined in para3 graph (3)(B) of section 1905(l) of the Social 

4 Security Act (42 U.S.C. 1396d(l))), Federally5 qualified health centers (as such term is defined 

6 in paragraph (2)(B) of such section), and rural 

7 health clinics (as such term is defined in section 

8 1861(aa) of such Act (42 U.S.C. 1395x(aa))); 

9 (H) researchers and policy experts in fields 

10 related to maternity care payment models; and 

11 (I) any other stakeholders as the Secretary 

12 determines appropriate, with a particular focus 

13 on stakeholders from demographic groups with 

14 disproportionate rates of adverse maternal 

15 health outcomes. 

16 (3) CONSIDERATIONS.—In establishing the 

17 Demonstration Project, the Secretary shall consider 

18 each of the following: 

19 (A) Findings from any evaluations of the 

20 Strong Start for Mothers and Newborns initia21 tive carried out by the Centers for Medicare & 

22 Medicaid Services, the Health Resources and 

23 Services Administration, and the Administra24 tion on Children and Families. 

25 (B) Any alternative payment model that— 


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1 (i) is designed to improve maternal 

2 health outcomes for racial and ethnic 

3 groups with disproportionate rates of ad4 verse maternal health outcomes; 

5 (ii) includes methods for stratifying 

6 patients by pregnancy risk level and, as 

7 appropriate, adjusting payments under 

8 such model to take into account pregnancy 

9 risk level; 

10 (iii) establishes evidence-based quality 

11 metrics for such payments; 

12 (iv) includes consideration of non-hos13 pital birth settings such as freestanding 

14 birth centers (as so defined); 

15 (v) includes consideration of social de16 terminants of health that are relevant to 

17 maternal health outcomes such as housing, 

18 transportation, nutrition, and other non19 clinical factors that influence maternal 

20 health outcomes; or 

21 (vi) includes diverse maternity care 

22 teams that include— 

23 (I) maternity care providers, in24 cluding obstetrician-gynecologists, 

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1 ants, midwives who meet, at a min2 imum, the international definition of 

3 the term ‘‘midwife’’ and global stand4 ards for midwifery education (as es5 tablished by the International Confed6 eration of Midwives), and nurse prac7 titioners— 

8 (aa) from racially, eth9 nically, and professionally diverse 

10 backgrounds; 

11 (bb) with experience prac12 ticing in racially and ethnically 

13 diverse communities; or 

14 (cc) who have undergone 

15 trainings on racism, implicit bias, 

16 and explicit bias; and 

17 (II) non-clinical perinatal health 

18 workers such as doulas, community 

19 health workers, peer supporters, cer20 tified lactation consultants, nutrition21 ists and dieticians, social workers, 

22 home visitors, and navigators. 

23 (4) ELIGIBILITY.—To be eligible to participate 

24 in the Demonstration Project, a State shall submit 

25 an application to the Secretary at such time, in such 


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1 manner, and containing such information as the Sec2 retary may require. 

3 (5) EVALUATION.—The Secretary shall conduct 

4 an evaluation of the Demonstration Project to deter5 mine the impact of the Demonstration Project on— 

6 (A) maternal health outcomes, with data 

7 stratified by race, ethnicity, socioeconomic indi8 cators, and any other factors as the Secretary 

9 determines appropriate; 

10 (B) spending on maternity care by States 

11 participating in the Demonstration Project; 

12 (C) to the extent practicable, subjective 

13 measures of patient experience; and 

14 (D) any other areas of assessment that the 

15 Secretary determines relevant. 

16 (6) REPORT.—Not later than 1 year after the 

17 completion or termination date of the Demonstration 

18 Project, the Secretary shall submit to the Committee 

19 on Energy and Commerce, the Committee on Ways 

20 and Means, and the Committee on Education and 

21 the Workforce of the House of Representatives and 

22 the Committee on Finance and the Committee on 

23 Health, Education, Labor, and Pensions of the Sen24 ate, and make publicly available, a report con25 taining— 


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1 (A) the results of any evaluation conducted 

2 under paragraph (5); and 

3 (B) a recommendation regarding whether 

4 the Demonstration Project should be continued 

5 after fiscal year 2028 and expanded on a na6 tional basis. 

7 (7) AUTHORIZATION OF APPROPRIATIONS.— 

8 There are authorized to be appropriated such sums 

9 as are necessary to carry out this subsection. 

10 (8) DEFINITIONS.—In this subsection: 

11 (A) ALTERNATIVE PAYMENT MODEL.—The 

12 term ‘‘alternative payment model’’ has the 

13 meaning given such term in section 

14 1833(z)(3)(C) of the Social Security Act (42 

15 U.S.C. 1395l(z)(3)(C)). 

16 (B) PERINATAL.—The term ‘‘perinatal’’ 

17 means the period beginning on the day a person 

18 becomes pregnant and ending on the last day of 

19 the 1-year period beginning on the last day of 

20 such person’s pregnancy. 

21 (b) MACPAC REPORT.— 

22 (1) IN GENERAL.—Not later than 2 years after 

23 the date of the enactment of this section, the Med24 icaid and CHIP Payment and Access Commission 

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1 tinuity of coverage under State plans under title 

2 XIX of the Social Security Act (42 U.S.C. 1396 et 

3 seq.) and State child health plans under title XXI of 

4 such Act (42 U.S.C. 1397aa et seq.) for pregnant 

5 and postpartum individuals. Such report shall, at a 

6 minimum, include the following: 

7 (A) An assessment of any existing policies 

8 under such State plans and such State child 

9 health plans regarding presumptive eligibility 

10 for pregnant individuals while their application 

11 for enrollment in such a State plan or such a 

12 State child health plan is being processed. 

13 (B) An assessment of any existing policies 

14 under such State plans and such State child 

15 health plans regarding measures to ensure con16 tinuity of coverage under such a State plan or 

17 such a State child health plan for pregnant and 

18 postpartum individuals, including such individ19 uals who need to change their health insurance 

20 coverage during their pregnancy or the 

21 postpartum period following their pregnancy. 

22 (C) An assessment of any existing policies 

23 under such State plans and such State child 

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1 roll under such a State plan or such a State 

2 child health plan as a parent. 

3 (D) If determined appropriate by the Com4 mission, any recommendations for the Depart5 ment of Health and Human Services, or such 

6 State plans and such State child health plans, 

7 to ensure continuity of coverage under such a 

8 State plan or such a State child health plan for 

9 pregnant and postpartum people. 

10 (2) POSTPARTUM DEFINED.—In this sub11 section, the term ‘‘postpartum’’ means the 1-year 

12 period beginning on the last day of a person’s preg13 nancy. 

14 SEC. 5211. PROTECTING MOMS AND BABIES AGAINST CLI15 MATE CHANGE. 

16 (a) GRANT PROGRAM TO PROTECT VULNERABLE

17 MOTHERS AND BABIES FROM CLIMATE CHANGE

18 RISKS.— 

19 (1) IN GENERAL.—Not later than 180 days 

20 after the date of enactment of this section, the Sec21 retary of Health and Human Services (in this sec22 tion referred to as the ‘‘Secretary’’) shall establish 

23 a grant program (in this subsection referred to as 

24 the ‘‘Program’’) to protect vulnerable individuals 

25 from risks associated with climate change. 


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1 (2) GRANT AUTHORITY.—In carrying out the 

2 Program, the Secretary may award, on a competitive 

3 basis, grants to 10 covered entities. 

4 (3) APPLICATIONS.—To be eligible for a grant 

5 under the Program, a covered entity shall submit to 

6 the Secretary an application at such time, in such 

7 form, and containing such information as the Sec8 retary may require, which shall include, at a min9 imum, a description of the following: 

10 (A) Plans for the use of grant funds 

11 awarded under the Program and how patients 

12 and stakeholder organizations were involved in 

13 the development of such plans. 

14 (B) How such grant funds will be targeted 

15 to geographic areas that have disproportionately 

16 high levels of risks associated with climate 

17 change for vulnerable individuals. 

18 (C) How such grant funds will be used to 

19 address racial and ethnic inequities in— 

20 (i) adverse maternal and infant health 

21 outcomes; and 

22 (ii) exposure to risks associated with 

23 climate change for vulnerable individuals. 

24 (D) Strategies to prevent an initiative as25 sisted with such grant funds from causing— 


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1 (i) adverse environmental impacts; 

2 (ii) displacement of residents and 

3 businesses; 

4 (iii) rent and housing price increases; 

5 or 

6 (iv) disproportionate adverse impacts 

7 on racial and ethnic minority groups and 

8 other underserved populations. 

9 (4) SELECTION OF GRANT RECIPIENTS.— 

10 (A) TIMING.—Not later than 270 days 

11 after the date of enactment of this Act, the Sec12 retary shall select the recipients of grants under 

13 the Program. 

14 (B) CONSULTATION.—In selecting covered 

15 entities for grants under the Program, the Sec16 retary shall consult with— 

17 (i) representatives of stakeholder or18 ganizations; 

19 (ii) the Administrator of the Environ20 mental Protection Agency; 

21 (iii) the Administrator of the National 

22 Oceanic and Atmospheric Administration; 

23 and 

24 (iv) from the Department of Health 

25 and Human Services— 


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1 (I) the Deputy Assistant Sec2 retary for Minority Health; 

3 (II) the Administrator of the 

4 Centers for Medicare & Medicaid 

5 Services; 

6 (III) the Administrator of the 

7 Health Resources and Services Ad8 ministration; 

9 (IV) the Director of the National 

10 Institutes of Health; and 

11 (V) the Director of the Centers 

12 for Disease Control and Prevention. 

13 (C) PRIORITY.—In selecting a covered en14 tity to be awarded a grant under the Program, 

15 the Secretary shall give priority to covered enti16 ties that serve a county— 

17 (i) designated, or located in an area 

18 designated, as a nonattainment area pur19 suant to section 107 of the Clean Air Act 

20 (42 U.S.C. 7407) for any air pollutant for 

21 which air quality criteria have been issued 

22 under section 108(a) of such Act (42 

23 U.S.C. 7408(a)); 

24 (ii) with a level of vulnerability of 

25 moderate-to-high or higher, according to 


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1 the Social Vulnerability Index of the Cen2 ters for Disease Control and Prevention; or 

3 (iii) with temperatures that pose a 

4 risk to human health, as determined by the 

5 Secretary, in consultation with the Admin6 istrator of the National Oceanic and At7 mospheric Administration and the Chair of 

8 the United States Global Change Research 

9 Program, based on the best available 

10 science. 

11 (D) LIMITATION.—A recipient of grant 

12 funds under the Program may not use such 

13 grant funds to serve a county that is served by 

14 any other recipient of a grant under the Pro15 gram. 

16 (5) USE OF FUNDS.—A covered entity awarded 

17 grant funds under the Program may only use such 

18 grant funds for the following: 

19 (A) Initiatives to identify risks associated 

20 with climate change for vulnerable individuals 

21 and to provide services and support to such in22 dividuals that address such risks, which may in23 clude— 

24 (i) training for health care providers, 

25 doulas, and other employees in hospitals, 


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1 birth centers, midwifery practices, and 

2 other health care practices that provide 

3 prenatal or labor and delivery services to 

4 vulnerable individuals on the identification 

5 of, and patient counseling relating to, risks 

6 associated with climate change for vulner7 able individuals; 

8 (ii) hiring, training, or providing re9 sources to community health workers and 

10 perinatal health workers who can help 

11 identify risks associated with climate 

12 change for vulnerable individuals, provide 

13 patient counseling about such risks, and 

14 carry out the distribution of relevant serv15 ices and support; 

16 (iii) enhancing the monitoring of risks 

17 associated with climate change for vulner18 able individuals, including by— 

19 (I) collecting data on such risks 

20 in specific census tracts, neighbor21 hoods, or other geographic areas; and 

22 (II) sharing such data with local 

23 health care providers, doulas, and 

24 other employees in hospitals, birth 

25 centers, midwifery practices, and 


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1 other health care practices that pro2 vide prenatal or labor and delivery 

3 services to local vulnerable individuals; 

4 and 

5 (iv) providing vulnerable individuals— 

6 (I) air conditioning units, resi7 dential weatherization support, filtra8 tion systems, household appliances, or 

9 related items; 

10 (II) direct financial assistance; 

11 and 

12 (III) services and support, in13 cluding housing and transportation 

14 assistance, to prepare for or recover 

15 from extreme weather events, which 

16 may include floods, hurricanes, 

17 wildfires, droughts, and related 

18 events. 

19 (B) Initiatives to mitigate levels of and ex20 posure to risks associated with climate change 

21 for vulnerable individuals, which shall be based 

22 on the best available science and which may in23 clude initiatives to— 


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1 (i) develop, maintain, or expand urban 

2 or community forestry initiatives and tree 

3 canopy coverage initiatives; 

4 (ii) improve infrastructure, including 

5 buildings and paved surfaces; 

6 (iii) develop or improve community 

7 outreach networks to provide culturally 

8 and linguistically appropriate information 

9 and notifications about risks associated 

10 with climate change for vulnerable individ11 uals; and 

12 (iv) provide enhanced services to ra13 cial and ethnic minority groups and other 

14 underserved populations. 

15 (6) LENGTH OF AWARD.—A grant under this 

16 subsection shall be disbursed over 4 fiscal years. 

17 (7) TECHNICAL ASSISTANCE.—The Secretary 

18 shall provide technical assistance to a covered entity 

19 awarded a grant under the Program to support the 

20 development, implementation, and evaluation of ac21 tivities funded with such grant. 

22 (8) REPORTS TO SECRETARY.— 

23 (A) ANNUAL REPORT.—For each fiscal 

24 year during which a covered entity is disbursed 

25 grant funds under the Program, such covered 


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1 entity shall submit to the Secretary a report 

2 that summarizes the activities carried out by 

3 such covered entity with such grant funds dur4 ing such fiscal year, which shall include a de5 scription of the following: 

6 (i) The involvement of stakeholder or7 ganizations in the implementation of initia8 tives assisted with such grant funds. 

9 (ii) Relevant health and environmental 

10 data, disaggregated, to the extent prac11 ticable, by race, ethnicity, gender, and 

12 pregnancy status. 

13 (iii) Qualitative feedback received 

14 from vulnerable individuals with respect to 

15 initiatives assisted with such grant funds. 

16 (iv) Criteria used in selecting the geo17 graphic areas assisted with such grant 

18 funds. 

19 (v) Efforts to address racial and eth20 nic inequities in adverse maternal and in21 fant health outcomes and in exposure to 

22 risks associated with climate change for 

23 vulnerable individuals. 


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1 (vi) Any negative and unintended im2 pacts of initiatives assisted with such grant 

3 funds, including— 

4 (I) adverse environmental im5 pacts; 

6 (II) displacement of residents 

7 and businesses; 

8 (III) rent and housing price in9 creases; and 

10 (IV) disproportionate adverse im11 pacts on racial and ethnic minority 

12 groups and other underserved popu13 lations. 

14 (vii) How the covered entity will ad15 dress and prevent any impacts described in 

16 clause (vi). 

17 (B) PUBLICATION.—Not later than 30 

18 days after the date on which a report is sub19 mitted under subparagraph (A), the Secretary 

20 shall publish such report on a public website of 

21 the Department of Health and Human Services. 

22 (9) REPORT TO CONGRESS.—Not later than the 

23 date that is 5 years after the date on which the Pro24 gram is established, the Secretary shall submit to 

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1 partment of Health and Human Services a report on 

2 the results of the Program, including the following: 

3 (A) Summaries of the annual reports sub4 mitted under paragraph (8). 

5 (B) Evaluations of the initiatives assisted 

6 with grant funds under the Program. 

7 (C) An assessment of the effectiveness of 

8 the Program in— 

9 (i) identifying risks associated with 

10 climate change for vulnerable individuals; 

11 (ii) providing services and support to 

12 such individuals; 

13 (iii) mitigating levels of and exposure 

14 to such risks; and 

15 (iv) addressing racial and ethnic in16 equities in adverse maternal and infant 

17 health outcomes and in exposure to such 

18 risks. 

19 (D) A description of how the Program 

20 could be expanded, including— 

21 (i) monitoring efforts or data collec22 tion that would be required to identify 

23 areas with high levels of risks associated 

24 with climate change for vulnerable individ25 uals; 


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1 (ii) how such areas could be identified 

2 using the strategy developed under sub3 section (d); and 

4 (iii) recommendations for additional 

5 funding. 

6 (10) COVERED ENTITY DEFINED.—In this sub7 section, the term ‘‘covered entity’’ means a consor8 tium of organizations serving a county that— 

9 (A) shall include a community-based orga10 nization; and 

11 (B) may include— 

12 (i) another stakeholder organization; 

13 (ii) the government of such county; 

14 (iii) the governments of one or more 

15 municipalities within such county; 

16 (iv) a State or local public health de17 partment or emergency management agen18 cy; 

19 (v) a local health care practice, which 

20 may include a licensed and accredited hos21 pital, birth center, midwifery practice, or 

22 other health care practice that provides 

23 prenatal or labor and delivery services to 

24 vulnerable individuals; 


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1 (vi) an Indian tribe or tribal organiza2 tion (as such terms are defined in section 

3 4 of the Indian Self-Determination and 

4 Education Assistance Act (25 U.S.C. 

5 5304)); 

6 (vii) an Urban Indian organization (as 

7 defined in section 4 of the Indian Health 

8 Care Improvement Act (25 U.S.C. 1603)); 

9 and 

10 (viii) an institution of higher edu11 cation. 

12 (11) AUTHORIZATION OF APPROPRIATIONS.— 

13 There is authorized to be appropriated to carry out 

14 this subsection $100,000,000 for fiscal years 2025 

15 through 2028. 

16 (b) GRANT PROGRAM FOR EDUCATION AND TRAIN17 ING AT HEALTH PROFESSION SCHOOLS.— 

18 (1) IN GENERAL.—Not later than 1 year after 

19 the date of enactment of this Act, the Secretary 

20 shall establish a grant program (in this subsection 

21 referred to as the ‘‘Program’’) to provide funds to 

22 health profession schools to support the development 

23 and integration of education and training programs 

24 for identifying and addressing risks associated with 

25 climate change for vulnerable individuals. 


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1 (2) GRANT AUTHORITY.—In carrying out the 

2 Program, the Secretary may award, on a competitive 

3 basis, grants to health profession schools. 

4 (3) APPLICATION.—To be eligible for a grant 

5 under the Program, a health profession school shall 

6 submit to the Secretary an application at such time, 

7 in such form, and containing such information as 

8 the Secretary may require, which shall include, at a 

9 minimum, a description of the following: 

10 (A) How such health profession school will 

11 engage with vulnerable individuals, and stake12 holder organizations representing such individ13 uals, in developing and implementing the edu14 cation and training programs supported by 

15 grant funds awarded under the Program. 

16 (B) How such health profession school will 

17 ensure that such education and training pro18 grams will address racial and ethnic inequities 

19 in exposure to, and the effects of, risks associ20 ated with climate change for vulnerable individ21 uals. 

22 (4) USE OF FUNDS.—A health profession school 

23 awarded a grant under the Program shall use the 

24 grant funds to develop, and integrate into the cur25 riculum and continuing education of such health 


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1 profession school, education and training on each of 

2 the following: 

3 (A) Identifying risks associated with cli4 mate change for vulnerable individuals and indi5 viduals with the intent to become pregnant. 

6 (B) How risks associated with climate 

7 change affect vulnerable individuals and individ8 uals with the intent to become pregnant. 

9 (C) Racial and ethnic inequities in expo10 sure to, and the effects of, risks associated with 

11 climate change for vulnerable individuals and 

12 individuals with the intent to become pregnant. 

13 (D) Patient counseling and mitigation 

14 strategies relating to risks associated with cli15 mate change for vulnerable individuals. 

16 (E) Relevant services and support for vul17 nerable individuals relating to risks associated 

18 with climate change and strategies for ensuring 

19 vulnerable individuals have access to such serv20 ices and support. 

21 (F) Implicit and explicit bias, racism, and 

22 discrimination. 

23 (G) Related topics identified by such 

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1 nerable individuals and stakeholder organiza2 tions representing such individuals. 

3 (5) PARTNERSHIPS.—In carrying out activities 

4 with grant funds, a health profession school awarded 

5 a grant under the Program may partner with one or 

6 more of the following: 

7 (A) A State or local public health depart8 ment. 

9 (B) A health care professional membership 

10 organization. 

11 (C) A stakeholder organization. 

12 (D) A health profession school. 

13 (E) An institution of higher education. 

14 (6) REPORTS TO SECRETARY.— 

15 (A) ANNUAL REPORT.—For each fiscal 

16 year during which a health profession school is 

17 disbursed grant funds under the Program, such 

18 health profession school shall submit to the Sec19 retary a report that describes the activities car20 ried out with such grant funds during such fis21 cal year. 

22 (B) FINAL REPORT.—Not later than the 

23 date that is 1 year after the end of the last fis24 cal year during which a health profession school 

25 is disbursed grant funds under the Program, 


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1 the health profession school shall submit to the 

2 Secretary a final report that summarizes the 

3 activities carried out with such grant funds. 

4 (7) REPORT TO CONGRESS.—Not later than the 

5 date that is 6 years after the date on which the Pro6 gram is established, the Secretary shall submit to 

7 Congress and publish on a public website of the De8 partment of Health and Human Services a report 

9 that includes the following: 

10 (A) A summary of the reports submitted 

11 under paragraph (6). 

12 (B) Recommendations to improve edu13 cation and training programs at health profes14 sion schools with respect to identifying and ad15 dressing risks associated with climate change 

16 for vulnerable individuals. 

17 (8) HEALTH PROFESSION SCHOOL DEFINED.— 

18 In this subsection, the term ‘‘health profession 

19 school’’ means an accredited— 

20 (A) medical school; 

21 (B) school of nursing; 

22 (C) midwifery program; 

23 (D) physician assistant education program; 

24 (E) teaching hospital; 

25 (F) residency or fellowship program; or 


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1 (G) other school or program determined 

2 appropriate by the Secretary. 

3 (9) AUTHORIZATION OF APPROPRIATIONS.— 

4 There is authorized to be appropriated to carry out 

5 this subsection $5,000,000 for fiscal years 2025 

6 through 2028. 

7 (c) NIH CONSORTIUM ON BIRTH AND CLIMATE

8 CHANGE RESEARCH.— 

9 (1) ESTABLISHMENT.—Not later than 1 year 

10 after the date of enactment of this Act, the Director 

11 of the National Institutes of Health (in this sub12 section referred to as the ‘‘Director of NIH’’) shall 

13 establish the Consortium on Birth and Climate 

14 Change Research (in this subsection referred to as 

15 the ‘‘Consortium’’). 

16 (2) DUTIES.— 

17 (A) IN GENERAL.—The Consortium shall 

18 coordinate, across the institutes, centers, and 

19 offices of the National Institutes of Health, re20 search on the risks associated with climate 

21 change for vulnerable individuals. 

22 (B) REQUIRED ACTIVITIES.—In carrying 

23 out subparagraph (A), the Consortium shall— 

24 (i) establish research priorities, in25 cluding by prioritizing research that— 


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1 (I) identifies the risks associated 

2 with climate change for vulnerable in3 dividuals with a particular focus on 

4 inequities in such risks among racial 

5 and ethnic minority groups and other 

6 underserved populations; and 

7 (II) identifies strategies to reduce 

8 levels of, and exposure to, such risks, 

9 with a particular focus on risks 

10 among racial and ethnic minority 

11 groups and other underserved popu12 lations; 

13 (ii) identify gaps in available data re14 lated to such risks; 

15 (iii) identify gaps in, and opportuni16 ties for, research collaborations; 

17 (iv) identify funding opportunities for 

18 community-based organizations and re19 searchers from racially, ethnically, and 

20 geographically diverse backgrounds; and 

21 (v) publish annual reports on the 

22 work and findings of the Consortium on a 

23 public website of the National Institutes of 

24 Health. 


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1 (3) MEMBERSHIP.—The Director of NIH shall 

2 appoint to the Consortium representatives of such 

3 institutes, centers, and offices of the National Insti4 tutes of Health as the Director of NIH considers ap5 propriate, including, at a minimum, representatives 

6 of— 

7 (A) the National Institute of Environ8 mental Health Sciences; 

9 (B) the National Institute on Minority 

10 Health and Health Disparities; 

11 (C) the Eunice Kennedy Shriver National 

12 Institute of Child Health and Human Develop13 ment; 

14 (D) the National Institute of Nursing Re15 search; and 

16 (E) the Office of Research on Women’s 

17 Health. 

18 (4) CHAIRPERSON.—The Chairperson of the 

19 Consortium shall be designated by the Director of 

20 NIH and selected from among the representatives 

21 appointed under paragraph (3). 

22 (5) CONSULTATION.—In carrying out the duties 

23 described in paragraph (2), the Consortium shall 

24 consult with— 


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1 (A) the heads of relevant Federal agencies, 

2 including— 

3 (i) the Environmental Protection 

4 Agency; 

5 (ii) the National Oceanic and Atmos6 pheric Administration; 

7 (iii) the Occupational Safety and 

8 Health Administration; and 

9 (iv) from the Department of Health 

10 and Human Services— 

11 (I) the Office of Minority Health 

12 in the Office of the Secretary; 

13 (II) the Centers for Medicare & 

14 Medicaid Services; 

15 (III) the Health Resources and 

16 Services Administration; 

17 (IV) the Centers for Disease 

18 Control and Prevention; 

19 (V) the Indian Health Service; 

20 and 

21 (VI) the Administration for Chil22 dren and Families; and 

23 (B) representatives of— 

24 (i) stakeholder organizations; 


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1 (ii) health care providers and profes2 sional membership organizations with ex3 pertise in maternal health or environ4 mental justice; 

5 (iii) State and local public health de6 partments; 

7 (iv) licensed and accredited hospitals, 

8 birth centers, midwifery practices, or other 

9 health care practices that provide prenatal 

10 or labor and delivery services to vulnerable 

11 individuals; and 

12 (v) institutions of higher education, 

13 including such institutions that are minor14 ity-serving institutions or have expertise in 

15 maternal health or environmental justice. 

16 (d) STRATEGY FOR IDENTIFYING CLIMATE CHANGE

17 RISK ZONES FOR VULNERABLE MOTHERS AND BABIES.— 

18 (1) IN GENERAL.—The Secretary, acting 

19 through the Director of the Centers for Disease 

20 Control and Prevention, shall develop a strategy (in 

21 this subsection referred to as the ‘‘Strategy’’) for 

22 designating areas that the Secretary determines to 

23 have a high risk of adverse maternal and infant 

24 health outcomes among vulnerable individuals as a 

25 result of risks associated with climate change. 


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1 (2) STRATEGY REQUIREMENTS.— 

2 (A) IN GENERAL.—In developing the 

3 Strategy, the Secretary shall establish a process 

4 to identify areas where vulnerable individuals 

5 are exposed to a high risk of adverse maternal 

6 and infant health outcomes as a result of risks 

7 associated with climate change in conjunction 

8 with other factors that can impact such health 

9 outcomes, including— 

10 (i) the incidence of diseases associated 

11 with air pollution, extreme heat, and other 

12 environmental factors; 

13 (ii) the availability and accessibility of 

14 maternal and infant health care providers; 

15 (iii) English-language proficiency 

16 among people of reproductive age; 

17 (iv) the health insurance status of 

18 people of reproductive age; 

19 (v) the number of people of reproduc20 tive age who are members of racial or eth21 nic groups with disproportionately high 

22 rates of adverse maternal and infant 

23 health outcomes; 


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1 (vi) the socioeconomic status of people 

2 of reproductive age, including with respect 

3 to— 

4 (I) poverty; 

5 (II) unemployment; 

6 (III) household income; and 

7 (IV) educational attainment; and 

8 (vii) access to quality housing, trans9 portation, and nutrition. 

10 (B) RESOURCES.—In developing the Strat11 egy, the Secretary shall identify, and incor12 porate a description of, the following: 

13 (i) Existing mapping tools or Federal 

14 programs that identify— 

15 (I) risks associated with climate 

16 change for vulnerable individuals; and 

17 (II) other factors that can influ18 ence maternal and infant health out19 comes, including the factors described 

20 in subparagraph (A). 

21 (ii) Environmental, health, socio22 economic, and demographic data relevant 

23 to identifying risks associated with climate 

24 change for vulnerable individuals. 


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1 (iii) Existing monitoring networks 

2 that collect data described in clause (ii), 

3 and any gaps in such networks. 

4 (iv) Federal, State, and local stake5 holders involved in maintaining monitoring 

6 networks identified under clause (iii), and 

7 how such stakeholders are coordinating 

8 their monitoring efforts. 

9 (v) Additional monitoring networks, 

10 and enhancements to existing monitoring 

11 networks, that would be required to ad12 dress gaps identified under clause (iii), in13 cluding at the subcounty and census tract 

14 level. 

15 (vi) Funding amounts required to es16 tablish the monitoring networks identified 

17 under clause (v) and recommendations for 

18 Federal, State, and local coordination with 

19 respect to such networks. 

20 (vii) Potential uses for data collected 

21 and generated as a result of the Strategy, 

22 including how such data may be used in 

23 determining recipients of grants under the 

24 program established by subsection (a) or 

25 other similar programs. 


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1 (viii) Other information the Secretary 

2 considers relevant for the development of 

3 the Strategy. 

4 (3) COORDINATION AND CONSULTATION.—In 

5 developing the Strategy, the Secretary shall— 

6 (A) coordinate with the Administrator of 

7 the Environmental Protection Agency and the 

8 Administrator of the National Oceanic and At9 mospheric Administration; and 

10 (B) consult with— 

11 (i) stakeholder organizations; 

12 (ii) health care providers and profes13 sional membership organizations with ex14 pertise in maternal health or environ15 mental justice; 

16 (iii) State and local public health de17 partments; 

18 (iv) licensed and accredited hospitals, 

19 birth centers, midwifery practices, or other 

20 health care providers that provide prenatal 

21 or labor and delivery services to vulnerable 

22 individuals; and 

23 (v) institutions of higher education, 

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1 ity-serving institutions or have expertise in 

2 maternal health or environmental justice. 

3 (4) NOTICE AND COMMENT.—At least 240 days 

4 before the date on which the Strategy is published 

5 in accordance with paragraph (5), the Secretary 

6 shall provide— 

7 (A) notice of the Strategy on a public 

8 website of the Department of Health and 

9 Human Services; and 

10 (B) an opportunity for public comment of 

11 at least 90 days. 

12 (5) PUBLICATION.—Not later than 18 months 

13 after the date of enactment of this Act, the Sec14 retary shall publish on a public website of the De15 partment of Health and Human Services— 

16 (A) the Strategy; 

17 (B) the public comments received under 

18 paragraph (4); and 

19 (C) the responses of the Secretary to such 

20 public comments. 

21 (e) DEFINITIONS.—In this section, the following defi22 nitions apply: 

23 (1) ADVERSE MATERNAL AND INFANT HEALTH

24 OUTCOMES.—The term ‘‘adverse maternal and in25 fant health outcomes’’ includes the outcomes of preVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 00781 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 term birth, low birth weight, stillbirth, infant or ma2 ternal mortality, and severe maternal morbidity. 

3 (2) INSTITUTION OF HIGHER EDUCATION.—The 

4 term ‘‘institution of higher education’’ has the 

5 meaning given such term in section 101 of the High6 er Education Act of 1965 (20 U.S.C. 1001). 

7 (3) MINORITY-SERVING INSTITUTION.—The 

8 term ‘‘minority-serving institution’’ means an entity 

9 specified in any of paragraphs (1) through (7) of 

10 section 371(a) of the Higher Education Act of 1965 

11 (20 U.S.C. 1067q(a)). 

12 (4) RACIAL AND ETHNIC MINORITY GROUP.— 

13 The term ‘‘racial and ethnic minority group’’ has the 

14 meaning given such term in section 1707(g) of the 

15 Public Health Service Act (42 U.S.C. 300u–6(g)). 

16 (5) RISKS ASSOCIATED WITH CLIMATE

17 CHANGE.—The term ‘‘risks associated with climate 

18 change’’ includes risks associated with extreme heat, 

19 air pollution, extreme weather events, and other en20 vironmental issues associated with climate change 

21 that can result in adverse maternal and infant 

22 health outcomes. 

23 (6) STAKEHOLDER ORGANIZATION.—The term 

24 ‘‘stakeholder organization’’ means— 


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1 (A) a community-based organization with 

2 expertise in providing assistance to vulnerable 

3 individuals; 

4 (B) a nonprofit organization with expertise 

5 in maternal or infant health or environmental 

6 justice; and 

7 (C) a patient advocacy organization rep8 resenting vulnerable individuals. 

9 (7) VULNERABLE INDIVIDUAL.—The term ‘‘vul10 nerable individual’’ means— 

11 (A) an individual who is pregnant; 

12 (B) an individual who was pregnant during 

13 any portion of the preceding 1-year period; and 

14 (C) an individual under 3 years of age. 

15 SEC. 5212. PROTECT MOMS FROM DOMESTIC VIOLENCE. 

16 (a) STUDY BY DEPARTMENT OF HEALTH AND

17 HUMAN SERVICES.— 

18 (1) STUDY.—The Secretary, in collaboration 

19 with the Health Resources and Services Administra20 tion, the Substance Abuse and Mental Health Serv21 ices Administration, and the Administration for 

22 Children and Families, and in consultation with the 

23 Attorney General of the United States, the Director 

24 of the Indian Health Service, and stakeholders (in25 cluding community-based organizations, culturally 


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1 specific organizations, and Tribal public health au2 thorities), shall conduct a study on the extent to 

3 which individuals are more at risk of maternal mor4 tality or severe maternal morbidity as a result of 

5 being a victim of domestic violence, dating violence, 

6 sexual assault, stalking, human trafficking, sex traf7 ficking, child sexual abuse, or forced marriage. 

8 (2) REPORTS.—Not later than 2 years after the 

9 date of enactment of this Act, the Secretary shall 

10 complete the study under paragraph (1) and submit 

11 a report to the Congress on the results of such 

12 study. Such report shall include— 

13 (A) an analysis of the extent to which do14 mestic violence, dating violence, sexual assault, 

15 stalking, human trafficking, sex trafficking, 

16 child sexual abuse, and forced marriage con17 tribute to, or result in, maternal mortality; 

18 (B) an analysis of the impact of domestic 

19 violence, dating violence, sexual assault, stalk20 ing, human trafficking, sex trafficking, child 

21 sexual abuse, and forced marriage on access to 

22 health care (including mental health care) and 

23 substance use disorder treatment and recovery 

24 support; 


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1 (C) a breakdown (including by race and 

2 ethnicity) of categories of individuals who are 

3 disproportionately victims of domestic violence, 

4 dating violence, sexual assault, stalking, human 

5 trafficking, sex trafficking, child sexual abuse, 

6 or forced marriage that contributes to, or re7 sults in, pregnancy-related death; 

8 (D) an analysis of the impact on health, 

9 mental health, and substance use resulting from 

10 domestic violence, dating violence, sexual as11 sault, stalking, human trafficking, sex traf12 ficking, child sexual abuse, and forced marriage 

13 among Alaskan Natives, Native Hawaiians, and 

14 American Indians during the prenatal and 

15 postpartum period; 

16 (E) an assessment of the factors that in17 crease or decrease risks for maternal mortality 

18 or severe maternal morbidity among victims of 

19 domestic violence, dating violence, sexual as20 sault, stalking, human trafficking, sex traf21 ficking, child sexual abuse, or forced marriage; 

22 (F) an assessment of increased risk of ma23 ternal mortality or severe maternal morbidity 

24 stemming from suicide, substance use disorders, 

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1 ing violence, sexual assault, stalking, human 

2 trafficking, sex trafficking, child sexual abuse, 

3 or forced marriage; 

4 (G) recommendations for legislative or pol5 icy changes— 

6 (i) to reduce maternal mortality rates; 

7 and 

8 (ii) to address health inequities that 

9 contribute to inequities in such rates and 

10 deaths; 

11 (H) best practices to reduce maternal mor12 tality and severe maternal morbidity among vic13 tims of domestic violence, dating violence, sex14 ual assault, stalking, human trafficking, sex 

15 trafficking, child sexual abuse, and forced mar16 riage, including— 

17 (i) reducing reproductive coercion, 

18 mental health conditions, and substance 

19 use coercion; and 

20 (ii) routinely assessing pregnant peo21 ple for domestic violence and other forms 

22 of reproductive violence; and 

23 (I) any other information on maternal 

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1 retary determines appropriate to include in the 

2 report. 

3 (b) STUDY BY NATIONAL ACADEMY OF MEDICINE.— 

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

5 enter into an arrangement with the National Acad6 emy of Medicine (or, if the Academy declines to 

7 enter into such arrangement, another appropriate 

8 entity) to study— 

9 (A) the impact of domestic violence, dating 

10 violence, sexual assault, stalking, human traf11 ficking, sex trafficking, child sexual abuse, and 

12 forced marriage on an individual’s health; rel13 ative to 

14 (B) maternal mortality and severe mater15 nal morbidity. 

16 (2) TOPICS.—The study under paragraph (1) 

17 shall— 

18 (A) examine— 

19 (i) whether domestic violence, dating 

20 violence, sexual assault, stalking, human 

21 trafficking, sex trafficking, child sexual 

22 abuse, or forced marriage, or generational 

23 intimate partner violence, trauma, and psy24 chiatric disorders, increase the risk of sui25 cide, substance use, and drug overdose 


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1 among pregnant and postpartum persons; 

2 and 

3 (ii) the intersection of domestic vio4 lence, dating violence, sexual assault, stalk5 ing, human trafficking, sex trafficking, 

6 child sexual abuse, and forced marriage as 

7 a social determinant of health; and 

8 (B) give particular focus to impacts among 

9 African American, American Indian, Native Ha10 waiian, Alaskan Native, and LGBTQ birthing 

11 persons. 

12 (c) GRANTS FOR INNOVATIVE APPROACHES.— 

13 (1) IN GENERAL.—The Secretary, acting 

14 through the Administrator of the Health Resources 

15 and Services Administration, and in collaboration 

16 with the Administration for Children and Families, 

17 the Indian Health Service, and the Substance Abuse 

18 and Mental Health Services Administration, shall 

19 award grants to eligible entities for developing and 

20 implementing innovative approaches to improve ma21 ternal and child health outcomes of victims of do22 mestic violence, dating violence, sexual assault, 

23 stalking, human trafficking, sex trafficking, child 

24 sexual abuse, or forced marriage. 


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1 (2) ELIGIBLE ENTITY.—To seek a grant under 

2 this subsection, an entity shall be— 

3 (A) a State, local, or federally recognized 

4 Tribal government; 

5 (B) a nonprofit organization or commu6 nity-based organization that provides prevention 

7 or intervention services related to domestic vio8 lence, dating violence, sexual assault, stalking, 

9 human trafficking, sex trafficking, child sexual 

10 abuse, or forced marriage; 

11 (C) a tribal organization or Urban Indian 

12 organization (as such terms are defined in sec13 tion 4 of the Indian Health Care Improvement 

14 Act (25 U.S.C. 1603)); 

15 (D) an entity, the principal purpose of 

16 which is to provide health care, such as a hos17 pital, clinic, health department, freestanding 

18 birthing center, perinatal health worker, or ma19 ternity care provider; 

20 (E) an institution of higher education; or 

21 (F) a comprehensive substance use dis22 order parenting program. 

23 (3) PRIORITY.—In awarding grants under this 

24 subsection, the Secretary shall give priority to appli25 cants proposing to address— 


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1 (A) mental health and substance use dis2 orders among pregnant persons; or 

3 (B) pregnant and postpartum persons ex4 periencing intimate partner violence. 

5 (4) FREESTANDING BIRTH CENTER DEFINED.— 

6 In this subsection, the term ‘‘freestanding birth cen7 ter’’ has the meaning given that term in section 

8 1905(l) of the Social Security Act (42 U.S.C. 

9 1396d(l)). 

10 (5) AUTHORIZATION OF APPROPRIATIONS.—To 

11 carry out this subsection, there is authorized to be 

12 appropriated $25,000,000 for the period of fiscal 

13 years 2025 through 2027. 

14 (d) GUIDANCE.—Not later than 2 years after the 

15 date of enactment of this Act, the Secretary shall issue 

16 and disseminate guidance to States, Tribes, territories, 

17 maternity care providers, and managed care entities on— 

18 (1) providing universal education on healthy re19 lationships and intimate partner violence; 

20 (2) developing protocols on— 

21 (A) routine assessment of intimate partner 

22 violence; and 

23 (B) health promotion and strategies for 

24 trauma-informed care plans; and 


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1 (3) creating sustainable partnerships with com2 munity-based organizations that address domestic vi3 olence, dating violence, sexual assault, stalking, 

4 human trafficking, sex trafficking, child sexual 

5 abuse, or forced marriage. 

6 (e) DEFINITIONS.—In this section: 

7 (1) The term ‘‘maternal mortality’’— 

8 (A) means death that— 

9 (i) occurs during, or within the 1-year 

10 period after, pregnancy; and 

11 (ii) is attributed to or aggravated by 

12 pregnancy-related or childbirth complica13 tions; and 

14 (B) includes a suicide, drug overdose 

15 death, homicide (including a domestic violence16 related homicide), or other death resulting from 

17 a mental health or substance use disorder at18 tributed to or aggravated by pregnancy-related 

19 or childbirth complications. 

20 (2) The term ‘‘maternity care provider’’ means 

21 a health care provider who— 

22 (A) is a physician, physician assistant, 

23 nurse, midwife who meets at a minimum the 

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1 lished by the International Confederation of 

2 Midwives, nurse practitioner, or clinical nurse 

3 specialist; and 

4 (B) has a focus on maternal or perinatal 

5 health. 

6 (3) The term ‘‘perinatal health worker’’ means 

7 a worker who— 

8 (A) is a doula, community health worker, 

9 peer supporter, breastfeeding and lactation edu10 cator or counselor, nutritionist or dietitian, 

11 childbirth educator, social worker, home visitor, 

12 language interpreter, or navigator; and 

13 (B) provides assistance with perinatal 

14 health. 

15 (4) The term ‘‘postpartum’’ refers to the 12- 

16 month period following childbirth. 

17 (5) The term ‘‘Secretary’’ means the Secretary 

18 of Health and Human Services. 

19 (6) The term ‘‘severe maternal morbidity’’ 

20 means a health condition, including a mental health 

21 condition or substance use disorder, that— 

22 (A) is attributed to or aggravated by preg23 nancy or childbirth; and 


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1 (B) results in significant short-term or 

2 long-term consequences to the health of the in3 dividual who was pregnant. 

4 SEC. 5213. MIDWIVES SCHOOLS AND PROGRAMS EXPAN5 SION. 

6 (a) MIDWIFERY SCHOOLS AND PROGRAMS.— 

7 (1) IN GENERAL.—Title VII of the Public 

8 Health Service Act is amended by inserting after 

9 section 760 (42 U.S.C. 294k) the following: 

10 ‘‘SEC. 760A. MIDWIFERY SCHOOLS AND PROGRAMS. 

11 ‘‘(a) IN GENERAL.—The Secretary may award grants 

12 to institutions of higher education (as defined in sub13 sections (a) and (b) of section 101 of the Higher Edu14 cation Act of 1965) for the following: 

15 ‘‘(1) Direct support of students in an accredited 

16 midwifery school or program. 

17 ‘‘(2) Establishment or expansion of an accred18 ited midwifery school or program. 

19 ‘‘(3) Securing, preparing, or providing support 

20 for increasing the number of, qualified preceptors 

21 for training the students of an accredited midwifery 

22 school or program. 

23 ‘‘(b) SPECIAL CONSIDERATIONS.—In awarding 

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1 cial consideration to any institution of higher education 

2 that— 

3 ‘‘(1) agrees to prioritize students who plan to 

4 practice in a health professional shortage area des5 ignated under section 332; and 

6 ‘‘(2) demonstrates a focus on increasing racial 

7 and ethnic minority representation in midwifery edu8 cation. 

9 ‘‘(c) RESTRICTION.—The Secretary shall not provide 

10 any assistance under this section to be used with respect 

11 to a midwifery school or program within a school of nurs12 ing (as defined in section 801). 

13 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.— 

14 ‘‘(1) IN GENERAL.—There is authorized to be 

15 appropriated to carry out this section $15,000,000 

16 for the period of fiscal years 2025 through 2029. 

17 ‘‘(2) ALLOCATION.—Of the amounts made 

18 available to carry out this section for any fiscal year, 

19 the Secretary shall use— 

20 ‘‘(A) 50 percent to award grants for pur21 poses specified in subsection (a)(1); 

22 ‘‘(B) 25 percent to award grants for pur23 poses specified in subsection (a)(2); and 

24 ‘‘(C) 25 percent to award grants for pur25 poses specified in subsection (a)(3).’’. 


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1 (2) DEFINITIONS.— 

2 (A) MIDWIFERY SCHOOL OR PROGRAM.— 

3 Section 799B(1)(A) of the Public Health Serv4 ice Act (42 U.S.C. 295p(1)(A)) is amended— 

5 (i) by inserting ‘‘ ‘midwifery school or 

6 program’,’’ before ‘‘and ‘school of chiro7 practic’ ’’; 

8 (ii) by inserting ‘‘a degree or certifi9 cate in midwifery or an equivalent degree 

10 or certificate,’’ before ‘‘and a degree of 

11 doctor of chiropractic or an equivalent de12 gree’’; and 

13 (iii) by striking ‘‘any such school’’ and 

14 inserting ‘‘any such school or program’’. 

15 (B) ACCREDITED.—Section 799B(1)(E) of 

16 the Public Health Service Act (42 U.S.C. 

17 295p(1)(E)) is amended by inserting ‘‘a mid18 wifery school or program,’’ before ‘‘or a grad19 uate program in health administration’’. 

20 (b) NURSE-MIDWIVES.—Title VIII of the Public 

21 Health Service Act is amended by inserting after section 

22 812 (as added by section 5205(c)), the following: 

23 ‘‘SEC. 812A. MIDWIFERY EXPANSION PROGRAM. 

24 ‘‘(a) IN GENERAL.—The Secretary may award grants 

25 to schools of nursing for the following: 


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1 ‘‘(1) Direct support of students in an accredited 

2 nurse-midwifery school or program. 

3 ‘‘(2) Establishment or expansion of an accred4 ited nurse-midwifery school or program. 

5 ‘‘(3) Securing, preparing, or providing support 

6 for increasing the numbers of, preceptors at clinical 

7 training sites to precept students training to become 

8 certified nurse-midwives. 

9 ‘‘(b) SPECIAL CONSIDERATIONS.—In awarding 

10 grants under subsection (a), the Secretary shall give spe11 cial consideration to any school of nursing that— 

12 ‘‘(1) agrees to prioritize students who choose to 

13 pursue an advanced education degree in nurse-mid14 wifery to practice in a health professional shortage 

15 area designated under section 332; and 

16 ‘‘(2) demonstrates a focus on increasing racial 

17 and ethnic minority representation in nurse-mid18 wifery education. 

19 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.— 

20 ‘‘(1) IN GENERAL.—To carry out this section, 

21 there is authorized to be appropriated $20,000,000 

22 for the period of fiscal years 2025 through 2029. 

23 ‘‘(2) ALLOCATION.—Of the amounts made 

24 available to carry out this section for any fiscal year, 

25 the Secretary shall use— 


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1 ‘‘(A) 50 percent to award grants for pur2 poses specified in subsection (a)(1); 

3 ‘‘(B) 25 percent to award grants for pur4 poses specified in subsection (a)(2); and 

5 ‘‘(C) 25 percent to award grants for pur6 poses specified in subsection (a)(3).’’. 

7 SEC. 5214. GESTATIONAL DIABETES. 

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

9 (42 U.S.C. 243 et seq.) is amended by adding after section 

10 317H (42 U.S.C. 247b–9) the following: 

11 ‘‘SEC. 317H–1. GESTATIONAL DIABETES. 

12 ‘‘(a) UNDERSTANDING AND MONITORING GESTA13 TIONAL DIABETES.— 

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

15 through the Director of the Centers for Disease 

16 Control and Prevention, in consultation with the Di17 abetes Mellitus Interagency Coordinating Committee 

18 established under section 429 and representatives of 

19 appropriate national health organizations, shall de20 velop a multisite gestational diabetes research 

21 project within the diabetes program of the Centers 

22 for Disease Control and Prevention to expand and 

23 enhance surveillance data and public health research 

24 on gestational diabetes. 


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1 ‘‘(2) AREAS TO BE ADDRESSED.—The research 

2 project developed under paragraph (1) shall ad3 dress— 

4 ‘‘(A) procedures to establish accurate and 

5 efficient systems for the collection of gestational 

6 diabetes data within each State and common7 wealth, territory, or possession of the United 

8 States; 

9 ‘‘(B) the progress of collaborative activities 

10 with the National Vital Statistics System, the 

11 National Center for Health Statistics, and 

12 State health departments with respect to the 

13 standard birth certificate, in order to improve 

14 surveillance of gestational diabetes; 

15 ‘‘(C) postpartum methods of tracking indi16 viduals with gestational diabetes after delivery 

17 as well as targeted interventions proven to 

18 lower the incidence of type 2 diabetes in that 

19 population; 

20 ‘‘(D) variations in the distribution of diag21 nosed and undiagnosed gestational diabetes, 

22 and of impaired fasting glucose tolerance and 

23 impaired fasting glucose, within and among 

24 groups of pregnant individuals; and 


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1 ‘‘(E) factors and culturally sensitive inter2 ventions that influence risks and reduce the in3 cidence of gestational diabetes and related com4 plications during childbirth, including cultural, 

5 behavioral, racial, ethnic, geographic, demo6 graphic, socioeconomic, and genetic factors. 

7 ‘‘(3) REPORT.—Not later than 2 years after the 

8 date of enactment of this section, and annually 

9 thereafter, the Secretary shall generate a report on 

10 the findings and recommendations of the research 

11 project including prevalence of gestational diabetes 

12 in the multisite area and disseminate the report to 

13 the appropriate Federal and non-Federal agencies. 

14 ‘‘(b) EXPANSION OF GESTATIONAL DIABETES RE15 SEARCH.— 

16 ‘‘(1) IN GENERAL.—The Secretary shall expand 

17 and intensify public health research regarding gesta18 tional diabetes. Such research may include— 

19 ‘‘(A) developing and testing novel ap20 proaches for improving postpartum diabetes 

21 testing or screening and for preventing type 2 

22 diabetes in individuals who can become preg23 nant with a history of gestational diabetes; and 

24 ‘‘(B) conducting public health research to 

25 further understanding of the epidemiologic, 


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1 socioenvironmental, behavioral, translation, and 

2 biomedical factors and health systems that in3 fluence the risk of gestational diabetes and the 

4 development of type 2 diabetes in individuals 

5 who can become pregnant with a history of ges6 tational diabetes. 

7 ‘‘(2) AUTHORIZATION OF APPROPRIATIONS.— 

8 There is authorized to be appropriated to carry out 

9 this subsection $5,000,000 for each of fiscal years 

10 2025 through 2029. 

11 ‘‘(c) DEMONSTRATION GRANTS TO LOWER THE

12 RATE OF GESTATIONAL DIABETES.— 

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

14 through the Director of the Centers for Disease 

15 Control and Prevention, shall award grants, on a 

16 competitive basis, to eligible entities for demonstra17 tion projects that implement evidence-based inter18 ventions to reduce the incidence of gestational diabe19 tes, the recurrence of gestational diabetes in subse20 quent pregnancies, and the development of type 2 di21 abetes in individuals who can become pregnant with 

22 a history of gestational diabetes. 

23 ‘‘(2) PRIORITY.—In making grants under this 

24 subsection, the Secretary shall give priority to 

25 projects focusing on— 


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1 ‘‘(A) helping individuals who can become 

2 pregnant who have 1 or more risk factors for 

3 developing gestational diabetes; 

4 ‘‘(B) working with individuals who can be5 come pregnant with a history of gestational dia6 betes during a previous pregnancy; 

7 ‘‘(C) providing postpartum care for indi8 viduals who can become pregnant with gesta9 tional diabetes; 

10 ‘‘(D) tracking cases where individuals who 

11 can become pregnant with a history of gesta12 tional diabetes developed type 2 diabetes; 

13 ‘‘(E) educating mothers with a history of 

14 gestational diabetes about the increased risk of 

15 their child developing diabetes; 

16 ‘‘(F) working to prevent gestational diabe17 tes and prevent or delay the development of 

18 type 2 diabetes in individuals who can become 

19 pregnant with a history of gestational diabetes; 

20 and 

21 ‘‘(G) achieving outcomes designed to assess 

22 the efficacy and cost-effectiveness of interven23 tions that can inform decisions on long-term 

24 sustainability, including third-party reimburse25 ment. 


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1 ‘‘(3) APPLICATION.—An eligible entity desiring 

2 to receive a grant under this subsection shall submit 

3 to the Secretary— 

4 ‘‘(A) an application at such time, in such 

5 manner, and containing such information as the 

6 Secretary may require; and 

7 ‘‘(B) a plan to— 

8 ‘‘(i) lower the rate of gestational dia9 betes during pregnancy; or 

10 ‘‘(ii) develop methods of tracking indi11 viduals who can become pregnant with a 

12 history of gestational diabetes and develop 

13 effective interventions to lower the inci14 dence of the recurrence of gestational dia15 betes in subsequent pregnancies and the 

16 development of type 2 diabetes. 

17 ‘‘(4) USES OF FUNDS.—An eligible entity re18 ceiving a grant under this subsection shall use the 

19 grant funds to carry out demonstration projects de20 scribed in paragraph (1), including— 

21 ‘‘(A) expanding community-based health 

22 promotion education, activities, and incentives 

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1 viduals who can become pregnant with a history 

2 of gestational diabetes; 

3 ‘‘(B) aiding State- and Tribal-based diabe4 tes prevention and control programs to collect, 

5 analyze, disseminate, and report surveillance 

6 data on individuals who can become pregnant 

7 with, and at risk for, gestational diabetes, the 

8 recurrence of gestational diabetes in subsequent 

9 pregnancies, and, for individuals who can be10 come pregnant with a history of gestational dia11 betes, the development of type 2 diabetes; and 

12 ‘‘(C) training and encouraging health care 

13 providers— 

14 ‘‘(i) to promote risk assessment, high15 quality care, and self-management for ges16 tational diabetes and the recurrence of ges17 tational diabetes in subsequent preg18 nancies; and 

19 ‘‘(ii) to prevent the development of 

20 type 2 diabetes in individuals who can be21 come pregnant with a history of gesta22 tional diabetes, and its complications in the 

23 practice settings of the health care pro24 viders. 


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1 ‘‘(5) REPORT.—Not later than 4 years after the 

2 date of enactment of this section, the Secretary shall 

3 prepare and submit to the Congress a report con4 cerning the results of the demonstration projects 

5 conducted through the grants awarded under this 

6 subsection. 

7 ‘‘(6) DEFINITION OF ELIGIBLE ENTITY.—In 

8 this subsection, the term ‘eligible entity’ means a 

9 nonprofit organization (such as a nonprofit academic 

10 center or community health center) or a State, Trib11 al, or local health agency. 

12 ‘‘(7) AUTHORIZATION OF APPROPRIATIONS.— 

13 There is authorized to be appropriated to carry out 

14 this subsection $5,000,000 for each of fiscal years 

15 2025 through 2029. 

16 ‘‘(d) POSTPARTUM FOLLOWUP REGARDING GESTA17 TIONAL DIABETES.—The Secretary, acting through the 

18 Director of the Centers for Disease Control and Preven19 tion, shall work with the State- and Tribal-based diabetes 

20 prevention and control programs assisted by the Centers 

21 to encourage postpartum followup after gestational diabe22 tes, as medically appropriate, for the purpose of reducing 

23 the incidence of gestational diabetes, the recurrence of 

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1 opment of type 2 diabetes in individuals with a history 

2 of gestational diabetes, and related complications.’’. 

3 SEC. 5215. CONSUMER EDUCATION CAMPAIGN. 

4 Section 229(b) of the Public Health Service Act (42 

5 U.S.C. 237a(b)) is amended— 

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

7 end; 

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

9 the end and inserting a semicolon; and 

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

11 ‘‘(8) not later than 1 year after the date of en12 actment of this paragraph, develop and implement a 

13 4-year culturally and linguistically appropriate 

14 multimedia consumer education campaign that is de15 signed to promote understanding and acceptance of 

16 evidence-based maternity practices and models of 

17 care for optimal maternity outcomes among individ18 uals of childbearing ages and families of such indi19 viduals and that— 

20 ‘‘(A) highlights the importance of pro21 tecting, promoting, and supporting the innate 

22 capacities of childbearing individuals and their 

23 newborns for childbirth, breastfeeding, and at24 tachment; 


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1 ‘‘(B) promotes understanding of the impor2 tance of using obstetric interventions when 

3 medically necessary and when supported by 

4 strong, high-quality evidence; 

5 ‘‘(C) highlights the widespread overuse of 

6 maternity practices that have been shown to 

7 have benefit when used appropriately in situa8 tions of medical necessity, but which can expose 

9 pregnant individuals, infants, or both to risk of 

10 harm if used routinely and indiscriminately; 

11 ‘‘(D) emphasizes the noninvasive maternity 

12 practices that have proven correlation or may 

13 be associated with improvement in outcomes 

14 with no detrimental side effects, and are signifi15 cantly underused in the United States, includ16 ing smoking cessation programs in pregnancy, 

17 group model prenatal care, continuous labor 

18 support, nonsupine positions for birth, and ex19 ternal version to turn breech babies at term; 

20 ‘‘(E) educates consumers about— 

21 ‘‘(i) the qualifications of licensed pro22 viders of maternity care, including obstetri23 cian-gynecologists, family physicians, cer24 tified nurse-midwives, certified midwives, 

25 and certified professional midwives; and 


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1 ‘‘(ii) the best evidence about the safe2 ty, satisfaction, outcomes, and costs of 

3 such providers; 

4 ‘‘(F) informs consumers about the best 

5 available research comparing birth center 

6 births, planned home births, and hospital 

7 births, including information about each set8 ting’s safety, satisfaction, outcomes, and costs; 

9 ‘‘(G) fosters participation in high-quality, 

10 evidence-based childbirth education that pro11 motes a healthy and safe approach to preg12 nancy, childbirth, and early parenting; is taught 

13 by certified educators, peer counselors, and 

14 health professionals; and promotes informed de15 cision making by childbearing individuals; 

16 ‘‘(H) informs consumers about— 

17 ‘‘(i) the effects of systemic, institu18 tional, and interpersonal racism on the 

19 health, well-being, and outcomes of birth20 ing people; 

21 ‘‘(ii) the importance of respectful, cul22 turally and linguistically appropriate, and 

23 culturally congruent care; and 


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1 ‘‘(iii) the value of community-based 

2 and community-led maternal care and sup3 port; and 

4 ‘‘(I) is pilot tested for consumer com5 prehension, cultural sensitivity, and acceptance 

6 of the messages across geographically, racially, 

7 ethnically, and linguistically diverse popu8 lations;’’. 

9 SEC. 5216. BIBLIOGRAPHIC DATABASE OF SYSTEMATIC RE10 VIEWS FOR CARE OF CHILDBEARING INDI11 VIDUALS AND NEWBORNS. 

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

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

14 Human Services, acting through the Director of the Agen15 cy for Healthcare Research and Quality, shall— 

16 (1) make publicly available an online biblio17 graphic database identifying systematic reviews, in18 cluding an explanation of the level and quality of 

19 evidence, for care of childbearing individuals and 

20 newborns; and 

21 (2) initiate regular updates that incorporate 

22 newly issued and updated systematic reviews. 

23 (b) SOURCES.—To aim for a comprehensive inventory 

24 of systematic reviews relevant to maternal and newborn 


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1 care, the database shall identify reviews from diverse 

2 sources, including— 

3 (1) scientific peer-reviewed journals; 

4 (2) databases, including the Cochrane Database 

5 of Systematic Reviews; and 

6 (3) internet websites of agencies and organiza7 tions throughout the world that produce such sys8 tematic reviews. 

9 (c) FEATURES.—The database shall— 

10 (1) provide bibliographic citations for each 

11 record within the database, and for each such cita12 tion include an explanation of the level and quality 

13 of evidence; 

14 (2) include abstracts, as available; 

15 (3) provide reference to companion documents 

16 as may exist for each review, such as evidence tables 

17 and guidelines or consumer educational materials de18 veloped from the review; 

19 (4) provide links to the source of the full review 

20 and to any companion documents; 

21 (5) provide links to the source of a previous 

22 version or update of the review; 

23 (6) be searchable by intervention or other topic 

24 of the review, reported outcomes, author, title, and 

25 source; and 


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1 (7) offer to users periodic electronic notification 

2 of database updates relating to users’ topics of inter3 est. 

4 (d) OUTREACH.—Not later than the first date the 

5 database is made publicly available and periodically there6 after, the Secretary of Health and Human Services shall 

7 publicize the availability, features, and uses of the data8 base under this section to the stakeholders described in 

9 subsection (e). 

10 (e) CONSULTATION.—For purposes of developing the 

11 database under this section and maintaining and updating 

12 such database, the Secretary of Health and Human Serv13 ices shall convene and consult with an advisory committee 

14 composed of relevant stakeholders, including— 

15 (1) Federal Medicaid administrators and State 

16 agencies administrating State plans under title XIX 

17 of the Social Security Act pursuant to section 

18 1902(a)(5) of such Act (42 U.S.C. 1396a(a)(5)); 

19 (2) providers of maternity and newborn care 

20 from both academic and community-based settings, 

21 including obstetrician-gynecologists, family physi22 cians, certified nurse midwives, certified midwives, 

23 certified professional midwives, physician assistants, 

24 perinatal nurses, pediatricians, and nurse practi25 tioners; 


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1 (3) maternal-fetal medicine specialists; 

2 (4) neonatologists; 

3 (5) childbearing individuals and advocates for 

4 such individuals, including childbirth educators cer5 tified by a nationally accredited program, rep6 resenting communities that are diverse in terms of 

7 race, ethnicity, indigenous status, and geographic 

8 area; 

9 (6) employers and purchasers; 

10 (7) health facility and system leaders, including 

11 both hospital and birth center facilities; 

12 (8) journalists; and 

13 (9) bibliographic informatics specialists. 

14 (f) AUTHORIZATION OF APPROPRIATIONS.—There is 

15 authorized to be appropriated $2,500,000 for each of fis16 cal years 2025 through 2027 for the purpose of developing 

17 the database and such sums as may be necessary for each 

18 subsequent fiscal year for updating the database and pro19 viding outreach and notification to users, as described in 

20 this section. 

21 SEC. 5217. DEVELOPMENT OF INTERPROFESSIONAL MA22 TERNITY CARE EDUCATIONAL MODELS AND 

23 TOOLS. 

24 (a) IN GENERAL.—Not later than 180 days after the 

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


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1 Human Services, acting in conjunction with the Adminis2 trator of Health Resources and Services Administration, 

3 shall convene, for a 1-year period, an Interprofessional 

4 Maternity Provider Education Commission (referred to in 

5 this section as the ‘‘Commission’’) to discuss and make 

6 recommendations for— 

7 (1) a consensus standard physiologic maternity 

8 care curriculum that takes into account the core 

9 competencies for basic midwifery practice such as 

10 those developed by the American College of Nurse11 Midwives and the North American Registry of Mid12 wives, and the educational objectives for physicians 

13 practicing in obstetrics and gynecology as deter14 mined by the Council on Resident Education in Ob15 stetrics and Gynecology; 

16 (2) suggestions for multidisciplinary use of the 

17 consensus physiologic curriculum; 

18 (3) strategies to integrate and coordinate edu19 cation across maternity care disciplines, including 

20 recommendations to increase medical and midwifery 

21 student exposure to out-of-hospital birth; 

22 (4) curriculum and strategies for continuing 

23 education of practicing perinatal professionals who 

24 have completed their undergraduate and graduate 

25 education; and 


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1 (5) pilot demonstrations of interprofessional 

2 educational models. 

3 (b) PARTICIPANTS.— 

4 (1) PROFESSIONS.—The Commission shall in5 clude maternity care educators, curriculum devel6 opers, service leaders, certification leaders, and ac7 creditation leaders from the various professions that 

8 provide or support maternity care in the United 

9 States. Such professions shall include obstetrician 

10 gynecologists, certified nurse midwives or certified 

11 midwives, family practice physicians, nurse practi12 tioners, physician assistants, certified professional 

13 midwives, perinatal nurses, doulas, lactation per14 sonnel, and community health workers. 

15 (2) CONSUMER ADVOCATES.—The Commission 

16 shall also include representation from maternity care 

17 consumer advocates. 

18 (c) CURRICULUM.—The consensus standard physio19 logic maternity care curriculum described in subsection 

20 (a)(1) shall— 

21 (1) have a public health focus with a foundation 

22 in health promotion and disease prevention; 

23 (2) foster physiologic childbearing and person 

24 and family centered care; 


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1 (3) reflect the extensive, growing research evi2 dence about— 

3 (A) the innate abilities and processes of 

4 the birthing person and the fetus or newborn 

5 for labor, birth, postpartum transition, 

6 breastfeeding, and attachment, when promoted, 

7 supported, and protected; and 

8 (B) the effects of factors that disturb and 

9 disrupt these processes; 

10 (4) integrate strategies to reduce maternal and 

11 infant morbidity and mortality; 

12 (5) incorporate recommendations to ensure re13 spectful, safe, and seamless consultation, referral, 

14 transport, and transfer of care when necessary; 

15 (6) include cultural sensitivity and strategies to 

16 decrease inequities in maternity outcomes; and 

17 (7) include implicit bias training. 

18 (d) REPORT.—Not later than 180 days after the final 

19 meeting of the Commission, the Secretary of Health and 

20 Human Services shall— 

21 (1) submit to Congress a report containing the 

22 recommendations made by the Commission under 

23 this section; and 

24 (2) make such report publicly available. 


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1 (e) AUTHORIZATION OF APPROPRIATIONS.—There 

2 are authorized to be appropriated to carry out this sec3 tion— 

4 (1) $1,000,000 for each of fiscal years 2025 

5 and 2026; and 

6 (2) such sums as are necessary for each of fis7 cal years 2027 through 2029. 

8 SEC. 5218. DISSEMINATION OF THE QUALITY FAMILY PLAN9 NING GUIDELINES. 

10 (a) IN GENERAL.—Not later than 180 days after the 

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

12 Human Services and the Director of the Centers for Dis13 ease Control and Prevention shall— 

14 (1) develop a plan for outreach to publicly fund15 ed health care providers, including federally qualified 

16 health centers (as defined in section 1861(aa)(4) of 

17 the Social Security Act (42 U.S.C. 1395x(aa)(4))) 

18 and branches of the Indian Health Service, about 

19 the quality family planning guidelines referred to in 

20 section 5304; and 

21 (2) award grants to eligible entities to imple22 ment such guidelines for all patients seeking family 

23 planning services. 


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1 (b) DEFINITION.—In this section, the term ‘‘eligible 

2 entity’’ means a publicly funded health care provider that 

3 serves persons of reproductive age. 

4 Subtitle D—Federal Agency 

5 Coordination on Maternal Health 

6 SEC. 5301. INTERAGENCY COORDINATING COMMITTEE ON 

7 THE PROMOTION OF OPTIMAL MATERNITY 

8 OUTCOMES. 

9 (a) IN GENERAL.—Part A of title II of the Public 

10 Health Service Act (42 U.S.C. 202 et seq.) is amended 

11 by adding at the end the following: 

12 ‘‘SEC. 229A. INTERAGENCY COORDINATING COMMITTEE ON 

13 THE PROMOTION OF OPTIMAL MATERNITY 

14 OUTCOMES. 

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

16 the Deputy Assistant Secretary for Women’s Health under 

17 section 229 and in collaboration with the Federal officials 

18 specified in subsection (b), shall establish the Interagency 

19 Coordinating Committee on the Promotion of Optimal Ma20 ternity Outcomes (referred to in this section as the 

21 ‘ICCPOM’). 

22 ‘‘(b) OTHER AGENCIES.—The officials specified in 

23 this subsection are the Secretary of Labor, the Secretary 

24 of Defense, the Secretary of Veterans Affairs, the Surgeon 

25 General, the Director of the Centers for Disease Control 


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1 and Prevention, the Administrator of the Health Re2 sources and Services Administration, the Administrator of 

3 the Centers for Medicare & Medicaid Services, the Direc4 tor of the Indian Health Service, the Administrator of the 

5 Substance Abuse and Mental Health Services Administra6 tion, the Director of the National Institute of Child Health 

7 and Human Development, the Director of the Agency for 

8 Healthcare Research and Quality, the Assistant Secretary 

9 for Children and Families, the Deputy Assistant Secretary 

10 for Minority Health, the Director of the Office of Per11 sonnel Management, and such other Federal officials as 

12 the Secretary of Health and Human Services determines 

13 to be appropriate. 

14 ‘‘(c) CHAIR.—The Deputy Assistant Secretary for 

15 Women’s Health shall serve as the chair of the ICCPOM. 

16 ‘‘(d) DUTIES.—The ICCPOM shall guide policy and 

17 program development across the Federal Government with 

18 respect to promotion of optimal maternity care, provided, 

19 however, that nothing in this section shall be construed 

20 as transferring regulatory or program authority from an 

21 agency to the ICCPOM. 

22 ‘‘(e) CONSULTATIONS.—The ICCPOM shall actively 

23 seek the input of, and shall consult with, all appropriate 

24 and interested stakeholders, including State health depart25 ments, public health research and interest groups, foundaVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 00817 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 tions, childbearing individuals and their advocates, and 

2 maternity care professional associations and organiza3 tions, reflecting racially, ethnically, demographically, and 

4 geographically diverse communities. 

5 ‘‘(f) ANNUAL REPORT.— 

6 ‘‘(1) IN GENERAL.—The Secretary, on behalf of 

7 the ICCPOM, shall annually submit to Congress a 

8 report that summarizes— 

9 ‘‘(A) all programs and policies of Federal 

10 agencies (including the Medicare Program 

11 under title XVIII of the Social Security Act and 

12 the Medicaid program under title XIX of such 

13 Act) designed to promote optimal maternity 

14 care, focusing particularly on programs and 

15 policies that support the adoption of evidence16 based maternity care, as defined by timely, sci17 entifically sound systematic reviews; 

18 ‘‘(B) all programs and policies of Federal 

19 agencies (including the Medicare Program 

20 under title XVIII of the Social Security Act and 

21 the Medicaid program under title XIX of such 

22 Act) designed to address the problems of mater23 nal mortality and morbidity, infant mortality, 

24 prematurity, and low birth weight, including 

25 such programs and policies designed to address 


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1 racial and ethnic inequities with respect to each 

2 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 ‘‘(2) REDUCING INEQUITIES WITH RESPECT TO

12 INDIGENOUS STATUS.—The information specified in 

13 paragraph (1)(C) shall be included in each such re14 port in a manner that disaggregates such informa15 tion by race, ethnicity, and indigenous status in 

16 order to determine the extent of progress in reduc17 ing racial and ethnic inequities and inequities related 

18 to indigenous status. 

19 ‘‘(3) CERTAIN INFORMATION.—Each report 

20 under paragraph (1) shall include information 

21 (disaggregated by race, ethnicity, and indigenous 

22 status, as applicable) on the following rates, trends, 

23 and costs by State: 

24 ‘‘(A) The rate and trend of primary cesar25 ean deliveries and repeat cesarean deliveries. 


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1 ‘‘(B) The rate and trend of vaginal births 

2 after cesarean. 

3 ‘‘(C) The rate and trend of vaginal breech 

4 births. 

5 ‘‘(D) The rate and trend of induction of 

6 labor. 

7 ‘‘(E) The rate and trend of freestanding 

8 birth center births. 

9 ‘‘(F) The rate and trend of planned and 

10 unplanned home birth. 

11 ‘‘(G) The rate and trends of attended 

12 births by different types of maternity care pro13 viders, including by an obstetrician-gyne14 cologist, family practice physician, obstetrician15 gynecologist, physician assistant, certified 

16 nurse-midwife, certified midwife, and certified 

17 professional midwife. 

18 ‘‘(H) The rate and trend of severe mater19 nal morbidity. 

20 ‘‘(I) The rates and trends of prenatal and 

21 postpartum anxiety and depression. 

22 ‘‘(J) The rate and trend of preterm birth. 

23 ‘‘(K) The rate and trend of low birth 

24 weight. 


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1 ‘‘(L) The cost of maternity care 

2 disaggregated by place of birth and provider of 

3 care, including— 

4 ‘‘(i) uncomplicated vaginal birth; 

5 ‘‘(ii) complicated vaginal birth; 

6 ‘‘(iii) uncomplicated cesarean birth; 

7 and 

8 ‘‘(iv) complicated cesarean birth. 

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

10 is authorized to be appropriated, in addition to amounts 

11 authorized to be appropriated under section 229(e), to 

12 carry out this section $1,000,000 for each of the fiscal 

13 years 2025 through 2029.’’. 

14 (b) CONFORMING AMENDMENTS.— 

15 (1) INCLUSION AS DUTY OF HHS OFFICE ON

16 WOMEN’S HEALTH.—Section 229(b) of the Public 

17 Health Service Act (42 U.S.C. 237a(b)) (as amend18 ed by section 5215) is amended by adding at the end 

19 the following: 

20 ‘‘(9) establish the Interagency Coordinating 

21 Committee on the Promotion of Optimal Maternity 

22 Outcomes in accordance with section 229A; and’’. 

23 (2) TREATMENT OF BIENNIAL REPORTS.—Sec24 tion 229(d) of such Act (42 U.S.C. 237a(d)) is 


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1 amended by inserting ‘‘(other than under subsection 

2 (b)(9))’’ after ‘‘under this section’’. 

3 SEC. 5302. EXPANSION OF CDC PREVENTION RESEARCH 

4 CENTERS PROGRAM TO INCLUDE CENTERS 

5 ON OPTIMAL MATERNITY OUTCOMES. 

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

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

8 Human Services shall support the establishment of addi9 tional Prevention Research Centers under the Prevention 

10 Research Center Program administered by the Centers for 

11 Disease Control and Prevention. Such additional centers 

12 shall each be known as a Center for Excellence on Optimal 

13 Maternity Outcomes. 

14 (b) RESEARCH.—Each Center for Excellence on Opti15 mal Maternity Outcomes shall— 

16 (1) conduct at least one focused program of re17 search to improve maternity outcomes, including the 

18 reduction of cesarean birth rates, early elective in19 ductions, prematurity rates, and low birth weight 

20 rates within an underserved population that has a 

21 disproportionately large burden of suboptimal mater22 nity outcomes, including maternal mortality and 

23 morbidity, infant mortality, prematurity, or low 

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1 veloping performance and quality measures for ac2 countability; 

3 (2) work with partners on special interest 

4 projects, as specified by the Centers for Disease 

5 Control and Prevention and other relevant agencies 

6 within the Department of Health and Human Serv7 ices, and on projects funded by other sources; and 

8 (3) involve a minimum of two distinct birth set9 ting models, such as— 

10 (A) a hospital labor and delivery model 

11 and freestanding birth center model; or 

12 (B) a hospital labor and delivery model 

13 and planned home birth model. 

14 (c) INTERDISCIPLINARY PROVIDERS.—Each Center 

15 for Excellence on Optimal Maternity Outcomes shall in16 clude the following interdisciplinary providers of maternity 

17 care: 

18 (1) Obstetrician-gynecologists. 

19 (2) At least two of the following providers: 

20 (A) Family practice physicians. 

21 (B) Nurse practitioners. 

22 (C) Physician assistants. 

23 (D) Certified professional midwives, cer24 tified nurse-midwives, or certified midwives. 


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1 (d) SERVICES.—Research conducted by each Center 

2 for Excellence on Optimal Maternity Outcomes shall in3 clude at least 2 (and preferably more) of the following sup4 portive provider services: 

5 (1) Mental health. 

6 (2) Doula labor support. 

7 (3) Nutrition education. 

8 (4) Childbirth education. 

9 (5) Social work. 

10 (6) Physical therapy or occupation therapy. 

11 (7) Substance use disorder services. 

12 (8) Home visiting. 

13 (e) COORDINATION.—The programs of research at 

14 each of the Centers of Excellence on Optimal Maternity 

15 Outcomes shall complement and not replicate the work of 

16 the other. 

17 (f) AUTHORIZATION OF APPROPRIATIONS.—There is 

18 authorized to be appropriated to carry out this section 

19 $2,000,000 for each of fiscal years 2025 through 2029. 


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1 SEC. 5303. EXPANDING MODELS TO BE TESTED BY CENTER 

2 FOR MEDICARE AND MEDICAID INNOVATION 

3 TO EXPLICITLY INCLUDE MATERNITY CARE 

4 AND CHILDREN’S HEALTH MODELS. 

5 Section 1115A(b)(2) of the Social Security Act (42 

6 U.S.C. 1315a(b)(2)), as amended by section 5209(b), is 

7 amended— 

8 (1) in subparagraph (B), by adding at the end 

9 the following: 

10 ‘‘(xxix) Promoting evidence-based 

11 models of care that have been associated 

12 with reductions in pregnancy-related and 

13 infant health inequities, including incor14 porating the use of and payment for 

15 doulas, particularly community-based 

16 doulas, and promoting support for people 

17 during pregnancy and for the one-year pe18 riod after the last day of such person’s 

19 pregnancy, through evidence-based models 

20 of antepartum, birth, postpartum care, and 

21 two-generation birthing person and new22 born care models, and supporting the risk23 appropriate use of out-of-hospital birth 

24 models, including births at home and in 

25 freestanding birth centers. Such models 

26 shall be selected and evaluated based on 


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1 their impact on quality, equity, and devel2 opmental outcomes, notwithstanding any 

3 other provision of this section.’’; 

4 (2) in subparagraph (C), by adding at the end 

5 the following: 

6 ‘‘(ix) Whether the model includes a 

7 regular process for ensuring the provision 

8 of culturally and linguistically appropriate 

9 services. 

10 ‘‘(x) Whether health care services and 

11 supportive services included in the model 

12 are tailored to community health and 

13 health-related social needs and provided by 

14 community-based and community-led pro15 viders. 

16 ‘‘(xi) Whether the model is designed 

17 to mitigate harmful effects of discrimina18 tion on the basis of race, sex, disability, 

19 ethnicity, language, and age.’’; and 

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

21 ‘‘(D) MANDATORY HEALTH EQUITY MOD22 ELS TO BE TESTED.—The Secretary shall se23 lect— 

24 ‘‘(i) Medicaid payment models for cul25 turally and linguistically appropriate 


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1 antepartum, labor and delivery, and 

2 postpartum doula services, including com3 munity-based doula services, that are— 

4 ‘‘(I) structured to provide pay5 ment to doulas as individuals, health 

6 care entity staff, or members of a 

7 doula group or collective, or through a 

8 third-party administrator; 

9 ‘‘(II) designed to reduce racial 

10 and intersecting health inequities; 

11 ‘‘(III) designed to provide doulas 

12 providing support with an equitable 

13 and sustainable reimbursement rate; 

14 ‘‘(IV) designed to reduce barriers 

15 to workforce entry for culturally and 

16 linguistically competent and racially 

17 congruent doulas to provide services 

18 to Medicaid enrollees; and 

19 ‘‘(V) designed with input from 

20 community-based doulas, maternal 

21 health advocates, reproductive justice 

22 advocates, and Medicaid beneficiaries; 

23 ‘‘(ii) a Medicaid episode-based pay24 ment model for pregnancy-related services, 

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1 portive services to address health-related 

2 social needs, during the prenatal, 

3 intrapartum, and postpartum periods, to 

4 improve health outcomes and reduce racial 

5 health inequities, and to be designed with 

6 input from maternity care providers, ma7 ternal health advocates, reproductive jus8 tice advocates, and Medicaid beneficiaries; 

9 ‘‘(iii) a Medicaid alternative payment 

10 model for a pregnancy-related health home 

11 service to improve health outcomes during 

12 and for one year after pregnancy and dur13 ing the newborn period, and to reduce ra14 cial health inequities, designed with input 

15 from maternity care providers, maternal 

16 health advocates, reproductive justice advo17 cates, and Medicaid beneficiaries; 

18 ‘‘(iv) a Medicaid perinatal health 

19 worker service delivery model for culturally 

20 and linguistically appropriate and respect21 ful health care and supportive services that 

22 are tailored to community health and 

23 health-related social needs, designed to im24 prove health outcomes and mitigate harm25 ful effects of racism and other forms of 


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1 discrimination, and provided by commu2 nity-based and community-led providers; 

3 and 

4 ‘‘(v) one or more models exclusively 

5 focused on early intervention and preven6 tion for children enrolled in a State plan 

7 (or waiver of such plan) under title XIX or 

8 a State child health plan under title XXI 

9 using evidence-based interventions includ10 ing parenting support programs, home-vis11 iting services, and dyadic therapy treat12 ment for children and adolescents at risk. 

13 Such models shall be selected and evaluated 

14 based on their impact on quality, equity, and 

15 developmental outcomes, notwithstanding any 

16 other provision of this section.’’. 

17 SEC. 5304. INTERAGENCY UPDATE TO THE QUALITY FAMILY 

18 PLANNING GUIDELINES. 

19 (a) IN GENERAL.—Not later than 180 days after the 

20 date of enactment of this Act, the Director of the Centers 

21 for Disease Control and Prevention and the Office of Pop22 ulation Affairs shall review and expand the 2014 Quality 

23 Family Planning Guidelines to address— 

24 (1) health inequities; and 


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1 (2) the importance of patient-directed contra2 ceptive decision making. 

3 (b) CONSULTATION.—In carrying out subsection (a), 

4 the Director of the Centers for Disease Control and Pre5 vention and the Office of Population Affairs shall convene 

6 a meeting, and solicit the views of, stakeholders including 

7 experts on health inequities, experts on reproductive coer8 cion, representatives of provider organizations, patient ad9 vocates, reproductive justice organizations, organizations 

10 that represent racial and ethnic minority communities, or11 ganizations that represent people with disabilities, organi12 zations that represent LGBTQ persons, and organizations 

13 that represent people with limited English proficiency. 

14 Subtitle E—Reproductive and 

15 Sexual Health 

16 SEC. 5401. SENSE OF CONGRESS ON URGENT ISSUES CON17 CERNING BARRIERS TO ABORTION ACCESS 

18 AND VITAL SOLUTIONS. 

19 It is the sense of Congress that eliminating the Hyde 

20 amendment, enacting the Equal Access to Abortion Cov21 erage in Health Insurance Act of 2021, and enacting the 

22 Women’s Health Protection Act of 2021, are critical to— 

23 (1) promoting equitable abortion access, includ24 ing coverage, for all who seek care; 


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1 (2) creating enforceable rights to receive, and 

2 receive coverage for, such care; 

3 (3) advancing equitable access to comprehensive 

4 health coverage, which cannot be achieved without 

5 abortion coverage; and 

6 (4) alleviating urgent racial, gender, and other 

7 inequities in health and health care and cor8 responding reproductive injustices. 

9 SEC. 5402. EMERGENCY CONTRACEPTION EDUCATION AND 

10 INFORMATION PROGRAMS. 

11 (a) EMERGENCY CONTRACEPTION PUBLIC EDU12 CATION PROGRAM.— 

13 (1) IN GENERAL.—The Secretary, acting 

14 through the Director of the Centers for Disease 

15 Control and Prevention, shall develop and dissemi16 nate to the public medically accurate and complete 

17 information on emergency contraceptives. 

18 (2) DISSEMINATION.—The Secretary may dis19 seminate medically accurate and complete informa20 tion under paragraph (1) directly or through ar21 rangements with nonprofit organizations, community 

22 health workers, including patient advocates, con23 sumer groups, institutions of higher education, clin24 ics, the media, and Federal, State, and local agen25 cies. 


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1 (3) INFORMATION.—The information dissemi2 nated under paragraph (1) shall— 

3 (A) include, at a minimum, a description 

4 of emergency contraceptives and an explanation 

5 of the use, safety, efficacy, affordability, and 

6 availability, including over-the-counter access, 

7 of such contraceptives and options for access to 

8 such contraceptives without cost-sharing 

9 through insurance and other programs; and 

10 (B) be pilot tested for consumer com11 prehension, cultural and linguistic appropriate12 ness, and acceptance of the messages across 

13 geographically, racially, ethnically, and linguis14 tically di-verse populations. 

15 (b) EMERGENCY CONTRACEPTION INFORMATION

16 PROGRAM FOR HEALTH CARE PROVIDERS.— 

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

18 through the Administrator of the Health Resources 

19 and Services Administration and in consultation 

20 with major medical and public health organizations, 

21 shall develop and disseminate to health care pro22 viders, including pharmacists, information on emer23 gency contraceptives. 


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1 (2) INFORMATION.—The information dissemi2 nated under paragraph (1) shall include, at a min3 imum— 

4 (A) information describing the use, safety, 

5 efficacy, and availability of emergency contra6 ceptives, and options for access without cost7 sharing through insurance and other programs; 

8 (B) a recommendation regarding the use of 

9 such contraceptives; and 

10 (C) information explaining how to obtain 

11 copies of the information developed under sub12 section (a) for distribution to the patients of 

13 the providers. 

14 (c) DEFINITIONS.—In this section: 

15 (1) HEALTH CARE PROVIDER.—The term 

16 ‘‘health care provider’’ means an individual who is li17 censed or certified under State law to provide health 

18 care services and who is operating within the scope 

19 of such license. Such term shall include a phar20 macist. 

21 (2) INSTITUTION OF HIGHER EDUCATION.—The 

22 term ‘‘institution of higher education’’ has the same 

23 meaning given such term in section 101(a) of the 

24 Higher Education Act of 1965 (20 U.S.C. 1001(a)). 


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1 (3) SECRETARY.—The term ‘‘Secretary’’ means 

2 the Secretary of Health and Human Services. 

3 (d) AUTHORIZATION OF APPROPRIATIONS.—There 

4 are authorized to be appropriated to carry out this section 

5 such sums as may be necessary for each of the fiscal years 

6 2025 through 2029. 

7 SEC. 5403. DUTIES OF PHARMACIES TO ENSURE PROVISION 

8 OF FDA-APPROVED CONTRACEPTION. 

9 Part B of title II of the Public Health Service Act 

10 (42 U.S.C. 238 et seq.) is amended by adding at the end 

11 the following: 

12 ‘‘SEC. 249. DUTIES OF PHARMACIES TO ENSURE PROVISION 

13 OF FDA-APPROVED CONTRACEPTION. 

14 ‘‘(a) IN GENERAL.—Subject to subsection (c), a 

15 pharmacy that receives Food and Drug Administration16 approved drugs or devices in interstate commerce shall 

17 maintain compliance with each of the following: 

18 ‘‘(1) If a customer requests a contraceptive or 

19 a medication related to a contraceptive, including 

20 emergency contraception, that is in stock, the phar21 macy shall ensure that the requested contraceptive 

22 or medication is provided to the customer without 

23 delay. 

24 ‘‘(2) If a customer requests a contraceptive or 

25 a medication related to a contraceptive that is not 


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1 in stock and the pharmacy in the normal course of 

2 business stocks contraception, the pharmacy shall 

3 immediately inform the customer that the requested 

4 contraceptive or medication is not in stock and with5 out delay offer the customer the following options: 

6 ‘‘(A) If the customer prefers to obtain the 

7 requested contraceptive or medication through a 

8 referral or transfer, the pharmacy shall— 

9 ‘‘(i) locate a pharmacy of the cus10 tomer’s choice or the closest pharmacy 

11 confirmed to have the requested contracep12 tive or medication in stock; and 

13 ‘‘(ii) refer the customer or transfer 

14 the prescription to that pharmacy. 

15 ‘‘(B) If the customer prefers for the phar16 macy to order the requested contraceptive or 

17 medication, the pharmacy shall obtain the con18 traceptive or medication under the pharmacy’s 

19 standard procedure for expedited ordering of 

20 medication and notify the customer when the 

21 contraceptive or medication arrives. 

22 ‘‘(3) The pharmacy shall ensure that— 

23 ‘‘(A) the pharmacy does not operate an en24 vironment in which customers are intimidated, 

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1 ices relating to a request for contraception or a 

2 medication related to a contraceptive; 

3 ‘‘(B) the pharmacy’s employees do not 

4 interfere with or obstruct the delivery of serv5 ices relating to a request for contraception or a 

6 medication related to a contraceptive; 

7 ‘‘(C) the pharmacy’s employees do not in8 tentionally misrepresent or deceive customers 

9 about the availability of a contraceptive or a 

10 medication related to a contraceptive, or the 

11 mechanism of action of such contraceptive or 

12 medication; 

13 ‘‘(D) the pharmacy’s employees do not 

14 breach medical confidentiality with respect to a 

15 request for a contraceptive or a medication re16 lated to a contraceptive or threaten to breach 

17 such confidentiality; or 

18 ‘‘(E) the pharmacy’s employees do not 

19 refuse to return a valid, lawful prescription for 

20 a contraceptive or a medication related to a 

21 contraceptive upon customer request. 

22 ‘‘(b) CONTRACEPTIVES NOT ORDINARILY

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1 ceptives or medications related to contraceptives, as the 

2 case may be, in the normal course of business. 

3 ‘‘(c) REFUSALS PURSUANT TO STANDARD PHAR4 MACY PRACTICE.—This section does not prohibit a phar5 macy from refusing to provide a contraceptive or a medi6 cation related to a contraceptive to a customer in accord7 ance with any of the following: 

8 ‘‘(1) If it is unlawful to dispense the requested 

9 contraceptive or medication to the customer without 

10 a valid, lawful prescription and no such prescription 

11 is presented. 

12 ‘‘(2) If the customer is unable to pay for the re13 quested contraceptive or medication. 

14 ‘‘(3) If the employee of the pharmacy refuses to 

15 provide the requested contraceptive or medication on 

16 the basis of a professional clinical judgment. 

17 ‘‘(d) RELATION TO OTHER LAW.— 

18 ‘‘(1) RULE OF CONSTRUCTION.—Nothing in 

19 this section shall be construed to invalidate or limit 

20 rights, remedies, procedures, or legal standards 

21 under title VII of the Civil Rights Act of 1964. 

22 ‘‘(2) CERTAIN CLAIMS.—The Religious Free23 dom Restoration Act of 1993 shall not provide a 

24 basis for a claim concerning, or a defense to a claim 


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1 under, this section, or provide a basis for challenging 

2 the application or enforcement of this section. 

3 ‘‘(e) PREEMPTION.—This section does not preempt 

4 any provision of State law or affect any professional obli5 gation made applicable by a State board or other entity 

6 responsible for licensing or discipline of pharmacies or 

7 pharmacists, to the extent that such State law or profes8 sional obligation provides protections for customers that 

9 are greater than the protections provided by this section. 

10 ‘‘(f) ENFORCEMENT.— 

11 ‘‘(1) CIVIL PENALTY.—A pharmacy that vio12 lates a requirement of subsection (a) is liable to the 

13 United States for a civil penalty in an amount not 

14 exceeding $1,000 per day of violation, not to exceed 

15 $100,000 for all violations adjudicated in a single 

16 proceeding. 

17 ‘‘(2) PRIVATE CAUSE OF ACTION.—Any person 

18 aggrieved as a result of a violation of a requirement 

19 of subsection (a) may, in any court of competent ju20 risdiction, commence a civil action against the phar21 macy involved to obtain appropriate relief, including 

22 actual and punitive damages, injunctive relief, and a 

23 reasonable attorney’s fee and costs. 

24 ‘‘(3) LIMITATIONS.—A civil action under para25 graph (1) or (2) may not be commenced against a 


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1 pharmacy after the expiration of the 5-year period 

2 beginning on the date on which the pharmacy alleg3 edly engaged in the violation involved. 

4 ‘‘(g) DEFINITIONS.—In this section: 

5 ‘‘(1) CONTRACEPTION.—The term ‘contracep6 tion’ or ‘contraceptive’ means any drug or device ap7 proved by the Food and Drug Administration to pre8 vent pregnancy. 

9 ‘‘(2) EMPLOYEE.—The term ‘employee’ means 

10 a person hired, by contract or any other form of an 

11 agreement, by a pharmacy. 

12 ‘‘(3) MEDICATION RELATED TO A CONTRACEP13 TIVE.—The term ‘medication related to a contracep14 tive’ means any drug or device approved by the Food 

15 and Drug Administration that a medical professional 

16 determines necessary to use before or in conjunction 

17 with use of a contraceptive. 

18 ‘‘(4) PHARMACY.—The term ‘pharmacy’ means 

19 an entity that— 

20 ‘‘(A) is authorized by a State to engage in 

21 the business of selling prescription drugs at re22 tail; and 

23 ‘‘(B) employs one or more employees. 


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1 ‘‘(5) PRODUCT.—The term ‘product’ means a 

2 Food and Drug Administration-approved drug or de3 vice. 

4 ‘‘(6) PROFESSIONAL CLINICAL JUDGMENT.— 

5 The term ‘professional clinical judgment’ means a 

6 clinical judgment, formed with the use of profes7 sional knowledge and skills, in accordance with pre8 vailing medical standards. 

9 ‘‘(7) WITHOUT DELAY.—The term ‘without 

10 delay’, with respect to a pharmacy providing, pro11 viding a referral for, or ordering contraception, or 

12 transferring the prescription for contraception, 

13 means within the usual and customary timeframe at 

14 the pharmacy for providing, providing a referral for, 

15 or ordering other products, or transferring the pre16 scription for other products, respectively. 

17 ‘‘(h) EFFECTIVE DATE.—This section shall take ef18 fect on the 31st day after the date of the enactment of 

19 this section, without regard to whether the Secretary has 

20 issued any guidance or final rule regarding this section.’’. 

21 SEC. 5404. REAL EDUCATION AND ACCESS FOR HEALTHY 

22 YOUTH ACT. 

23 (a) SHORT TITLE.—This section may be cited as the 

24 ‘‘Real Education and Access for Healthy Youth Act of 

25 2024’’. 


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1 (b) DEFINITIONS.—In this section: 

2 (1) AGE AND DEVELOPMENTALLY APPRO3 PRIATE.—The term ‘‘age and developmentally appro4 priate’’ means topics, messages, and teaching meth5 ods suitable to particular ages, age groups, or devel6 opmental levels, based on cognitive, emotional, so7 cial, and behavioral capacity of most young people at 

8 that age level. 

9 (2) CONSENT.—The term ‘‘consent’’ means af10 firmative, conscious, and voluntary agreement to en11 gage in interpersonal, physical, or sexual activity. 

12 (3) CULTURALLY RESPONSIVE.—The term ‘‘cul13 turally responsive’’ means education and services 

14 that— 

15 (A) embrace and actively engage and ad16 just to young people and their various cultural 

17 identities; 

18 (B) recognize the ways in which many 

19 marginalized young people face unique barriers 

20 in society that result in increased adverse 

21 health outcomes and associated stereotypes; and 

22 (C) may address the ways in which racism 

23 has shaped national health care policy, the last24 ing historical trauma associated with reproduc25 tive health experiments and forced sterilizations 


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1 of Black, Latine, and Indigenous communities, 

2 or sexual stereotypes assigned to young People 

3 of Color or LGBTQ+ people. 

4 (4) EVIDENCE-INFORMED.—The term ‘‘evi5 dence-informed’’ means incorporates characteristics, 

6 content, or skills that have been proven to be effec7 tive through evaluation in changing sexual behavior. 

8 (5) GENDER EXPRESSION.—The term ‘‘gender 

9 expression’’ means the expression of one’s gender, 

10 such as through behavior, clothing, haircut, or voice, 

11 and which may or may not conform to socially de12 fined behaviors and characteristics typically associ13 ated with being either masculine or feminine. 

14 (6) GENDER IDENTITY.—The term ‘‘gender 

15 identity’’ means the gender-related identity, appear16 ance, mannerisms, or other gender-related character17 istics of an individual, regardless of the individual’s 

18 designated sex at birth. 

19 (7) INCLUSIVE.—The term ‘‘inclusive’’ means 

20 content and skills that ensure marginalized young 

21 people are valued, respected, centered, and sup22 ported in sex education instruction and materials. 

23 (8) INSTITUTION OF HIGHER EDUCATION.—The 

24 term ‘‘institution of higher education’’ has the 


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1 meaning given the term in section 101 of the Higher 

2 Education Act of 1965 (20 U.S.C. 1001). 

3 (9) INTERPERSONAL VIOLENCE.—The term 

4 ‘‘interpersonal violence’’ means abuse, assault, bul5 lying, dating violence, domestic violence, harassment, 

6 intimate partner violence, or stalking. 

7 (10) LOCAL EDUCATIONAL AGENCY.—The term 

8 ‘‘local educational agency’’ has the meaning given 

9 the term in section 8101 of the Elementary and Sec10 ondary Education Act of 1965 (20 U.S.C. 7801). 

11 (11) MARGINALIZED YOUNG PEOPLE.—The 

12 term ‘‘marginalized young people’’ means young peo13 ple who are disadvantaged by underlying structural 

14 barriers and social inequities, including young people 

15 who are— 

16 (A) Black, Indigenous, Latine, Asian 

17 American, Native Hawaiian, Pacific Islander, 

18 and other People of Color; 

19 (B) immigrants; 

20 (C) in contact with the foster care system; 

21 (D) in contact with the juvenile justice sys22 tem; 

23 (E) experiencing homelessness; 

24 (F) pregnant or parenting; 


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1 (G) lesbian, gay, bisexual, transgender, or 

2 queer; 

3 (H) living with HIV; 

4 (I) living with disabilities; 

5 (J) from families with low-incomes; or 

6 (K) living in rural areas. 

7 (12) MEDICALLY ACCURATE AND COMPLETE.— 

8 The term ‘‘medically accurate and complete’’ means 

9 that— 

10 (A) the information provided through the 

11 education is verified or supported by the weight 

12 of research conducted in compliance with ac13 cepted scientific methods and is published in 

14 peer-reviewed journals, where applicable; or 

15 (B) the education contains information 

16 that leading professional organizations and 

17 agencies with relevant expertise in the field rec18 ognize as accurate, objective, and complete. 

19 (13) RESILIENCE.—The term ‘‘resilience’’ 

20 means the ability to adapt to trauma and tragedy. 

21 (14) SECRETARY.—The term ‘‘Secretary’’ 

22 means the Secretary of Health and Human Services. 

23 (15) SEX EDUCATION.—The term ‘‘sex edu24 cation’’ means high quality teaching and learning 

25 that— 


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1 (A) is delivered, to the maximum extent 

2 practicable, following the National Sexuality 

3 Education Standards of the Future of Sex Ed 

4 Initiative; 

5 (B) is about a broad variety of topics re6 lated to sex and sexuality, including— 

7 (i) puberty and adolescent develop8 ment; 

9 (ii) sexual and reproductive anatomy 

10 and physiology; 

11 (iii) sexual orientation, gender iden12 tity, and gender expression; 

13 (iv) contraception, pregnancy, preg14 nancy options, and reproduction; 

15 (v) HIV and other STIs; 

16 (vi) consent and healthy relationships; 

17 and 

18 (vii) interpersonal violence; 

19 (C) explores values and beliefs about such 

20 topics; and 

21 (D) helps young people in gaining the 

22 skills that are needed to navigate relationships 

23 and manage one’s own sexual health. 

24 (16) SEXUAL HEALTH SERVICES.—The term 

25 ‘‘sexual health services’’ includes— 


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1 (A) sexual health information, education, 

2 and counseling; 

3 (B) all methods of contraception approved 

4 by the Food and Drug Administration; 

5 (C) routine gynecological care, including 

6 human papillomavirus (HPV) vaccines and can7 cer screenings; 

8 (D) pre-exposure prophylaxis or post-expo9 sure prophylaxis; 

10 (E) substance use and mental health serv11 ices; 

12 (F) interpersonal violence survivor services; 

13 and 

14 (G) other pregnancy and STI prevention, 

15 care, or treatment services. 

16 (17) SEXUAL ORIENTATION.—The term ‘‘sexual 

17 orientation’’ means an individual’s romantic, emo18 tional, or sexual attraction to other people. 

19 (18) STATE EDUCATIONAL AGENCY.—The term 

20 ‘‘State educational agency’’ has the meaning given 

21 the term in section 8101 of the Elementary and Sec22 ondary Education Act of 1965 (20 U.S.C. 7801). 

23 (19) TRAUMA.—The term ‘‘trauma’’ means a 

24 response to an event, series of events, or set of cir25 cumstances that is experienced or witnessed by an 


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1 individual or group of people as physically or emo2 tionally harmful or life-threatening with lasting ad3 verse effects on their functioning and mental, phys4 ical, social, emotional, or spiritual well-being. 

5 (20) TRAUMA-INFORMED AND RESILIENCE-ORI6 ENTED.—The term ‘‘trauma-informed and resil7 ience-oriented’’ means an approach that realizes the 

8 prevalence of trauma, recognizes the various ways 

9 individuals, organizations, and communities may re10 spond to trauma differently, recognizes that resil11 ience can be built, and responds by putting this 

12 knowledge into practice. 

13 (21) YOUNG PEOPLE.—The term ‘‘young peo14 ple’’ means individuals who are ages 10 through 29 

15 at the time of commencement of participation in a 

16 project supported under this section. 

17 (22) YOUTH-FRIENDLY SEXUAL HEALTH SERV18 ICES.—The term ‘‘youth-friendly sexual health serv19 ices’’ means sexual health services that are provided 

20 in a confidential, equitable, and accessible manner 

21 that makes it easy and comfortable for young people 

22 to seek out and receive services. 

23 (c) GRANTS FOR SEX EDUCATION AT ELEMENTARY

24 AND SECONDARY SCHOOLS AND YOUTH-SERVING ORGA25 NIZATIONS.— 


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1 (1) PROGRAM AUTHORIZED.—The Secretary, in 

2 coordination with the Secretary of Education, shall 

3 award grants, on a competitive basis, to eligible enti4 ties to enable such eligible entities to carry out 

5 projects that provide young people with sex edu6 cation. 

7 (2) DURATION.—Grants awarded under this 

8 section shall be for a period of 5 years. 

9 (3) ELIGIBLE ENTITY.—In this section, the 

10 term ‘‘eligible entity’’ means a public or private enti11 ty that delivers evidence-based sex education to 

12 young people. 

13 (4) APPLICATIONS.—An eligible entity desiring 

14 a grant under this section shall submit an applica15 tion to the Secretary at such time, in such manner, 

16 and containing such information as the Secretary 

17 may require. 

18 (5) PRIORITY.—In awarding grants under this 

19 section, the Secretary shall give priority to eligible 

20 entities that are— 

21 (A) State educational agencies or local 

22 educational agencies; or 

23 (B) Indian Tribes or Tribal organizations, 

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1 mination and Education Assistance Act (25 

2 U.S.C. 5304). 

3 (6) USE OF FUNDS.—Each eligible entity that 

4 receives a grant under this section shall use the 

5 grant funds to carry out a project that provides 

6 young people with sex education. 

7 (d) GRANTS FOR SEX EDUCATION AT INSTITUTIONS

8 OF HIGHER EDUCATION.— 

9 (1) PROGRAM AUTHORIZED.—The Secretary, in 

10 coordination with the Secretary of Education, shall 

11 award grants, on a competitive basis, to institutions 

12 of higher education or consortia of such institutions 

13 to enable such institutions to provide students with 

14 age and developmentally appropriate sex education. 

15 (2) DURATION.—Grants awarded under this 

16 section shall be for a period of 5 years. 

17 (3) APPLICATIONS.—An institution of higher 

18 education or consortium of such institutions desiring 

19 a grant under this section shall submit an applica20 tion to the Secretary at such time, in such manner, 

21 and containing such information as the Secretary 

22 may require. 

23 (4) PRIORITY.—In awarding grants under this 

24 section, the Secretary shall give priority to an insti25 tution of higher education that— 


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1 (A) has an enrollment of needy students, 

2 as defined in section 318(b) of the Higher Edu3 cation Act of 1965 (20 U.S.C. 1059e(b)); 

4 (B) is a Hispanic-serving institution, as 

5 defined in section 502(a) of such Act (20 

6 U.S.C. 1101a(a)); 

7 (C) is a Tribal College or University, as 

8 defined in section 316(b) of such Act (20 

9 U.S.C. 1059c(b)); 

10 (D) is an Alaska Native-serving institution, 

11 as defined in section 317(b) of such Act (20 

12 U.S.C. 1059d(b)); 

13 (E) is a Native Hawaiian-serving institu14 tion, as defined in section 317(b) of such Act 

15 (20 U.S.C. 1059d(b)); 

16 (F) is a Predominantly Black Institution, 

17 as defined in section 318(b) of such Act (20 

18 U.S.C. 1059e(b)); 

19 (G) is a Native American-serving, non20 tribal institution, as defined in section 319(b) 

21 of such Act (20 U.S.C. 1059f(b)); 

22 (H) is an Asian American and Native 

23 American Pacific Islander-serving institution, as 

24 defined in section 320(b) of such Act (20 

25 U.S.C. 1059g(b)); or 


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1 (I) is a minority institution, as defined in 

2 section 365 of such Act (20 U.S.C. 1067k), 

3 with an enrollment of needy students, as de4 fined in section 312 of such Act (20 U.S.C. 

5 1058). 

6 (5) USES OF FUNDS.—An institution of higher 

7 education or consortium of such institutions receiv8 ing a grant under this section shall use grant funds 

9 to develop and implement a project to integrate sex 

10 education into the institution of higher education in 

11 order to reach a large number of students, by car12 rying out 1 or more of the following activities: 

13 (A) Adopting and incorporating age and 

14 developmentally appropriate sex education into 

15 student orientation, general education, or 

16 courses. 

17 (B) Developing or adopting and imple18 menting educational programming outside of 

19 class that delivers age and developmentally ap20 propriate sex education to students. 

21 (C) Developing or adopting and imple22 menting innovative technology-based approaches 

23 to deliver age and developmentally appropriate 

24 sex education to students. 


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1 (D) Developing or adopting and imple2 menting peer-led activities to generate discus3 sion, educate, and raise awareness among stu4 dents about age and developmentally appro5 priate sex education. 

6 (E) Developing or adopting and imple7 menting policies and practices to link students 

8 to sexual health services. 

9 (e) GRANTS FOR EDUCATOR TRAINING.— 

10 (1) PROGRAM AUTHORIZED.—The Secretary, in 

11 coordination with the Secretary of Education, shall 

12 award grants, on a competitive basis, to eligible enti13 ties to enable such eligible entities to carry out the 

14 activities described in paragraph (5). 

15 (2) DURATION.—Grants awarded under this 

16 section shall be for a period of 5 years. 

17 (3) ELIGIBLE ENTITY.—In this section, the 

18 term ‘‘eligible entity’’ means— 

19 (A) a State educational agency or local 

20 educational agency; 

21 (B) an Indian Tribe or Tribal organiza22 tion, as defined in section 4 of the Indian Self23 Determination and Education Assistance Act 

24 (25 U.S.C. 5304); 

25 (C) a State or local department of health; 


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1 (D) an educational service agency, as de2 fined in section 8101 of the Elementary and 

3 Secondary Education Act of 1965 (20 U.S.C. 

4 7801); 

5 (E) a nonprofit institution of higher edu6 cation or a consortium of such institutions; or 

7 (F) a national or statewide nonprofit orga8 nization or consortium of nonprofit organiza9 tions that has as its primary purpose the im10 provement of provision of sex education through 

11 training and effective teaching of sex education. 

12 (4) APPLICATION.—An eligible entity desiring a 

13 grant under this section shall submit an application 

14 to the Secretary at such time, in such manner, and 

15 containing such information as the Secretary may 

16 require. 

17 (5) AUTHORIZED ACTIVITIES.— 

18 (A) REQUIRED ACTIVITY.—Each eligible 

19 entity receiving a grant under this section shall 

20 use grant funds for professional development 

21 and training of relevant teachers, health edu22 cators, faculty, administrators, and staff, in 

23 order to increase effective teaching of sex edu24 cation to young people. 


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1 (B) PERMISSIBLE ACTIVITIES.—Each eligi2 ble entity receiving a grant under this section 

3 may use grant funds to— 

4 (i) provide training and support for 

5 educators about the content, skills, and 

6 professional disposition needed to imple7 ment sex education effectively; 

8 (ii) develop and provide training and 

9 support to educators on incorporating anti10 racist and gender inclusive policies and 

11 practices in sex education; 

12 (iii) support the dissemination of in13 formation on effective practices and re14 search findings concerning the teaching of 

15 sex education; 

16 (iv) support research on— 

17 (I) effective sex education teach18 ing practices; and 

19 (II) the development of assess20 ment instruments and strategies to 

21 document— 

22 (aa) young people’s under23 standing of sex education; and 

24 (bb) the effects of sex edu25 cation; 


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1 (v) convene conferences on sex edu2 cation, in order to effectively train edu3 cators in the provision of sex education; 

4 and 

5 (vi) develop and disseminate appro6 priate research-based materials to foster 

7 sex education. 

8 (C) SUBGRANTS.—Each eligible entity re9 ceiving a grant under this section may award 

10 subgrants to nonprofit organizations that pos11 sess a demonstrated record of providing train12 ing to teachers, health educators, faculty, ad13 ministrators, and staff on sex education to— 

14 (i) train educators in sex education; 

15 (ii) support internet or distance learn16 ing related to sex education; 

17 (iii) promote rigorous academic stand18 ards and assessment techniques to guide 

19 and measure student performance in sex 

20 education; 

21 (iv) encourage replication of best 

22 practices and model programs to promote 

23 sex education; 


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1 (v) develop and disseminate effective, 

2 research-based sex education learning ma3 terials; or 

4 (vi) develop academic courses on the 

5 pedagogy of sex education at institutions 

6 of higher education. 

7 (f) AUTHORIZATION OF GRANTS TO SUPPORT THE

8 DELIVERY OF SEXUAL HEALTH SERVICES TO

9 MARGINALIZED YOUNG PEOPLE.— 

10 (1) PROGRAM AUTHORIZED.—The Secretary 

11 shall award grants, on a competitive basis, to eligible 

12 entities to enable such entities to provide youth13 friendly sexual health services to marginalized young 

14 people. 

15 (2) DURATION.—Grants awarded under this 

16 section shall be for a period of 5 years. 

17 (3) ELIGIBLE ENTITY.—In this section, the 

18 term ‘‘eligible entity’’ means— 

19 (A) a public or private youth-serving orga20 nization; or 

21 (B) a covered entity, as defined in section 

22 340B of the Public Health Service Act (42 

23 U.S.C. 256b). 

24 (4) APPLICATIONS.—An eligible entity desiring 

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1 tion to the Secretary at such time, in such manner, 

2 and containing such information as the Secretary 

3 may require. 

4 (5) USES OF FUNDS.—Each eligible entity that 

5 receives a grant under this section may use the 

6 grant funds to— 

7 (A) develop and implement an evidence-in8 formed project to deliver sexual health services 

9 to marginalized young people; 

10 (B) establish, alter, or modify staff posi11 tions, service delivery policies and practices, 

12 service delivery locations, service delivery envi13 ronments, service delivery schedules, or other 

14 services components in order to increase youth15 friendly sexual health services to marginalized 

16 young people; 

17 (C) conduct outreach to marginalized 

18 young people to invite them to participate in 

19 the eligible entity’s sexual health services and to 

20 provide feedback to inform improvements in the 

21 delivery of such services; 

22 (D) establish and refine systems of referral 

23 to connect marginalized young people to other 

24 sexual health services and supportive services; 


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1 (E) establish partnerships and collabora2 tions with entities providing services to 

3 marginalized young people to link such young 

4 people to sexual health services, such as by de5 livering health services at locations where they 

6 congregate, providing transportation to loca7 tions where sexual health services are provided, 

8 or other linkages to services approaches; 

9 (F) provide evidence-informed, comprehen10 sive in scope, confidential, equitable, accessible, 

11 medically accurate and complete, age and devel12 opmentally appropriate, culturally responsive, 

13 and trauma-informed and resilience-oriented 

14 sexual health information to marginalized 

15 young people in the languages and cultural con16 texts that are most appropriate for the 

17 marginalized young people to be served by the 

18 eligible entity; 

19 (G) promote effective communication re20 garding sexual health among marginalized 

21 young people; and 

22 (H) provide training and support for eligi23 ble entity personnel and community members 

24 who work with marginalized young people about 

25 the content, skills, and professional disposition 


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1 needed to provide youth-friendly sex education 

2 and youth-friendly sexual health services. 

3 (g) REPORTING AND IMPACT EVALUATION.— 

4 (1) GRANTEE REPORT TO SECRETARY.—For 

5 each year a grantee receives grant funds under sub6 section (c), (d), (e), or (f) the grantee shall submit 

7 to the Secretary a report that includes— 

8 (A) a description of the use of grant funds 

9 by the grantee; 

10 (B) a description of how the use of grant 

11 funds has increased the access of young people 

12 to sex education or sexual health services; and 

13 (C) such other information as the Sec14 retary may require. 

15 (2) SECRETARY’S REPORT TO CONGRESS.—Not 

16 later than 1 year after the date of the enactment of 

17 this section, and annually thereafter for a period of 

18 5 years, the Secretary shall prepare and submit to 

19 Congress a report on the activities funded under this 

20 section. The Secretary’s report to Congress shall in21 clude— 

22 (A) a statement of how grants awarded by 

23 the Secretary meet the purposes of the grants; 

24 and 

25 (B) information about— 


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1 (i) the number of grantees that are 

2 receiving grant funds under subsections 

3 (c), (d), (e), and (f); 

4 (ii) the specific activities supported by 

5 grant funds awarded under subsections (c), 

6 (d), (e), and (f); 

7 (iii) the number of young people 

8 served by projects funded under sub9 sections (c),(d), and (f), in the aggregate 

10 and disaggregated and cross-tabulated by 

11 grant program, race and ethnicity, sex, 

12 sexual orientation, gender identity, and 

13 other characteristics determined by the 

14 Secretary (except that such disaggregation 

15 or cross-tabulation shall not be required in 

16 a case in which the results would reveal 

17 personally identifiable information about 

18 an individual young person); 

19 (iv) the number of teachers, health 

20 educators, faculty, school administrators, 

21 and staff trained under subsection (e); and 

22 (v) the status of the evaluation re23 quired under paragraph (3). 

24 (3) MULTI-YEAR EVALUATION.— 


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1 (A) IN GENERAL.—Not later than 6 

2 months after the date of the enactment of this 

3 section, the Secretary shall enter into a contract 

4 with a nonprofit organization with experience in 

5 conducting impact evaluations to conduct a 

6 multi-year evaluation on the impact of the 

7 projects funded under subsections (c), (d), (e), 

8 and (f) and to report to Congress and the Sec9 retary on the findings of such evaluation. 

10 (B) EVALUATION.—The evaluation con11 ducted under this subsection shall— 

12 (i) be conducted in a manner con13 sistent with relevant, nationally recognized 

14 professional and technical evaluation 

15 standards; 

16 (ii) use sound statistical methods and 

17 techniques relating to the behavioral 

18 sciences, including quasi-experimental de19 signs, inferential statistics, and other 

20 methodologies and techniques that allow 

21 for conclusions to be reached; 

22 (iii) be carried out by an independent 

23 organization that has not received a grant 

24 under subsection (c), (d), (e), or (f); and 


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1 (iv) be designed to provide informa2 tion on output measures and outcome 

3 measures to be determined by the Sec4 retary. 

5 (C) REPORT.—Not later than 6 years after 

6 the date of enactment of this section, the orga7 nization conducting the evaluation under this 

8 paragraph shall prepare and submit to the ap9 propriate committees of Congress and the Sec10 retary an evaluation report. Such report shall 

11 be made publicly available, including on the 

12 website of the Department of Health and 

13 Human Services. 

14 (h) NONDISCRIMINATION.—Activities funded under 

15 this section shall not discriminate on the basis of actual 

16 or perceived sex (including sexual orientation and gender 

17 identity), age, parental status, race, color, ethnicity, na18 tional origin, disability, or religion. Nothing in this section 

19 shall be construed to invalidate or limit rights, remedies, 

20 procedures, or legal standards available under any other 

21 Federal law or any law of a State or a political subdivision 

22 of a State, including the Civil Rights Act of 1964 (42 

23 U.S.C. 2000a et seq.), title IX of the Education Amend24 ments of 1972 (20 U.S.C. 1681 et seq.), section 504 of 

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1 icans with Disabilities Act of 1990 (42 U.S.C. 12101 et 

2 seq.), and section 1557 of the Patient Protection and Af3 fordable Care Act (42 U.S.C. 18116). 

4 (i) LIMITATION.—No Federal funds provided under 

5 this section may be used for sex education or sexual health 

6 services that— 

7 (1) withhold health-promoting or life-saving in8 formation about sexuality-related topics, including 

9 HIV; 

10 (2) are medically inaccurate or incomplete; 

11 (3) promote gender or racial stereotypes or are 

12 unresponsive to gender or racial inequities; 

13 (4) fail to address the needs of sexually active 

14 young people; 

15 (5) fail to address the needs of pregnant or par16 enting young people; 

17 (6) fail to address the needs of survivors of 

18 interpersonal violence; 

19 (7) fail to address the needs of young people of 

20 all physical, developmental, or mental abilities; 

21 (8) fail to be inclusive of individuals with vary22 ing gender identities, gender expressions, and sexual 

23 orientations; or 

24 (9) are inconsistent with the ethical imperatives 

25 of medicine and public health. 


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1 (j) AMENDMENTS TO OTHER LAWS.— 

2 (1) AMENDMENT TO THE PUBLIC HEALTH

3 SERVICE ACT.—Section 2500 of the Public Health 

4 Service Act (42 U.S.C. 300ee) is amended by strik5 ing subsections (b) through (d) and inserting the fol6 lowing: 

7 ‘‘(b) CONTENTS OF PROGRAMS.—All programs of 

8 education and information receiving funds under this sub9 chapter shall include information about the potential ef10 fects of intravenous substance use.’’. 

11 (2) AMENDMENTS TO THE ELEMENTARY AND

12 SECONDARY EDUCATION ACT OF 1965.—Section 8526 

13 of the Elementary and Secondary Education Act of 

14 1965 (20 U.S.C. 7906) is amended— 

15 (A) by striking paragraphs (3), (5), and 

16 (6); 

17 (B) by redesignating paragraph (4) as 

18 paragraph (3); 

19 (C) in paragraph (3), as redesignated by 

20 paragraph (2), by inserting ‘‘or’’ after the semi21 colon; and 

22 (D) by redesignating paragraph (7) as 

23 paragraph (4). 

24 (k) FUNDING.— 


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1 (1) AUTHORIZATION.—For the purpose of car2 rying out this section, there is authorized to be ap3 propriated $100,000,000 for each of fiscal years 

4 2025 through 2030. Amounts appropriated under 

5 this subsection shall remain available until expended. 

6 (2) RESERVATIONS OF FUNDS.— 

7 (A) IN GENERAL.—The Secretary— 

8 (i) shall reserve not more than 30 per9 cent of the amount authorized under para10 graph (1) for the purposes of awarding 

11 grants for sex education at elementary and 

12 secondary schools and youth-serving orga13 nizations under subsection (c); 

14 (ii) shall reserve not more than 10 

15 percent of the amount authorized under 

16 paragraph (1) for the purpose of awarding 

17 grants for sex education at institutions of 

18 higher education under subsection (d); 

19 (iii) shall reserve not more than 15 

20 percent of the amount authorized under 

21 paragraph (1) for the purpose of awarding 

22 grants for educator training under sub23 section (e); 

24 (iv) shall reserve not more than 30 

25 percent of the amount authorized under 


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1 paragraph (1) for the purpose of awarding 

2 grants for sexual health services for 

3 marginalized youth under subsection (f); 

4 and 

5 (v) shall reserve not less than 5 per6 cent of the amount authorized under para7 graph (1) for the purpose of carrying out 

8 the reporting and impact evaluation re9 quired under subsection (g). 

10 (B) RESEARCH, TRAINING, AND TECH11 NICAL ASSISTANCE.—The Secretary shall re12 serve not less than 10 percent of the amount 

13 authorized under paragraph (1) for expendi14 tures by the Secretary to provide, directly or 

15 through a competitive grant process, research, 

16 training, and technical assistance, including dis17 semination of research and information regard18 ing effective and promising practices, providing 

19 consultation and resources, and developing re20 sources and materials to support the activities 

21 of recipients of grants. In carrying out such 

22 functions, the Secretary shall collaborate with a 

23 variety of entities that have expertise in sex 

24 education and sexual health services standards 


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1 setting, design, development, delivery, research, 

2 monitoring, and evaluation. 

3 (3) REPROGRAMMING OF ABSTINENCE ONLY

4 UNTIL MARRIAGE PROGRAM FUNDING.—The unobli5 gated balance of funds made available to carry out 

6 section 510 of the Social Security Act (42 U.S.C. 

7 710) (as in effect on the day before the date of en8 actment of this section) are transferred and shall be 

9 used by the Secretary to carry out this section. The 

10 amounts transferred and made available to carry out 

11 this section shall remain available until expended. 

12 (4) REPEAL OF ABSTINENCE ONLY UNTIL MAR13 RIAGE PROGRAM.—Section 510 of the Social Secu14 rity Act (42 U.S.C. 710 et seq.) is repealed. 

15 SEC. 5405. COMPASSIONATE ASSISTANCE FOR RAPE EMER16 GENCIES. 

17 (a) MEDICARE.— 

18 (1) LIMITATION ON PAYMENT.—Section 

19 1866(a)(1) of the Social Security Act (42 U.S.C. 

20 1395cc(a)(1)), as amended by section 5201(f), is 

21 further amended— 

22 (A) in subparagraph (W), by moving the 

23 indentation 2 ems to the left; 

24 (B) in subparagraph (X), by moving the 

25 indentation 2 ems to the left; 


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1 (C) in subparagraph (Y)(ii)(V), by striking 

2 ‘‘and’’ at the end; 

3 (D) in subparagraph (Z)(iii), by striking 

4 the period and inserting ‘‘, and’’; and 

5 (E) by inserting after subparagraph (Z) 

6 the following new subparagraph: 

7 ‘‘(AA) in the case of a hospital or critical access 

8 hospital, to adopt and enforce a policy to ensure 

9 compliance with the requirements of subsection (l) 

10 and to meet the requirements of such subsection.’’. 

11 (2) ASSISTANCE TO VICTIMS.—Section 1866 of 

12 the Social Security Act (42 U.S.C. 1395cc) is 

13 amended by adding at the end the following new 

14 subsection: 

15 ‘‘(l) COMPASSIONATE ASSISTANCE FOR RAPE EMER16 GENCIES.— 

17 ‘‘(1) IN GENERAL.—For purposes of subsection 

18 (a)(1)(AA), a hospital meets the requirements of 

19 this subsection if the hospital provides each of the 

20 services described in paragraph (2) to each indi21 vidual, whether or not eligible for benefits under this 

22 title or under any other form of health insurance, 

23 who comes to the hospital on or after January 1, 

24 2025, and— 


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1 ‘‘(A) who states to hospital personnel that 

2 they are victims of sexual assault; 

3 ‘‘(B) who is accompanied by an individual 

4 who states to hospital personnel that the indi5 vidual is a victim of sexual assault; or 

6 ‘‘(C) whom hospital personnel, during the 

7 course of treatment and care for the individual, 

8 have reason to believe is a victim of sexual as9 sault. 

10 ‘‘(2) REQUIRED SERVICES DESCRIBED.—For 

11 purposes of paragraph (1), the services described in 

12 this subparagraph are the following: 

13 ‘‘(A) Provision of medically and factually 

14 accurate and unbiased written and oral infor15 mation about emergency contraception that— 

16 ‘‘(i) is written in clear and concise 

17 language; 

18 ‘‘(ii) is readily comprehensible; 

19 ‘‘(iii) includes an explanation that 

20 emergency contraceptives— 

21 ‘‘(I) have been approved by the 

22 Food and Drug Administration for in23 dividuals and are a safe and effective 

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1 tected intercourse or contraceptive 

2 failure if taken in a timely manner; 

3 ‘‘(II) are more effective the soon4 er it is taken; and 

5 ‘‘(III) do not cause an abortion 

6 and cannot interrupt an established 

7 pregnancy; 

8 ‘‘(iv) meet such conditions regarding 

9 the provision of such information in lan10 guages other than English as the Secretary 

11 may establish; and 

12 ‘‘(v) are provided without regard to 

13 the ability of the individual or their family 

14 to pay costs associated with the provision 

15 of such information to the individual. 

16 ‘‘(B) Immediate offer to provide emergency 

17 contraception to the individual at the hospital 

18 and, in the case that such individual accepts 

19 such offer, immediate provision to such indi20 vidual of such contraception on the same day it 

21 is requested without regard to the inability of 

22 the individual or their family to pay costs asso23 ciated with the offer and provision of such con24 traception. 


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1 ‘‘(C) Development and implementation of a 

2 written policy to ensure that an individual is 

3 present at the hospital, or on-call, who— 

4 ‘‘(i) has authority to dispense or pre5 scribe emergency contraception, independ6 ently, or under a protocol prepared by a 

7 physician for the administration of emer8 gency contraception at the hospital to a 

9 victim of sexual assault; and 

10 ‘‘(ii) is trained to comply with the re11 quirements of this section. 

12 ‘‘(D) Provision of medically and factually 

13 accurate and unbiased written and oral infor14 mation and counseling about post-exposure pro15 phylaxis (referred to in this paragraph as 

16 ‘PEP’) protocol for the prevention of HIV. 

17 ‘‘(E) Immediate offer to begin PEP to the 

18 individual at the hospital except in cases where 

19 the medical professional’s best judgement is 

20 that further evaluation is required or that such 

21 a regimen will be substantially detrimental to 

22 the health of such individual. Such provision 

23 shall be offered regardless of the individual’s 

24 ability to pay. Hospitals shall be responsible for 


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1 ensuring adequate supply of PEP medications 

2 to provide to patients. 

3 ‘‘(3) HOSPITAL DEFINED.—For purposes of 

4 this paragraph, the term ‘hospital’ includes a critical 

5 access hospital, as defined in section 

6 1861(mm)(1).’’. 

7 (b) LIMITATION ON PAYMENT UNDER MEDICAID.— 

8 Section 1903(i) of the Social Security Act (42 U.S.C. 

9 1396b(i)), as amended by section 4106(b)(2), is further 

10 amended— 

11 (1) in paragraph (27), by striking ‘‘or’’ after 

12 the semicolon; 

13 (2) in paragraph (28), by striking the period 

14 and inserting ‘‘; or’’; and 

15 (3) by inserting after paragraph (28) the fol16 lowing new paragraph: 

17 ‘‘(29) with respect to any amount expended for 

18 care or services furnished under the plan by a hos19 pital on or after January 1, 2025, unless such hos20 pital meets the requirements specified in section 

21 1866(l) for purposes of title XVIII.’’. 

22 SEC. 5406. MENSTRUAL EQUITY FOR ALL ACT OF 2024. 

23 (a) SHORT TITLE.—This section may be cited as the 

24 ‘‘Menstrual Equity For All Act of 2024’’. 


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1 (b) MENSTRUAL PRODUCTS FOR STUDENTS AT ELE2 MENTARY AND SECONDARY SCHOOLS.— 

3 (1) IN GENERAL.—Section 4108(5)(C) of the 

4 Elementary and Secondary Education Act of 1965 

5 (20 U.S.C. 7118(5)(C)) is amended— 

6 (A) in clause (vi), by striking ‘‘or’’ after 

7 the semicolon; 

8 (B) in clause (vii), by inserting ‘‘or’’ after 

9 the semicolon; and 

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

11 ‘‘(viii) provide free menstrual products 

12 to students who use menstrual products;’’. 

13 (2) DEFINITIONS.—Section 4102 of the Ele14 mentary and Secondary Education Act of 1965 (20 

15 U.S.C. 7112) is amended— 

16 (A) by redesignating paragraphs (6) 

17 through (8) as paragraphs (7) through (9), re18 spectively; and 

19 (B) by inserting after paragraph (5) the 

20 following: 

21 ‘‘(6) MENSTRUAL PRODUCTS.—The term ‘men22 strual products’ means sanitary napkins and tam23 pons that conform to applicable industry stand24 ards.’’. 


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1 (3) RULEMAKING.—Not later than 1 year after 

2 the date of enactment of this section, the Secretary 

3 of Education, in consultation with the Secretary of 

4 Health and Human Services, shall promulgate rules 

5 with respect to the definition of ‘‘menstrual prod6 ucts’’ in paragraph (6) of section 4102 of the Ele7 mentary and Secondary Education Act of 1965 (20 

8 U.S.C. 7112), as amended by paragraph (2). 

9 (c) MENSTRUAL PRODUCTS FOR STUDENTS AT IN10 STITUTIONS OF HIGHER EDUCATION.— 

11 (1) PURPOSE.—The purpose of this subsection 

12 is to alleviate— 

13 (A) the barriers to academic success faced 

14 by many college and graduate students due to 

15 the inability of such students to afford to pur16 chase menstrual products; and 

17 (B) the unique set of burdens that college 

18 and graduate students experiencing period pov19 erty face that can be compounded by lack of ac20 cess to basic needs such as housing, food, trans21 portation, and access to physical and mental 

22 health services. 

23 (2) IN GENERAL.—The Secretary of Education 

24 shall establish a program to award grants, on a comVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 00874 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 petitive basis, to not less than 4 institutions of high2 er education to— 

3 (A) support programs that provide free 

4 menstrual products to students; and 

5 (B) report on best practices of such pro6 grams. 

7 (3) APPLICATION.—To apply for a grant under 

8 this subsection, an institution of higher education 

9 shall submit to the Secretary an application in such 

10 form, at such time, and containing such information 

11 as the Secretary determines appropriate, including 

12 an assurance that such grant will be used to carry 

13 out the activities described in paragraph (5). 

14 (4) COMMUNITY COLLEGES.—Not less than 50 

15 percent of the grants awarded under this subsection 

16 shall be awarded to community colleges. 

17 (5) GRANT USES.—A grant awarded under this 

18 subsection may only be used to— 

19 (A) carry out or expand activities that 

20 fund programs that support direct provision of 

21 free menstrual products to students in appro22 priate campus locations, including— 

23 (i) campus restroom facilities; 

24 (ii) wellness centers; and 

25 (iii) on-campus residential buildings; 


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1 (B) report on best practices of such pro2 grams; 

3 (C) conduct outreach to students to en4 courage participation in menstrual equity pro5 grams and services; 

6 (D) help eligible students apply for and en7 roll in local, State, and Federal public assist8 ance programs; and 

9 (E) coordinate and collaborate with gov10 ernment or community-based organizations to 

11 carry out the activities described in subpara12 graphs (A) through (D). 

13 (6) PRIORITY.—In awarding grants under this 

14 subsection, the Secretary shall prioritize— 

15 (A) institutions with respect to which not 

16 less than 25 percent of the enrolled students re17 ceive a Federal Pell Grant; and 

18 (B) historically Black colleges and univer19 sities, Hispanic-serving institutions, Asian 

20 American and Native American Pacific Is21 lander-serving institutions, and other minority 

22 serving institutions. 

23 (7) DEFINITIONS.—In this subsection: 

24 (A) INSTITUTION OF HIGHER EDU25 CATION.—The term ‘‘institution of higher eduVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 00876 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 cation’’ has the meaning given that term in sec2 tion 101 of the Higher Education Act of 1965 

3 (20 U.S.C. 1001)). 

4 (B) MENSTRUAL PRODUCT DEFINED.— 

5 The term ‘‘menstrual product’’ means a sani6 tary napkin or tampon that conforms to indus7 try standards. 

8 (8) AUTHORIZATION OF APPROPRIATIONS.— 

9 There are authorized to be appropriated $5,000,000 

10 out of funds appropriated for a fiscal year to the 

11 Fund for the Improvement of Postsecondary Edu12 cation under section 741 of the Higher Education 

13 Act of 1965 (20 U.S.C. 1138) to carry out the grant 

14 program under this subsection. 

15 (d) MENSTRUAL PRODUCTS FOR INCARCERATED IN16 DIVIDUALS AND DETAINEES.— 

17 (1) MENSTRUAL PRODUCTS DEFINED.—In this 

18 subsection, the term ‘‘menstrual products’’ means 

19 sanitary napkins and tampons that conform to appli20 cable industry standards. 

21 (2) REQUIREMENT FOR STATES.—Beginning on 

22 the date that is 180 days after the date of the enact23 ment of this Act, and annually thereafter, the chief 

24 executive officer of each State that receives a grant 

25 under subpart 1 of part E of title I of the Omnibus 


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1 Crime Control and Safe Streets Act of 1968 (34 

2 U.S.C. 10151 et seq.) shall submit to the Attorney 

3 General a certification, in such form and containing 

4 such information as the Attorney General may re5 quire, that— 

6 (A) all incarcerated individuals and detain7 ees in the State have access to menstrual prod8 ucts— 

9 (i) on demand; and 

10 (ii) at no cost to the incarcerated indi11 viduals and detainees; and 

12 (B) no visitor of an incarcerated individual 

13 or detainee of the State is prohibited from vis14 iting an incarcerated individual or detainee due 

15 to the visitor’s use of menstrual products. 

16 (3) REDUCTION IN GRANT FUNDING.—In the 

17 case of a State of which the chief executive officer 

18 fails to submit a certification required under para19 graph (2) in a fiscal year, the Attorney General shall 

20 reduce the amount that the State would otherwise 

21 receive under section 505 of title I of the Omnibus 

22 Crime Control and Safe Streets Act of 1968 (34 

23 U.S.C. 10156) by 20 percent for the following fiscal 

24 year. 


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1 (4) REALLOCATION.—Amounts not allocated to 

2 a State under section 505 of title I of the Omnibus 

3 Crime Control and Safe Streets Act of 1968 (34 

4 U.S.C. 10156) for a fiscal year pursuant to para5 graph (3) shall be reallocated under such section to 

6 States that submit certifications under paragraph 

7 (2). 

8 (5) AVAILABILITY FOR FEDERAL PRISONERS.— 

9 The Attorney General shall make rules requiring, 

10 and the Director of the Bureau of Prisons shall take 

11 such actions as may be necessary to ensure, the dis12 tribution and accessibility without charge of men13 strual products to prisoners in the custody of the 

14 Bureau of Prisons, including any prisoner in a Fed15 eral penal or correctional institution, any Federal 

16 prisoner in a State penal or correctional institution, 

17 and any Federal prisoner in a facility administered 

18 by a private detention entity, to ensure that each 

19 prisoner who requires menstrual products may re20 ceive them in sufficient quantity. 

21 (6) AVAILABILITY FOR DETAINEES.—The Sec22 retary of Homeland Security shall take such actions 

23 as may be necessary to ensure that menstrual prod24 ucts are distributed and made accessible to each 

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1 rity, including any alien in a facility administered by 

2 a private detention entity, at no expense to the alien. 

3 (e) MENSTRUAL PRODUCTS AVAILABILITY FOR

4 HOMELESS INDIVIDUALS UNDER EMERGENCY FOOD AND

5 SHELTER GRANT PROGRAM.—Subsection (a) of section 

6 316 of the McKinney-Vento Homeless Assistance Act (42 

7 U.S.C. 11346(a)) is amended— 

8 (1) in paragraph (5), by striking ‘‘and’’ at the 

9 end; 

10 (2) in paragraph (6), by striking the period at 

11 the end and inserting ‘‘; and’’; and 

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

13 paragraph: 

14 ‘‘(7) guidelines that ensure that amounts pro15 vided under the program to private nonprofit organi16 zations and local governments may be used to pro17 vide sanitary napkins and tampons that conform to 

18 applicable industry standards.’’. 

19 (f) MENSTRUAL PRODUCTS COVERED BY MED20 ICAID.— 

21 (1) IN GENERAL.—Section 1905 of the Social 

22 Security Act (42 U.S.C. 1396d), as amended by sec23 tion 5201, is further amended— 

24 (A) in subsection (a)— 


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1 (i) in paragraph (32), by striking ‘‘; 

2 and’’ and inserting a semicolon; 

3 (ii) by redesignating paragraph (33) 

4 as paragraph (34); and 

5 (iii) by inserting after paragraph (32) 

6 the following new paragraph: 

7 ‘‘(33) menstrual products (as defined in sub8 section (qq)); and’’; and 

9 (B) by adding at the end the following new 

10 subsection: 

11 ‘‘(qq) MENSTRUAL PRODUCTS.—For purposes of 

12 subsection (a)(33), the term ‘menstrual products’ means 

13 menstrual cups, menstrual discs, menstrual underwear, 

14 and sanitary napkins and tampons, that conform to appli15 cable industry standards.’’. 

16 (2) EFFECTIVE DATE.— 

17 (A) IN GENERAL.—Subject to subpara18 graph (B), the amendments made by this sub19 section shall apply with respect to medical as20 sistance furnished during or after the first cal21 endar quarter beginning on or after the date 

22 that is 1 year after the date of the enactment 

23 of this Act. 

24 (B) EXCEPTION FOR STATE LEGISLA25 TION.—In the case of a State plan under title 


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1 XIX of the Social Security Act (42 U.S.C. 1396 

2 et seq.) that the Secretary of Health and 

3 Human Services determines requires State leg4 islation in order for the respective plan to meet 

5 any requirement imposed by amendments made 

6 by this subsection, the respective plan shall not 

7 be regarded as failing to comply with the re8 quirements of such title solely on the basis of 

9 its failure to meet such an additional require10 ment before the first day of the first calendar 

11 quarter beginning after the close of the first 

12 regular session of the State legislature that be13 gins after the date of the enactment of this Act. 

14 For purposes of the previous sentence, in the 

15 case of a State that has a 2-year legislative ses16 sion, each year of the session shall be consid17 ered to be a separate regular session of the 

18 State legislature. 

19 (g) MENSTRUAL PRODUCTS FOR EMPLOYEES.—Sec20 tion 6 of the Occupational Safety and Health Act of 1970 

21 (29 U.S.C. 655) is amended by adding at the end the fol22 lowing: 

23 ‘‘(h) The Secretary shall by rule promulgate a re24 quirement that each employer with not less than 100 em25 ployees provide menstrual products free of charge for emVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 00882 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 ployees of the employer. For purposes of the preceding 

2 sentence, ‘menstrual products’ means sanitary napkins 

3 and tampons that conform to applicable industry stand4 ards.’’. 

5 (h) MENSTRUAL PRODUCTS IN FEDERAL BUILD6 INGS.— 

7 (1) DEFINITIONS.—In this subsection: 

8 (A) APPROPRIATE AUTHORITY.—The term 

9 ‘‘appropriate authority’’ means the head of a 

10 Federal agency, the Architect of the Capitol, or 

11 any other official authority responsible for the 

12 operation of a covered public building. 

13 (B) COVERED PUBLIC BUILDING.— 

14 (i) IN GENERAL.—The term ‘‘covered 

15 public building’’ means a public building 

16 (as defined in section 3301(a) of title 40, 

17 United States Code) that is open to the 

18 public and contains a public restroom. 

19 (ii) INCLUSIONS.—The term ‘‘covered 

20 public building’’ includes specified build21 ings and grounds (as defined in section 

22 6301 of title 40, United States Code) and 

23 the Capitol Buildings (as defined in section 

24 5101 of that title). 


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1 (C) COVERED RESTROOM.—The term ‘‘cov2 ered restroom’’ means a restroom in a covered 

3 public building. 

4 (D) MENSTRUAL PRODUCTS.—The term 

5 ‘‘menstrual products’’ means sanitary napkins 

6 and tampons that conform to applicable indus7 try standards. 

8 (2) REQUIREMENT.—Each appropriate author9 ity shall ensure that menstrual products are stocked 

10 in, and available free of charge in, each covered rest11 room in each covered public building under the juris12 diction of that authority. 

13 (i) MENSTRUAL PRODUCTS IN THE SOCIAL SERVICES

14 BLOCK GRANT PROGRAM.— 

15 (1) INCREASE IN FUNDING FOR SOCIAL SERV16 ICES BLOCK GRANT PROGRAM.— 

17 (A) IN GENERAL.—The amount specified 

18 in subsection (c) of section 2003 of the Social 

19 Security Act (42 U.S.C. 1397b) for purposes of 

20 subsections (a) and (b) of such section is 

21 deemed to be $1,900,000,000 for each of fiscal 

22 years 2025 through 2028, of which, the amount 

23 equal to $200,000,000, reduced by the amounts 

24 reserved under subparagraph (B)(ii) for each 


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1 such fiscal year, shall be obligated by States in 

2 accordance with paragraph (2). 

3 (B) APPROPRIATION.— 

4 (i) IN GENERAL.—Out of any money 

5 in the Treasury of the United States not 

6 otherwise appropriated, there is appro7 priated $200,000,000 for each of fiscal 

8 years 2025 through 2028, to carry out this 

9 subsection. 

10 (ii) RESERVATIONS.— 

11 (I) PURPOSES.—The Secretary 

12 shall reserve, from the amount appro13 priated under clause (i) to carry out 

14 this subsection— 

15 (aa) for each of fiscal years 

16 2025 through 2028, not more 

17 than 2 percent of the amount ap18 propriated for the fiscal year for 

19 purposes of entering into an 

20 agreement with an eligible entity 

21 described in clause (iii) to assist 

22 in providing technical assistance 

23 and training, to support effective 

24 policy, practice, research, and 

25 cross-system collaboration among 


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1 grantees and subgrantees, and to 

2 assist in the administration of 

3 the program described in this 

4 subsection; and 

5 (bb) for fiscal year 2025, an 

6 amount, not to exceed 

7 $2,000,000, for purposes of con8 ducting an evaluation under 

9 paragraph (4). 

10 (II) NO STATE ENTITLEMENT TO

11 RESERVED FUNDS.—The State enti12 tlement under section 2002(a) of the 

13 Social Security Act (42 U.S.C. 

14 1397a(a)) shall not apply to the 

15 amounts reserved under subclause (I). 

16 (iii) ELIGIBLE ENTITY DESCRIBED.— 

17 An eligible entity described in this clause is 

18 a nonprofit organization described in sec19 tion 501(c)(3) of the Internal Revenue 

20 Code of 1986 and exempt from taxation 

21 under section 501(a) of such Code, that— 

22 (I) has experience in more than 1 

23 State in the area of community dis24 tributions of basic need services, in25 cluding experience collecting, 


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1 warehousing, and distributing basic 

2 necessities such as menstrual prod3 ucts; 

4 (II) demonstrates competency to 

5 implement a project, provide fiscal ac6 countability, collect data, and prepare 

7 reports and other necessary docu8 mentation; and 

9 (III) demonstrates a willingness 

10 to share information with researchers, 

11 practitioners, and other interested 

12 parties. 

13 (2) RULES GOVERNING USE OF ADDITIONAL

14 FUNDS.— 

15 (A) IN GENERAL.—Funds are used in ac16 cordance with this paragraph if— 

17 (i) the State, in consultation with rel18 evant stakeholders, including agencies, pro19 fessional associations, and nonprofit orga20 nizations, distributes the funds to eligible 

21 entities to— 

22 (I) decrease the unmet need for 

23 menstrual products by low-income 

24 menstruating individuals through— 


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1 (aa) the distribution of free 

2 menstrual products; 

3 (bb) community outreach to 

4 assist in participation in existing 

5 menstrual product distribution 

6 programs; or 

7 (cc) improving access to 

8 menstrual products among low9 income individuals; and 

10 (II) increase the ability of com11 munities and low-income families in 

12 such communities to provide for the 

13 need for menstrual products of low-in14 come adults; and 

15 (ii) the funds are used subject to the 

16 limitations in section 2005 of the Social 

17 Security Act (42 U.S.C. 1397d). 

18 (B) ALLOWABLE USES BY ELIGIBLE ENTI19 TIES.— 

20 (i) IN GENERAL.—An eligible entity 

21 receiving funds made available under para22 graph (1) shall use the funds for any of 

23 the following: 


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1 (I) To pay for the purchase and 

2 distribution of menstrual products 

3 among low-income individuals. 

4 (II) To integrate activities car5 ried out under subclause (I) with 

6 other basic needs assistance programs 

7 serving low-income families, including 

8 the following: 

9 (aa) Programs funded by 

10 the temporary assistance for 

11 needy families program under 

12 part A of title IV of the Social 

13 Security Act (42 U.S.C. 601 et 

14 seq.), including the State mainte15 nance of effort provisions of such 

16 program. 

17 (bb) Programs designed to 

18 support the health of eligible chil19 dren, such as the Children’s 

20 Health Insurance Program under 

21 title XXI of the Social Security 

22 Act, the Medicaid program under 

23 title XIX of such Act, or State 

24 funded health care programs. 


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1 (cc) Programs funded 

2 through the special supplemental 

3 nutrition program for women, in4 fants, and children under section 

5 17 of the Child Nutrition Act of 

6 1966. 

7 (dd) Programs that offer 

8 early home visiting services, in9 cluding the maternal, infant, and 

10 early childhood home visiting 

11 program (including the Tribal 

12 home visiting program) under 

13 section 511 of the Social Security 

14 Act (42 U.S.C. 711). 

15 (III) To provide training or tech16 nical assistance in carrying out activi17 ties under this subsection. 

18 (IV) To cover administrative 

19 costs. 

20 (ii) LIMITATION ON USE OF FUNDS

21 FOR ADMINISTRATIVE COSTS.—An eligible 

22 entity receiving funds made available under 

23 this subsection shall not use more than 9 

24 percent of the funds for administrative 

25 costs incurred pursuant to this subsection. 


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1 (C) AVAILABILITY OF FUNDS.— 

2 (i) FUNDS DISTRIBUTED TO ELIGIBLE

3 ENTITIES.—Funds made available under 

4 paragraph (1) that are distributed to an el5 igible entity by a State for a fiscal year 

6 may be expended by the eligible entity only 

7 in such fiscal year or the succeeding fiscal 

8 year. 

9 (ii) EVALUATION.—Funds reserved 

10 under paragraph (1)(B)(ii)(I)(aa) to carry 

11 out the evaluation under paragraph (4) 

12 shall be available for expenditure through 

13 September 30, 2029. 

14 (D) NO EFFECT ON OTHER PROGRAMS.— 

15 Any assistance or benefits received by a family 

16 through funds made available under paragraph 

17 (1) shall be disregarded for purposes of deter18 mining the family’s eligibility for, or amount of, 

19 benefits under any other Federal needs-based 

20 programs. 

21 (3) ANNUAL REPORTS.—Section 2004 of the 

22 Social Security Act shall apply with respect to pay23 ments made to a State under this section in the 

24 same way it applies with respect to payments made 

25 to a State under section 2002 of such Act. 


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1 (4) EVALUATION.—The Secretary, in consulta2 tion with States, the eligible entities described in 

3 paragraph (1)(B)(iii) receiving funds made available 

4 under this subsection, shall— 

5 (A) not later than December 30, 2031, 

6 complete an evaluation of the effectiveness of 

7 the assistance program carried out pursuant to 

8 this subsection, such as the effect of activities 

9 carried out under this Act on mitigating the 

10 health risks of unmet menstrual products need 

11 among individuals in low-income families; 

12 (B) not later than March 31, 2032, submit 

13 to the Committees on Energy and Commerce 

14 and on Ways and Means of the House of Rep15 resentatives and the Committee on Finance of 

16 the Senate a report on the results of the evalua17 tion; and 

18 (C) not later than April 30, 2032, publish 

19 the results of the evaluation on the internet 

20 website of the Department of Health and 

21 Human Services. 

22 (5) GUIDANCE.—Not later than 180 days after 

23 the date of the enactment of this Act, the Secretary 

24 shall issue guidance regarding how the provisions of 

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1 formation regarding eligible entities, allowable use of 

2 funds, and reporting requirements. 

3 (6) BEST PRACTICES.—The Secretary of Health 

4 and Human Services, in cooperation with the Sec5 retary of Education, shall develop best practices for 

6 school officials to use in discussing menstruation 

7 with students, and shall publish this information on 

8 the internet website of the Department of Health 

9 and Human Services. 

10 (7) DEFINITIONS.—In this subsection: 

11 (A) MENSTRUAL PRODUCTS.—The term 

12 ‘‘menstrual products’’ means menstrual cups, 

13 menstrual discs, menstrual underwear, and san14 itary napkins and tampons, that conform to ap15 plicable industry standards. 

16 (B) ELIGIBLE ENTITIES.—The term ‘‘eligi17 ble entity’’ means a State or local governmental 

18 entity, an Indian tribe or tribal organization (as 

19 defined in section 4 of the Indian Self-Deter20 mination and Education Assistance Act), or a 

21 nonprofit organization described in section 

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

23 and exempt from taxation under section 501(a) 

24 of such Code that— 


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1 (i) has experience in the area of com2 munity distributions of basic need services, 

3 including experience collecting, 

4 warehousing, and distributing basic neces5 sities such as diapers, food, or menstrual 

6 products; 

7 (ii) demonstrates competency to im8 plement a project, provide fiscal account9 ability, collect data, and prepare reports 

10 and other necessary documentation; and 

11 (iii) demonstrates a willingness to 

12 share information with researchers, practi13 tioners, and other interested parties. 

14 (C) STATE.—The term ‘‘State’’ has the 

15 meaning given in section 1101(a)(1) of the So16 cial Security Act for purposes of title XX of 

17 such Act. 

18 (8) LIMITATION ON AUTHORIZATION OF APPRO19 PRIATIONS.—For the administration of this sub20 section, there are authorized to be appropriated to 

21 the Secretary of Health and Human Services not 

22 more than $6,000,000 for fiscal years 2025 through 

23 2028. 

24 (9) EXEMPTION FROM SEQUESTRATION.— 

25 Funds made available to carry out this subsection 


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1 shall be exempt from reduction under any order 

2 issued under the Balanced Budget and Emergency 

3 Deficit Control Act of 1985. 

4 (j) MENSTRUAL PRODUCTS AND TAXATION.— 

5 (1) IN GENERAL.—It shall be unlawful for a 

6 State, or unit of local government of a State, to im7 pose a tax on the retail sale of a menstrual product. 

8 (2) DEFINITIONS.—For purposes of this sub9 section: 

10 (A) MENSTRUAL PRODUCT.—The term 

11 ‘‘menstrual products’’ means menstrual cups, 

12 menstrual discs, menstrual underwear, and san13 itary napkins and tampons, that conform to ap14 plicable industry standards. 

15 (B) STATE.—The term ‘‘State’’ means any 

16 of the several States or the District of Colum17 bia. 

18 (3) EFFECTIVE DATE.—This subsection shall 

19 take effect 120 days after the date of the enactment 

20 of this subsection. 

21 (k) MENSTRUAL PRODUCTS IN TANF.— 

22 (1) IN GENERAL.—Section 403(a) of the Social 

23 Security Act (42 U.S.C. 603(a)) is amended by add24 ing at the end the following: 

25 ‘‘(6) GRANTS FOR MENSTRUAL PRODUCTS.— 


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1 ‘‘(A) IN GENERAL.—The Secretary may 

2 make grants, on a competitive basis, for each 

3 fiscal year to eligible applicants for the grants, 

4 in such amounts as the Secretary deems appro5 priate to enable the eligible applicants to pro6 vide, to covered families that include an indi7 vidual who is capable of menstruating, such 

8 benefits as are needed to ensure that the indi9 vidual can purchase menstrual products for per10 sonal use. 

11 ‘‘(B) DEFINITIONS.—In subparagraph (A): 

12 ‘‘(i) COVERED FAMILIES.—The term 

13 ‘covered families’ means families eligible 

14 for assistance under a State program fund15 ed under this part. 

16 ‘‘(ii) ELIGIBLE APPLICANT.—The 

17 term ‘eligible applicant’ means— 

18 ‘‘(I) a State to which a grant is 

19 made under paragraph (1) for a fiscal 

20 year; and 

21 ‘‘(II) a political subdivision of a 

22 State that administers the State pro23 gram funded under this part in the 

24 political subdivision. 


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1 ‘‘(iii) MENSTRUAL PRODUCTS.—The 

2 term ‘menstrual products’ means men3 strual cups, menstrual discs, menstrual un4 derwear, and sanitary napkins and tam5 pons, that conform to applicable industry 

6 standards. 

7 ‘‘(C) CONSIDERATION OF APPLICATIONS.— 

8 The Secretary shall award grants under this 

9 paragraph on the basis of how effectively the 

10 programs proposed by the eligible applicants 

11 will help low-income individuals suffering from 

12 material deprivation meet their need for men13 strual products. 

14 ‘‘(D) ADMINISTRATION.—A State or polit15 ical subdivision to which a grant is made under 

16 this paragraph may use the grant to provide 

17 benefits under this paragraph in such form and 

18 in such manner as the State or political subdivi19 sion deems appropriate. 

20 ‘‘(E) TREATMENT OF ASSISTANCE.—Bene21 fits provided using funds made available under 

22 this paragraph shall not be considered assist23 ance under any State program funded under 

24 this part. 


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1 ‘‘(F) APPROPRIATION.—Out of any money 

2 in the Treasury of the United States not other3 wise appropriated, there are appropriated for 

4 fiscal year 2025 and each succeeding fiscal year 

5 $10,000,000 for grants under this paragraph.’’. 

6 (2) EVALUATIONS.—Section 413 of such Act 

7 (42 U.S.C. 613) is amended by redesignating sub8 section (h) as subsection (i) and inserting after sub9 section (g) the following: 

10 ‘‘(h) EVALUATIONS OF GRANTS FOR MENSTRUAL

11 PRODUCTS.— 

12 ‘‘(1) IN GENERAL.—The Secretary shall submit 

13 to the Congress reports, in writing, that evaluate the 

14 effectiveness of the benefit program provided for in 

15 section 403(a)(6). Each such report shall, for the 

16 period covered by the report— 

17 ‘‘(A) describe— 

18 ‘‘(i) the extent of material deprivation 

19 in the population, including lacking suffi20 cient funds to regularly purchase neces21 sities such as menstrual products; and 

22 ‘‘(ii) the extent to which the program 

23 alleviated such material deprivation; 

24 ‘‘(B) specify the number and identity of 

25 the entities to which a grant has been made 


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1 under such section, and the amount of the 

2 grant made to each such entity; 

3 ‘‘(C) describe how the grantees used the 

4 grants to provide benefits under the program; 

5 ‘‘(D) specify the number of individuals who 

6 received the benefits; 

7 ‘‘(E) describe how efficacious the program 

8 has been in helping low-income individuals meet 

9 their need for menstrual products; 

10 ‘‘(F) describe the extent to which the pro11 gram has improved the economic security of the 

12 benefit recipients; and 

13 ‘‘(G) include such other relevant informa14 tion as the Secretary deems appropriate. 

15 ‘‘(2) TIMING.—The Secretary shall submit a re16 port that meets the requirements of paragraph (1) 

17 within 2 years after the date of the enactment of 

18 this paragraph and every 2 years thereafter.’’. 

19 SEC. 5407. ADDITIONAL FOCUS AREA FOR THE OFFICE ON 

20 WOMEN’S HEALTH. 

21 Section 229(b) of the Public Health Service Act (42 

22 U.S.C. 237a(b)), as amended by sections 5215 and 5301, 

23 is further amended by adding at the end the following: 

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1 sumers, and other stakeholders concerning optimal 

2 maternity care and support for the provision of such 

3 care, including the priorities of— 

4 ‘‘(A) protecting, promoting, and supporting 

5 the innate capacities of childbearing individuals 

6 and their newborns for childbirth, 

7 breastfeeding, and attachment; 

8 ‘‘(B) using obstetric interventions only 

9 when such interventions are supported by 

10 strong, high-quality evidence, and minimizing 

11 overuse of maternity practices that have been 

12 shown to have benefit in limited situations and 

13 that can expose people, infants, or both to risk 

14 of harm if used routinely and indiscriminately, 

15 including overuse of continuous electronic fetal 

16 monitoring, labor induction, epidural analgesia, 

17 primary cesarean section, and routine repeat ce18 sarean birth; 

19 ‘‘(C) reliably incorporating noninvasive, 

20 evidence-based practices that have a docu21 mented correlation with considerable improve22 ment in outcomes with no detrimental side ef23 fects, such as incorporation of smoking ces24 sation programs in pregnancy, maternal immu25 nizations, and proven models (including group 


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1 prenatal care, midwifery care, and doula sup2 port) that integrate health assessment, edu3 cation, and support into a unified program, and 

4 supporting evidence-based breastfeeding pro5 motion efforts with respect for a breastfeeding 

6 individual’s personal decisionmaking; 

7 ‘‘(D) a shared understanding of the quali8 fications of licensed providers of maternity care 

9 and the best evidence about the safety, satisfac10 tion, outcomes, and costs of maternity care, and 

11 appropriate deployment of such caregivers with12 in the maternity care workforce to address the 

13 needs of childbearing individuals and newborns 

14 and the growing shortage of maternity care15 givers; 

16 ‘‘(E) a shared understanding of the results 

17 of the best available research comparing hos18 pital, birth center, and planned home births, in19 cluding information about each setting’s safety, 

20 satisfaction, outcomes, and costs; 

21 ‘‘(F) a shared understanding of the impor22 tance for the safety and choices of birthing 

23 families of an integrated maternity care system 

24 with seamless processes for consultation, shared 

25 care, transfer and transport across maternity 


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1 care settings, and use of providers when birth2 ing people and their newborns require a higher 

3 level of care; 

4 ‘‘(G) advancing high-quality, evidence5 based childbirth education that— 

6 ‘‘(i) promotes a healthy and safe ap7 proach to pregnancy, childbirth, and early 

8 parenting; 

9 ‘‘(ii) is taught by certified educators, 

10 peer counselors, and health professionals; 

11 and 

12 ‘‘(iii) promotes informed decision13 making by childbearing individuals; and 

14 ‘‘(H) developing measures that enable a 

15 more robust, balanced set of standardized ma16 ternity care measures, including performance 

17 and quality measures.’’. 

18 SEC. 5408. INCLUDING SERVICES FURNISHED BY CERTAIN 

19 STUDENTS, INTERNS, AND RESIDENTS SU20 PERVISED BY CERTIFIED NURSE MIDWIVES 

21 OR CERTIFIED MIDWIVES WITHIN INPATIENT 

22 HOSPITAL SERVICES UNDER MEDICARE. 

23 (a) IN GENERAL.—Section 1861(b) of the Social Se24 curity Act (42 U.S.C. 1395x(b)) is amended— 


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

2 end and inserting ‘‘, or in the case of services in a 

3 hospital or osteopathic hospital by a student midwife 

4 or an intern or resident-in-training under a teaching 

5 program previously described in this paragraph who 

6 is in the field of obstetrics and gynecology, if such 

7 student midwife, intern, or resident-in-training is su8 pervised by a certified nurse-midwife or certified 

9 midwife to the extent permitted under applicable 

10 State law and as may be authorized by the hos11 pital;’’; 

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

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

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

15 paragraph: 

16 ‘‘(8) a certified nurse-midwife or certified mid17 wife where the hospital has a teaching program ap18 proved as specified in paragraph (6), if— 

19 ‘‘(A) the hospital elects to receive any pay20 ment due under this title for reasonable costs of 

21 such services; and 

22 ‘‘(B) all certified nurse-midwives or cer23 tified midwives in such hospital agree not to bill 

24 charges for professional services rendered in 


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1 such hospital to individuals covered under the 

2 insurance program established by this title.’’. 

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

4 subsection (a) shall apply to services furnished on or after 

5 the date of the enactment of this Act. 

6 SEC. 5409. GRANTS TO PROFESSIONAL ORGANIZATIONS 

7 AND MINORITY-SERVING INSTITUTIONS TO 

8 INCREASE DIVERSITY IN MATERNAL, REPRO9 DUCTIVE, AND SEXUAL HEALTH PROFES10 SIONALS. 

11 (a) GRANTS TO HEALTH PROFESSIONAL ORGANIZA12 TIONS.— 

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

14 Human Services, acting through the Administrator 

15 of the Health Resources and Services Administration 

16 (referred to in this section as the ‘‘Secretary’’), shall 

17 carry out a grant program under which the Sec18 retary may make to eligible organizations— 

19 (A) for fiscal year 2025, planning grants 

20 described in paragraph (2); and 

21 (B) for the subsequent 4-year period, im22 plementation grants described in paragraph (3). 

23 (2) PLANNING GRANTS.— 


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1 (A) IN GENERAL.—Planning grants de2 scribed in this paragraph are grants for each of 

3 the following purposes: 

4 (i) To collect data and identify any 

5 workforce inequalities, with respect to a 

6 health profession, at each of the following 

7 stages along the health professional con8 tinuum: 

9 (I) Pipeline availability, with re10 spect to students at the high school 

11 and college or university levels consid12 ering, and working toward, entrance 

13 in the profession, including inequal14 ities due to barriers triggered by 

15 criminal records. 

16 (II) Entrance into the training 

17 program for the profession. 

18 (III) Graduation from such train19 ing program. 

20 (IV) Entrance into practice, in21 cluding inequalities due to barriers 

22 triggered by criminal records. 

23 (V) Retention in practice for 

24 more than a 5-year period. 


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1 (ii) To develop one or more strategies 

2 to address the workforce inequalities with3 in the health profession, as identified 

4 under (and in response to the findings pur5 suant to) clause (i). 

6 (B) APPLICATION.—To be eligible to re7 ceive a grant under this paragraph, an eligible 

8 health professional organization shall submit to 

9 the Secretary an application in such form and 

10 manner and containing such information as 

11 specified by the Secretary. 

12 (C) AMOUNT.—Each grant awarded under 

13 this paragraph shall be for an amount not to 

14 exceed $300,000. 

15 (D) REPORT.—Each recipient of a grant 

16 under this paragraph shall submit to the Sec17 retary a report containing— 

18 (i) information on the extent and dis19 tribution of workforce inequalities identi20 fied through the grant; and 

21 (ii) reasonable objectives and strate22 gies developed to address such inequalities 

23 within a 5-, 10-, and 25-year period. 

24 (3) IMPLEMENTATION GRANTS.— 


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1 (A) IN GENERAL.—Implementation grants 

2 described in this paragraph are grants to imple3 ment one or more of the strategies developed 

4 pursuant to a planning grant awarded under 

5 paragraph (2). 

6 (B) APPLICATION.—To be eligible to re7 ceive a grant under this paragraph, an eligible 

8 health professional organization shall submit to 

9 the Secretary an application in such form and 

10 manner as specified by the Secretary. Each 

11 such application shall contain information on— 

12 (i) the capability of the organization 

13 to carry out a strategy described in sub14 paragraph (A); 

15 (ii) the involvement of partners or 

16 coalitions; 

17 (iii) the organization’s plans for devel18 oping sustainability of the implementation 

19 efforts after the culmination of the grant 

20 cycle; and 

21 (iv) any other matter specified by the 

22 Secretary. 

23 (C) AMOUNT; DURATION.—Each grant 

24 awarded under this paragraph shall be for an 

25 amount not to exceed $500,000 for each year of 


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1 the grant. The term of a grant under this para2 graph shall not exceed 4 years. 

3 (D) REPORTS.—For each of the first 3 

4 years for which an eligible health professional 

5 organization is awarded a grant under this 

6 paragraph, the organization shall submit to the 

7 Secretary a report on the activities carried out 

8 by such organization through the grant during 

9 such year and objectives for the subsequent 

10 year. For the fourth year for which an eligible 

11 health professional organization is awarded a 

12 grant under this paragraph, the organization 

13 shall submit to the Secretary a report that in14 cludes an analysis of all the activities carried 

15 out by the organization through the grant and 

16 a detailed plan for the continuation of the orga17 nization’s implementation efforts. 

18 (4) ELIGIBLE HEALTH PROFESSIONAL ORGANI19 ZATION DEFINED.—For purposes of this subsection, 

20 the term ‘‘eligible health professional organization’’ 

21 means a professional organization representing ob22 stetrician-gynecologists, certified nurse midwives, 

23 certified midwives, family practice physicians, nurse 

24 practitioners whose scope of practice includes preg25 nancy-related or sexual and reproductive health care, 


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1 physician assistants whose scope of practice includes 

2 obstetrical or sexual and reproductive health care, 

3 certified professional midwives, adolescent medicine 

4 specialists who provide sexual and reproductive 

5 health care, or pediatricians who provide sexual and 

6 reproductive health care. 

7 (b) GRANTS TO MINORITY-SERVING INSTITU8 TIONS.— 

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

10 out a grant program under which the Secretary may 

11 make to eligible minority-serving institutions— 

12 (A) for fiscal years 2025 and 2026, plan13 ning grants described in paragraph (2); and 

14 (B) for the subsequent 10-year period, im15 plementation grants described in paragraph (3). 

16 (2) PLANNING GRANTS.— 

17 (A) IN GENERAL.—Planning grants de18 scribed in this paragraph are grants for plans 

19 relating to 1 or more of the following purposes: 

20 (i) To develop or expand academic 

21 programs to educate maternity care clini22 cians and maternity care support per23 sonnel, including— 


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1 (I) nurses who have the intention 

2 of providing maternity, newborn, or 

3 sexual and reproductive health care; 

4 (II) nurse practitioners whose 

5 scope of practice includes maternity, 

6 newborn, or sexual and reproductive 

7 health care; and 

8 (III) maternity care support per9 sonnel, such as doulas and lactation 

10 counselors. 

11 (ii) To develop or expand academic 

12 programs to educate obstetrician-gyne13 cologists. 

14 (B) APPLICATION.—To be eligible to re15 ceive a grant under this paragraph, an eligible 

16 minority-serving institution shall submit to the 

17 Secretary an application in such form and man18 ner and containing such information as speci19 fied by the Secretary. 

20 (C) AMOUNT.—Each grant awarded under 

21 this paragraph shall be for an amount not to 

22 exceed $400,000 for each of 2 years. 

23 (D) REPORT.—Each recipient of a grant 

24 under this paragraph shall submit to the Sec25 retary an annual report describing the planned 


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1 development or expansion of academic pro2 grams, including— 

3 (i) the types of clinical or support per4 sonnel to be served and the degrees or cer5 tificates to be conferred; 

6 (ii) the associated curricula; 

7 (iii) the faculty and their capabilities 

8 and commitments, including any plans for 

9 recruitment; 

10 (iv) the anticipated number of stu11 dents to be enrolled and plans for their re12 cruitment and social, emotional, and finan13 cial support; and 

14 (v) the objectives and strategies for 

15 addressing inequalities and preparing stu16 dents to provide high-quality culturally 

17 congruent care. 

18 (3) IMPLEMENTATION GRANTS.— 

19 (A) IN GENERAL.—Implementation grants 

20 described in this paragraph are grants to imple21 ment the plans developed under paragraph (2). 

22 (B) APPLICATION.—To be eligible to re23 ceive a grant under this paragraph, an eligible 

24 minority-serving institution shall submit to the 

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1 ner as specified by the Secretary. Each such ap2 plication shall contain information on the capa3 bility of the institution to carry out a plan de4 scribed in paragraph (2), plans for sustain5 ability of the academic program involved after 

6 the culmination of the grant cycle, and any 

7 other matter specified by the Secretary. 

8 (C) AMOUNT.—Each grant under this 

9 paragraph shall be for an amount not to exceed 

10 $1,000,000 for each year during the 10-year 

11 period of the grant. 

12 (D) REPORTS.— 

13 (i) INITIAL PERIOD.—For each of the 

14 first 9 years for which an eligible minority15 serving institution is awarded a grant 

16 under this paragraph, the institution shall 

17 submit a report to the Secretary on the ac18 tivities carried out by such institution 

19 through the grant during such year and 

20 objectives for the subsequent year. 

21 (ii) FINAL YEAR.—For the tenth year 

22 for which an eligible minority-serving insti23 tution is awarded a grant under this para24 graph, the organization shall submit to the 

25 Secretary a report that includes an analVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 00912 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 ysis of all the activities carried out by the 

2 institution through the grant and a de3 tailed plan for continuation of the aca4 demic program. 

5 (4) MINORITY-SERVING INSTITUTION.—For the 

6 purposes of this subsection, the term ‘‘minority-serv7 ing institution’’ means any of the following: 

8 (A) A Hispanic-serving institution, as that 

9 term is defined in section 502(a) of the Higher 

10 Education Act of 1965 (20 U.S.C. 1101a(a)). 

11 (B) A Tribal College or University, as that 

12 term is defined in section 316(b) of the Higher 

13 Education Act of 1965 (20 U.S.C. 1059c(b)). 

14 (C) An Alaska Native-serving institution, 

15 as that term is defined in section 317(b) of the 

16 Higher Education Act of 1965 (20 U.S.C. 

17 1059d(b)). 

18 (D) A Native Hawaiian-serving institution, 

19 as that term is defined in section 317(b) of the 

20 Higher Education Act of 1965 (20 U.S.C. 

21 1059d(b)). 

22 (E) A Predominantly Black Institution, as 

23 that term is defined in section 318(b) of the 

24 Higher Education Act of 1965 (20 U.S.C. 

25 1059e(b)). 


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1 (F) A Native American-serving, nontribal 

2 institution, as that term is defined in section 

3 319(b) of the Higher Education Act of 1965 

4 (20 U.S.C. 1059f(b)). 

5 (G) An Asian American and Native Amer6 ican Pacific Islander-serving institution, as that 

7 term is defined in section 320(b) of the Higher 

8 Education Act of 1965 (20 U.S.C. 1059g(b)). 

9 (c) AUTHORIZATION OF APPROPRIATIONS.—There is 

10 authorized to be appropriated to carry out— 

11 (1) subsection (a), $2,000,000 for fiscal year 

12 2025 and $3,000,000 for each of the fiscal years 

13 2026 through 2029; and 

14 (2) subsection (b), $4,000,000 for each of fiscal 

15 years 2025 and 2026 and $10,000,000 for each of 

16 fiscal years 2027 through 2036. 

17 Subtitle F—Children’s Health 

18 SEC. 5501. CARING FOR KIDS ACT. 

19 (a) PERMANENT EXTENSION OF CHILDREN’S

20 HEALTH INSURANCE PROGRAM.— 

21 (1) IN GENERAL.—Section 2104(a)(28) of the 

22 Social Security Act (42 U.S.C. 1397dd(a)(28)) is 

23 amended to read as follows: 


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1 ‘‘(28) for fiscal year 2029 and each subsequent 

2 year, such sums as are necessary to fund allotments 

3 to States under subsections (c) and (m).’’. 

4 (2) ALLOTMENTS.— 

5 (A) IN GENERAL.—Section 2104(m) of the 

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

7 amended— 

8 (i) in paragraph (2)(B)— 

9 (I) in the matter preceding clause 

10 (i), by striking ‘‘through (27)’’ and in11 serting ‘‘through (28)’’; and 

12 (II) in clause (i), by striking 

13 ‘‘2023, and 2029’’ and inserting ‘‘and 

14 2023’’; 

15 (ii) in paragraph (7)— 

16 (I) in subparagraph (A), by strik17 ing ‘‘and ending with fiscal year 

18 2029,’’; and 

19 (II) in the flush left matter at 

20 the end, by striking ‘‘fiscal year 2026, 

21 or fiscal year 2028’’ and inserting 

22 ‘‘fiscal year 2026, or a subsequent 

23 even-numbered fiscal year’’; 

24 (iii) in paragraph (9)— 


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1 (I) by striking ‘‘(10), or (11)’’ 

2 and inserting ‘‘or (10)’’; and 

3 (II) by striking ‘‘2023, or 2029,’’ 

4 and inserting ‘‘or 2023’’; and 

5 (iv) by striking paragraph (11). 

6 (B) CONFORMING AMENDMENT.—Section 

7 50101(b)(2) of the Bipartisan Budget Act of 

8 2018 (Public Law 115–123) is repealed. 

9 (b) PERMANENT EXTENSIONS OF OTHER PROGRAMS

10 AND DEMONSTRATION PROJECTS.— 

11 (1) PEDIATRIC QUALITY MEASURES PRO12 GRAM.—Section 1139A(i)(1) of the Social Security 

13 Act (42 U.S.C. 1320b–9a(i)(1)) is amended— 

14 (A) in subparagraph (D), by striking ‘‘; 

15 and’’ and inserting a semicolon; 

16 (B) in subparagraph (E), by striking the 

17 period at the end and inserting ‘‘; and’’; and 

18 (C) by adding at the end the following new 

19 subparagraph: 

20 ‘‘(F) for a subsequent fiscal year, the 

21 amount appropriated under this paragraph for 

22 the previous fiscal year, increased by the per23 centage increase in the consumer price index for 

24 all urban consumers (all items; United States 

25 city average) over such previous fiscal year, for 


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1 the purpose of carrying out this section (other 

2 than subsections (e), (f), and (g)).’’. 

3 (2) EXPRESS LANE ELIGIBILITY OPTION.—Sec4 tion 1902(e)(13) of the Social Security Act (42 

5 U.S.C. 1396a(e)(13)) is amended by striking sub6 paragraph (I). 

7 (3) ASSURANCE OF AFFORDABILITY STANDARD

8 FOR CHILDREN AND FAMILIES.— 

9 (A) IN GENERAL.—Section 2105(d)(3) of 

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

11 1397ee(d)(3)) is amended— 

12 (i) in the paragraph heading, by strik13 ing ‘‘THROUGH SEPTEMBER 30, 2029’’; and 

14 (ii) in subparagraph (A), in the mat15 ter preceding clause (i)— 

16 (I) by striking ‘‘During the pe17 riod that begins on the date of enact18 ment of the Patient Protection and 

19 Affordable Care Act and ends on Sep20 tember 30, 2029’’ and inserting ‘‘Be21 ginning on the date of the enactment 

22 of the Patient Protection and Afford23 able Care Act’’; 

24 (II) by striking ‘‘During the pe25 riod that begins on October 1, 2019, 


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1 and ends on September 30, 2029’’ 

2 and inserting ‘‘Beginning on October 

3 1, 2019’’; and 

4 (III) by striking ‘‘The preceding 

5 sentences shall not be construed as 

6 preventing a State during any such 

7 periods from’’ and inserting ‘‘The pre8 ceding sentences shall not be con9 strued as preventing a State from’’. 

10 (B) CONFORMING AMENDMENTS.—Section 

11 1902(gg)(2) of the Social Security Act (42 

12 U.S.C. 1396a(gg)(2)) is amended— 

13 (i) in the paragraph heading, by strik14 ing ‘‘THROUGH SEPTEMBER 30, 2029’’; and 

15 (ii) by striking ‘‘through September 

16 30’’ and all that follows through ‘‘ends on 

17 September 30, 2029’’ and inserting ‘‘(but 

18 beginning on October 1, 2019’’. 

19 (4) QUALIFYING STATES OPTION.—Section 

20 2105(g)(4) of the Social Security Act (42 U.S.C. 

21 1397ee(g)(4)) is amended— 

22 (A) in the paragraph heading, by striking 

23 ‘‘FOR FISCAL YEARS 2009 THROUGH 2029’’ and 

24 inserting ‘‘AFTER FISCAL YEAR 2008’’; and 


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1 (B) in subparagraph (A), by striking ‘‘for 

2 any of fiscal years 2009 through 2029’’ and in3 serting ‘‘for any fiscal year after fiscal year 

4 2008’’. 

5 (5) OUTREACH AND ENROLLMENT PROGRAM.— 

6 Section 2113 of the Social Security Act (42 U.S.C. 

7 1397mm) is amended— 

8 (A) in subsection (a)— 

9 (i) in paragraph (1), by striking ‘‘dur10 ing the period of fiscal years 2009 through 

11 2029’’ and inserting ‘‘, beginning with fis12 cal year 2009,’’; 

13 (ii) in paragraph (2)— 

14 (I) by striking ‘‘10 percent of 

15 such amounts’’ and inserting ‘‘10 per16 cent of such amounts for the period or 

17 the fiscal year for which such amounts 

18 are appropriated’’; and 

19 (II) by striking ‘‘during such pe20 riod’’ and inserting ‘‘, during such pe21 riod or such fiscal year,’’; and 

22 (iii) in paragraph (3), by striking 

23 ‘‘For the period of fiscal years 2024 

24 through 2029, an amount equal to 10 per25 cent of such amounts’’ and inserting ‘‘BeVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 00919 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 ginning with fiscal year 2024, an amount 

2 equal to 10 percent of such amounts for 

3 the period or the fiscal year for which such 

4 amounts are appropriated’’; and 

5 (B) in subsection (g)— 

6 (i) by striking ‘‘and $40,000,000’’ and 

7 inserting ‘‘$40,000,000’’; and 

8 (ii) by inserting after ‘‘fiscal years 

9 2028 and 2029,’’ the following: 

10 ‘‘$12,000,000 for fiscal year 2030, and, 

11 for each fiscal year after fiscal year 2030, 

12 the amount appropriated under this sub13 section for the previous fiscal year, in14 creased by the percentage increase in the 

15 consumer price index for all urban con16 sumers (all items; United States city aver17 age) over such previous fiscal year,’’. 

18 (6) CHILD ENROLLMENT CONTINGENCY

19 FUND.—Section 2104(n) of the Social Security Act 

20 (42 U.S.C. 1397dd(n)) is amended— 

21 (A) in paragraph (2)— 

22 (i) in subparagraph (A)(ii)— 

23 (I) by striking ‘‘and 2024 

24 through 2028’’ and inserting ‘‘and for 


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1 each fiscal year after fiscal year 

2 2023’’; and 

3 (II) by striking ‘‘2023, and 

4 2029’’ and inserting ‘‘and 2023’’; and 

5 (ii) in subparagraph (B)— 

6 (I) by striking ‘‘2024 through 

7 2028’’ and inserting ‘‘and for each 

8 fiscal year after fiscal year 2023’’; 

9 and 

10 (II) by striking ‘‘2023, and 

11 2029’’ and inserting ‘‘and 2023’’; and 

12 (B) in paragraph (3)(A)— 

13 (i) by striking ‘‘fiscal years 2024 

14 through 2028’’ and inserting ‘‘a fiscal year 

15 after fiscal year 2023’’; and 

16 (ii) by striking ‘‘2023, or 2029’’ and 

17 inserting ‘‘or 2023’’. 

18 SEC. 5502. END DIAPER NEED ACT OF 2024. 

19 (a) TARGETED FUNDING FOR DIAPER ASSISTANCE

20 (INCLUDING DIAPERING SUPPLIES AND ADULT INCONTI21 NENCE MATERIALS AND SUPPLIES) THROUGH THE SO22 CIAL SERVICES BLOCK GRANT PROGRAM.— 

23 (1) INCREASE IN FUNDING FOR SOCIAL SERV24 ICES BLOCK GRANT PROGRAM.— 


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1 (A) IN GENERAL.—The amount specified 

2 in subsection (c) of section 2003 of the Social 

3 Security Act (42 U.S.C. 1397b) for purposes of 

4 subsections (a) and (b) of such section is 

5 deemed to be $1,900,000,000 for each of fiscal 

6 years 2025 through 2028, of which, the amount 

7 equal to $200,000,000, reduced by the amounts 

8 reserved under subparagraph (B)(ii) for each 

9 such fiscal year, shall be obligated by States in 

10 accordance with paragraph (2). 

11 (B) APPROPRIATION.— 

12 (i) IN GENERAL.—Out of any money 

13 in the Treasury of the United States not 

14 otherwise appropriated, there is appro15 priated $200,000,000 for each of fiscal 

16 years 2025 through 2028, to carry out this 

17 subsection. 

18 (ii) RESERVATIONS.— 

19 (I) PURPOSES.—The Secretary 

20 shall reserve, from the amount appro21 priated under clause (i) to carry out 

22 this subsection— 

23 (aa) for each of fiscal years 

24 2025 through 2028, not more 

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1 propriated for the fiscal year for 

2 purposes of entering into an 

3 agreement with a national entity 

4 described in clause (iii) to assist 

5 in providing technical assistance 

6 and training, to support effective 

7 policy, practice, research, and 

8 cross-system collaboration among 

9 grantees and subgrantees, and to 

10 assist in the administration of 

11 the program described in this 

12 subsection; and 

13 (bb) for fiscal year 2025, an 

14 amount, not to exceed 

15 $2,000,000, for purposes of con16 ducting an evaluation under 

17 paragraph (4). 

18 (II) NO STATE ENTITLEMENT TO

19 RESERVED FUNDS.—The State enti20 tlement under section 2002(a) of the 

21 Social Security Act (42 U.S.C. 

22 1397a(a)) shall not apply to the 

23 amounts reserved under subclause (I). 

24 (iii) NATIONAL ENTITY DESCRIBED.— 

25 A national entity described in this clause is 


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1 a nonprofit organization described in sec2 tion 501(c)(3) of the Internal Revenue 

3 Code of 1986 and exempt from taxation 

4 under section 501(a) of such Code, that— 

5 (I) has experience in more than 1 

6 State in the area of— 

7 (aa) community distribu8 tions of basic need services, in9 cluding experience collecting, 

10 warehousing, and distributing 

11 basic necessities such as diapers, 

12 food, or menstrual products; 

13 (bb) child care; 

14 (cc) child development ac15 tivities in low-income commu16 nities; or 

17 (dd) motherhood, father18 hood, or parent education efforts 

19 serving low-income parents of 

20 young children; 

21 (II) demonstrates competency to 

22 implement a project, provide fiscal ac23 countability, collect data, and prepare 

24 reports and other necessary docu25 mentation; and 


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1 (III) demonstrates a willingness 

2 to share information with researchers, 

3 practitioners, and other interested 

4 parties. 

5 (2) RULES GOVERNING USE OF ADDITIONAL

6 FUNDS.— 

7 (A) IN GENERAL.—Funds are used in ac8 cordance with this paragraph if— 

9 (i) the State, in consultation with rel10 evant stakeholders, including agencies, pro11 fessional associations, and nonprofit orga12 nizations, distributes the funds to eligible 

13 entities to— 

14 (I) decrease the need for diapers 

15 and diapering supplies and adult in16 continence materials and supplies in 

17 low-income families and meet such 

18 unmet needs of infants and toddlers, 

19 medically complex children, and low20 income adults and adults with disabil21 ities in such families through— 

22 (aa) the distribution of free 

23 diapers and diapering supplies, 

24 medically necessary diapers, and 


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1 adult incontinence materials and 

2 supplies; 

3 (bb) community outreach to 

4 assist in participation in existing 

5 diaper distribution programs or 

6 programs that distribute medi7 cally necessary diapers or adult 

8 incontinence materials and sup9 plies; or 

10 (cc) improving access to dia11 pers and diapering supplies, 

12 medically necessary diapers, and 

13 adult incontinence materials and 

14 supplies; and 

15 (II) increase the ability of com16 munities and low-income families in 

17 such communities to provide for the 

18 need for diapers and diapering sup19 plies, medically necessary diapers, and 

20 adult incontinence materials and sup21 plies, of infants and toddlers, medi22 cally complex children, and low-income 

23 adults and adults with disabilities; 


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1 (ii) the funds are used subject to the 

2 limitations in section 2005 of the Social 

3 Security Act (42 U.S.C. 1397d); 

4 (iii) the funds are used to supplement, 

5 not supplant, State general revenue funds 

6 provided for the purposes described in 

7 clause (i); and 

8 (iv) the funds are not used for costs 

9 that are reimbursable by the Federal 

10 Emergency Management Agency, under a 

11 contract for insurance, or by self-insur12 ance. 

13 (B) ALLOWABLE USES BY ELIGIBLE ENTI14 TIES.—An eligible entity receiving funds made 

15 available under paragraph (1) shall use the 

16 funds for any of the following: 

17 (i) To pay for the purchase and dis18 tribution of diapers and diapering supplies, 

19 medically necessary diapers, and funding 

20 diaper (including medically necessary dia21 pers) distribution that serves low-income 

22 families with— 

23 (I) 1 or more children 3 years of 

24 age or younger; or 


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1 (II) 1 or more medically complex 

2 children. 

3 (ii) To pay for the purchase and dis4 tribution of adult incontinence materials 

5 and supplies and funding distribution of 

6 such materials and supplies that serves 

7 low-income families with 1 or more low-in8 come adults or adults with disabilities who 

9 rely on adult incontinence materials and 

10 supplies. 

11 (iii) To integrate activities carried out 

12 under clause (i) with other basic needs as13 sistance programs serving eligible children 

14 and their families, including the following: 

15 (I) Programs funded by the tem16 porary assistance for needy families 

17 program under part A of title IV of 

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

19 601 et seq.), including the State 

20 maintenance of effort provisions of 

21 such program. 

22 (II) Programs designed to sup23 port the health of eligible children, 

24 such as the Children’s Health Insur25 ance Program under title XXI of the 


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1 Social Security Act, the Medicaid pro2 gram under title XIX of such Act, or 

3 State-funded health care programs. 

4 (III) Programs funded through 

5 the special supplemental nutrition 

6 program for women, infants, and chil7 dren under section 17 of the Child 

8 Nutrition Act of 1966. 

9 (IV) Programs that offer early 

10 home visiting services, including the 

11 maternal, infant, and early childhood 

12 home visiting program (including the 

13 Tribal home visiting program) under 

14 section 511 of the Social Security Act 

15 (42 U.S.C. 711). 

16 (V) Programs to provide im17 proved and affordable access to child 

18 care, including programs funded 

19 through the Child Care and Develop20 ment Fund, the temporary assistance 

21 for needy families program under part 

22 A of title IV of the Social Security 

23 Act (42 U.S.C. 601 et seq.), or a 

24 State-funded program. 

25 (C) AVAILABILITY OF FUNDS.— 


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1 (i) FUNDS DISTRIBUTED TO ELIGIBLE

2 ENTITIES.—Funds made available under 

3 paragraph (1) that are distributed to an el4 igible entity by a State for a fiscal year 

5 may be expended by the eligible entity only 

6 in such fiscal year or the succeeding fiscal 

7 year. 

8 (ii) EVALUATION.—Funds reserved 

9 under paragraph (1)(B)(ii)(I)(aa) to carry 

10 out the evaluation under paragraph (4) 

11 shall be available for expenditure during 

12 the 3-year period that begins on the date 

13 of enactment of this Act. 

14 (D) NO EFFECT ON OTHER PROGRAMS.— 

15 Any assistance or benefits received by a family 

16 through funds made available under paragraph 

17 (1) shall be disregarded for purposes of deter18 mining the family’s eligibility for, or amount of, 

19 benefits under any other Federal needs-based 

20 programs. 

21 (3) ANNUAL REPORTS.—A State shall include 

22 in the annual report required under section 2006 of 

23 the Social Security Act (42 U.S.C. 1397e) covering 

24 each of fiscal years 2024 through 2027, information 

25 detailing how eligible entities, including subgrantees, 


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1 used funds made available under paragraph (1) to 

2 distribute diapers and diapering supplies and adult 

3 incontinence materials and supplies to families in 

4 need. Each such report shall include the following: 

5 (A) The number and age of infants, tod6 dlers, medically complex children, and low-in7 come adults and adults with disabilities who re8 ceived assistance or benefits through such 

9 funds. 

10 (B) The number of families that have re11 ceived assistance or benefits through such 

12 funds. 

13 (C) The number of diapers, medically nec14 essary diapers, or adult incontinence materials 

15 and supplies (such as adult diapers, briefs, pro16 tective underwear, pull-ons, pull-ups, liners, 

17 shields, guards, pads, undergarments), and the 

18 number of each type of diapering or adult in19 continence supply, distributed through the use 

20 of such funds. 

21 (D) The ZIP Code or ZIP Codes where the 

22 eligible entity (or subgrantee) distributed dia23 pers and diapering supplies and adult inconti24 nence materials and supplies. 


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1 (E) The method or methods the eligible en2 tity (or subgrantee) uses to distribute diapers 

3 and diapering supplies and, adult incontinence 

4 materials and supplies. 

5 (F) Such other information as the Sec6 retary may specify. 

7 (4) EVALUATION.—The Secretary, in consulta8 tion with States, the national entity described in 

9 paragraph (1)(B)(iii), and eligible entities receiving 

10 funds made available under this subsection, shall— 

11 (A) not later than 2 years after the date 

12 of enactment of this Act— 

13 (i) complete an evaluation of the effec14 tiveness of the assistance program carried 

15 out pursuant to this subsection, such as 

16 the effect of activities carried out under 

17 this section on mitigating the health and 

18 developmental risks of unmet diaper need 

19 among infants, toddlers, medically complex 

20 children, and other family members in low21 income families, including the risks of dia22 per dermatitis, urinary tract infections, 

23 and parental and child depression and anx24 iety; 


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1 (ii) submit to the relevant congres2 sional committees a report on the results 

3 of such evaluation; and 

4 (iii) publish the results of the evalua5 tion on the internet website of the Depart6 ment of Health and Human Services; 

7 (B) not later than 3 years after the date 

8 of enactment of this Act, update the evaluation 

9 required by subparagraph (A)(i); and 

10 (C) not later than 90 days after completion 

11 of the updated evaluation under subparagraph 

12 (B)— 

13 (i) submit to the relevant congres14 sional committees a report describing the 

15 results of such updated evaluation; and 

16 (ii) publish the results of such evalua17 tion on the internet website of the Depart18 ment of Health and Human Services. 

19 (5) GUIDANCE.—Not later than 180 days after 

20 enactment of this Act, the Secretary shall issue 

21 guidance regarding how the provisions of this sub22 section should be carried out, including information 

23 regarding eligible entities, allowable use of funds, 

24 and reporting requirements. 

25 (6) DEFINITIONS.—In this subsection: 


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1 (A) ADULT INCONTINENCE MATERIALS

2 AND SUPPLIES.—The term ‘‘adult incontinence 

3 materials and supplies’’ means those supplies 

4 that are used to assist low-income adults or 

5 adults with disabilities and includes adult dia6 pers, briefs, protective underwear, pull-ons, 

7 pull-ups, liners, shields, guards, pads, undergar8 ments, disposable wipes, over-the-counter adult 

9 diaper rash cream products, intermittent cath10 eterization, indwelling catheters, condom cath11 eters, urinary drainage bags, external collection 

12 devices, wearable urinals, and penile clamps. 

13 (B) ADULTS WITH DISABILITIES.—The 

14 term ‘‘adults with disabilities’’ means individ15 uals who— 

16 (i) have attained age 18; and 

17 (ii) have a disability (as such term is 

18 defined, with respect to an individual, in 

19 section 3 of the Americans with Disabil20 ities Act of 1990 (42 U.S.C. 12102)). 

21 (C) DIAPER.—The term ‘‘diaper’’ means 

22 an absorbent garment that— 

23 (i) is washable or disposable that may 

24 be worn by an infant or toddler who is not 

25 toilet-trained; and 


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1 (ii) if disposable— 

2 (I) does not use any latex or 

3 common allergens; and 

4 (II) meets or exceeds the quality 

5 standards for diapers commercially 

6 available through retail sale in the fol7 lowing categories: 

8 (aa) Absorbency (with ac9 ceptable rates for first and sec10 ond wetting). 

11 (bb) Waterproof outer cover. 

12 (cc) Flexible leg openings. 

13 (dd) Refastening closures. 

14 (D) DIAPERING SUPPLIES.—The term 

15 ‘‘diapering supplies’’ means items, including di16 aper wipes and diaper cream, necessary to en17 sure that— 

18 (i) an eligible child using a diaper is 

19 properly cleaned and protected from diaper 

20 rash; or 

21 (ii) a medically complex child who 

22 uses a medically necessary diaper is prop23 erly cleaned and protected from diaper 

24 rash. 


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1 (E) ELIGIBLE CHILD.—The term ‘‘eligible 

2 child’’ means a child who— 

3 (i) has not attained 4 years of age; 

4 and 

5 (ii) is a member of a low-income fam6 ily. 

7 (F) ELIGIBLE ENTITIES.—The term ‘‘eligi8 ble entity’’ means a State or local governmental 

9 entity, an Indian tribe or tribal organization (as 

10 defined in section 4 of the Indian Self-Deter11 mination and Education Assistance Act), or a 

12 nonprofit organization described in section 

13 501(c)(3) of the Internal Revenue Code of 1986 

14 and exempt from taxation under section 501(a) 

15 of such Code that— 

16 (i) has experience in the area of— 

17 (I) community distributions of 

18 basic need services, including experi19 ence collecting, warehousing, and dis20 tributing basic necessities such as dia21 pers, food, or menstrual products; 

22 (II) child care; 

23 (III) child development activities 

24 in low-income communities; or 


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1 (IV) motherhood, fatherhood, or 

2 parent education efforts serving low3 income parents of young children; 

4 (ii) demonstrates competency to im5 plement a project, provide fiscal account6 ability, collect data, and prepare reports 

7 and other necessary documentation; and 

8 (iii) demonstrates a willingness to 

9 share information with researchers, practi10 tioners, and other interested parties. 

11 (G) FEDERAL POVERTY LINE.—The term 

12 ‘‘Federal poverty line’’ means the Federal pov13 erty line as defined by the Office of Manage14 ment and Budget and revised annually in ac15 cordance with section 673(2) of the Omnibus 

16 Budget Reconciliation Act of 1981 applicable to 

17 a family of the size involved. 

18 (H) LOW-INCOME.—The term ‘‘low-in19 come’’, with respect to a family, means a family 

20 whose self-certified income is not more than 

21 200 percent of the Federal poverty line. 

22 (I) MEDICALLY COMPLEX CHILD.—The 

23 term ‘‘medically complex child’’ means an indi24 vidual who has attained age 3 and for whom a 

25 licensed health care provider has provided a diVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 00937 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 agnosis of bowel or bladder incontinence, a 

2 bowel or bladder condition that causes excess 

3 urine or stool (such as short gut syndrome or 

4 diabetes insipidus), or a severe skin condition 

5 that causes skin erosions (such as epidermolysis 

6 bullosa). 

7 (J) MEDICALLY NECESSARY DIAPER.—The 

8 term ‘‘medically necessary diaper’’ means an 

9 absorbent garment that is— 

10 (i) washable or disposable; 

11 (ii) worn by a medically complex child 

12 who has been diagnosed with bowel or 

13 bladder incontinence, a bowel or bladder 

14 condition that causes excess urine or stool 

15 (such as short gut syndrome or diabetes 

16 insipidus), or a severe skin condition that 

17 causes skin erosions (such as epidermolysis 

18 bullosa) and needs such garment to correct 

19 or ameliorate such condition; and 

20 (iii) if disposable— 

21 (I) does not use any latex or 

22 common allergens; and 

23 (II) meets or exceeds the quality 

24 standards for diapers commercially 


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1 available through retail sale in the fol2 lowing categories: 

3 (aa) Absorbency (with ac4 ceptable rates for first and sec5 ond wetting). 

6 (bb) Waterproof outer cover. 

7 (cc) Flexible leg openings. 

8 (dd) Refastening closures. 

9 (7) EXEMPTION OF PROGRAM FROM SEQUES10 TRATION.— 

11 (A) IN GENERAL.—Section 255(h) of the 

12 Balanced Budget and Emergency Deficit Con13 trol Act of 1985 (2 U.S.C. 905(h)) is amended 

14 by inserting after ‘‘Supplemental Security In15 come Program (28–0406–0–1–609).’’ the fol16 lowing: 

17 ‘‘Targeted funding for States for diaper assist18 ance (including diapering supplies and adult inconti19 nence materials and supplies) through the Social 

20 Services Block Grant Program.’’. 

21 (B) APPLICABILITY.—The amendment 

22 made by this paragraph shall apply to any se23 questration order issued under the Balanced 

24 Budget and Emergency Deficit Control Act of 


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1 1985 (2 U.S.C. 900 et seq.) on or after the 

2 date of enactment of this Act. 

3 (b) IMPROVING ACCESS TO DIAPERS FOR MEDICALLY

4 COMPLEX CHILDREN.—Section 1915(c) of the Social Se5 curity Act (42 U.S.C. 1396n(c)) is amended by adding at 

6 the end the following new paragraph: 

7 ‘‘(11)(A) In the case of any waiver under this sub8 section that provides medical assistance to a medically 

9 complex child who has been diagnosed with bowel or blad10 der incontinence, a bowel or bladder condition that causes 

11 excess urine or stool (such as short gut syndrome or diabe12 tes insipidus), or a severe skin condition that causes skin 

13 erosions (such as epidermolysis bullosa), such medical as14 sistance shall include, for the duration of the waiver, the 

15 provision of 200 medically necessary diapers per month 

16 and diapering supplies. Such medical assistance may in17 clude the provision of medically necessary diapers in 

18 amounts greater than 200 if a licensed health care pro19 vider (such as a physician, nurse practitioner, or physician 

20 assistant) specifies that such greater amounts are nec21 essary for such medically complex child. 

22 ‘‘(B) For purposes of this paragraph: 

23 ‘‘(i) The term ‘medically complex child’ means 

24 an individual who has attained age 3 and for whom 


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1 a licensed health care provider has provided a diag2 nosis of 1 or more significant chronic conditions. 

3 ‘‘(ii) The term ‘medically necessary diaper’ 

4 means an absorbent garment that is— 

5 ‘‘(I) washable or disposable; 

6 ‘‘(II) worn by a medically complex child 

7 who has been diagnosed with a condition de8 scribed in subparagraph (A) and needs such 

9 garment to correct or ameliorate such condition; 

10 and 

11 ‘‘(III) if disposable— 

12 ‘‘(aa) does not use any latex or com13 mon allergens; and 

14 ‘‘(bb) meets or exceeds the quality 

15 standards for diapers commercially avail16 able through retail sale in the following 

17 categories: 

18 ‘‘(AA) Absorbency (with accept19 able rates for first and second wet20 ting). 

21 ‘‘(BB) Waterproof outer cover. 

22 ‘‘(CC) Flexible leg openings. 

23 ‘‘(DD) Refastening closures. 

24 ‘‘(iii) The term ‘diapering supplies’ means 

25 items, including diaper wipes and diaper creams, 


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1 necessary to ensure that a medically complex child 

2 who has been diagnosed with a condition described 

3 in subparagraph (A) and uses a medically necessary 

4 diaper is properly cleaned and protected from diaper 

5 rash.’’. 

6 (c) INCLUSION OF DIAPERS AND DIAPERING SUP7 PLIES AS QUALIFIED MEDICAL EXPENSES.— 

8 (1) HEALTH SAVINGS ACCOUNTS.—Section 

9 223(d)(2) of the Internal Revenue Code of 1986 is 

10 amended— 

11 (A) by inserting ‘‘, medically necessary dia12 pers, and diapering supplies’’ after ‘‘menstrual 

13 care products’’ in the last sentence of subpara14 graph (A); and 

15 (B) by adding at the end the following new 

16 subparagraph: 

17 ‘‘(E) MEDICALLY NECESSARY DIAPERS

18 AND DIAPERING SUPPLIES.—For purposes of 

19 this paragraph— 

20 ‘‘(i) MEDICALLY NECESSARY DIA21 PERS.—The term ‘medically necessary dia22 per’ means an absorbent garment which is 

23 washable or disposable and which is worn 

24 by an individual who has attained 3 years 

25 of age because of medical necessity, such 


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1 as someone who has been diagnosed with 

2 bowel or bladder incontinence, a bowel or 

3 bladder condition that causes excess urine 

4 or stool (such as short gut syndrome or di5 abetes insipidus), or a severe skin condi6 tion that causes skin erosions (such as 

7 epidermolysis bullosa) and needs such gar8 ment to correct or ameliorate such condi9 tion, to serve a preventative medical pur10 pose, or to correct or ameliorate defects or 

11 physical or mental illnesses or conditions 

12 diagnosed by a licensed health care pro13 vider, and, if disposable— 

14 ‘‘(I) does not use any latex or 

15 common allergens; and 

16 ‘‘(II) meets or exceeds the quality 

17 standards for diapers commercially 

18 available through retail sale in the fol19 lowing categories: 

20 ‘‘(aa) Absorbency (with ac21 ceptable rates for first and sec22 ond wetting). 

23 ‘‘(bb) Waterproof outer 

24 cover. 

25 ‘‘(cc) Flexible leg openings. 


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1 ‘‘(dd) Refastening closures. 

2 ‘‘(ii) DIAPERING SUPPLIES.—The 

3 term ‘diapering supplies’ means items, in4 cluding diaper wipes and diaper creams, 

5 necessary to ensure that an individual 

6 wearing medically necessary diapers is 

7 properly cleaned and protected from diaper 

8 rash.’’. 

9 (2) ARCHER MSAS.—The last sentence of sec10 tion 220(d)(2)(A) of such Code is amended by in11 serting ‘‘, medically necessary diapers (as defined in 

12 section 223(d)(2)(E)), and diapering supplies (as de13 fined in section 223(d)(2)(E))’’ after ‘‘menstrual 

14 care products (as defined in section 223(d)(2)(D))’’. 

15 (3) HEALTH FLEXIBLE SPENDING ARRANGE16 MENTS AND HEALTH REIMBURSEMENT ARRANGE17 MENTS.—Section 106(f) of such Code is amended— 

18 (A) by inserting ‘‘, medically necessary dia19 pers (as defined in section 223(d)(2)(E)), and 

20 diapering supplies (as defined in section 

21 223(d)(2)(E))’’ after ‘‘menstrual care products 

22 (as defined in section 223(d)(2)(D))’’; and 

23 (B) in the heading, by inserting ‘‘, MEDI24 CALLY NECESSARY DIAPERS, AND DIAPERING


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1 SUPPLIES’’ after ‘‘MENSTRUAL CARE PROD2 UCTS’’. 

3 (4) EFFECTIVE DATES.— 

4 (A) DISTRIBUTIONS FROM CERTAIN AC5 COUNTS.—The amendments made by para6 graphs (1) and (2) shall apply to amounts paid 

7 after December 31, 2024. 

8 (B) REIMBURSEMENTS.—The amendment 

9 made by paragraph (3) shall apply to expenses 

10 incurred after December 31, 2024. 

11 SEC. 5503. DECREASING THE RISK FACTORS FOR SUDDEN 

12 UNEXPECTED INFANT DEATH AND SUDDEN 

13 UNEXPLAINED DEATH IN CHILDHOOD. 

14 (a) ESTABLISHMENT.—The Secretary of Health and 

15 Human Services, acting through the Administrator of the 

16 Health Resources and Services Administration and in con17 sultation with the Director of the Centers for Disease Con18 trol and Prevention and the Director of the National Insti19 tutes of Health (in this section referred to as the ‘‘Sec20 retary’’), shall establish and implement a culturally and 

21 linguistically competent public health awareness and edu22 cation campaign to provide information that is focused on 

23 decreasing the risk factors for sudden unexpected infant 

24 death and sudden unexplained death in childhood, includ25 ing educating individuals about safe sleep environments, 


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1 sleep positions, and reducing exposure to smoking during 

2 pregnancy and after birth. 

3 (b) TARGETED POPULATIONS.—The campaign under 

4 subsection (a) shall be designed to reduce health inequal5 ities through the targeting of populations with high rates 

6 of sudden unexpected infant death or of sudden unex7 plained death in childhood. 

8 (c) CONSULTATION.—In establishing and imple9 menting the campaign under subsection (a), the Secretary 

10 shall consult with national organizations representing (col11 lectively) health care providers, including nurses and phy12 sicians, parents, child care providers, children’s advocacy 

13 and safety organizations, maternal and child health pro14 grams, nutrition professionals focusing on (collectively) 

15 people, infants, and children, and other individuals and 

16 groups determined necessary by the Secretary for such es17 tablishment and implementation. 

18 (d) GRANTS.— 

19 (1) IN GENERAL.—In carrying out the cam20 paign under subsection (a), the Secretary shall 

21 award grants to national organizations, State and 

22 local health departments, and community-based or23 ganizations for the conduct of education and out24 reach programs for nurses, parents, child care proVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 00946 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 viders, community health workers, public health 

2 agencies, and community organizations. 

3 (2) APPLICATION.—To be eligible to receive a 

4 grant under paragraph (1), an entity shall submit to 

5 the Secretary an application at such time, in such 

6 manner, and containing such information as the Sec7 retary may require. 

8 (e) 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 2025 through 2029. 

12 Subtitle G—Elder Care 

13 SEC. 5601. EXPENSES FOR HOUSEHOLD AND ELDER CARE 

14 SERVICES NECESSARY FOR GAINFUL EM15 PLOYMENT. 

16 (a) IN GENERAL.—Subpart A of part IV of sub17 chapter A of chapter 1 of the Internal Revenue Code of 

18 1986 is amended by inserting after section 25E the fol19 lowing new section: 

20 ‘‘SEC. 25F. EXPENSES FOR HOUSEHOLD AND ELDER CARE 

21 SERVICES NECESSARY FOR GAINFUL EM22 PLOYMENT. 

23 ‘‘(a) ALLOWANCE OF CREDIT.— 

24 ‘‘(1) IN GENERAL.—In the case of an individual 

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1 uals (as defined in subsection (b)(1)) with respect to 

2 such individual, there shall be allowed as a credit 

3 against the tax imposed by this chapter for the tax4 able year an amount equal to the applicable percent5 age of the employment-related expenses (as defined 

6 in subsection (b)(3)) paid by such individual during 

7 the taxable year. 

8 ‘‘(2) APPLICABLE PERCENTAGE DEFINED.—For 

9 purposes of paragraph (1), the term ‘applicable per10 centage’ means 35 percent reduced (but not below 

11 20 percent) by 1 percentage point for each $2,000 

12 (or fraction thereof) by which the taxpayer’s ad13 justed gross income for the taxable year exceeds 

14 $15,000. 

15 ‘‘(b) DEFINITIONS OF QUALIFYING INDIVIDUAL AND

16 EMPLOYMENT-RELATED EXPENSES.—For purposes of 

17 this section— 

18 ‘‘(1) QUALIFYING INDIVIDUAL.—The term 

19 ‘qualifying individual’ means an individual who— 

20 ‘‘(A) has attained age 50, and 

21 ‘‘(B) satisfies the requirements of any of 

22 the following clauses: 

23 ‘‘(i) An individual who bears a rela24 tionship to the taxpayer described in sub25 paragraph (C) or (D) of section 152(d)(2) 


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1 (relating to fathers, mothers, and ances2 tors). 

3 ‘‘(ii) An individual who would be a de4 pendent of the taxpayer (as defined in sec5 tion 152, determined without regard to 

6 subsections (b)(1) and (b)(2)) as a quali7 fying relative described in section 

8 152(d)(1) if— 

9 ‘‘(I) in lieu of the requirements 

10 under subparagraphs (B) and (C) of 

11 such section, with respect to such in12 dividual— 

13 ‘‘(aa) the taxpayer has pro14 vided over one-half of the individ15 ual’s support for the calendar 

16 year in which such taxable year 

17 begins and each of the preceding 

18 4 taxable years, and 

19 ‘‘(bb) the individual’s modi20 fied adjusted gross income for 

21 the calendar year in which such 

22 taxable year begins is less than 

23 the exemption amount (as de24 fined in section 151(d)), 


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1 ‘‘(II) the individual is physically 

2 or mentally incapable of caring for 

3 himself or herself, and 

4 ‘‘(III) the individual has the 

5 same principal place of abode as the 

6 taxpayer for more than one-half of 

7 such taxable year. 

8 ‘‘(iii) The spouse of the taxpayer, if 

9 such spouse is physically or mentally in10 capable of caring for himself or herself. 

11 ‘‘(2) MODIFIED ADJUSTED GROSS INCOME.— 

12 The term ‘modified adjusted gross income’ means 

13 adjusted gross income determined without regard to 

14 section 86. 

15 ‘‘(3) EMPLOYMENT-RELATED EXPENSES.— 

16 ‘‘(A) IN GENERAL.—The term ‘employ17 ment-related expenses’ means amounts paid for 

18 the following expenses, but only if such ex19 penses are incurred to enable the taxpayer to be 

20 gainfully employed for any period for which 

21 there are one or more qualifying individuals 

22 with respect to the taxpayer: 

23 ‘‘(i) Expenses for household services 

24 with respect to the qualifying individual. 


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1 ‘‘(ii) Expenses for the care of a quali2 fying individual, including expenses for res3 pite care and hospice care. 

4 ‘‘(B) EXCEPTION.—The term ‘employ5 ment-related expenses’ shall not include services 

6 provided outside the taxpayer’s household un7 less such expenses are incurred for the care 

8 of— 

9 ‘‘(i) a qualifying individual described 

10 in paragraph (1)(A), or 

11 ‘‘(ii) a qualifying individual (not de12 scribed in paragraph (1)(A)) who regularly 

13 spends at least 8 hours each day in the 

14 taxpayer’s household. 

15 ‘‘(C) DEPENDENT CARE CENTERS.—The 

16 term ‘employment-related expenses’ shall not 

17 include services provided outside the taxpayer’s 

18 household by a dependent care center (as de19 fined in subparagraph (D)) unless— 

20 ‘‘(i) such center complies with all ap21 plicable laws and regulations of the State 

22 and local government in which such center 

23 is located, and 

24 ‘‘(ii) the requirements of subpara25 graph (B) are met. 


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1 ‘‘(D) DEPENDENT CARE CENTER DE2 FINED.—For purposes of this paragraph, the 

3 term ‘dependent care center’ means any facility 

4 which— 

5 ‘‘(i) provides care for more than 6 in6 dividuals (other than individuals who re7 side at the facility), and 

8 ‘‘(ii) receives a fee, payment, or grant 

9 for providing services for any of the indi10 viduals (regardless of whether such facility 

11 is operated for profit). 

12 ‘‘(c) DOLLAR LIMIT ON AMOUNT CREDITABLE.—The 

13 amount of the employment-related expenses incurred dur14 ing any taxable year which may be taken into account 

15 under subsection (a) shall not exceed— 

16 ‘‘(1) if there is 1 qualifying individual with re17 spect to the taxpayer for such taxable year, $3,000, 

18 or 

19 ‘‘(2) if there are 2 or more qualifying individ20 uals with respect to the taxpayer for such taxable 

21 year, $6,000. 

22 The amount determined under this subsection shall be re23 duced by the aggregate amount excludable from gross in24 come under section 129 for the taxable year. 


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1 ‘‘(d) EARNED INCOME LIMITATION.—The amount of 

2 the employment-related expenses incurred during any tax3 able year which may be taken into account under sub4 section (a) shall not exceed— 

5 ‘‘(1) in the case of an individual who is not 

6 married at the close of such year, such individual’s 

7 earned income for such year, or 

8 ‘‘(2) in the case of an individual who is married 

9 at the close of such year, the lesser of such individ10 ual’s earned income or the earned income of his 

11 spouse for such year. 

12 ‘‘(e) SPECIAL RULES.—For purposes of this sec13 tion— 

14 ‘‘(1) PLACE OF ABODE.—An individual shall 

15 not be treated as having the same principal place of 

16 abode of the taxpayer if at any time during the tax17 able year of the taxpayer the relationship between 

18 the individual and the taxpayer is in violation of 

19 local law. 

20 ‘‘(2) MARRIED COUPLES MUST FILE JOINT RE21 TURN.—In the case of an individual who is married 

22 as of the close of the taxable year, the credit shall 

23 be allowed under subsection (a) only if a joint return 

24 is filed for the taxable year under section 6013. 


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1 ‘‘(3) MARITAL STATUS.—An individual legally 

2 separated from his or her spouse under a decree of 

3 divorce or of separate maintenance shall not be con4 sidered as married. 

5 ‘‘(4) CERTAIN MARRIED INDIVIDUALS LIVING

6 APART.—In the case of an individual who is married 

7 and does not file a joint return for the taxable year, 

8 if— 

9 ‘‘(A) such individual— 

10 ‘‘(i) maintains as his or her home a 

11 household which constitutes for more than 

12 one-half of the taxable year the principal 

13 place of abode of a qualifying individual, 

14 and 

15 ‘‘(ii) furnishes over half of the cost of 

16 maintaining such household during the 

17 taxable year, and 

18 ‘‘(B) during the last 6 months of such tax19 able year, such individual’s spouse is not a 

20 member of such household, 

21 such individual shall not be considered as married. 

22 ‘‘(5) PAYMENTS TO RELATED INDIVIDUALS.— 

23 No credit shall be allowed under subsection (a) for 

24 any amount paid by the taxpayer to an individual— 


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1 ‘‘(A) with respect to whom, for the taxable 

2 year, a deduction under section 151(c) (relating 

3 to deduction for personal exemptions for de4 pendents) is allowable either to the taxpayer or 

5 the taxpayer’s spouse, or 

6 ‘‘(B) who— 

7 ‘‘(i) is a child of the taxpayer (within 

8 the meaning of section 152(f)(1)), and 

9 ‘‘(ii) has not attained the age of 19 at 

10 the close of the taxable year. 

11 For purposes of this paragraph, the term ‘taxable 

12 year’ means the taxable year of the taxpayer in 

13 which the service (as described in clause (i) of sub14 section (b)(3)(A)) is performed or the care (as de15 scribed in clause (ii) of such subsection) is provided. 

16 ‘‘(6) IDENTIFYING INFORMATION REQUIRED

17 WITH RESPECT TO SERVICE PROVIDER.—No credit 

18 shall be allowed under subsection (a) for any amount 

19 paid to any person unless— 

20 ‘‘(A) the name, address, and taxpayer 

21 identification number of such person are in22 cluded on the return of tax for the taxable year 

23 in which the credit under this section is being 

24 claimed, or 


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1 ‘‘(B) if such person is an organization de2 scribed in section 501(c)(3) and exempt from 

3 tax under section 501(a), the name and address 

4 of such person are included on the return of tax 

5 for the taxable year in which the credit under 

6 this section is being claimed. 

7 In the case of a failure to provide the information 

8 required under the preceding sentence, the preceding 

9 sentence shall not apply if it is shown that the tax10 payer exercised due diligence in attempting to pro11 vide the information so required. 

12 ‘‘(7) IDENTIFYING INFORMATION REQUIRED

13 WITH RESPECT TO QUALIFYING INDIVIDUALS.—No 

14 credit shall be allowed under this section with re15 spect to any qualifying individual unless the TIN of 

16 such individual is included on the return of tax for 

17 the taxable year in which the credit under this sec18 tion is being claimed. 

19 ‘‘(f) REGULATIONS.—The Secretary shall prescribe 

20 such regulations as may be necessary to carry out the pur21 poses of this section.’’. 

22 (b) CLERICAL AMENDMENT.—The table of sections 

23 for subpart A of part IV of subchapter A of chapter 1 

24 of the Internal Revenue Code of 1986 is amended by inVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 00956 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 serting after the item relating to section 25E the following 

2 new item: 

‘‘Sec. 25F. Expenses for household and elder care services necessary for gainful 

employment.’’. 

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

4 this section shall apply to taxable years beginning after 

5 the date of the enactment of this Act. 

6 Subtitle H—Miscellaneous 

7 Provisions 

8 SEC. 5701. CLARIFICATION SUPPORTING PERMISSIBLE USE 

9 OF FUNDS FOR STILLBIRTH PREVENTION AC10 TIVITIES. 

11 Section 501(a) of the Social Security Act (42 U.S.C. 

12 701(a)) is amended— 

13 (1) in paragraph (1)(B), by inserting ‘‘to re14 duce the incidence of stillbirth,’’ after ‘‘among chil15 dren,’’; and 

16 (2) in paragraph (2), by inserting after ‘‘follow17 up services’’ the following: ‘‘, and for evidence-based 

18 programs and activities and outcome research to re19 duce the incidence of stillbirth (including tracking 

20 and awareness of fetal movements, improvement of 

21 birth timing for pregnancies with risk factors, initia22 tives that encourage safe sleeping positions during 

23 pregnancy, screening and surveillance for fetal 

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1 sation during pregnancy, community-based programs 

2 that provide home visits or other types of support, 

3 and any other research or evidence-based program4 ming to prevent stillbirths)’’. 

5 TITLE VI—MENTAL HEALTH AND 

6 SUBSTANCE USE DISORDERS 

7 SEC. 6001. SENSE OF CONGRESS. 

8 It is the sense of the Congress that it is imperative 

9 that a comprehensive public health approach to addressing 

10 trauma and mental health care be focused on care delivery 

11 that is culturally and linguistically appropriate. 

12 Subtitle A—Access to Care and 

13 Funding Streams 

14 SEC. 6101. COVERAGE OF SUBSTANCE USE DISORDER 

15 COUNSELOR SERVICES AND PEER SUPPORT 

16 SPECIALIST SERVICES UNDER PART B OF 

17 THE MEDICARE PROGRAM. 

18 (a) COVERAGE OF SERVICES.— 

19 (1) IN GENERAL.—Section 1861(s)(2) of the 

20 Social Security Act (42 U.S.C. 1395x(s)(2)), as 

21 amended by section 4251(c)(1), is amended— 

22 (A) in subparagraph (JJ), by striking 

23 ‘‘and’’ at the end; 

24 (B) by inserting ‘‘and’’ at the end of sub25 paragraph (KK); and 


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1 (C) by adding at the end the following new 

2 subparagraph: 

3 ‘‘(LL) substance use disorder counselor services 

4 (as defined in subsection (qqq)(1)), and peer support 

5 specialist services (as defined in subsection 

6 (qqq)(3));’’. 

7 (2) DEFINITIONS.—Section 1861 of the Social 

8 Security Act (42 U.S.C. 1395x), as amended by sec9 tions 2007(b), 4221(a), and 4251(c)(2), is amended 

10 by adding at the end the following new subsection: 

11 ‘‘Substance Use Disorder Counselor Services; Substance 

12 Use Disorder Counselor; Peer Support Specialist 

13 Services; Peer Support Specialist 

14 ‘‘(qqq)(1) The term ‘substance use disorder counselor 

15 services’ means services performed by a substance use dis16 order counselor (as defined in paragraph (2)) for the diag17 nosis and treatment of substance use disorder and addic18 tion that the substance use disorder counselor is legally 

19 authorized to perform under State law (or the State regu20 latory mechanism provided by the State law) of the State 

21 in which such services are performed, as would otherwise 

22 be covered if furnished by a physician or as incident to 

23 a physician’s professional service, but only if no facility 

24 or other provider charges or is paid any amounts with re25 spect to the furnishing of such services. 


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1 ‘‘(2) The term ‘substance use disorder counselor’ 

2 means an individual who— 

3 ‘‘(A) has performed at least 2 years of super4 vised substance use disorder counselor practice; 

5 ‘‘(B) in the case of an individual performing 

6 services in a State that provides for licensure or cer7 tification of substance use disorder counselors or 

8 professional counselors, is licensed or certified as a 

9 substance use disorder counselor or professional 

10 counselor in such State; or 

11 ‘‘(C) is a drug and alcohol counselor as defined 

12 in section 40.281 of title 49, Code of Federal Regu13 lations. 

14 ‘‘(3) The term ‘peer support specialist services’ 

15 means services performed by a peer support specialist (as 

16 defined in paragraph (4)) for the well-being of individuals 

17 needing mental health support that the peer support spe18 cialist is legally authorized to perform under State law (or 

19 the State regulatory mechanism provided by the State 

20 law) of the State in which such services are performed, 

21 as would otherwise be covered if furnished by a physician 

22 or as incident to a physician’s professional service, but 

23 only if no facility or other provider charges or is paid any 

24 amounts with respect to the furnishing of such services. 


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1 ‘‘(4) The term ‘peer support specialist’ means an in2 dividual who— 

3 ‘‘(A) is an individual living in recovery with 

4 mental illness, addiction, or justice system involve5 ment; 

6 ‘‘(B) has skills learned in formal training; 

7 ‘‘(C) uses assets-based framing in speaking 

8 about mental health, recovery, and well-being; and 

9 ‘‘(D) delivers services in behavioral health set10 tings to promote mind-body recovery and resil11 iency.’’. 

12 (3) PROVISION FOR PAYMENT UNDER PART

13 B.—Section 1832(a)(2)(B) of the Social Security 

14 Act (42 U.S.C. 1395k(a)(2)(B)) is amended by add15 ing at the end the following new clause: 

16 ‘‘(v) substance use disorder counselor 

17 services and peer support specialist serv18 ices;’’. 

19 (4) AMOUNT OF PAYMENT.—Section 1833(a)(1) 

20 of the Social Security Act (42 U.S.C. 1395l(a)(1)), 

21 as amended by section 4251(c)(3), is amended— 

22 (A) by striking ‘‘and’’ before ‘‘(II)’’; and 

23 (B) by inserting before the semicolon at 

24 the end the following: ‘‘, and (JJ) with respect 

25 to substance use disorder counselor services and 


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1 peer support specialist services under section 

2 1861(s)(2)(LL), the amounts paid shall be 80 

3 percent of the lesser of the actual charge for 

4 the services or 75 percent of the amount deter5 mined for payment of a psychologist under sub6 paragraph (L)’’. 

7 (5) EXCLUSION OF PEER SUPPORT SPECIALIST

8 SERVICES FROM SKILLED NURSING FACILITY PRO9 SPECTIVE PAYMENT SYSTEM.—Section 

10 1888(e)(2)(A)(ii) of the Social Security Act (42 

11 U.S.C. 1395yy(e)(2)(A)(ii)) is amended by inserting 

12 ‘‘peer support specialist services (as defined in sec13 tion 1861(qqq)(3)),’’ after ‘‘mental health counselor 

14 services (as defined in section 1861(lll)(3))’’. 

15 (6) INCLUSION OF SUBSTANCE USE DISORDER

16 COUNSELORS AS PRACTITIONERS FOR ASSIGNMENT

17 OF CLAIMS.—Section 1842(b)(18)(C) of the Social 

18 Security Act (42 U.S.C. 1395u(b)(18)(C)) is amend19 ed by adding at the end the following new clauses: 

20 ‘‘(ix) A substance use disorder counselor (as de21 fined in section 1861(qqq)(2)). 

22 ‘‘(x) A peer support specialist (as defined in 

23 section 1861(qqq)(4)).’’. 

24 (b) COVERAGE OF CERTAIN MENTAL HEALTH SERV25 ICES PROVIDED IN RURAL HEALTH CLINICS AND FEDERVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 00962 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 ALLY QUALIFIED HEALTH CENTERS.—Section 

2 1861(aa)(1)(B) of the Social Security Act (42 U.S.C. 

3 1395x(aa)(1)(B)) is amended by striking ‘‘or by a mental 

4 health counselor (as defined in subsection (lll)(4))’’ and 

5 inserting ‘‘by a mental health counselor (as defined in sub6 section (lll)(4)), by a substance use disorder counselor (as 

7 defined in subsection (qqq)(2)), or by a peer support spe8 cialist (as defined in subsection (qqq)(4))’’. 

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

10 this section shall apply with respect to services furnished 

11 on or after January 1, 2025. 

12 SEC. 6102. REAUTHORIZATION OF MINORITY FELLOWSHIP 

13 PROGRAM. 

14 Section 597(c) of the Public Health Service Act (42 

15 U.S.C. 290ll(c)) is amended by striking ‘‘$25,000,000 for 

16 each of fiscal years 2023 through 2027’’ and inserting 

17 ‘‘$36,700,000 for each of fiscal years 2025 through 

18 2029’’. 

19 SEC. 6103. ADDITIONAL FUNDS FOR NATIONAL INSTITUTES 

20 OF HEALTH. 

21 (a) IN GENERAL.—In addition to amounts otherwise 

22 authorized to be appropriated to the National Institutes 

23 of Health, there is authorized to be appropriated to such 

24 Institutes $150,000,000 for each of fiscal years 2025 

25 through 2030— 


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1 (1) to build relations with communities and 

2 conduct or support clinical research, including clin3 ical research on racial or ethnic disparities in phys4 ical and mental health; and 

5 (2) to carry out the Strategic Framework For 

6 Addressing Youth Mental Health Disparities devel7 oped by the National Institute of Mental Health. 

8 (b) DEFINITION.—In this section, the term ‘‘clinical 

9 research’’ has the meaning given to such term in section 

10 409 of the Public Health Service Act (42 U.S.C. 284d). 

11 SEC. 6104. ADDITIONAL FUNDS FOR NATIONAL INSTITUTE 

12 ON MINORITY HEALTH AND HEALTH DISPARI13 TIES. 

14 In addition to amounts otherwise authorized to be ap15 propriated to the National Institute on Minority Health 

16 and Health Disparities, there is authorized to be appro17 priated to such Institute $750,000,000 for each of fiscal 

18 years 2025 through 2030. 

19 SEC. 6105. GRANTS FOR INCREASING RACIAL AND ETHNIC 

20 MINORITY ACCESS TO HIGH-QUALITY TRAU21 MA SUPPORT SERVICES AND MENTAL 

22 HEALTH CARE. 

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

24 Human Services (in this section referred to as the ‘‘Sec25 retary’’), acting through the Assistant Secretary for MenVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 00964 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 tal Health and Substance Use, shall award grants to eligi2 ble entities to establish or expand programs for the pur3 pose of increasing racial and ethnic minority access to 

4 high-quality trauma support services and mental health 

5 care. 

6 (b) ELIGIBLE ENTITIES.—To seek a grant under this 

7 section, an entity shall be a community-based program or 

8 organization that— 

9 (1) provides culturally and linguistically appro10 priate programs and resources that are aligned with 

11 evidence-based practices for trauma-informed care; 

12 and 

13 (2) has demonstrated expertise in serving com14 munities of color or can partner with a program that 

15 has such demonstrated expertise. 

16 (c) USE OF FUNDS.—As a condition on receipt of a 

17 grant under this section, a grantee shall agree to use the 

18 grant to increase racial and ethnic minority access to high19 quality trauma support services and mental health care, 

20 such as by— 

21 (1) establishing and maintaining community22 based programs providing evidence-based services in 

23 trauma-informed care and culturally specific services 

24 and other resources; 


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1 (2) developing innovative, culturally specific 

2 strategies and projects to enhance access to trauma3 informed care and resources for racial and ethnic 

4 minorities who face obstacles to using more tradi5 tional services and resources (such as obstacles in 

6 geographic access to providers, insurance coverage, 

7 and access to audio and video technologies); 

8 (3) working with State and local governments 

9 and social service agencies to develop and enhance 

10 effective strategies to provide culturally specific serv11 ices to racial and ethnic minorities; 

12 (4) increasing communities’ capacity to provide 

13 culturally specific resources and support for commu14 nities of color; 

15 (5) working in cooperation with the community 

16 to develop education and prevention strategies high17 lighting culturally specific issues and resources re18 garding racial and ethnic minorities; 

19 (6) providing culturally specific programs for 

20 racial and ethnic minorities exposed to law enforce21 ment violence; and 

22 (7) examining the dynamics of culture and its 

23 impact on victimization and healing. 

24 (d) PRIORITY.—In awarding grants under this sec25 tion, the Secretary shall give priority to eligible entities 


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1 proposing to serve communities that have faced high rates 

2 of community trauma, including from exposure to law en3 forcement violence, intergenerational poverty, civil unrest, 

4 discrimination, or oppression. 

5 (e) GRANT PERIOD.—The period of a grant under 

6 this section shall be 4 years. 

7 (f) EVALUATION.—Not later than 6 months after the 

8 end of the period of all grants under this section, the Sec9 retary shall— 

10 (1) conduct an evaluation of the programs 

11 funded by a grant under this section; 

12 (2) include in such evaluation an assessment of 

13 the outcomes of each such program; and 

14 (3) submit a report on the results of such eval15 uation to the Congress. 

16 (g) AUTHORIZATION OF APPROPRIATIONS.—To carry 

17 out this section, there is authorized to be appropriated 

18 $20,000,000 for each of fiscal years 2025 through 2029. 

19 Subtitle B—Interprofessional Care 

20 SEC. 6201. HEALTH PROFESSIONS COMPETENCIES TO AD21 DRESS RACIAL AND ETHNIC MENTAL HEALTH 

22 INEQUITIES. 

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

24 Human Services, acting through the Assistant Secretary 


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1 for Mental Health and Substance Use, shall award grants 

2 to qualified national organizations for the purposes of— 

3 (1) developing, and disseminating to health pro4 fessional educational programs, culturally and lin5 guistically appropriate curricula or core com6 petencies addressing mental health inequities among 

7 racial and ethnic minority groups for use in the 

8 training of students in the professions of social 

9 work, psychology, psychiatry, marriage and family 

10 therapy, mental health counseling, peer support, and 

11 substance use disorder counseling; and 

12 (2) certifying community health workers and 

13 peer wellness specialists with respect to such cur14 ricula and core competencies and integrating and ex15 panding the use of such workers and specialists into 

16 health care and community-based settings to address 

17 mental health inequities among racial and ethnic mi18 nority groups. 

19 (b) CURRICULA; CORE COMPETENCIES.—Organiza20 tions receiving funds under subsection (a) may use the 

21 funds to engage in the following activities related to the 

22 development and dissemination of curricula or core com23 petencies described in subsection (a)(1): 

24 (1) Formation of committees or working groups 

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1 sions schools to identify core competencies relating 

2 to mental health inequities among racial and ethnic 

3 minority groups. 

4 (2) Planning of workshops in collaboration with 

5 community-based organizations and communities of 

6 color in national fora to directly facilitate public 

7 input, including input from communities of color 

8 with lived experience, into the educational needs as9 sociated with mental health inequities among racial 

10 and ethnic minority groups. 

11 (3) Dissemination and promotion of the use of 

12 curricula or core competencies in undergraduate and 

13 graduate health professions training programs na14 tionwide. 

15 (4) Establishing external stakeholder advisory 

16 boards to provide meaningful input into policy and 

17 program development and best practices to reduce 

18 mental health inequities among racial and ethnic 

19 groups, including participation and leadership from 

20 communities of color with lived experience of the im21 pacts of mental health inequities. 

22 (c) DEFINITIONS.—In this section: 

23 (1) QUALIFIED NATIONAL ORGANIZATION.—The 

24 term ‘‘qualified national organization’’ means a na25 tional organization that focuses on the education of 


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1 students in programs of social work, occupational 

2 therapy, psychology, psychiatry, substance use coun3 seling, and marriage and family therapy. 

4 (2) RACIAL AND ETHNIC MINORITY GROUP.— 

5 The term ‘‘racial and ethnic minority group’’ has the 

6 meaning given to such term in section 1707(g) of 

7 the Public Health Service Act (42 U.S.C. 300u– 

8 6(g)). 

9 (d) 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 2025 through 2029. 

13 SEC. 6202. INTERPROFESSIONAL HEALTH CARE TEAMS FOR 

14 BEHAVIORAL HEALTH CARE. 

15 Part D of title V of the Public Health Service Act 

16 (42 U.S.C. 290dd et seq.) is amended by adding at the 

17 end the following: 

18 ‘‘SEC. 553. INTERPROFESSIONAL HEALTH CARE TEAMS FOR 

19 PROVISION OF BEHAVIORAL HEALTH CARE 

20 IN PRIMARY CARE SETTINGS. 

21 ‘‘(a) GRANTS.—The Secretary, acting through the 

22 Assistant Secretary, shall award grants to eligible entities 

23 for the purpose of establishing interprofessional health 

24 care teams that provide behavioral health care. 


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1 ‘‘(b) ELIGIBLE ENTITIES.—To be eligible to receive 

2 a grant under this section, an entity shall be a Federally 

3 qualified health center (as defined in section 1861(aa) of 

4 the Social Security Act), rural health clinic, women’s 

5 health clinic, or behavioral health program (including any 

6 such program operated by a community-based organiza7 tion) serving a high proportion of individuals from racial 

8 and ethnic minority groups (as defined in section 

9 1707(g)). 

10 ‘‘(c) LOAN FORGIVENESS.—To encourage qualified 

11 and diverse allied health professionals to enter the mental 

12 health field, an eligible entity receiving a grant under this 

13 section shall agree to use not less than $10,000 of the 

14 grant funds on a loan forgiveness program for practi15 tioners who commit to working in the mental health field 

16 for a period of 2 years. 

17 ‘‘(d) SCIENTIFICALLY AND CULTURALLY BASED.— 

18 Integrated health care funded through this section shall 

19 be scientifically and culturally based, taking into consider20 ation the results of the most recent peer-reviewed research 

21 available, including information on language accessibility, 

22 cultural humility, diversity of practitioners, and consider23 ation of social determinants of health. 

24 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—To 

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1 priated $20,000,000 for each of fiscal years 2025 through 

2 2029.’’. 

3 SEC. 6203. INTEGRATED HEALTH CARE DEMONSTRATION 

4 PROGRAM. 

5 Part D of title V of the Public Health Service Act 

6 (42 U.S.C. 290dd et seq.), as amended by section 6202, 

7 is amended by adding at the end the following: 

8 ‘‘SEC. 554. INTERPROFESSIONAL HEALTH CARE TEAMS FOR 

9 PROVISION OF BEHAVIORAL HEALTH CARE 

10 IN PRIMARY CARE SETTINGS. 

11 ‘‘(a) GRANTS.—The Secretary shall award grants to 

12 eligible entities for the purpose of establishing interprofes13 sional health care teams that provide behavioral health 

14 care. 

15 ‘‘(b) ELIGIBLE ENTITIES.—To be eligible to receive 

16 a grant under this section, an entity shall be a Federally 

17 qualified health center (as defined in section 1861(aa) of 

18 the Social Security Act), rural health clinic, or behavioral 

19 health program, serving a high proportion of individuals 

20 from racial and ethnic minority groups (as defined in sec21 tion 1707(g)). 

22 ‘‘(c) SCIENTIFICALLY BASED.—Integrated health 

23 care funded through this section shall be scientifically 

24 based, taking into consideration the results of the most 

25 recent peer-reviewed research available. 


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1 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—To 

2 carry out this section, there is authorized to be appro3 priated $20,000,000 for each of the first 5 fiscal years 

4 following the date of enactment of the Health Equity and 

5 Accountability Act 2024.’’. 

6 Subtitle C—Workforce 

7 Development 

8 SEC. 6301. BUILDING AN EFFECTIVE WORKFORCE IN MEN9 TAL HEALTH. 

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

11 Human Services, in coordination with the Assistant Sec12 retary for Mental Health and Substance Use, the Adminis13 trator of the Health Resources and Services Administra14 tion, the Secretary of Labor, and advocacy and behavioral 

15 and mental health organizations serving vulnerable popu16 lations, including youth and young adults, people with low 

17 incomes, and people of color, shall— 

18 (1) develop, strengthen, and implement strate19 gies to bolster career pathways for diverse mental 

20 health professionals; 

21 (2) identify the breadth of settings where men22 tal health care and behavioral health care can take 

23 place; and 


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1 (3) identify current mental health professional 

2 workforce shortages, inclusive of shortages of diverse 

3 mental health professionals. 

4 (b) CONTENTS.—Strategies under subsection (a) 

5 shall include— 

6 (1) the variety of settings where mental health 

7 professionals are needed, including community-based 

8 organizations, women’s centers, shelters, organiza9 tions focused on youth development, workforce agen10 cies, job placement and development centers, emer11 gency rooms, the special supplemental nutrition pro12 gram for women, infants, and children under section 

13 17 of the Child Nutrition Act of 1966 (42 U.S.C. 

14 1786), food banks, legal aid, and benefit issuers (as 

15 defined in section 3 of the Food and Nutrition Act 

16 of 2008 (7 U.S.C. 2012)); 

17 (2) defining career pathways in mental and be18 havioral health, to help diverse communities under19 stand the variety of careers in mental and behavioral 

20 health that are available; 

21 (3) building career pathways in mental and be22 havioral health as part of the curriculum at the 

23 postsecondary education level; 

24 (4) providing accessible training and certifi25 cation pathways for diverse lay health workers such 


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1 as community health workers and other peer support 

2 specialists to ensure that careers pay a living wage; 

3 (5) creating incentives for students in the fields 

4 of occupational therapy, social work, psychology, 

5 medicine, and nursing to learn more about mental 

6 health, and to include a mental health rotation, with 

7 a particular focus in racially and ethnically diverse 

8 communities, as a part of the health professional 

9 curricula; 

10 (6) including training and education for teach11 ers about the basics of section 504 of the Rehabilita12 tion Act of 1973 (29 U.S.C. 794) and individualized 

13 education programs (as defined in section 614(d) of 

14 the Individuals with Disabilities Education Act (20 

15 U.S.C. 1414(d))); 

16 (7) researching, developing, and implementing 

17 programs for mental and behavioral health profes18 sionals to prevent burnout; and 

19 (8) finding better and increased avenues to en20 sure equity by providing better loan forgiveness pro21 grams, including a focus area within the National 

22 Health Service Corps focused on community trauma. 

23 (c) USE OF FUNDS.—Programs and activities funded 

24 under this section shall be consistent with subsection 

25 (a)(1) and shall include the following: 


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1 (1) Subgrants to entities serving youth and 

2 young adults which demonstrate a need for an in3 creased mental health workforce, using strategies de4 scribed in subsection (a)(1). 

5 (2) Funding towards the Health Resources and 

6 Services Administration’s Behavioral Health Work7 force Education and Training Program. 

8 (3) Funding towards the development and im9 plementation of a National Health Service Corps 

10 program focused on community trauma. 

11 (d) AUTHORIZATION OF APPROPRIATIONS.—There 

12 are authorized to be appropriated to carry out this section 

13 $50,000,000 for each of fiscal years 2025 through 2035. 

14 SEC. 6302. DEMONSTRATION PROGRAM TO INCREASE LAN15 GUAGE ACCESS AT ELIGIBLE HEALTH CEN16 TERS. 

17 (a) GRANTS.—The Secretary shall carry out a dem18 onstration program consisting of awarding grants to eligi19 ble health centers to recruit, hire, employ, and supervise 

20 qualified behavioral health professionals who— 

21 (1) are proficient in speaking and under22 standing both spoken English and at least one other 

23 spoken language, including any necessary specialized 

24 vocabulary, terminology, and phraseology; 


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1 (2) are able to effectively, accurately, and im2 partially communicate directly with limited English 

3 proficient individuals in their primary language; and 

4 (3) are, or will be, employed— 

5 (A) directly by the eligible health center; or 

6 (B) through a contract between the eligible 

7 health center and the qualified behavioral 

8 health professional under which such profes9 sional provides services as part of the eligible 

10 health center’s workforce or under supervision 

11 by the health center, in order to provide behav12 ioral health services in another language. 

13 (b) PREFERENCE.—In selecting grant recipients 

14 under subsection (a), the Secretary shall give preference 

15 to eligible health centers at which at least 10 percent of 

16 the patients are best served in a language other than 

17 English, as indicated by data in the Uniform Data System 

18 of the Health Resources and Services Administration (or 

19 any successor database). 

20 (c) OUTREACH.—An eligible health center receiving 

21 a grant under this section shall use a portion of the grant 

22 funds to disseminate information about the behavioral 

23 health services supported through the grant. 

24 (d) REPORTS.— 


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1 (1) INITIAL REPORT.—Not later than 6 months 

2 after the first grants are awarded under subsection 

3 (a), the Secretary shall submit to the Committee on 

4 Appropriations and the Committee on Energy and 

5 Commerce of the House of Representatives, the 

6 Committee on Appropriations and the Committee on 

7 Health, Education, Labor, and Pensions of the Sen8 ate, and other appropriate congressional committees, 

9 a report on the implementation of the program 

10 under this section. Such report shall include— 

11 (A) the languages spoken by the qualified 

12 behavioral health professionals recruited pursu13 ant to a grant under subsection (a); 

14 (B) the eligible health center at which each 

15 such professional was placed; 

16 (C) how many eligible health centers re17 ceived grants under subsection (a); 

18 (D) an analysis, conducted in consultation 

19 with the eligible health centers receiving grants 

20 under subsection (a), of the effectiveness of 

21 such grants at increasing language access to be22 havioral health services; and 

23 (E) best practices, developed in consulta24 tion with eligible health centers receiving grants 

25 under subsection (a), for the recruitment and 


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1 retention of qualified behavioral health profes2 sionals at such health centers. 

3 (2) FINAL REPORT.—Not later than the end of 

4 fiscal year 2026, the Secretary shall submit to the 

5 Committee on Appropriations and the Committee on 

6 Energy and Commerce of the House of Representa7 tives, the Committee on Appropriations and the 

8 Committee on Health, Education, Labor, and Pen9 sions of the Senate, and other appropriate congres10 sional committees, a final report on the implementa11 tion of the program under this section, including the 

12 information, analysis, and best practices described in 

13 subparagraphs (A) through (E) of paragraph (1). 

14 (e) DEFINITIONS.—In this section: 

15 (1) The term ‘‘eligible health center’’ means a 

16 health center (as defined in section 330 of the Pub17 lic Health Service Act (42 U.S.C. 254b)) that is al18 ready receiving assistance pursuant to one or more 

19 grants under such section 330 at the time of the 

20 award to such health center of a supplemental grant 

21 under subsection (a). 

22 (2) The term ‘‘qualified behavioral health pro23 fessional’’ means— 

24 (A) a behavioral and mental health profes25 sional (as defined in section 331(a)(3)(E)(i) of 


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1 the Public Health Service Act (42 U.S.C. 

2 254d(a)(3)(E)(i))); 

3 (B) a substance use disorder counselor; 

4 (C) an occupational therapist; or 

5 (D) an individual who— 

6 (i) has not yet been licensed or cer7 tified to serve as a professional listed in 

8 any of subparagraphs (A) through (C); 

9 and 

10 (ii) will serve at the eligible health 

11 center under the supervision of a licensed 

12 individual or certified professional so list13 ed. 

14 (3) The term ‘‘Secretary’’ means the Secretary 

15 of Health and Human Services. 

16 (f) FUNDING.—Subject to the availability of appro17 priations, out of amounts otherwise appropriated under 

18 section 760(g) of the Public Health Service Act (42 U.S.C. 

19 294k(g)), the Secretary is authorized to use up to 

20 $10,000,000 for each of fiscal years 2025 through 2030 

21 to carry out this section. 


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1 SEC. 6303. HEALTH PROFESSIONS COMPETENCIES TO AD2 DRESS RACIAL AND ETHNIC MINORITY MEN3 TAL HEALTH DISPARITIES. 

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

5 Human Services may award grants to qualified national 

6 organizations for the purposes of— 

7 (1) developing, and disseminating to health pro8 fessional educational programs, best practices or 

9 core competencies addressing mental health dispari10 ties among racial and ethnic minority groups for use 

11 in the training of students in the professions of so12 cial work, psychology, psychiatry, marriage and fam13 ily therapy, mental health counseling, and substance 

14 use disorder counseling; and 

15 (2) certifying community health workers and 

16 peer wellness specialists with respect to such best 

17 practices and core competencies and integrating and 

18 expanding the use of such workers and specialists 

19 into health care to address mental health disparities 

20 among racial and ethnic minority groups. 

21 (b) BEST PRACTICES; CORE COMPETENCIES.—Orga22 nizations receiving funds under subsection (a) may use the 

23 funds to engage in the following activities related to the 

24 development and dissemination of best practices or core 

25 competencies described in subsection (a)(1): 


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1 (1) Formation of committees or working groups 

2 composed of experts from accredited health profes3 sions schools to identify best practices and core com4 petencies relating to mental health disparities among 

5 racial and ethnic minority groups. 

6 (2) Planning of workshops at the national level 

7 to allow for public input into the educational needs 

8 associated with mental health disparities among ra9 cial and ethnic minority groups. 

10 (3) Dissemination and promotion of the use of 

11 best practices or core competencies for culturally 

12 and linguistically appropriate mental health services 

13 in undergraduate and graduate health professions 

14 training programs nationwide. 

15 (4) Establishing external stakeholder advisory 

16 boards to provide meaningful input into policy and 

17 program development and best practices to reduce 

18 mental health disparities among racial and ethnic 

19 minority groups. 

20 (c) DEFINITIONS.—In this section: 

21 (1) QUALIFIED NATIONAL ORGANIZATION.—The 

22 term ‘‘qualified national organization’’ means a na23 tional organization that focuses on the education of 

24 students in one or more of the professions of social 

25 work, psychology, psychiatry, marriage and family 


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1 therapy, mental health counseling, and substance 

2 misuse counseling. 

3 (2) RACIAL AND ETHNIC MINORITY GROUP.— 

4 The term ‘‘racial and ethnic minority group’’ has the 

5 meaning given to such term in section 1707(g) of 

6 the Public Health Service Act (42 U.S.C. 300u– 

7 6(g)). 

8 Subtitle D—Children’s Mental 

9 Health 

10 SEC. 6401. GRANT PROGRAMS TO SUPPORT PEDIATRIC BE11 HAVIORAL HEALTH CARE. 

12 Part D of title III of the Public Health Service Act 

13 (42 U.S.C. 254b et seq.) is amended by inserting after 

14 subpart V the following new subpart: 

15 ‘‘Subpart VI—Pediatric Behavioral Health Programs 

16 ‘‘SEC. 340A–1. PROGRAM TO IMPROVE ACCESS TO COMMU17 NITY-BASED PEDIATRIC BEHAVIORAL 

18 HEALTH CARE. 

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

20 the Administrator of the Health Resources and Services 

21 Administration, shall award grants, contracts, or coopera22 tive agreements to eligible entities for the purpose of sup23 porting pediatric behavioral health care integration and 

24 coordination within communities to meet local community 

25 needs. 


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1 ‘‘(b) ELIGIBLE ENTITIES.—Entities eligible for 

2 grants under subsection (a) include— 

3 ‘‘(1) health care providers, including family 

4 physicians, pediatric medical sub-specialists, and 

5 surgical specialists; 

6 ‘‘(2) children’s hospitals; 

7 ‘‘(3) facilities that are eligible to receive funds 

8 under section 340E or 340H; 

9 ‘‘(4) nonprofit medical facilities that predomi10 nantly treat individuals under the age of 21; 

11 ‘‘(5) rural health clinics and Federally qualified 

12 health centers (as such terms are defined in section 

13 1861(aa) of the Social Security Act); 

14 ‘‘(6) pediatric mental health and substance use 

15 disorder providers, such as child and adolescent psy16 chiatrists, psychologists, developmental and behav17 ioral pediatricians, general pediatricians, advanced 

18 practice nurses, social workers, licensed professional 

19 counselors, and other licensed professionals that pro20 vide mental health and substance use disorder serv21 ices to patients under 21 years of age; 

22 ‘‘(7) children’s advocacy centers described in 

23 section 214(c)(2)(B) of the Victims of Child Abuse 

24 Act of 1990; 

25 ‘‘(8) school-based health centers; and 


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1 ‘‘(9) other entities as determined appropriate by 

2 the Secretary. 

3 ‘‘(c) PRIORITIZATION.—In making awards under sub4 section (a), the Secretary shall prioritize— 

5 ‘‘(1) applicants that provide children and ado6 lescents from high-need, rural, or under-resourced 

7 communities with services across the continuum of 

8 children’s mental health and substance use disorder 

9 care; and 

10 ‘‘(2) applicants that predominantly provide care 

11 to children and adolescents that demonstrate plans 

12 to utilize funds to expand provision of care to chil13 dren, adolescents, and youth under age 21. 

14 ‘‘(d) USE OF FUNDS.—Activities that may be funded 

15 through an award under subsection (a) include— 

16 ‘‘(1) increasing the capacity of pediatric prac17 tices, family medicine practices, and school-based 

18 health centers to integrate pediatric mental, emo19 tional, and behavioral health services into their prac20 tices including through co-location of mental, emo21 tional, and behavioral health providers; 

22 ‘‘(2) training for non-clinical pediatric health 

23 care workers, including care coordinators and navi24 gators, on child and adolescent mental health and 


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1 substance use disorder, trauma-informed care, and 

2 local resources to support children and caregivers; 

3 ‘‘(3) expanding evidence-based, integrated mod4 els of care for pediatric mental health and substance 

5 use disorder services; 

6 ‘‘(4) pediatric practice integration for the provi7 sion of pediatric mental health and substance use 

8 disorder services; 

9 ‘‘(5) addressing surge capacity for pediatric 

10 mental health and substance use disorder needs; 

11 ‘‘(6) providing pediatric mental, emotional, and 

12 behavioral health services to children as delivered by 

13 mental health and substance use disorder profes14 sionals utilizing telehealth services; 

15 ‘‘(7) establishing or maintaining initiatives to 

16 allow more children to access care outside of emer17 gency departments, including partial hospitalization, 

18 step down residency programs, and intensive out19 patient programs; 

20 ‘‘(8) supporting, enhancing, or expanding pedi21 atric mental health and substance use disorder pre22 ventive and crisis intervention services; 

23 ‘‘(9) establishing or maintaining pediatric men24 tal health and substance use disorder urgent care or 

25 walk-in clinics; 


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1 ‘‘(10) establishing or maintaining community2 based pediatric mental health and substance use dis3 order initiatives, such as partnerships with schools 

4 and early childhood education programs; 

5 ‘‘(11) addressing other access and coordination 

6 gaps to pediatric mental health and substance use 

7 disorder services in the community for children; and 

8 ‘‘(12) supporting the collection of data on chil9 dren and adolescents’ mental health needs, service 

10 utilization and availability, and demographic data, to 

11 capture community needs and identify gaps and bar12 riers in children’s access to care, in a manner that 

13 protects personal privacy, consistent with applicable 

14 Federal and State privacy laws. 

15 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—To 

16 carry out this section, there is authorized to be appro17 priated such sums as may be necessary for each of fiscal 

18 years 2025 through 2029. 

19 ‘‘SEC. 340A–2. PEDIATRIC BEHAVIORAL HEALTH WORK20 FORCE TRAINING PROGRAM. 

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

22 the Administrator of the Health Resources and Services 

23 Administration, shall award grants, contracts, or coopera24 tive agreements to eligible entities for the purpose of supVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 00987 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 porting evidence-based pediatric mental health and sub2 stance use disorder workforce training. 

3 ‘‘(b) ELIGIBLE ENTITIES.—Entities eligible for 

4 grants under subsection (a) include— 

5 ‘‘(1) children’s hospitals; 

6 ‘‘(2) facilities that are eligible to receive funds 

7 under section 340E or 340H; 

8 ‘‘(3) nonprofit medical facilities that predomi9 nantly treat individuals under the age of 21; 

10 ‘‘(4) rural health clinics and Federally qualified 

11 health centers (as such terms are defined in section 

12 1861(aa) of the Social Security Act); 

13 ‘‘(5) entities that employ mental health and 

14 substance use disorder professionals, such as child 

15 and adolescent psychiatrists, psychologists, develop16 mental and behavioral pediatricians, general pedia17 tricians, advanced practice nurses, social workers, li18 censed professional counselors, or other licensed pro19 fessionals that provide mental health or substance 

20 use disorder services to patients under 21 years of 

21 age; and 

22 ‘‘(6) other pediatric health care providers as de23 termined appropriate by the Secretary. 


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1 ‘‘(c) USE OF FUNDS.—Activities that may be sup2 ported through an award under subsection (a) include the 

3 following: 

4 ‘‘(1) Training to enhance the capabilities of the 

5 existing pediatric workforce, including pediatricians, 

6 primary care physicians, advanced practice reg7 istered nurses, and other pediatric health care pro8 viders, including expanded training in pediatric men9 tal health and substance use disorders, and cul10 turally and developmentally appropriate care for 

11 children with mental health conditions. 

12 ‘‘(2) Training to support multi-disciplinary 

13 teams to provide pediatric mental health and sub14 stance use disorder treatment, including through in15 tegrated care models. 

16 ‘‘(3) Initiatives to accelerate the time to licen17 sure within the pediatric mental health or substance 

18 use disorder workforce. 

19 ‘‘(4) Activities to expand recruitment and reten20 tion, increase workforce diversity, or enhance work21 force training for critical pediatric mental health 

22 professions, including— 

23 ‘‘(A) child and adolescent psychiatrists; 

24 ‘‘(B) psychiatric nurses; 

25 ‘‘(C) psychologists; 


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1 ‘‘(D) family therapists; 

2 ‘‘(E) social workers; 

3 ‘‘(F) mental health counselors; 

4 ‘‘(G) developmental and behavioral pedia5 tricians; 

6 ‘‘(H) pediatric substance use disorder spe7 cialists; and 

8 ‘‘(I) other mental health care providers as 

9 determined appropriate by the Secretary. 

10 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—To 

11 carry out this section, there is authorized to be appro12 priated such sums as may be necessary for each of fiscal 

13 years 2025 through 2029.’’. 

14 SEC. 6402. INCREASING FEDERAL INVESTMENT IN PEDI15 ATRIC BEHAVIORAL HEALTH SERVICES. 

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

17 seq.) (as amended by section 2004) is amended by adding 

18 at the end the following: 


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1 ‘‘TITLE XXXV—ASSISTANCE FOR 

2 CONSTRUCTION AND MOD3 ERNIZATION OF CHILDREN’S 

4 MENTAL HEALTH AND SUB5 STANCE USE DISORDER IN6 FRASTRUCTURE 

7 ‘‘SEC. 3501. INCREASING FEDERAL INVESTMENT IN PEDI8 ATRIC BEHAVIORAL HEALTH SERVICES. 

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

10 the Administrator of the Health Resources and Services 

11 Administration, shall award grants, contracts, or coopera12 tive agreements to eligible entities for the purpose of im13 proving their ability to provide pediatric behavioral health 

14 services, including by— 

15 ‘‘(1) constructing or modernizing sites of care 

16 for pediatric behavioral health services; 

17 ‘‘(2) expanding capacity to provide pediatric be18 havioral health services, including enhancements to 

19 digital infrastructure, telehealth capabilities, or other 

20 improvements to patient care infrastructure; 

21 ‘‘(3) supporting the reallocation of existing re22 sources to accommodate pediatric behavioral health 

23 patients, including by converting or adding a suffi24 cient number of beds to establish or increase the 

25 hospital’s inventory of licensed and operational, 


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1 short-term psychiatric and substance use inpatient 

2 beds; and 

3 ‘‘(4) addressing gaps in the continuum of care 

4 for children, by expanding capacity to provide inter5 mediate levels of care, such as intensive outpatient 

6 services, partial hospitalization programs, and day 

7 programs that can prevent hospitalizations and sup8 port children as they transition back to their homes 

9 and communities. 

10 ‘‘(b) ELIGIBILITY.—To be eligible to seek an award 

11 under this section, an entity shall be a hospital or rural 

12 health clinic that predominantly treats individuals under 

13 the age of 21, including any hospital that receives funds 

14 under section 340E. 

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

16 carry out this section, there is authorized to be appro17 priated such sums as may be necessary for each of fiscal 

18 years 2025 through 2029. 

19 ‘‘(d) SUPPLEMENT, NOT SUPPLANT.—Funds pro20 vided under this section shall be used to supplement, not 

21 supplant Federal and non-Federal funds available for car22 rying out the activities described in this section. 

23 ‘‘(e) REPORTING.— 

24 ‘‘(1) REPORTS FROM AWARD RECIPIENTS.—Not 

25 later than 180 days after the completion of activities 


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1 funded by an award under this section, the entity 

2 that received such award shall submit a report to 

3 the Secretary on the activities conducted using funds 

4 from such award, and other information as the Sec5 retary may require. 

6 ‘‘(2) REPORTS TO CONGRESS.—Not later than 

7 one year after the completion of activities funded by 

8 an award under this section, the Secretary shall sub9 mit to the Committee on Energy and Commerce of 

10 the House of Representatives and the Committee on 

11 Health, Education, Labor, and Pensions of the Sen12 ate a report on the projects and activities conducted 

13 with funds awarded under this section, and the out14 come of such projects and activities. Such report 

15 shall include— 

16 ‘‘(A) the number of projects supported by 

17 awards made under this section; 

18 ‘‘(B) an overview of the impact, if any, of 

19 such projects on pediatric health care infra20 structure, including any impact on access to pe21 diatric mental health and substance use dis22 order services; 

23 ‘‘(C) recommendations for improving the 

24 investment program under this section; and 


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1 ‘‘(D) any other considerations as the Sec2 retary determines appropriate.’’. 

3 SEC. 6403. MENTAL HEALTH IN SCHOOLS. 

4 (a) TECHNICAL AMENDMENTS.—The second part G 

5 (relating to services provided through religious organiza6 tions) of title V of the Public Health Service Act (42 

7 U.S.C. 290kk et seq.) is amended— 

8 (1) by redesignating such part as part J; and 

9 (2) by redesignating sections 581 through 584 

10 as sections 596 through 596C, respectively. 

11 (b) SCHOOL-BASED MENTAL HEALTH AND CHIL12 DREN.—Section 581 of the Public Health Service Act (42 

13 U.S.C. 290hh) (relating to children and violence) is 

14 amended to read as follows: 

15 ‘‘SEC. 581. SCHOOL-BASED MENTAL HEALTH; CHILDREN 

16 AND ADOLESCENTS. 

17 ‘‘(a) IN GENERAL.—The Secretary, in consultation 

18 with the Secretary of Education, shall, through grants, 

19 contracts, or cooperative agreements awarded to eligible 

20 entities described in subsection (c), provide comprehensive 

21 school-based mental health services and supports to assist 

22 children in local communities and schools (including 

23 schools funded by the Bureau of Indian Education) deal24 ing with traumatic experiences, grief, bereavement, risk of 


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1 suicide, and violence. Such services and supports shall 

2 be— 

3 ‘‘(1) developmentally, linguistically, and cul4 turally appropriate; 

5 ‘‘(2) trauma-informed; and 

6 ‘‘(3) incorporate positive behavioral interven7 tions and supports. 

8 ‘‘(b) ACTIVITIES.—Grants, contracts, or cooperative 

9 agreements awarded under subsection (a), shall, as appro10 priate, be used for— 

11 ‘‘(1) implementation of school- and community12 based mental health programs that— 

13 ‘‘(A) build awareness of individual trauma 

14 and the intergenerational, continuum of impacts 

15 of trauma on populations; 

16 ‘‘(B) train appropriate staff to identify, 

17 and screen for, signs of trauma exposure, men18 tal health disorders, or risk of suicide; and 

19 ‘‘(C) incorporate positive behavioral inter20 ventions, family engagement, student treatment, 

21 and multigenerational supports to foster the 

22 health and development of children, prevent 

23 mental health disorders, and ameliorate the im24 pact of trauma; 


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1 ‘‘(2) technical assistance to local communities 

2 with respect to the development of programs de3 scribed in paragraph (1); 

4 ‘‘(3) facilitating community partnerships among 

5 families, students, law enforcement agencies, edu6 cation agencies, mental health and substance use 

7 disorder service systems, family-based mental health 

8 service systems, child welfare agencies, health care 

9 providers (including primary care physicians, mental 

10 health professionals, and other professionals who 

11 specialize in children’s mental health such as child 

12 and adolescent psychiatrists), institutions of higher 

13 education, faith-based programs, trauma networks, 

14 and other community-based systems to address child 

15 and adolescent trauma, mental health issues, and vi16 olence; and 

17 ‘‘(4) establishing mechanisms for children and 

18 adolescents to report incidents of violence or plans 

19 by other children, adolescents, or adults to commit 

20 violence. 

21 ‘‘(c) REQUIREMENTS.— 

22 ‘‘(1) IN GENERAL.—To be eligible for a grant, 

23 contract, or cooperative agreement under subsection 

24 (a), an entity shall be a partnership that includes— 


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1 ‘‘(A) a State educational agency, as de2 fined in section 8101 of the Elementary and 

3 Secondary Education Act of 1965, in coordina4 tion with one or more local educational agen5 cies, as defined in section 8101 of the Elemen6 tary and Secondary Education Act of 1965, or 

7 a consortium of any entities described in sub8 paragraph (B), (C), (D), or (E) of section 

9 8101(30) of such Act; and 

10 ‘‘(B) at least 1 community-based mental 

11 health provider, including a public or private 

12 mental health entity, health care entity, family13 based mental health entity, trauma network, or 

14 other community-based entity, as determined by 

15 the Secretary (and which may include addi16 tional entities such as a human services agency, 

17 law enforcement or juvenile justice entity, child 

18 welfare agency, agency, an institution of higher 

19 education, or another entity, as determined by 

20 the Secretary). 

21 ‘‘(2) COMPLIANCE WITH HIPAA.—Any patient 

22 records developed by covered entities through activi23 ties under the grant shall meet the regulations pro24 mulgated under section 264(c) of the Health Insur25 ance Portability and Accountability Act of 1996. 


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1 ‘‘(3) COMPLIANCE WITH FERPA.—Section 444 

2 of the General Education Provisions Act (commonly 

3 known as the ‘Family Educational Rights and Pri4 vacy Act of 1974’) shall apply to any entity that is 

5 a member of the partnership in the same manner 

6 that such section applies to an educational agency or 

7 institution (as that term is defined in such section). 

8 ‘‘(d) GEOGRAPHICAL DISTRIBUTION.—The Secretary 

9 shall ensure that grants, contracts, or cooperative agree10 ments under subsection (a) will be distributed equitably 

11 among the regions of the country and among urban and 

12 rural areas. 

13 ‘‘(e) DURATION OF AWARDS.—With respect to a 

14 grant, contract, or cooperative agreement under sub15 section (a), the period during which payments under such 

16 an award will be made to the recipient shall be 5 years, 

17 with options for renewal. 

18 ‘‘(f) EVALUATION AND MEASURES OF OUTCOMES.— 

19 ‘‘(1) DEVELOPMENT OF PROCESS.—The Assist20 ant Secretary shall develop a fiscally appropriate 

21 process for evaluating activities carried out under 

22 this section. Such process shall include— 

23 ‘‘(A) the development of guidelines for the 

24 submission of program data by grant, contract, 

25 or cooperative agreement recipients; 


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1 ‘‘(B) the development of measures of out2 comes (in accordance with paragraph (2)) to be 

3 applied by such recipients in evaluating pro4 grams carried out under this section; and 

5 ‘‘(C) the submission of annual reports by 

6 such recipients concerning the effectiveness of 

7 programs carried out under this section. 

8 ‘‘(2) MEASURES OF OUTCOMES.—The Assistant 

9 Secretary shall develop measures of outcomes to be 

10 applied by recipients of assistance under this section 

11 to evaluate the effectiveness of programs carried out 

12 under this section, including outcomes related to the 

13 student, family, and local educational systems sup14 ported by this Act. 

15 ‘‘(3) SUBMISSION OF ANNUAL DATA.—An eligi16 ble entity described in subsection (c) that receives a 

17 grant, contract, or cooperative agreement under this 

18 section shall annually submit to the Assistant Sec19 retary a report that includes data to evaluate the 

20 success of the program carried out by the entity 

21 based on whether such program is achieving the pur22 poses of the program. Such reports shall utilize the 

23 measures of outcomes under paragraph (2) in a rea24 sonable manner to demonstrate the progress of the 

25 program in achieving such purposes. 


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1 ‘‘(4) EVALUATION BY ASSISTANT SECRETARY.— 

2 Based on the data submitted under paragraph (3), 

3 the Assistant Secretary shall annually submit to 

4 Congress a report concerning the results and effec5 tiveness of the programs carried out with assistance 

6 received under this section. 

7 ‘‘(5) LIMITATION.—An eligible entity shall use 

8 not more than 20 percent of amounts received under 

9 a grant under this section to carry out evaluation 

10 activities under this subsection. 

11 ‘‘(g) INFORMATION AND EDUCATION.—The Sec12 retary shall disseminate best practices based on the find13 ings of the knowledge development and application under 

14 this section. 

15 ‘‘(h) AMOUNT OF GRANTS AND AUTHORIZATION OF

16 APPROPRIATIONS.— 

17 ‘‘(1) AMOUNT OF GRANTS.—A grant under this 

18 section shall be in an amount that is not more than 

19 $2,000,000 for each of the first 5 fiscal years fol20 lowing the date of enactment of the Health Equity 

21 and Accountability Act 2024. The Secretary shall 

22 determine the amount of each such grant based on 

23 the population of children up to age 21 of the area 

24 to be served under the grant. 


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1 ‘‘(2) AUTHORIZATION OF APPROPRIATIONS.— 

2 There is authorized to be appropriated to carry out 

3 this section, $300,000,000 for each of fiscal years 

4 2025 through 2028.’’. 

5 (c) CONFORMING AMENDMENT.—Part G of title V of 

6 the Public Health Service Act (42 U.S.C. 290hh et seq.), 

7 as amended by subsection (b), is amended by striking the 

8 part designation and heading and inserting the following: 

9 ‘‘PART G—SCHOOL-BASED MENTAL HEALTH’’. 

10 SEC. 6404. ADDITIONAL SUPPORT FOR YOUTH AND YOUNG 

11 ADULT MENTAL HEALTH SERVICE PROVI12 SION. 

13 Section 1903 of the Social Security Act (42 U.S.C. 

14 1396b) is amended by adding at the end the following new 

15 subsection: 

16 ‘‘(cc) YOUTH AND YOUNG ADULT INTERVENTION

17 SERVICES.— 

18 ‘‘(1) IN GENERAL.—Notwithstanding section 

19 1902(a)(1) (relating to Statewideness), section 

20 1902(a)(10)(B) (relating to comparability), section 

21 1902(a)(23)(A) (relating to freedom of choice of 

22 providers), or section 1902(a)(27) (relating to pro23 vider agreements), a State may, during the 5-year 

24 period beginning on the first day of the fiscal year 

25 quarter that begins on or after January 1, 2024, 


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1 provide medical assistance for qualifying youth and 

2 young adult mental health and substance use inter3 vention services (as defined in paragraph (2)(C)) 

4 under a State plan amendment or waiver approved 

5 under section 1115 or 1915(c). 

6 ‘‘(2) DEFINITIONS.—For the purposes of this 

7 subsection: 

8 ‘‘(A) PRIORITY SERVICE.—The term ‘pri9 ority service’ means any of the following if vol10 untarily received and provided in a manner that 

11 maintains the privacy and confidentiality of pa12 tient information consistent with Federal and 

13 State requirements: 

14 ‘‘(i) Community-based mobile crisis 

15 intervention services, as defined in section 

16 1947. 

17 ‘‘(ii) Telehealth. 

18 ‘‘(iii) Youth peer support. 

19 ‘‘(iv) Screening for adverse childhood 

20 experiences. 

21 ‘‘(v) Trauma responsive care. 

22 ‘‘(vi) Other priority services for youth, 

23 as defined by the Secretary. 

24 ‘‘(B) QUALIFIED MENTAL HEALTH PRO25 VIDERS.—The term ‘qualified mental health 


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1 providers’ means a behavioral health care pro2 fessional who is capable of conducting an as3 sessment of the individual, in accordance with 

4 the professional’s permitted scope of practice 

5 under State law, and other professionals or 

6 paraprofessionals with appropriate expertise in 

7 youth and young adult behavioral health or 

8 mental health, including social workers, peer 

9 support specialists, recovery coaches, commu10 nity health workers, mental health clinicians, 

11 and others, as designated by the State and ap12 proved by the Secretary. 

13 ‘‘(C) QUALIFYING YOUTH AND YOUNG

14 ADULT MENTAL HEALTH AND SUBSTANCE USE

15 INTERVENTION SERVICES DEFINED.—The term 

16 ‘qualifying youth and young adult mental health 

17 and substance use intervention services’ means, 

18 with respect to a State, items and services for 

19 which medical assistance is available under the 

20 State plan under this title or a waiver of such 

21 plan, that are— 

22 ‘‘(i) furnished to an individual 16 to 

23 25 years of age who is— 

24 ‘‘(I) experiencing a mental health 

25 or substance use disorder crisis; 


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1 ‘‘(II) subject to the juvenile or 

2 adult justice system as defined in sec3 tion 3102 of title 29, United States 

4 Code; 

5 ‘‘(III)(aa) experiencing homeless6 ness (as defined in section 41403(6) 

7 of the Violence Against Women Act of 

8 1994 (42 U.S.C. 14043e–2(6))); 

9 ‘‘(bb) a homeless child or youth 

10 (as defined in section 725(2) of the 

11 McKinney-Vento Homeless Assistance 

12 Act (42 U.S.C. 11434a(2))); 

13 ‘‘(cc) a runaway, in foster care, 

14 or has aged out of the foster care sys15 tem; 

16 ‘‘(dd) a child eligible for assist17 ance under section 477 of the Social 

18 Security Act (42 U.S.C. 677); or 

19 ‘‘(ee) in an out-of-home place20 ment; 

21 ‘‘(IV) pregnant or parenting as 

22 defined in section 3102 of title 29, 

23 United States Code; 


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1 ‘‘(V) a youth who is an individual 

2 with a disability as defined in section 

3 3102 of title 29, United States Code; 

4 ‘‘(VI) a low-income youth requir5 ing additional assistance to enter or 

6 complete an educational program or 

7 to secure or hold employment as de8 fined in section 3102 of title 29, 

9 United States Code; or 

10 ‘‘(VII) living in a community that 

11 has faced acute or long-term exposure 

12 to substantial discrimination, histor13 ical oppression, intergenerational pov14 erty, civil unrest, or a high rate of vio15 lence or drug overdose deaths; 

16 ‘‘(ii) furnished by qualified mental 

17 health providers; and 

18 ‘‘(iii) a priority service. 

19 ‘‘(D) TELEHEALTH.—The term ‘telehealth’ 

20 means use of electronic information and tele21 communications technologies, including voice 

22 only audio, text, remote patient monitoring, and 

23 mHealth via applications, to support clinical 

24 mental health care, patient and professional 


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1 health-related education, public health, and 

2 health administration. 

3 ‘‘(3) PAYMENTS.—Notwithstanding section 

4 1905(b), beginning January 1, 2024, during each of 

5 the first 20 fiscal quarters that a State meets the 

6 requirements described in paragraph (4), the Fed7 eral medical assistance percentage applicable to 

8 amounts expended by the State for medical assist9 ance for qualifying youth and young adult mental 

10 health and substance use intervention services fur11 nished during such quarter shall be equal to 100 

12 percent. 

13 ‘‘(4) REQUIREMENTS.—The requirements de14 scribed in this paragraph are the following: 

15 ‘‘(A) The State demonstrates, to the satis16 faction of the Secretary— 

17 ‘‘(i) that it will be able to support the 

18 provision of qualifying youth and young 

19 adult mental health and substance use 

20 intervention services that meet the condi21 tions specified in paragraphs (1) and (2); 

22 and 

23 ‘‘(ii) how it will support coordination 

24 between qualified mental health providers 

25 and substance use teams and community 


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1 partners, including health care providers, 

2 to enable the provision of services, needed 

3 referrals, and other activities identified by 

4 the Secretary. 

5 ‘‘(B) The State provides assurances satis6 factory to the Secretary that— 

7 ‘‘(i) any additional Federal funds re8 ceived by the State for qualifying youth 

9 and young adult mental health and sub10 stance use intervention services provided 

11 under this subsection that are attributable 

12 to the increased Federal medical assistance 

13 percentage under paragraph (3)(A) will be 

14 used to supplement, and not supplant, the 

15 level of State funds expended for such 

16 services for fiscal year 2024; 

17 ‘‘(ii) if the State made qualifying 

18 youth and young adult mental health and 

19 substance use intervention services avail20 able in a region of the State in fiscal year 

21 2023 the State will continue to make such 

22 services available in such region under this 

23 subsection at the same level that the State 

24 made such services available in such fiscal 

25 year; and 


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1 ‘‘(iii) the State will conduct the eval2 uation and assessment, and submit the re3 port required under paragraph (5). 

4 ‘‘(5) STATE EVALUATION AND REPORT.— 

5 ‘‘(A) STATE EVALUATION.—Not later than 

6 4 fiscal quarters after a State begins providing 

7 qualifying youth and young adult mental health 

8 and substance use intervention services in ac9 cordance with this subsection, the State shall 

10 enter into a contract with an independent entity 

11 or organization to conduct an evaluation for the 

12 purposes of— 

13 ‘‘(i) determining the effect of the pro14 vision of such services on— 

15 ‘‘(I) emergency room visits; 

16 ‘‘(II) use of ambulatory services; 

17 ‘‘(III) hospitalizations; 

18 ‘‘(IV) the involvement of law en19 forcement in mental health or sub20 stance use disorder crisis events; and 

21 ‘‘(V) the diversion of individuals 

22 from jails or similar settings; and 

23 ‘‘(ii) assessing— 

24 ‘‘(I) the types of services pro25 vided to individuals; 


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1 ‘‘(II) the types of events re2 sponded to; 

3 ‘‘(III) cost savings or cost-effec4 tiveness attributable to such services; 

5 ‘‘(IV) the experiences of individ6 uals who receive qualifying youth and 

7 young adult mental health and sub8 stance use intervention services; 

9 ‘‘(V) the successful connection of 

10 individuals with follow-up services; 

11 and 

12 ‘‘(VI) other relevant outcomes 

13 identified by the Secretary. 

14 ‘‘(B) COMPARISON TO HISTORICAL MEAS15 URES.—The contract described in subparagraph 

16 (A) shall specify that the evaluation is based on 

17 a comparison of the historical measures of 

18 State performance with respect to the outcomes 

19 specified under such subparagraph to the 

20 State’s performance with respect to such out21 comes during the period beginning with the 

22 first quarter in which the State begins pro23 viding qualifying youth and young adult mental 

24 health and substance use intervention services 

25 in accordance with this subsection. 


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1 ‘‘(C) REPORT.—Not later than 2 years 

2 after a State begins to provide qualifying youth 

3 and young adult mental health and substance 

4 use intervention services in accordance with this 

5 subsection, the State shall submit a report to 

6 the Secretary on the following: 

7 ‘‘(i) The results of the evaluation car8 ried out under subparagraph (A). 

9 ‘‘(ii) The number of individuals who 

10 received qualifying youth and young adult 

11 mental health and substance use interven12 tion services. 

13 ‘‘(iii) Demographic information re14 garding such individuals when available, 

15 including the race and ethnicity, age, sex, 

16 sexual orientation, gender identity, and ge17 ographic location of such individuals. 

18 ‘‘(iv) The processes and models devel19 oped by the State to provide qualifying 

20 youth and young adult mental health and 

21 substance use intervention services under 

22 such the State plan or waiver, including 

23 the processes developed to provide referrals 

24 for, or coordination with, follow-up care 

25 and services. 


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1 ‘‘(v) Lessons learned regarding the 

2 provision of such services. 

3 ‘‘(D) PUBLIC AVAILABILITY.—The State 

4 shall make the report required under subpara5 graph (C) publicly available, including on the 

6 website of the appropriate State agency, upon 

7 submission of such report to the Secretary. 

8 ‘‘(6) BEST PRACTICES REPORT.— 

9 ‘‘(A) IN GENERAL.—Not later than 3 years 

10 after the first State begins to provide qualifying 

11 youth and young adult mental health and sub12 stance use intervention services in accordance 

13 with this subsection, the Secretary shall submit 

14 a report to Congress that— 

15 ‘‘(i) identifies the States that elected 

16 to provide services in accordance with this 

17 subsection; 

18 ‘‘(ii) summarizes the information re19 ported by such States under paragraph 

20 (5)(C); and 

21 ‘‘(iii) identifies best practices for the 

22 effective delivery of youth and young adult 

23 mental health and substance use interven24 tion services. 


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1 ‘‘(B) PUBLIC AVAILABILITY.—The report 

2 required under subparagraph (A) shall be made 

3 publicly available, including on the website of 

4 the Department of Health and Human Services, 

5 upon submission to Congress. 

6 ‘‘(7) NONDISCRIMINATION.— 

7 ‘‘(A) FEDERALLY FUNDED ACTIVITIES.— 

8 (i) For the purpose of applying the prohibitions 

9 against discrimination on the basis of age under 

10 the Age Discrimination Act of 1975 (42 U.S.C. 

11 6101 et seq.), on the basis of handicap under 

12 section 504 of the Rehabilitation Act of 1973 

13 (29 U.S.C. 794), on the basis of sex under title 

14 IX of the Education Amendments of 1972 (20 

15 U.S.C. 1681 et seq.), or on the basis of race, 

16 color, or national origin under title VI of the 

17 Civil Rights Act of 1964 (42 U.S.C. 2000d et 

18 seq.), programs and activities funded in whole 

19 or in part with funds made available under this 

20 subchapter are considered to be programs and 

21 activities receiving Federal financial assistance. 

22 ‘‘(ii) No person shall on the ground of sex 

23 or religion be excluded from participation in, be 

24 denied the benefits of, or be subjected to dis25 crimination under, any program or activity 


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1 funded in whole or in part with funds made 

2 available under this title. 

3 ‘‘(B) COMPLIANCE.—Whenever the Sec4 retary finds that a State, or an entity that has 

5 received a payment from an allotment to a 

6 State under section 702(c) of this title, has 

7 failed to comply with a provision of law referred 

8 to in subsection (a)(1), with subsection (a)(2), 

9 or with an applicable regulation (including one 

10 prescribed to carry out subsection (a)(2)), he 

11 shall notify the chief executive officer of the 

12 State and shall request him to secure compli13 ance. If within a reasonable period of time, not 

14 to exceed 60 days, the chief executive officer 

15 fails or refuses to secure compliance, the Sec16 retary may— 

17 ‘‘(i) refer the matter to the Attorney 

18 General with a recommendation that an 

19 appropriate civil action be instituted; 

20 ‘‘(ii) exercise the powers and functions 

21 provided by title VI of the Civil Rights Act 

22 of 1964 (42 U.S.C. 2000d et seq.), the 

23 Age Discrimination Act of 1975 (42 

24 U.S.C. 6101 et seq.), or section 504 of the 


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1 Rehabilitation Act of 1973 (29 U.S.C. 

2 794), as may be applicable; or 

3 ‘‘(iii) take such other action as may 

4 be provided by law. 

5 ‘‘(C) AUTHORITY OF ATTORNEY GENERAL; 

6 CIVIL ACTIONS.—When a matter is referred to 

7 the Attorney General pursuant to subsection 

8 (b)(1), or whenever he has reason to believe 

9 that the entity is engaged in a pattern or prac10 tice in violation of a provision of law referred 

11 to in subsection (a)(1) or in violation of sub12 section (a)(2), the Attorney General may bring 

13 a civil action in any appropriate district court 

14 of the United States for such relief as may be 

15 appropriate, including injunctive relief.’’. 

16 SEC. 6405. EARLY INTERVENTION AND PREVENTION PRO17 GRAMS FOR TRANSITION-AGE YOUTH. 

18 (a) IN GENERAL.—Section 1912(b)(1) of the Public 

19 Health Service Act (42 U.S.C. 300x–1(b)(1)) is amend20 ed— 

21 (1) by redesignating subparagraph (E) as sub22 paragraph (F); and 

23 (2) by inserting after subparagraph (D) the fol24 lowing: 


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1 ‘‘(E) EARLY INTERVENTION AND PREVEN2 TION PROGRAMS FOR TRANSITION-AGE

3 YOUTH.—The plan shall describe the State’s 

4 plans to carry out demonstration grants or con5 tracts for early intervention and prevention pro6 grams for transition-age youth of 16 to 25 

7 years of age who meet one or more of the cri8 teria specified in section 129(a)(1)(B) of the 

9 Workforce Innovation and Opportunity Act to 

10 be considered out-of-school youth.’’. 

11 (b) SET-ASIDE.—Section 1920 of the Public Health 

12 Service Act (42 U.S.C. 300x–9) is amended by adding at 

13 the end the following: 

14 ‘‘(e) EARLY INTERVENTION AND PREVENTION PRO15 GRAMS FOR TRANSITION-AGE YOUTH.— 

16 ‘‘(1) IN GENERAL.—Except as provided in para17 graph (2), a State shall expend at least 15 percent 

18 of the amount of the allotment of the State pursuant 

19 to a funding agreement under section 1911 for each 

20 fiscal year to support programs described in section 

21 1912(b)(1)(E). 

22 ‘‘(2) STATE FLEXIBILITY.—In lieu of expending 

23 15 percent of the amount of the allotment for a fis24 cal year as required by paragraph (1), a State may 

25 elect to expend not less than 30 percent of such 


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1 amount to support such programs by the end of two 

2 consecutive fiscal years.’’. 

3 SEC. 6406. STRATEGIES TO INCREASE ACCESS TO TELE4 HEALTH UNDER MEDICAID AND CHILDREN’S 

5 HEALTH INSURANCE PROGRAM. 

6 (a) GUIDANCE.—Not later than 1 year after the date 

7 of the enactment of this Act, the Secretary of Health and 

8 Human Services shall issue and disseminate guidance to 

9 States to clarify strategies to overcome existing barriers 

10 and increase access to telehealth under the Medicaid pro11 gram under title XIX of the Social Security Act (42 

12 U.S.C. 1396 et seq.) and the Children’s Health Insurance 

13 Program under title XXI of such Act (42 U.S.C. 1397aa 

14 et seq.). Such guidance shall include technical assistance 

15 and best practices regarding— 

16 (1) telehealth delivery of covered services; 

17 (2) recommended voluntary billing codes, modi18 fiers, and place-of-service designations for telehealth 

19 and other virtual health care services; 

20 (3) the simplification or alignment (including 

21 through reciprocity) of provider licensing, 

22 credentialing, and enrollment protocols with respect 

23 to telehealth across States, State Medicaid plans 

24 under such title XIX, and Medicaid managed care 


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1 organizations, including during national public 

2 health emergencies; 

3 (4) existing strategies States can use to inte4 grate telehealth and other virtual health care serv5 ices into value-based health care models; and 

6 (5) examples of States that have used waivers 

7 under the Medicaid program to test expanded access 

8 to telehealth, including during the emergency period 

9 described in section 1135(g)(1)(B) of the Social Se10 curity Act (42 U.S.C. 1320b–5(g)(1)(B)). 

11 (b) STUDIES.— 

12 (1) TELEHEALTH IMPACT ON HEALTH CARE

13 ACCESS.—Not later than 1 year after the date of the 

14 enactment of this Act, the Medicaid and CHIP Pay15 ment and Access Commission shall conduct a study, 

16 with respect to a minimum of 10 States across geo17 graphic regions of the United States, and submit to 

18 Congress a report, on the impact of telehealth on 

19 health care access, utilization, cost, and outcomes, 

20 broken down by race, ethnicity, sex, age, disability 

21 status, and ZIP Code. Such report shall— 

22 (A) evaluate cost, access, utilization, out23 comes, and patient experience data from across 

24 the health care field, including States, Medicaid 

25 managed care organizations, provider organizaVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 01017 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 tions, and other organizations that provide or 

2 pay for telehealth under the Medicaid program 

3 and Children’s Health Insurance Program; 

4 (B) identify barriers and potential solu5 tions to provider entry and participation in tele6 health that States are experiencing, as well as 

7 barriers to providing telehealth across State 

8 lines, including during times of public health 

9 crisis or public health emergency; 

10 (C) determine the frequency at which out11 of-State telehealth is provided to patients en12 rolled in the Medicaid program and the poten13 tial impact on access to telehealth if State Med14 icaid policies were more aligned; and 

15 (D) identify and evaluate opportunities for 

16 more alignment among such policies to promote 

17 access to telehealth across all States, State 

18 Medicaid plans under title XIX of the Social 

19 Security Act (42 U.S.C. 1396 et seq.), State 

20 child health plans under title XXI of such Act 

21 (42 U.S.C. 1397aa et seq.), and Medicaid man22 aged care organizations, including the potential 

23 for regional compacts or reciprocity agreements. 

24 (2) FEDERAL AGENCY TELEHEALTH COLLABO25 RATION.—Not later than 1 year after the date of the 


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1 enactment of this Act, the Comptroller General of 

2 the United States shall conduct a study and submit 

3 to Congress a report evaluating collaboration be4 tween Federal agencies with respect to telehealth 

5 services furnished under the Medicaid or CHIP pro6 gram to individuals under the age of 18, including 

7 such services furnished to such individuals in early 

8 care and education settings. Such report shall in9 clude recommendations on— 

10 (A) opportunities for Federal agencies to 

11 improve collaboration with respect to such tele12 health services; and 

13 (B) opportunities for collaboration between 

14 Federal agencies to expand telehealth access to 

15 such individuals enrolled under the Medicaid or 

16 CHIP program, including in early care and 

17 education settings. 

18 SEC. 6407. YOUTH AND YOUNG ADULT MENTAL HEALTH 

19 PROMOTION, PREVENTION, INTERVENTION, 

20 AND TREATMENT. 

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

22 (as amended by section 5001) is amended by adding at 

23 the end the following: 


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1 ‘‘SEC. 399Z–4. YOUTH AND YOUNG ADULT MENTAL HEALTH 

2 PROMOTION, PREVENTION, INTERVENTION, 

3 AND TREATMENT. 

4 ‘‘(a) GRANTS.—The Secretary shall— 

5 ‘‘(1) award grants to eligible entities to develop, 

6 maintain, or enhance youth and young adult mental 

7 health promotion, prevention, intervention, and 

8 treatment programs, including— 

9 ‘‘(A) programs for youth and young adults 

10 who may be likely to develop, are showing early 

11 signs of, or have been diagnosed with a mental 

12 health condition, including a serious emotional 

13 disturbance; and 

14 ‘‘(B) infrastructure and organization 

15 change at a State, tribal, or territorial level to 

16 improve cross-system collaboration, service ca17 pacity, and expertise related to youth and 

18 young adults; and 

19 ‘‘(2) ensure that programs funded through 

20 grants under this section use community-driven, evi21 dence-informed, or evidence-based models, practices, 

22 and methods that are, as appropriate, culturally and 

23 linguistically appropriate, and can be replicated in 

24 other appropriate settings. 

25 ‘‘(b) ELIGIBLE TRANSITION AGE YOUTH AND ENTI26 TIES.—In this section: 


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1 ‘‘(1) ELIGIBLE ENTITY.—The term ‘eligible en2 tity’ means— 

3 ‘‘(A) a local educational agency; 

4 ‘‘(B) a State educational agency; 

5 ‘‘(C) an institution of higher education (or 

6 consortium of such institutions), which may in7 clude a recovery program at an institution of 

8 higher education; 

9 ‘‘(D) a local board, or a one-stop operator, 

10 as defined in section 3 of the Workforce Inno11 vation and Opportunity Act; 

12 ‘‘(E) a nonprofit organization with appro13 priate expertise in providing services or pro14 grams for children, adolescents, or young 

15 adults, excluding a school; 

16 ‘‘(F) a State, political subdivision of a 

17 State, Indian tribe, or tribal organization; or 

18 ‘‘(G) a high school or dormitory serving 

19 high school students that receives funding from 

20 the Bureau of Indian Education. 

21 ‘‘(2) ELIGIBLE TRANSITION AGE YOUTH.—The 

22 term ‘eligible transition age youth’ means a youth or 

23 young adult from age 16 to not more than 25 years 

24 of age who is— 


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1 ‘‘(A) an out-of-school youth as defined in 

2 section 129(a)(1)(B) of the Workforce Innova3 tion and Opportunity Act; 

4 ‘‘(B) a homeless individual (as defined in 

5 section 41403(6) of the Violence Against 

6 Women Act of 1994), a homeless child or youth 

7 (as defined in section 725(2) of the McKinney8 Vento Homeless Assistance Act) a runaway, in 

9 foster care or has aged out of the foster care 

10 system, a child eligible for assistance under sec11 tion 477 of the Social Security Act, or in an 

12 out-of-home placement; 

13 ‘‘(C) an individual who is pregnant or par14 enting, as referred to in section 129(a)(1)(B) of 

15 the Workforce Innovation and Opportunity Act; 

16 ‘‘(D) a youth who is an individual with a 

17 disability, as referred to in section 129(a)(1)(B) 

18 of the Workforce Innovation and Opportunity 

19 Act; 

20 ‘‘(E) a low-income individual who requires 

21 additional assistance to enter or complete an 

22 educational program or to secure or hold em23 ployment, as referred to in section 129(a)(1)(B) 

24 of the Workforce Innovation and Opportunity 

25 Act; or 


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1 ‘‘(F) living in a community that has faced 

2 acute or long-term exposure to substantial dis3 crimination, historical oppression, intergenera4 tional poverty, civil unrest, a high rate of vio5 lence, or drug overdose deaths. 

6 ‘‘(c) APPLICATION.—An eligible entity seeking a 

7 grant under subsection (a) shall submit to the Secretary 

8 an application at such time, in such manner, and con9 taining such information as the Secretary may require. 

10 ‘‘(d) USE OF FUNDS FOR MENTAL HEALTH PRO11 MOTION, PREVENTION, INTERVENTION AND TREATMENT

12 PROGRAMS.—An eligible entity may use amounts awarded 

13 under a grant under subsection (a)(1) to carry out the 

14 following: 

15 ‘‘(1) Creation, implementation, and expansion 

16 of services and supports that are culturally and lin17 guistically appropriate and youth guided, involve and 

18 include family and community members (including 

19 business leaders and faith-based organizations), and 

20 provide for continuity of care between child- and 

21 adult-serving systems to ensure seamless transition. 

22 ‘‘(2) Infrastructure and organization change at 

23 a State, Tribal, or territorial level to improve cross24 system collaboration, service capacity, and expertise 

25 related to youth and young adults with, or at risk 


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1 of, mental health conditions and substance use dis2 orders as they transition into adult roles and respon3 sibilities. 

4 ‘‘(3) Public awareness and cross-system pro5 vider training for individuals employed at institu6 tions of higher education and community colleges, 

7 behavioral health providers, individuals working in 

8 the criminal justice system, primary care providers, 

9 vocational service providers, and child welfare work10 ers. 

11 ‘‘(e) MATCHING FUNDS.—The Secretary may not 

12 award a grant under this section to an eligible entity un13 less the eligible entity agrees, with respect to the costs to 

14 be incurred by the eligible entity in carrying out the activi15 ties described in subsection (d), to make available non16 Federal contributions (in cash or in kind) toward such 

17 costs in an amount that is not less than 10 percent of 

18 the total amount of Federal funds provided in the grant. 

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

20 carry out this section, there are authorized to be appro21 priated $25,000,000 for each of fiscal years 2025 through 

22 2034.’’. 


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1 Subtitle E—Community-Based Care 

2 SEC. 6501. MENTAL HEALTH AT THE BORDER. 

3 (a) SHORT TITLE.—This section may be cited as the 

4 ‘‘Immigrants’ Mental Health Act of 2024’’. 

5 (b) DEFINITIONS.—In this section: 

6 (1) FORWARD OPERATING BASE.—The term 

7 ‘‘forward operating base’’ means a permanent facil8 ity established by U.S. Customs and Border Protec9 tion in forward or remote locations, and designated 

10 as such by U.S. Customs and Border Protection. 

11 (2) U.S. CUSTOMS AND BORDER PROTECTION

12 FACILITY.—The term ‘‘U.S. Customs and Border 

13 Protection facility’’ means any of the following facili14 ties that typically detain migrants on behalf of U.S. 

15 Customs and Border Protection: 

16 (A) U.S. Border Patrol stations. 

17 (B) Ports of entry. 

18 (C) Checkpoints. 

19 (D) Forward operating bases. 

20 (E) Secondary inspection areas. 

21 (F) Short-term custody facilities. 

22 (c) TRAINING FOR CERTAIN CBP PERSONNEL IN

23 MENTAL HEALTH ISSUES.— 

24 (1) TRAINING TO IDENTIFY RISK FACTORS AND

25 WARNING SIGNS IN IMMIGRANTS AND REFUGEES.— 


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1 (A) IN GENERAL.—The Commissioner for 

2 U.S. Customs and Border Protection, in con3 sultation with the Assistant Secretary for Men4 tal Health and Substance Use of the Depart5 ment of Health and Human Services, the Ad6 ministrator of the Health Resources and Serv7 ices Administration, and nongovernmental ex8 perts in the delivery of health care in humani9 tarian crises and in the delivery of health care 

10 to children, shall develop and implement a 

11 training curriculum for U.S. Customs and Bor12 der Protection agents and officers assigned to 

13 U.S. Customs and Border Protection facilities 

14 to enable such agents and officers to identify 

15 the risk factors and warning signs in immi16 grants and refugees of mental health issues re17 lating to trauma. 

18 (B) REQUIREMENTS.—The training cur19 riculum described in subparagraph (A) shall— 

20 (i) apply to all U.S. Customs and 

21 Border Protection agents and officers 

22 working at U.S. Customs and Border Pro23 tection facilities; 

24 (ii) provide for crisis intervention 

25 using a trauma-informed approach; and 


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1 (iii) provide for mental health 

2 screenings for immigrants and refugees ar3 riving at the border in their preferred lan4 guage or with appropriate language assist5 ance. 

6 (2) TRAINING TO ADDRESS MENTAL HEALTH

7 AND WELLNESS OF CBP AGENTS AND OFFICERS.— 

8 (A) IN GENERAL.—The Commissioner of 

9 U.S. Customs and Border Protection, in con10 sultation with the Assistant Secretary for Men11 tal Health and Substance Use of the Depart12 ment of Health and Human Services, the Ad13 ministrator of the Health Resources and Serv14 ices Administration, and nongovernmental ex15 perts in the delivery of mental health care, shall 

16 develop and implement a training curriculum 

17 for U.S. Customs and Border Protection agents 

18 and officers assigned to U.S. Customs and Bor19 der Protection facilities to address the mental 

20 health and wellness of individuals working at 

21 such facilities. 

22 (B) REQUIREMENT.—The training cur23 riculum described in subparagraph (A) shall be 

24 designed to help U.S. Customs and Border ProVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 01027 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 tection agents and officers working at U.S. 

2 Customs and Border Protection facilities— 

3 (i) to better manage their own stress 

4 and the stress of their coworkers; and 

5 (ii) to be more aware of the psycho6 logical pressures experienced during their 

7 jobs. 

8 (3) ANNUAL REVIEW OF TRAINING.—Beginning 

9 in fiscal year 2025, the Assistant Secretary for Men10 tal Health and Substance Use shall— 

11 (A) conduct an annual review of the train12 ing implemented pursuant to subsections (a) 

13 and (b); and 

14 (B) submit the results of each such review, 

15 including any recommendations for improve16 ment of such training, to— 

17 (i) the Commissioner of U.S. Customs 

18 and Border Protection; 

19 (ii) the Committee on Appropriations 

20 of the Senate; 

21 (iii) the Committee on Health, Edu22 cation, Labor, and Pensions of the Senate; 

23 (iv) the Committee on Homeland Se24 curity and Governmental Affairs of the 

25 Senate; 


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1 (v) the Committee on Appropriations 

2 of the House of Representatives; 

3 (vi) the Committee on Energy and 

4 Commerce of the House of Representa5 tives; 

6 (vii) the Committee on Homeland Se7 curity of the House of Representatives; 

8 and 

9 (viii) the Committee on the Judiciary 

10 of the House of Representatives. 

11 (4) AUTHORIZATION OF APPROPRIATIONS.—To 

12 carry out this section, there is authorized to be ap13 propriated— 

14 (A) for fiscal year 2025, $50,000 to de15 velop the training described in paragraphs (1) 

16 and (2); and 

17 (B) for each of the fiscal years 2026 

18 through 2030— 

19 (i) $20,000 to implement such train20 ing; and 

21 (ii) such additional sums as may be 

22 necessary to review and make rec23 ommendations for such training pursuant 

24 to paragraph (3). 


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1 (d) STAFFING BORDER FACILITIES AND DETENTION

2 CENTERS.— 

3 (1) IN GENERAL.—To adequately evaluate the 

4 mental health needs of immigrants, refugees, border 

5 patrol agents, and staff, the Commissioner of U.S. 

6 Customs and Border Protection shall assign not 

7 fewer than 1 qualified mental or behavioral health 

8 expert to each U.S. Customs and Border Protection 

9 facility. 

10 (2) QUALIFICATIONS.—Each mental or behav11 ioral health expert assigned pursuant to paragraph 

12 (1) shall be— 

13 (A) bilingual; 

14 (B) well-versed in culturally appropriate 

15 and trauma-informed interventions; and 

16 (C) have particular expertise in child or 

17 adolescent mental health or family mental 

18 health. 

19 (3) AUTHORIZATION OF APPROPRIATIONS.—To 

20 carry out this subsection, there is authorized to be 

21 appropriated $3,000,000 for each of the fiscal years 

22 2025 through 2029. 

23 (e) NO SHARING OF DEPARTMENT OF HEALTH AND

24 HUMAN SERVICES MENTAL HEALTH INFORMATION FOR

25 ASYLUM DETERMINATIONS, IMMIGRATION HEARINGS, OR


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1 DEPORTATION PROCEEDINGS.—The officers, employees, 

2 and agents of the Department of Health and Human Serv3 ices, including the Office of Refugee Resettlement, may 

4 not share with the Department of Homeland Security, and 

5 the officers, employees, and agents of the Department of 

6 Homeland Security may not request or receive from the 

7 Department of Health and Human Services, for the pur8 poses of an asylum determination, immigration hearing, 

9 or deportation proceeding, any information or record 

10 that— 

11 (1) concerns the mental health of an alien; and 

12 (2) was obtained or produced by a mental or 

13 behavioral health professional while the alien was in 

14 a shelter or otherwise in the custody of the Federal 

15 Government. 

16 SEC. 6502. ASIAN AMERICAN, AFRICAN AMERICAN, NATIVE 

17 HAWAIIAN, PACIFIC ISLANDER, INDIGENOUS, 

18 MIDDLE EASTERN AND NORTH AFRICAN, AND 

19 HISPANIC AND LATINO BEHAVIORAL HEALTH 

20 OUTREACH AND EDUCATION STRATEGY. 

21 Part D of title V of the Public Health Service Act 

22 (42 U.S.C. 290dd et seq.), as amended by section 6203, 

23 is amended by adding at the end the following: 


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1 ‘‘SEC. 555. BEHAVIORAL OUTREACH AND EDUCATION 

2 STRATEGY. 

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

4 the Assistant Secretary for Mental Health and Substance 

5 Use, shall, in coordination with advocacy and behavioral 

6 organizations serving populations of Asian American, Afri7 can American, Native Hawaiian, Pacific Islander, Indige8 nous, Middle Eastern and North African (in this section 

9 referred to as ‘MENA’), and Hispanic and Latino/a/x indi10 viduals or communities, develop and implement an out11 reach and education strategy to promote behavioral 

12 health, emphasize that behavioral health conditions are 

13 treatable and that reasonable accommodations under sec14 tion 504 of the Rehabilitation Act of 1973 and titles II 

15 and III of the Americans with Disabilities Act of 1990 

16 are necessary and may help, as well as reduce stigma asso17 ciated with mental health conditions and substance use 

18 disorder among the Asian American, African American, 

19 Native Hawaiian, Pacific Islander, Indigenous, MENA, 

20 and Hispanic and Latino/a/x populations. Such strategy 

21 shall— 

22 ‘‘(1) be designed to— 

23 ‘‘(A) meet the diverse cultural and lan24 guage needs of the various Asian American, Af25 rican American, Indigenous, MENA, Native 


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1 Hawaiian, Pacific Islander, and Hispanic and 

2 Latino/a/x populations; and 

3 ‘‘(B) ensure that approaches recommended 

4 in the strategy are developmentally (with re5 spect to the beneficiary’s relative age and expe6 rience) and age appropriate, as well as cog7 nitively accessible to persons with cognitive dis8 abilities; 

9 ‘‘(2) increase awareness of symptoms of mental 

10 illnesses common among such populations, taking 

11 into account differences within subgroups (such as 

12 gender, gender identity, age, sexual orientation, dis13 ability, and ethnicity) of such populations; 

14 ‘‘(3) provide information on evidence-based, cul15 turally and linguistically appropriate and adapted 

16 interventions and treatments; 

17 ‘‘(4) ensure full participation of, and engage, 

18 both consumers and community members rep19 resenting the communities of focus in the develop20 ment and implementation of materials; and 

21 ‘‘(5) seek to broaden the perspective among 

22 both individuals in such communities and stake23 holders serving such communities to use a com24 prehensive public health approach to promoting be25 havioral health that addresses a holistic view of 


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1 health by focusing on the intersection between be2 havioral and physical health. 

3 ‘‘(b) REPORTS.—Beginning not later than 1 year 

4 after the date of the enactment of this section and annu5 ally thereafter, the Secretary, acting through the Assistant 

6 Secretary, shall submit to the Congress, and make publicly 

7 available, a report on the extent to which the strategy de8 veloped and implemented under subsection (a) increased 

9 behavioral health outcomes associated with mental health 

10 conditions and substance use disorder among Asian Amer11 ican, African American, Native Hawaiian, Pacific Is12 lander, Indigenous, MENA, and Hispanic and Latino/a/ 

13 x populations. 

14 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 

15 is authorized to be appropriated to carry out this section 

16 $15,000,000 for each of fiscal years 2025 through 2030.’’. 

17 Subtitle F—Reports 

18 SEC. 6601. ADDRESSING RACIAL AND ETHNIC MINORITY 

19 MENTAL HEALTH DISPARITIES RESEARCH 

20 GAPS. 

21 Not later than 9 months after the date of the enact22 ment of this Act, the Director of the National Institutes 

23 of Health, in consultation with the Director of the Na24 tional Institute of Mental Health and the Assistant Sec25 retary of Substance Use and Mental Health, shall enter 


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1 into an arrangement with the National Academies of 

2 Sciences, Engineering, and Medicine (or, if the National 

3 Academies of Sciences, Engineering, and Medicine decline 

4 to enter into such an arrangement, the Patient-Centered 

5 Outcomes Research Institute, the Agency for Healthcare 

6 Research and Quality, or another appropriate entity)— 

7 (1) to conduct a study with respect to mental 

8 health disparities research gaps in racial and ethnic 

9 minority groups (as defined in section 1707(g) of 

10 the Public Health Service Act (42 U.S.C. 300u– 

11 6(g))); and 

12 (2) to submit to the Congress a report on the 

13 results of such study, including— 

14 (A) a compilation of information on the 

15 prevalence of mental health outcomes in such 

16 racial and ethnic minority groups; and 

17 (B) an assessment of information on the 

18 impact of exposure to community violence, ad19 verse childhood experiences, structural bias, and 

20 other psychological traumas on mental health 

21 outcomes in such racial and minority groups. 


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1 SEC. 6602. RESEARCH ON ADVERSE HEALTH EFFECTS AS2 SOCIATED WITH INTERACTIONS WITH LAW 

3 ENFORCEMENT. 

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

5 Human Services, acting through the Director of the Office 

6 of Minority Health of the Centers for Disease Control and 

7 Prevention (established pursuant to section 1707A of the 

8 Public Health Service Act (42 U.S.C. 300u–6a)) (in this 

9 section referred to as the ‘‘Secretary’’), shall conduct re10 search on the adverse health effects associated with inter11 actions with law enforcement. 

12 (b) EFFECTS AMONG RACIAL AND ETHNIC MINORI13 TIES.—The research under subsection (a) shall include re14 search on— 

15 (1) the health consequences, both individual 

16 and community-wide, of trauma related to violence 

17 committed by law enforcement among racial and 

18 ethnic minorities; and 

19 (2) the disproportionate burden of morbidity 

20 and mortality associated with such trauma. 

21 (c) REPORT.—Not later than 1 year after the date 

22 of enactment of this Act, the Secretary shall— 

23 (1) complete the research under this section; 

24 and 


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1 (2) submit to the Congress a report on the find2 ings, conclusions, and recommendations resulting 

3 from such research. 

4 SEC. 6603. GEOACCESS STUDY. 

5 Not later than 180 days after the date of enactment 

6 of this Act, the Assistant Secretary for Mental Health and 

7 Substance Use shall— 

8 (1) conduct a study to— 

9 (A) determine which geographic areas of 

10 the United States have shortages of racially and 

11 ethnically diverse mental health providers, as 

12 well as mental health providers trained to work 

13 with racially and ethnically diverse clients and 

14 clients with multiple mental health, cognitive, 

15 and developmental disabilities; and 

16 (B) assess the preparedness of mental 

17 health providers to deliver culturally and lin18 guistically appropriate, affordable, and acces19 sible services; and 

20 (2) submit a report to Congress on the results 

21 of such study. 

22 SEC. 6604. CO-OCCURRING CONDITIONS. 

23 (a) GAO REPORT.—Not later than 2 years after the 

24 date of enactment of this Act, the Comptroller General 

25 of the United States shall submit to Congress a report 


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1 on barriers to care for persons with co-occurring condi2 tions and access to care in the United States. Such report 

3 shall include the information and recommendations de4 scribed in subsection (b). 

5 (b) CONTENT OF REPORT.—The report under sub6 section (a) shall include— 

7 (1) an assessment of current barriers to behav8 ioral health and substance use disorder treatment 

9 for low-income, uninsured, and Medicaid-enrolled 

10 adults, and recommendations for addressing such 

11 barriers, particularly for women and diverse racial 

12 and ethnic groups; 

13 (2) an assessment of— 

14 (A) how many adults have a behavioral 

15 health condition and options for adults to re16 ceive behavioral health and substance use dis17 order treatment in nonexpansion States; 

18 (B) Medicaid expansion States who provide 

19 behavioral health coverage for newly eligible en20 rollees; 

21 (C) how enrollment in coverage affects 

22 treatment availability; and 

23 (D) the impacts of COVID–19 to receiving 

24 and accessing treatment for behavioral health, 

25 substance use disorders, and diverse racial and 


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1 ethnic groups, and recommendations for ad2 dressing such barriers; 

3 (3) an assessment of current barriers, inclusive 

4 of social determinants of health and cultural bar5 riers, that prevent adults from receiving behavioral 

6 health and substance use disorder treatment, and 

7 recommendations for addressing such barriers, par8 ticularly for low-income women and adults from ra9 cial and ethnic groups; 

10 (4) an assessment of disparities in access to ad11 diction counselors and mental or behavioral health 

12 care providers acting in accordance with State law, 

13 stratified by race, ethnicity, gender identity, geo14 graphic location, and insurance type, and rec15 ommendations to promote greater access equity; and 

16 (5) recommendations to promote greater equity 

17 in access to care for behavioral services and sub18 stance use disorders, particularly for low-income 

19 women and adults from diverse racial and ethnic 

20 groups. 

21 SEC. 6605. STUDY AND REPORT ON THE AANHPI YOUTH 

22 MENTAL HEALTH CRISIS. 

23 (a) STUDY.— 

24 (1) IN GENERAL.—The Secretary, acting 

25 through the Assistant Secretary for Mental Health 


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1 and Substance Use (referred to in this section as the 

2 ‘‘Secretary’’), in coordination with the Director of 

3 the National Institutes of Health, the Director of 

4 the Centers for Disease Control and Prevention, and 

5 the Director of the Office of Minority Health, shall 

6 conduct a study on behavioral health among 

7 AANHPI youth. 

8 (2) ELEMENTS.—Such study required under 

9 paragraph (1) shall include an assessment of— 

10 (A) the prevalence, risk factors, and root 

11 causes of mental health challenges, substance 

12 misuse, and mental health and substance use 

13 disorders among AANHPI youth; 

14 (B) the prevalence among AANHPI youth 

15 of attempted suicide, nonfatal substance use 

16 overdose, and death by suicide or substance use 

17 overdose; and 

18 (C) AANHPI youth that received treat19 ment for mental health and substance use dis20 orders. 

21 (b) REPORT.—Not later than 1 year after the date 

22 of the enactment of this Act, the Secretary shall submit 

23 to the Committee on Health, Education, Labor, and Pen24 sions of the Senate and the Committee on Energy and 

25 Commerce of the House of Representatives, and make 


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1 publicly available, a report on the findings of the study 

2 conducted under subsection (a), including— 

3 (1) identification of the barriers to accessing 

4 behavioral health services for AANHPI youth; 

5 (2) identification of root causes of mental 

6 health challenges and substance misuse among 

7 AANHPI youth; 

8 (3) recommendations for actions to be taken by 

9 the Secretary to improve behavioral health among 

10 AANHPI youth; 

11 (4) recommendations for legislative or adminis12 trative action to improve the behavioral health of 

13 AANHPI youth experiencing depression, suicide, 

14 and overdose, and to reduce the prevalence of de15 pression, suicide, and overdose among AANHPI 

16 youth; and 

17 (5) such other recommendations as the Sec18 retary determines appropriate. 

19 (c) DATA.—Any data included in the study or report 

20 under this section shall be disaggregated by race, eth21 nicity, age, sex, gender identity, sexual orientation, geo22 graphic region, disability status, and other relevant fac23 tors, in a manner that protects personal privacy and that 

24 is consistent with applicable Federal and State privacy 

25 law. 


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1 (d) AUTHORIZATION OF APPROPRIATIONS.—For pur2 poses of carrying out this section, there is authorized to 

3 be appropriated $1,500,000 for fiscal year 2025. 

4 SEC. 6606. STUDY AND REPORT ON STRATEGIES ON THE 

5 AANHPI BEHAVIORAL HEALTH WORKFORCE 

6 SHORTAGE. 

7 (a) STUDY.— 

8 (1) IN GENERAL.—The Secretary, acting 

9 through the Assistant Secretary for Mental Health 

10 and Substance Use (referred to in this section as the 

11 ‘‘Secretary’’), in coordination with the Administrator 

12 of the Health Resources and Services Administra13 tion, the Secretary of Labor, and the Director of the 

14 Office of Minority Health, shall conduct a study on 

15 strategies for increasing the behavioral health pro16 fessional workforce that identify as AANHPI. 

17 (2) ELEMENTS.—Such study required under 

18 paragraph (1) shall consider— 

19 (A) the total number of licensed behavioral 

20 health providers in the United States who iden21 tify as AANHPI; 

22 (B) with respect to each such provider, in23 formation regarding the current type of license, 

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1 ployer (such as hospital, Federally-qualified 

2 health center, school, or private practice); 

3 (C) information regarding the cultural and 

4 linguistic capabilities of such providers, includ5 ing languages spoken proficiently; and 

6 (D) the relevant barriers to enrollment in 

7 behavioral health professional education pro8 grams and entering the behavioral workforce 

9 for AANHPI individuals. 

10 (b) REPORT.—Not later than 1 year after the date 

11 of the enactment of this Act, the Secretary shall submit 

12 to the Committee on Health, Education, Labor, and Pen13 sions of the Senate and the Committee on Energy and 

14 Commerce of the House of Representatives, and make 

15 publicly available, a report on the findings of the study 

16 conducted under subsection (a), including— 

17 (1) identification of AANHPI licensed behav18 ioral health providers’ knowledge and awareness of 

19 the barriers to quality behavioral health care services 

20 faced by AANHPI individuals, including stigma, lim21 ited English proficiency, and lack of health insur22 ance coverage; 

23 (2) recommendations for actions to be taken by 

24 the Secretary to increase the number of AANHPI li25 censed behavioral health professionals; 


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1 (3) recommendations for legislative or adminis2 trative action to improve the enrollment of AANHPI 

3 individuals in behavioral health professional edu4 cation programs; and 

5 (4) such other recommendations as the Sec6 retary determines appropriate. 

7 (c) DATA.—Any data included in the study or report 

8 under this section shall be disaggregated by race, eth9 nicity, age, sex, gender identity, sexual orientation, geo10 graphic region, disability status, and other relevant fac11 tors, in a manner that protects personal privacy and that 

12 is consistent with applicable Federal and State privacy 

13 law. 

14 (d) DEFINITION.—In this section the term ‘‘licensed 

15 behavioral health provider’’ means any individual licensed 

16 to provide mental health or substance use disorder serv17 ices, including in the professions of social work, psy18 chology, psychiatry, marriage and family therapy, mental 

19 health counseling, and substance use disorder counseling. 

20 (e) AUTHORIZATION OF APPROPRIATIONS.—For pur21 poses of carrying out this section, there is authorized to 

22 be appropriated $1,500,000 for fiscal year 2025. 


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1 Subtitle G—Miscellaneous 

2 Provisions 

3 SEC. 6701. STRENGTHENING MENTAL HEALTH SUPPORTS 

4 FOR BIPOC COMMUNITIES. 

5 (a) IN GENERAL.—Section 1942(a) of the Public 

6 Health Service Act (42 U.S.C. 300x–52(a)) is amended— 

7 (1) by redesignating paragraphs (2) and (3) as 

8 paragraphs (5) and (6), respectively; and 

9 (2) by inserting after paragraph (1) the fol10 lowing: 

11 ‘‘(2) services provided by the State to adults 

12 with a serious mental illness and children with a se13 rious emotional disturbance who are members of ra14 cial and ethnic minority groups, including— 

15 ‘‘(A) the extent to which such services are 

16 provided to such adults and children; and 

17 ‘‘(B) the outcomes experienced by such 

18 adults and children as a result of the provision 

19 of such services, including with respect to— 

20 ‘‘(i) diversions from hospitalization 

21 and criminal justice system involvement; 

22 ‘‘(ii) treatment for first episode psy23 chosis or undefined psychosis; 

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1 ments and interventions for suicidal idea2 tion; 

3 ‘‘(iv) response through crisis services, 

4 including mobile crisis services; 

5 ‘‘(v) treatment of individuals who are 

6 experiencing homelessness or housing inse7 curity and individuals residing in rural 

8 communities; and 

9 ‘‘(vi) increased patient family and 

10 caregiver engagement and education on se11 rious mental illness to reduce social stigma 

12 and promote healthy social support for pa13 tients; 

14 ‘‘(3) any outreach by the State to, and the hir15 ing of, providers of mental health services from mul16 tiple disciplines (such as a psychologist, psychiatrist, 

17 peer support provider, or social worker) who are 

18 members of racial and ethnic minority groups; 

19 ‘‘(4) any outreach by the State to providers 

20 from multiple disciplines of mental health services— 

21 ‘‘(A) to provide training on culturally ef22 fective, culturally affirming, and linguistically 

23 competent services; and 


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1 ‘‘(B) to increase awareness of community2 defined practices by practitioners of racial and 

3 ethnic minority groups;’’. 

4 (b) APPLICABILITY.—The amendments made by sub5 section (a) shall apply with respect to funding agreements 

6 entered into under section 1911 or 1921 of the Public 

7 Health Service Act (42 U.S.C. 300x; 42 U.S.C. 300x–21) 

8 on or after the date of the enactment of this Act. 

9 SEC. 6702. STRONG SUPPORT FOR CHILDREN. 

10 (a) DATA ANALYSIS AND STRATEGY IMPLEMENTA11 TION TO PREVENT AND MITIGATE CHILDHOOD TRAU12 MA.—Title XXXI of the Public Health Service Act (42 

13 U.S.C. 300kk) is amended by adding at the end the fol14 lowing: 

15 ‘‘SEC. 3102. DATA ANALYSIS AND STRATEGY IMPLEMENTA16 TION TO PREVENT AND MITIGATE CHILD17 HOOD TRAUMA. 

18 ‘‘(a) IN GENERAL.—The Secretary shall establish a 

19 program— 

20 ‘‘(1) to support the development and implemen21 tation of programs that use data analysis methods 

22 to identify and facilitate strategies for early inter23 vention and prevention, in order to prevent and miti24 gate childhood trauma and support communities and 

25 families, including— 


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1 ‘‘(A) improving connections through care 

2 coordination; 

3 ‘‘(B) aligning community initiatives in tar4 geted areas of need; and 

5 ‘‘(C) expanding community capacity 

6 through cross-sector collaboration; and 

7 ‘‘(2) to evaluate the effectiveness of these pro8 grams in improving outcomes for children. 

9 ‘‘(b) GRANTS.—The Secretary shall award grants to 

10 up to 5 eligible entities to carry out the activities described 

11 in subsection (a). 

12 ‘‘(c) USE OF FUNDS.—A grant for activities under 

13 this section shall be used to support the development and 

14 implementation of programs that use data analysis meth15 ods to identify and facilitate strategies for early interven16 tion and prevention, in order to prevent and mitigate 

17 childhood trauma and support communities and families, 

18 including as follows: 

19 ‘‘(1) Utilize data analysis methods to— 

20 ‘‘(A) identify specific geographic areas, 

21 such as census tracts, with a high prevalence of 

22 adverse childhood experiences and significant 

23 risk factors for poor outcomes for children 

24 (such as increased risk of experiencing adverse 


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1 childhood experiences), including areas with 

2 high rates of— 

3 ‘‘(i) poor public health outcomes in4 cluding illness, disease, suicide, and mor5 tality; 

6 ‘‘(ii) exclusionary discipline practices, 

7 including suspensions, expulsions, and re8 ferrals to law enforcement, as well as low 

9 graduation rates; 

10 ‘‘(iii) substance use disorders; 

11 ‘‘(iv) poverty; 

12 ‘‘(v) foster system involvement or re13 ferrals; 

14 ‘‘(vi) housing instability and homeless15 ness; 

16 ‘‘(vii) food insecurity; 

17 ‘‘(viii) inequity, including disparities 

18 in income, wealth, employment, educational 

19 attainment, health care access, and public 

20 health outcomes, along lines of race, sex, 

21 sexuality and gender identity, ethnicity, or 

22 nationality; 

23 ‘‘(ix) incarceration rates; or 

24 ‘‘(x) other indicators of adversity as 

25 defined by the Secretary; and 


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1 ‘‘(B) identify strategies to improve out2 comes for children aged 0 through 17 that build 

3 on strengths in communities that could be fur4 ther supported, including— 

5 ‘‘(i) existing support networks for 

6 families; and 

7 ‘‘(ii) enhanced connections to commu8 nity-based organizations. 

9 ‘‘(2) Implement strategies identified pursuant 

10 to paragraph (1)(B) to facilitate outreach and in11 volvement of children and their caregivers in Fed12 eral, State, or local programs that provide repar13 ative, gender-responsive, culturally specific, and 

14 trauma-informed prevention services, and for which 

15 children and their caregivers are eligible, including— 

16 ‘‘(A) home visiting programs; 

17 ‘‘(B) training and education on parenting 

18 skills; 

19 ‘‘(C) substance use disorder prevention and 

20 treatment that is voluntary and noncoercive; 

21 ‘‘(D) mental health supports and care that 

22 is voluntary and noncoercive; 

23 ‘‘(E) family and intimate partner violence 

24 prevention services; 

25 ‘‘(F) child advocacy center programming; 


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1 ‘‘(G) economic and nutrition support serv2 ices; 

3 ‘‘(H) housing support services, including 

4 emergency and temporary shelter for those ex5 periencing homelessness and housing insecurity, 

6 as well as stable, long-term housing; 

7 ‘‘(I) voluntary, noncoercive, gender-respon8 sive, and culturally specific mental health sup9 ports in school and early childhood education 

10 center-based settings; 

11 ‘‘(J) wraparound programs for 

12 transitioning youth and youth currently in the 

13 foster system; 

14 ‘‘(K) programming to support the health 

15 and well-being of lesbian, gay, bisexual, 

16 transgender, and intersex children and their 

17 families; and 

18 ‘‘(L) family resource center services. 

19 ‘‘(d) SPECIAL RULES.— 

20 ‘‘(1) PRIMARY PAYER RESTRICTION.—The Sec21 retary may not award a grant under this section to 

22 an eligible entity for a service if the service to be 

23 provided is available pursuant to the State plan ap24 proved under title XIX of the Social Security Act for 

25 the State in which the program funded by the grant 


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1 is being conducted unless the State and all eligible 

2 subdivisions involved— 

3 ‘‘(A) will enter into agreements with public 

4 or nonprofit private entities under which the 

5 entities will provide the service; and 

6 ‘‘(B) demonstrate that the State and all el7 igible subdivisions will ensure that the entities 

8 providing the service— 

9 ‘‘(i) will seek payment for each such 

10 service rendered in accordance with the 

11 usual payment schedule under the State 

12 plan; and 

13 ‘‘(ii) the entities have entered into a 

14 participation agreement and are qualified 

15 to receive payments under such plan. 

16 ‘‘(2) IMPLEMENTATION.—An eligible entity that 

17 receives a grant under this section may use— 

18 ‘‘(A) not more than 25 percent of the 

19 amounts made available through the grant for 

20 the first 24 months of the grant period to uti21 lize data analysis methods to— 

22 ‘‘(i) identify specific geographic areas 

23 where care coordination, prevention and 

24 early intervention, and facilitation services 

25 will be provided; and 


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1 ‘‘(ii) identify support and intervention 

2 services to improve outcomes for children 

3 located in a geographic area identified 

4 under subsection (c)(1)(A); and 

5 ‘‘(B) not more than 10 percent of the 

6 grant in each subsequent year to continue data 

7 analysis activities. 

8 ‘‘(3) ADMINISTRATION.—An eligible entity that 

9 receives a grant under this section may not use more 

10 than 5 percent of amounts received through the 

11 grant for administration, reporting, and program 

12 oversight functions, including the development of 

13 systems to improve data collection and data sharing 

14 for the purposes of improving services and the provi15 sion of care. 

16 ‘‘(4) PRIORITY.— 

17 ‘‘(A) IN GENERAL.—In awarding grants 

18 under this section, the Secretary shall give pri19 ority, to the extent practical, to eligible entities 

20 that use community-based system dynamic 

21 modeling as the primary data analysis method. 

22 ‘‘(B) SYSTEM DYNAMIC MODELING DE23 FINED.—The term ‘system dynamic modeling’ 

24 means a method of data analysis and predictive 

25 modeling that includes— 


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1 ‘‘(i) utilization of community-based 

2 participatory research methods for involv3 ing community in the process of under4 standing and changing systems and evalu5 ating outcomes of grants; 

6 ‘‘(ii) consideration of a multitude of 

7 environmental risk factors and ascertain8 ment of the significance of contributing 

9 community risk factors for purposes of 

10 identifying strategies to reduce adverse 

11 child outcomes, including— 

12 ‘‘(I) maltreatment cases; 

13 ‘‘(II) involvement with the juve14 nile criminal legal system or foster 

15 system; 

16 ‘‘(III) exclusionary school dis17 cipline; or 

18 ‘‘(IV) exposure to violence; and 

19 ‘‘(iii) identification of cross-sector re20 sponses involving reparative, trauma-in21 formed, culturally specific, gender-respon22 sive, and community-based organizations 

23 to reduce adverse child outcomes. 

24 ‘‘(5) SUBGRANT.— 


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1 ‘‘(A) IN GENERAL.—An eligible entity that 

2 receives a grant under this section shall use at 

3 least 25 percent of the total amount of the 

4 grant to make subgrants to organizations that 

5 aid in implementing the strategy identified 

6 under subsection (c)(1)(B) for preventing and 

7 mitigating childhood trauma and supporting 

8 communities and families. 

9 ‘‘(B) ELIGIBILITY.—To be eligible to re10 ceive a subgrant under this paragraph, an orga11 nization shall prepare and submit to the eligible 

12 entity an application in such form, and con13 taining such information, as the eligible entity 

14 may require, including evidence that the— 

15 ‘‘(i) needs of the population to be 

16 served are urgent and are not met by the 

17 services currently available in the geo18 graphic area; and 

19 ‘‘(ii) organization has the capacity to 

20 provide the services listed in subsection 

21 (c)(2). 

22 ‘‘(C) SUPPLEMENT, NOT SUPPLANT.— 

23 Subgrant funds received pursuant to this para24 graph by an organization shall be used to sup25 plement and not supplant State or local funds 


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1 provided to the partnership organization for 

2 services listed in subsection (c)(2). 

3 ‘‘(e) APPLICATION.—To be eligible to receive a grant 

4 under this section, an eligible entity shall submit to the 

5 Secretary an application in such form, and containing 

6 such information, as the Secretary may require, to include 

7 the following: 

8 ‘‘(1) A demonstration that— 

9 ‘‘(A) the applicant utilizes trauma-in10 formed, culturally specific, and gender-respon11 sive practices, including a demonstration of the 

12 extent to which the applicant has trained staff 

13 in these practices; 

14 ‘‘(B) the applicant has the capacity to ad15 minister the grant, including conducting all re16 quired data analysis activities; and 

17 ‘‘(C) services will be provided to children 

18 and families in an accessible, culturally rel19 evant, and linguistically specific manner con20 sistent with local needs. 

21 ‘‘(2) A preliminary analysis of how the appli22 cant will use the grant to— 

23 ‘‘(A) identify the geographic area or areas 

24 to be served using data analysis methods; 


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1 ‘‘(B) utilize data analysis methods to iden2 tify strategies to improve outcomes for children 

3 in the geographic area; 

4 ‘‘(C) facilitate strategies identified through 

5 care coordination efforts; and 

6 ‘‘(D) track data for evaluation of out7 comes. 

8 ‘‘(3) A detailed project plan for the use of the 

9 grant that includes anticipated technical assistance 

10 needs. 

11 ‘‘(4) Additional funding sources, including State 

12 and local funds, supporting the prevention and miti13 gation of adverse childhood experiences. 

14 ‘‘(f) GRANT AMOUNT.—The amount of a grant under 

15 this section shall not exceed $9,500,000. 

16 ‘‘(g) PERIOD OF A GRANT.—The period of a grant 

17 under this section shall not exceed 7 years. 

18 ‘‘(h) SERVICE PROVISION WITHOUT REGARD TO

19 ABILITY TO PAY.—As a condition on receipt of a grant 

20 under this section, an eligible entity shall agree that any 

21 assistance provided to an individual through the grant will 

22 be provided without regard to— 

23 ‘‘(1) the ability of the individual to pay for such 

24 services; 


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1 ‘‘(2) the current or past health condition of the 

2 individual to be served; 

3 ‘‘(3) the immigration status of the individual to 

4 be served; 

5 ‘‘(4) the sexual orientation and gender identity 

6 of the individual to be served; and 

7 ‘‘(5) any prior involvement of the individual in 

8 the criminal legal system. 

9 ‘‘(i) PROHIBITIONS.—In addition to any other prohi10 bitions determined by the Secretary, an eligible entity may 

11 not use a grant under this section to— 

12 ‘‘(1) use data analysis methods to inform indi13 vidual case decisions, including child removal or 

14 placement decisions, or to target services at certain 

15 individuals or families; 

16 ‘‘(2) require any individual or family to partici17 pate in any service or program as a condition of re18 ceipt of a benefit to which the individual or family 

19 is otherwise eligible; 

20 ‘‘(3) increase the presence or funding of law en21 forcement surveillance, involvement, or activity in 

22 implementing the strategies identified under sub23 section (c)(1)(B); or 

24 ‘‘(4) enable the practice of conversion therapy. 

25 ‘‘(j) EVALUATION.— 


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1 ‘‘(1) DATA MODEL EVALUATION.—Not later 

2 than 36 months after the date of enactment of this 

3 section, the Assistant Secretary for Planning and 

4 Evaluation of the Department of Health and Human 

5 Services, in coordination with the grantees receiving 

6 a grant under this section, shall complete an evalua7 tion of the effectiveness of the data model accuracy 

8 of the grant program under this section to address 

9 each of the following: 

10 ‘‘(A) Determining the effectiveness of the 

11 grantees’ use of data analysis methods to iden12 tify geographic areas pursuant to subsection 

13 (c)(1). 

14 ‘‘(B) Examining the grantees’ development 

15 and utilization of data analysis methods. 

16 ‘‘(C) Examining the grantees’ ability to ef17 fectively utilize data analysis methods in future 

18 prevention work. 

19 ‘‘(D) Establishing a method for rigorously 

20 evaluating the activities of grantees and com21 paring the reduction of child and family expo22 sure to adverse experiences in other commu23 nities with similar demographics. 

24 ‘‘(E) Examining the grantees’ utilization of 

25 community-based system dynamics modeling 


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1 methods and other community engagement 

2 methods. 

3 ‘‘(2) PROGRAM EVALUATION.—Not later than 6 

4 years after the date of enactment of this section, the 

5 Assistant Secretary for Planning and Evaluation of 

6 the Department of Health and Human Services, in 

7 coordination with eligible entities receiving grants 

8 under this section, shall complete an evaluation of 

9 the effectiveness of the grant program under this 

10 section. 

11 ‘‘(3) DATA COLLECTION.— 

12 ‘‘(A) IN GENERAL.—The Assistant Sec13 retary for Planning and Evaluation of the De14 partment of Health and Human Services and 

15 each eligible entity receiving a grant under this 

16 section shall collect any relevant data necessary 

17 to complete the evaluations required by para18 graphs (1) and (2) to include— 

19 ‘‘(i) the activities funded by the grant 

20 under this section, including development 

21 and implementation data analysis methods; 

22 ‘‘(ii) the number of children and of 

23 families receiving coordination and facilita24 tion of care and services; and 


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1 ‘‘(iii) the effect of activities supported 

2 by the grant under this section on the local 

3 area serviced by the program, including 

4 such effects on— 

5 ‘‘(I) children and adolescents’ 

6 health and well-being; 

7 ‘‘(II) the number of children who 

8 enter into or depart from foster serv9 ices; and 

10 ‘‘(III) homelessness and housing 

11 insecurity. 

12 ‘‘(B) STUDY.— 

13 ‘‘(i) IN GENERAL.—Not later than 7 

14 years after the date of enactment of this 

15 section, the Assistant Secretary for Plan16 ning and Evaluation of the Department of 

17 Health and Human Services shall— 

18 ‘‘(I) complete a study on the re19 sults of the grant program under this 

20 section using the community-based 

21 participatory action research method, 

22 which focuses on social, structural, 

23 and physical environmental inequities 

24 through active involvement of commu25 nity members, clients, organizational 


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1 representatives, and researchers in all 

2 aspects of the research process; and 

3 ‘‘(II) submit a report on the re4 sults of the study to the Congress. 

5 ‘‘(ii) PARTNERS.—In conducting the 

6 study under clause (i), the Assistant Sec7 retary for Planning and Evaluation of the 

8 Department of Health and Human Serv9 ices shall ensure that partners and persons 

10 that have participated in the grant pro11 gram under this section on every level, es12 pecially those such partners or persons re13 ceiving services and support through the 

14 program, have an opportunity to contribute 

15 their expertise to evaluating the strategy 

16 and outcomes. 

17 ‘‘(k) REPORT.—Not later than three months after the 

18 completion of the evaluation required by subsection (j)(2), 

19 the Assistant Secretary for Planning and Evaluation of 

20 the Department of Health and Human Services shall sub21 mit to Congress and make available to the public on the 

22 internet website of the Department of Health and Human 

23 Services a report based upon the evaluation under sub24 section (j)(2), to include— 


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1 ‘‘(1) the impact of the program under this sec2 tion on homelessness and housing insecurity, sub3 stance use disorder and drug deaths, incarceration, 

4 foster system involvement, and other child and fam5 ily outcomes as identified by the Assistant Secretary 

6 for Planning and Evaluation of the Department of 

7 Health and Human Services; 

8 ‘‘(2) an analysis of which elements of the pro9 gram should be replicated and scaled by govern10 mental or non-governmental entities; and 

11 ‘‘(3) such recommendations for legislation and 

12 administrative action as the Secretary determines 

13 appropriate. 

14 ‘‘(l) DEFINITIONS.—In this section: 

15 ‘‘(1) The term ‘adverse childhood experience’ 

16 means a potentially traumatic experience that occurs 

17 in childhood and can have a tremendous impact on 

18 the child’s lifelong health and opportunity outcomes, 

19 such as any of the following: 

20 ‘‘(A) Abuse, such as any of the following: 

21 ‘‘(i) Emotional and psychological 

22 abuse. 

23 ‘‘(ii) Physical abuse. 

24 ‘‘(iii) Sexual abuse. 


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1 ‘‘(B) Household challenges such as any of 

2 the following: 

3 ‘‘(i) A household member is treated 

4 violently. 

5 ‘‘(ii) A household member has a sub6 stance use disorder. 

7 ‘‘(iii) A household member has a men8 tal health condition. 

9 ‘‘(iv) Parental separation or divorce. 

10 ‘‘(v) A household member is incarcer11 ated, is placed in immigrant detention, or 

12 has been deported. 

13 ‘‘(vi) A household member has a life14 threatening illness such as COVID–19. 

15 ‘‘(C) Neglect. 

16 ‘‘(D) Living in— 

17 ‘‘(i) impoverished communities that 

18 lack access to human services; 

19 ‘‘(ii) areas of high unemployment 

20 neighborhoods; or 

21 ‘‘(iii) communities experiencing de 

22 facto segregation. 

23 ‘‘(E) Experiencing food insecurity and 

24 poor nutrition. 

25 ‘‘(F) Witnessing violence. 


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1 ‘‘(G) Involvement with the foster system. 

2 ‘‘(H) Experiencing discrimination. 

3 ‘‘(I) Dealing with historical and ongoing 

4 traumas due to systemic and interpersonal rac5 ism. 

6 ‘‘(J) Dealing with historical and ongoing 

7 traumas regarding systemic and interpersonal 

8 sexism, homophobia, biphobia, and transphobia. 

9 ‘‘(K) Dealing with the threat of deporta10 tion or detention as a result of immigration sta11 tus. 

12 ‘‘(L) The impacts of multigenerational pov13 erty resulting from limited educational and eco14 nomic opportunities. 

15 ‘‘(M) Living through natural disasters 

16 such as earthquakes, forest fires, floods, or hur17 ricanes. 

18 ‘‘(2) The term ‘eligible entity’ means a State or 

19 local health department. 

20 ‘‘(3) The term ‘practice of conversion ther21 apy’— 

22 ‘‘(A) means any practice or treatment by 

23 any person that seeks to change another indi24 vidual’s sexual orientation or gender identity, 

25 including efforts to change behaviors or gender 


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1 expressions, or to eliminate or reduce sexual or 

2 romantic attractions or feelings toward individ3 uals of the same gender, if such person receives 

4 monetary compensation in exchange for any 

5 such practice or treatment; and 

6 ‘‘(B) does not include any practice or 

7 treatment that does not seek to change sexual 

8 orientation or gender identity and— 

9 ‘‘(i) provides assistance to an indi10 vidual undergoing a gender transition; or 

11 ‘‘(ii) provides acceptance, support, 

12 and understanding of a client or facilita13 tion of a client’s coping, social support, 

14 and identity exploration and development. 

15 ‘‘(m) AUTHORIZATION OF APPROPRIATIONS.—There 

16 is authorized to be appropriated to carry out this section 

17 for the period of fiscal years 2025 through 2031— 

18 ‘‘(1) to carry out subsection (a)(1) through the 

19 award of grants under subsection (b)— 

20 ‘‘(A) $47,500,000 for grants; and 

21 ‘‘(B) such sums as may be necessary for 

22 the administrative costs of carrying out such 

23 subsection; and 

24 ‘‘(2) $7,500,000 to carry out the evaluation 

25 under subsection (a)(2).’’. 


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1 (b) CARE COORDINATION GRANTS.—Part E of title 

2 XII of the Public Health Service Act (42 U.S.C. 300d– 

3 51 et seq.) is amended by adding at the end the following 

4 new section: 

5 ‘‘SEC. 1255. CARE COORDINATION GRANTS. 

6 ‘‘(a) IN GENERAL.—The Secretary shall award 

7 grants to eligible entities to establish or expand trauma8 informed care coordination services to support— 

9 ‘‘(1) children aged 0 through 5 at risk of ad10 verse childhood experiences; and 

11 ‘‘(2) their caregivers, including prenatal people 

12 of any age. 

13 ‘‘(b) NUMBER OF GRANTS.—Subject to the avail14 ability of appropriations, the Secretary shall award not 

15 fewer than 9 and not more than 40 grants under this sec16 tion. 

17 ‘‘(c) AMOUNT OF GRANTS.—Subject to the avail18 ability of appropriations, the amount of a grant under this 

19 section for a fiscal year shall be— 

20 ‘‘(1) not less than $250,000; and 

21 ‘‘(2) not more than $1,000,000. 

22 ‘‘(d) ELIGIBLE ENTITIES.—To be eligible to receive 

23 a grant under this section, an entity shall be a local gov24 ernment or Indian Tribe, acting through the public health 


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1 department thereof if such government or Tribe has a 

2 public health department. 

3 ‘‘(e) PRIORITY.— 

4 ‘‘(1) IN GENERAL.—In awarding grants under 

5 this section, the Secretary shall give priority to eligi6 ble entities proposing to serve communities with a 

7 high need for trauma-informed care coordination 

8 services, as demonstrated by indicators such as— 

9 ‘‘(A) pregnant people who face barriers to 

10 prenatal care; 

11 ‘‘(B) mortality or morbidity of people giv12 ing birth or infants; 

13 ‘‘(C) caretakers and parents who are living 

14 with a mental health condition or substance use 

15 disorder; 

16 ‘‘(D) a high prevalence of community vio17 lence, including domestic violence, as dem18 onstrated by instances of homicide and public 

19 health statistics, including treatment of injury 

20 or trauma; 

21 ‘‘(E) high proportions of low-income chil22 dren; 

23 ‘‘(F) a high prevalence of child fatalities or 

24 near fatalities related to child abuse and ne25 glect; 


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1 ‘‘(G) significant disparities in health out2 comes for people giving birth and infants; 

3 ‘‘(H) a high rate of exclusionary discipline 

4 and referrals to law enforcement; and 

5 ‘‘(I) a high rate of homelessness and hous6 ing instability. 

7 ‘‘(2) DATA FROM TRIBAL AREAS.—The Sec8 retary, acting through the Director of the Indian 

9 Health Service, shall consult with Indian Tribes to 

10 establish criteria to measure indicators of need, for 

11 purposes of paragraph (1), with respect to Tribal 

12 areas. 

13 ‘‘(f) USE OF FUNDS.— 

14 ‘‘(1) REQUIRED USES.— 

15 ‘‘(A) IN GENERAL.—A grant received 

16 under this section shall be used to establish or 

17 expand gender-responsive, culturally specific, 

18 trauma-informed care coordination services, in19 cluding by instituting and conducting risk and 

20 needs assessments including— 

21 ‘‘(i) using strengths-based approaches 

22 focused on protective factors for children 

23 and their caregivers, including prenatal 

24 people of any age; and 


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1 ‘‘(ii) inputting screening results into a 

2 centralized intake system to promote a sin3 gle point of access system across providers 

4 and services. 

5 ‘‘(B) TRAINING.—A grant received under 

6 this section shall be used to ensure that individ7 uals employed through the grant funds, in 

8 whole or in part, have received sufficient and 

9 up-to-date training on trauma-informed care 

10 and strategies that are reparative, culturally 

11 sensitive, gender responsive, and healing cen12 tered. 

13 ‘‘(2) PERMISSIBLE USES.—A grant received 

14 under this section may be used for any of the fol15 lowing: 

16 ‘‘(A) Employing care coordinators, case 

17 managers, community health workers, certified 

18 infant mental health specialists, and outreach 

19 and engagement specialists to work with chil20 dren and their caregivers, including prenatal in21 dividuals, to prevent and respond to adverse 

22 childhood experiences by connecting clients with 

23 culturally specific, trauma-informed care treat24 ment services, including economic, social, food, 

25 and housing supports. 


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1 ‘‘(B) Providing training described in para2 graph (1)(B) to community health providers 

3 and community partners. 

4 ‘‘(C) Expanding, enhancing, modifying, 

5 and connecting the existing network of commu6 nity programs and services to achieve a more 

7 comprehensive and coordinated system of care 

8 approach, including— 

9 ‘‘(i) developing local infrastructure to 

10 bolster and shape community support sys11 tems and map and build access to services 

12 in a coordinated and comprehensive way; 

13 and 

14 ‘‘(ii) creating infrastructure to con15 duct outreach to children and families, in16 cluding those experiencing homelessness 

17 and housing instability, so they acquire ac18 cess to the services and supports they need 

19 and the benefits to which they are entitled. 

20 ‘‘(D) Compiling information on resources 

21 (including any referral services) available 

22 through community-based organizations and 

23 local, State, and Federal agencies, such as— 

24 ‘‘(i) programs addressing social deter25 minants of health, including— 


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1 ‘‘(I) emergency, temporary, and 

2 long-term housing; 

3 ‘‘(II) programs that offer free or 

4 affordable and nutritious food; 

5 ‘‘(III) vocational and workforce 

6 development; and 

7 ‘‘(IV) transportation supports; 

8 ‘‘(ii) home visiting programs for new 

9 parents and their infants; 

10 ‘‘(iii) workforce development programs 

11 to support caregivers in skill building; 

12 ‘‘(iv) trauma-responsive, parenting 

13 skills-building programs; 

14 ‘‘(v) the continuum of substance use 

15 prevention, intervention, and treatment 

16 programs and mental health support pro17 grams, including programs with trauma-in18 formed, gender-responsive, and culturally 

19 specific counseling; and 

20 ‘‘(vi) childcare support and early 

21 childhood education, including Head Start 

22 and Early Head Start programs. 

23 ‘‘(E) Subject to subsection (g)(1), estab24 lishing or updating a database that compiles 


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1 data used to track the effectiveness of the care 

2 coordination services funded through the grant. 

3 ‘‘(F) Developing and implementing referral 

4 partnership agreements with community-based 

5 organizations, parent organizations, substance 

6 use disorder treatment providers and facilities, 

7 housing and shelter providers, health care pro8 viders, mental health care providers, and Fed9 eral and State offices and programs that imple10 ment practices to support children ages 0 

11 through 5 who are at risk of adverse childhood 

12 experiences and their caregivers, including pre13 natal people. Such practices shall include— 

14 ‘‘(i) a bilateral ‘warm handoff’ system 

15 whereby a grantee understands the needs 

16 of the children and their families, and fam17 ilies are involved in addressing these needs; 

18 and 

19 ‘‘(ii) an active service connection 

20 whereby the children and families are each 

21 actively connected with a resource in a 

22 well-coordinated way that ensures avail23 ability and direct contact. 

24 ‘‘(G) Supporting cross-system planning 

25 and collaboration among employees who may 


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1 work in emergency medical services, health care 

2 services, public health, early childhood edu3 cation, and substance use disorder treatment 

4 and recovery support. 

5 ‘‘(H) Providing or subsidizing services to 

6 address barriers that children, prenatal individ7 uals, and caregivers face to utilizing community 

8 resources and services, such as by providing or 

9 subsidizing transportation or childcare costs as 

10 applicable and within reasonable amounts. 

11 ‘‘(I) Creating or expanding infrastructure 

12 and investing in technology, including the provi13 sion of communications technology and internet 

14 service to children and their caregivers, to en15 able increased telemedicine capabilities to reach 

16 participants. 

17 ‘‘(3) INDIAN TRIBES.—In the case of an eligible 

18 entity that is an Indian Tribe, the Secretary may 

19 waive such provisions of this subsection as the Sec20 retary determines appropriate. 

21 ‘‘(4) PROHIBITIONS.—In addition to any other 

22 prohibitions determined by the Secretary, an eligible 

23 entity may not use a grant under this section to— 

24 ‘‘(A) use data analysis methods to inform 

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1 moval or placement decisions, or to target serv2 ices at certain individuals or families; 

3 ‘‘(B) require any individual or family to 

4 participate in any service or program as a con5 dition of receipt of a benefit to which the indi6 vidual or family is otherwise eligible; or 

7 ‘‘(C) increase the presence or funding of 

8 law enforcement surveillance, involvement, or 

9 activity in connection with trauma-informed 

10 care coordination services supported pursuant 

11 to this section. 

12 ‘‘(g) REQUIREMENTS.—As a condition on receipt of 

13 a grant under this section, an eligible entity shall agree 

14 to each of the following funding conditions: 

15 ‘‘(1) RESTRICTION OF FUNDING ALLOCATION.— 

16 The eligible entity will not use more than 30 percent 

17 of the funds made available to the entity through the 

18 grant (for the total grant period) to establish or up19 date a database pursuant to subsection (f)(2)(E). 

20 ‘‘(2) ACCESSIBLE SETTING.— 

21 ‘‘(A) IN GENERAL.—The eligible entity will 

22 ensure that all care coordination services pro23 vided through the grant are provided in a set24 ting that is accessible, including through mobile 

25 settings, to— 


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1 ‘‘(i) low-income or no-income individ2 uals, including individuals experiencing 

3 homelessness or housing instability; and 

4 ‘‘(ii) individuals in rural areas. 

5 ‘‘(B) COMMUNITY OUTREACH.—In com6 plying with subparagraph (A), the eligible entity 

7 will ensure that at least 50 percent of the care 

8 coordination services provided through the 

9 grant occur in community settings that are con10 venient to the children and caregivers who are 

11 being served, such as homes, schools, and shel12 ters, whether for initial outreach or as part of 

13 long-term care. 

14 ‘‘(3) SUPPLEMENT, NOT SUPPLANT.—The 

15 grant will be used to supplement, not supplant other 

16 Federal, State, or local funds available for care co17 ordination services. 

18 ‘‘(4) CONFIDENTIALITY.—The eligible entity 

19 will maintain the confidentiality of individuals receiv20 ing services through the grant in a manner con21 sistent with applicable law. 

22 ‘‘(5) PARTNERING; RISK STRATIFICATION.—In 

23 providing care coordination services through the 

24 grant, the eligible entity will— 


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1 ‘‘(A) partner with community-based orga2 nizations with experience serving child popu3 lations prenatally through age 5; 

4 ‘‘(B) coordinate with the local agency re5 sponsible for administering the State plan ap6 proved under title XIX of the Social Security 

7 Act; and 

8 ‘‘(C) employ risk stratification to develop 

9 different effective models of care for different 

10 populations based on their needs. 

11 ‘‘(h) APPLICATION.— 

12 ‘‘(1) IN GENERAL.—To seek a grant under this 

13 section, an eligible entity shall submit an application 

14 to the Secretary at such time, in such manner, and 

15 containing such information, as the Secretary may 

16 require. 

17 ‘‘(2) CONTENTS.—An application under para18 graph (1) shall, at a minimum, contain each of the 

19 following: 

20 ‘‘(A) Goals to be achieved through the 

21 grant, including the activities that will be un22 dertaken to achieve those goals. 

23 ‘‘(B) The number of individuals likely to 

24 be served through the grant, including demo25 graphic data on the populations to be served. 


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1 ‘‘(C) Existing programs and services that 

2 can be used to significantly increase the propor3 tion of children and families who receive needed 

4 supports and services. 

5 ‘‘(D) A plan for expanding, coordinating, 

6 or modifying the existing network of programs 

7 and services to meet the needs of children and 

8 families for preventing and mitigating the trau9 matic impact of adverse childhood experiences. 

10 ‘‘(E) A demonstration of the ability of the 

11 eligible entity to reach the individuals to be 

12 served, including by partnering with local stake13 holders. 

14 ‘‘(F) An indication of how the personnel 

15 involved are reflective of the communities to be 

16 served. 

17 ‘‘(G) A list of stakeholders with whom the 

18 entity plans to partner or consult. 

19 ‘‘(i) REPORTING BY GRANTEES.—Not later than 4 

20 years after the date of enactment of this section, an eligi21 ble entity receiving a grant under this section shall submit 

22 to the Secretary a report on the activities funded through 

23 the grant. Such report shall include, at a minimum, a de24 scription of— 


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1 ‘‘(1) the number of individuals served through 

2 activities funded through the grant, including demo3 graphics as applicable; 

4 ‘‘(2) the number of referrals made through the 

5 grant and the rate of such referrals successfully 

6 linked or closed; 

7 ‘‘(3) a qualitative analysis or number of collabo8 rative partnerships with other organizations in car9 rying out the activities funded through the grant; 

10 ‘‘(4) the number of services provided to individ11 uals through the grant; 

12 ‘‘(5) aggregated and de-identified outcomes ex13 perienced by individuals served through the grant 

14 such as— 

15 ‘‘(A) the rate of successful service connec16 tions; 

17 ‘‘(B) any increases in development of pro18 tective factors for children; 

19 ‘‘(C) any increase in development of pro20 tective factors for the caregivers; 

21 ‘‘(D) any mitigation of the negative out22 comes associated with adverse childhood experi23 ences or decreased likelihood of children experi24 encing an adverse childhood experience as evi25 denced by— 


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1 ‘‘(i) decreased presence of law en2 forcement or other punitive State surveil3 lance in the community; 

4 ‘‘(ii) a parent completing substance 

5 use treatment; 

6 ‘‘(iii) a parent receiving voluntary 

7 treatment for mental health-related condi8 tions; 

9 ‘‘(iv) a family entering into or main10 taining a stable housing situation; 

11 ‘‘(v) a family achieving or maintaining 

12 economic security; 

13 ‘‘(vi) a parent achieving or maintain14 ing job stability; or 

15 ‘‘(vii) a child meeting developmental 

16 markers for school readiness; and 

17 ‘‘(E) reports of satisfaction with the co18 ordination of care by people served; and 

19 ‘‘(6) any other information required by the Sec20 retary. 

21 ‘‘(j) CONVENING PARTICIPANTS FOR SHARING LES22 SONS LEARNED.—After the period of all grants awarded 

23 under this section has concluded, the Assistant Secretary 

24 for Planning and Evaluation of the Department of Health 

25 and Human Services shall provide an in-person or online 


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1 opportunity for persons participating in the programs 

2 funded through this section to share with each other— 

3 ‘‘(1) lessons learned; 

4 ‘‘(2) challenges experienced; and 

5 ‘‘(3) ideas for next steps and solutions. 

6 ‘‘(k) COMPILING FINDINGS AND CONCLUSIONS.— 

7 After providing the opportunity required by subsection (j), 

8 the Secretary shall— 

9 ‘‘(1) compile the findings and conclusions of 

10 grantees under this section on the provision of care 

11 coordination services described in subsection (a); 

12 ‘‘(2) submit a report on such findings and con13 clusions to the appropriate congressional commit14 tees; and 

15 ‘‘(3) make such report publicly available. 

16 ‘‘(l) DEFINITIONS.—In this section: 

17 ‘‘(1) ADVERSE CHILDHOOD EXPERIENCE.—The 

18 term ‘adverse childhood experience’ means a poten19 tially traumatic experience that occurs in childhood 

20 and can have a tremendous impact on the child’s 

21 lifelong health and opportunity outcomes, such as 

22 any of the following: 

23 ‘‘(A) Abuse, such as any of the following: 

24 ‘‘(i) Emotional and psychological 

25 abuse. 


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1 ‘‘(ii) Physical abuse. 

2 ‘‘(iii) Sexual abuse. 

3 ‘‘(B) Household challenges such as any of 

4 the following: 

5 ‘‘(i) A household member is treated 

6 violently. 

7 ‘‘(ii) A household member has a sub8 stance use disorder. 

9 ‘‘(iii) A household member has a men10 tal health condition. 

11 ‘‘(iv) Parental separation or divorce. 

12 ‘‘(v) A household member is incarcer13 ated, is placed in immigrant detention, or 

14 has been deported. 

15 ‘‘(vi) A household member has a life16 threatening illness such as COVID–19. 

17 ‘‘(C) Neglect. 

18 ‘‘(D) Living in— 

19 ‘‘(i) impoverished communities that 

20 lack access to human services; 

21 ‘‘(ii) areas of high unemployment 

22 neighborhoods; or 

23 ‘‘(iii) communities experiencing de 

24 facto segregation. 


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1 ‘‘(E) Experiencing food insecurity and 

2 poor nutrition. 

3 ‘‘(F) Witnessing violence. 

4 ‘‘(G) Involvement with the foster system. 

5 ‘‘(H) Experiencing discrimination. 

6 ‘‘(I) Dealing with historical and ongoing 

7 traumas due to systemic and interpersonal rac8 ism. 

9 ‘‘(J) Dealing with historical and ongoing 

10 traumas regarding systemic and interpersonal 

11 sexism, homophobia, biphobia, and transphobia. 

12 ‘‘(K) Dealing with the threat of deporta13 tion or detention as a result of immigration sta14 tus. 

15 ‘‘(L) The impacts of multigenerational pov16 erty resulting from limited educational and eco17 nomic opportunities. 

18 ‘‘(M) Living through natural disasters 

19 such as earthquakes, forest fires, floods, or hur20 ricanes. 

21 ‘‘(2) CARE COORDINATION.—The term ‘care co22 ordination’ means an active, ongoing process that— 

23 ‘‘(A) assists children ages 0 through 5 at 

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1 cluding prenatal people of any age, to identify, 

2 access, and use community resources and serv3 ices; 

4 ‘‘(B) is client centered and comprehensive 

5 of the services a child or caregiver may need; 

6 ‘‘(C) ensures a closed loop referral by ob7 taining feedback from the families served; and 

8 ‘‘(D) works across systems and services to 

9 promote collaboration to effectively meet the 

10 needs of community members. 

11 ‘‘(3) INDIAN TRIBE.—The term ‘Indian Tribe’ 

12 has the meaning given such term in section 4 of the 

13 Indian Self-Determination and Education Assistance 

14 Act. 

15 ‘‘(4) PROTECTIVE FACTORS.—The term ‘protec16 tive factors’ refers to any supportive element in a 

17 child or caretaker’s life that helps the child or care18 taker to withstand trauma such as a stable school 

19 environment or supportive peer relationships. 

20 ‘‘(m) AUTHORIZATION OF APPROPRIATIONS.— 

21 ‘‘(1) IN GENERAL.—To carry out this section, 

22 there is authorized to be appropriated $15,000,000 

23 for each of the 5 fiscal years following the fiscal year 

24 in which this section is enacted. 


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1 ‘‘(2) GRANTS TO INDIAN TRIBES.—Of the 

2 amount made available to carry out this section for 

3 a fiscal year, the Secretary shall use not less than 

4 10 percent of such amount for grants to eligible en5 tities that are Indian Tribes. 

6 ‘‘(3) ADMINISTRATIVE EXPENSES.—Of the 

7 amount made available to carry out this section for 

8 a fiscal year, the Secretary may use not more than 

9 15 percent of such amount for administrative ex10 penses, including the expenses of the Assistant Sec11 retary for Planning and Evaluation of the Depart12 ment of Health and Human Services for compiling 

13 and reporting information. 

14 ‘‘(4) TECHNICAL ASSISTANCE.—Of the amount 

15 made available to carry out this section for a fiscal 

16 year, the Secretary may reserve up to 5 percent of 

17 such amount to provide technical assistance to eligi18 ble entities in preparing and submitting applications 

19 under this section.’’. 

20 SEC. 6703. IMPROVING ACCESS TO MENTAL HEALTH. 

21 (a) ACCESS TO CLINICAL SOCIAL WORKERS.—Sec22 tion 1833(a)(1) of the Social Security Act (42 U.S.C. 

23 1395l(a)(1)) is amended— 


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1 (1) in subparagraph (D), by striking ‘‘such ne2 gotiated rate,,’’ and inserting ‘‘such negotiated 

3 rate,’’; and 

4 (2) in subparagraph (F)(ii) by striking ‘‘75 per5 cent of the amount determined for payment of a 

6 psychologist under clause (L)’’ and inserting ‘‘85 

7 percent of the fee schedule amount provided under 

8 section 1848’’. 

9 (b) ACCESS TO CLINICAL SOCIAL WORKER SERVICES

10 PROVIDED TO RESIDENTS OF SKILLED NURSING FACILI11 TIES.— 

12 (1) IN GENERAL.—Section 1888(e)(2)(A)(ii) of 

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

14 1395yy(e)(2)(A)(ii)), as amended by section 

15 6101(a)(5), is amended by inserting ‘‘clinical social 

16 worker services,’’ after ‘‘peer support specialist serv17 ices (as defined in section 1861(qqq)(3)),’’. 

18 (2) CONFORMING AMENDMENT.—Section 

19 1861(hh)(2) of the Social Security Act (42 U.S.C. 

20 1395x(hh)(2)) is amended by striking ‘‘and other 

21 than services furnished to an inpatient of a skilled 

22 nursing facility which the facility is required to pro23 vide as a requirement for participation’’. 

24 (c) ACCESS TO THE COMPLETE SET OF CLINICAL SO25 CIAL WORKER SERVICES.—Section 1861(hh)(2) of the SoVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 01086 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 cial Security Act (42 U.S.C. 1395x(hh)(2)) is further 

2 amended by striking ‘‘for the diagnosis and treatment of 

3 mental illnesses (other than services’’ and inserting ‘‘(in4 cluding services for the diagnosis and treatment of mental 

5 illnesses or services for health and behavior assessment 

6 and intervention (identified as of January 1, 2022, by 

7 HCPCS codes 96150 through 96161 (and any succeeding 

8 codes)), but not including services’’. 

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

10 this section shall apply to items and services furnished on 

11 or after January 1, 2025. 

12 SEC. 6704. PROGRAM TO ESTABLISH PUBLIC-PRIVATE CON13 TRIBUTIONS TO INCREASE THE AVAILABLE 

14 WORKFORCE OF SCHOOL-BASED MENTAL 

15 HEALTH SERVICE PROVIDERS. 

16 (a) PROGRAM AUTHORIZED.—The Secretary shall 

17 carry out a program under which eligible graduate institu18 tions may enter into an agreement with the Secretary to 

19 cover a portion of the cost of attendance of a participating 

20 student, which contributions shall be matched by equiva21 lent contributions towards such cost of attendance by the 

22 Secretary. 

23 (b) DESIGNATION OF PROGRAM.—The program 

24 under this section shall be known as the ‘‘Mental Health 

25 Excellence in Schools Program’’. 


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1 (c) AGREEMENTS.—The Secretary shall enter into an 

2 agreement with each eligible graduate institution seeking 

3 to participate in the program under this section. Each 

4 agreement shall specify the following: 

5 (1) The manner (whether by direct grant, schol6 arship, or otherwise) in which the eligible graduate 

7 institution will contribute to the cost of attendance 

8 of a participating student. 

9 (2) The maximum amount of the contribution 

10 to be made by the eligible graduate institution with 

11 respect to any particular participating student in 

12 any given academic year. 

13 (3) The maximum number of individuals for 

14 whom the eligible graduate institution will make con15 tributions in any given academic year. 

16 (4) That the eligible graduate institution, in se17 lecting participating students to receive assistance 

18 under the program, shall prioritize the participating 

19 students described in subsection (d)(2). 

20 (5) Such other matters as the Secretary and 

21 the eligible graduate institution determine appro22 priate. 

23 (d) OUTREACH.—The Secretary shall— 

24 (1) make publicly available and periodically up25 date on the internet website of the Department of 


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1 Education a list of the eligible graduate institutions 

2 participating in the program under this section that 

3 shall specify, for each such graduate institution, ap4 propriate information on the agreement between the 

5 Secretary and such eligible graduate institution 

6 under subsection (c); and 

7 (2) conduct outreach about the program under 

8 this section to participating students who, as under9 graduates— 

10 (A) received a Federal Pell Grant under 

11 section 401 of the Higher Education Act of 

12 1965 (20 U.S.C. 1070a); or 

13 (B) attended an institution listed in section 

14 371(a) of the Higher Education Act of 1965 

15 (20 U.S.C. 1067q(a)). 

16 (e) MATCHING CONTRIBUTIONS.—The Secretary may 

17 provide a contribution of not more than 50 percent of the 

18 cost of attendance of a participating student if the eligible 

19 graduate institution at which such student is enrolled en20 ters into an agreement under subsection (c) with the Sec21 retary to match such contribution. 

22 (f) MONITORING AND EVALUATION.—As a condition 

23 of participation in the program under this section, each 

24 eligible graduate institution shall agree to submit an an25 nual report to the Secretary describing— 


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1 (1) the number of students served by the pro2 gram; 

3 (2) the percentage of tuition cost covered by the 

4 program; 

5 (3) the number of participating students who 

6 were also recipients of a Federal Pell Grant; and 

7 (4) as applicable, the graduation rates and 

8 post-graduate employment of participating students. 

9 (g) INTERIM REPORT.—Not later than 2 years after 

10 the first contributions are provided under this section, the 

11 Secretary shall submit an interim report to Congress 

12 based on the annual reports required by subsection (f). 

13 (h) INDEPENDENT NATIONAL EVALUATION.— 

14 (1) IN GENERAL.—Not later than 4 years after 

15 the date of enactment of this Act, the Secretary 

16 shall provide for the commencement of an inde17 pendent national evaluation of the outcomes and ef18 fectiveness of the program under this section. 

19 (2) REPORT TO CONGRESS.—Not later than 90 

20 days after receiving the results of such independent 

21 national evaluation, the Secretary shall submit a re22 port to Congress containing the findings of the eval23 uation and the Secretary’s recommendations for im24 provements to the program. 

25 (i) DEFINITIONS.—In this section: 


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1 (1) COST OF ATTENDANCE.—The term ‘‘cost of 

2 attendance’’ has the meaning given the term in sec3 tion 472 of the Higher Education Act of 1965 (20 

4 U.S.C. 1087ll). 

5 (2) ELIGIBLE GRADUATE INSTITUTION.—The 

6 term ‘‘eligible graduate institution’’ means an insti7 tution of higher education that offers a program of 

8 study that leads to a graduate degree— 

9 (A) in school psychology that is accredited 

10 or approved by the National Association of 

11 School Psychologists’ Program Accreditation 

12 Board or the Commission on Accreditation of 

13 the American Psychological Association and 

14 that prepares students in such program for the 

15 State licensing or certification examination in 

16 school psychology at the specialist level; 

17 (B) in an accredited school counseling pro18 gram that prepares students in such program 

19 for the State licensing or certification examina20 tion in school counseling; 

21 (C) in school social work that is accredited 

22 by the Council on Social Work Education and 

23 that prepares students in such program for the 

24 State licensing or certification examination in 

25 school social work; 


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1 (D) in another school-based mental health 

2 field that prepares students in such program 

3 for the State licensing or certification examina4 tion in such field, if applicable; or 

5 (E) in any combination of study described 

6 in subparagraphs (A) through (D). 

7 (3) INSTITUTION OF HIGHER EDUCATION.—The 

8 term ‘‘institution of higher education’’ has the 

9 meaning given the term in section 101 of the Higher 

10 Education Act of 1965 (20 U.S.C. 1001). 

11 (4) PARTICIPATING STUDENT.—The term ‘‘par12 ticipating student’’ means an individual who is en13 rolled in a graduate degree program in a school14 based mental health field at a participating eligible 

15 graduate institution. 

16 (5) SCHOOL-BASED MENTAL HEALTH FIELD.— 

17 The term ‘‘school-based mental health field’’ means 

18 any of the following fields: 

19 (A) School counseling. 

20 (B) School social work. 

21 (C) School psychology. 

22 (D) Any other field of study that leads to 

23 employment as a school-based mental health 

24 services provider, as determined by the Sec25 retary. 


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1 (6) SCHOOL-BASED MENTAL HEALTH SERVICES

2 PROVIDER.—The term ‘‘school-based mental health 

3 services provider’’ has the meaning given the term in 

4 section 4102 of the Elementary and Secondary Edu5 cation Act of 1965 (20 U.S.C. 7112). 

6 (7) SECRETARY.—The term ‘‘Secretary’’ means 

7 the Secretary of Education. 

8 (j) AUTHORIZATION OF APPROPRIATIONS.—There 

9 are authorized to be appropriated to carry out this sec10 tion— 

11 (1) $20,000,000 for fiscal year 2025; 

12 (2) $30,000,000 for fiscal year 2026; and 

13 (3) $50,000,000 for each of fiscal years 2027 

14 through 2029. 

15 SEC. 6705. SCHOOL SOCIAL WORKERS IMPROVING STU16 DENT SUCCESS. 

17 (a) SCHOOL SOCIAL WORKER GRANTS.— 

18 (1) PURPOSES.—The purpose of this section is 

19 to assist States and local educational agencies in hir20 ing additional school social workers in order to in21 crease access to mental health and other student 

22 support services to students in elementary schools 

23 and secondary schools in the United States to the 

24 minimum ratios recommended by the National Asso25 ciation of Social Workers, the School Social Work 


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1 Association of America, and the American Council 

2 for School Social Work of 1 school social worker for 

3 every 250 students, and 1 school social worker for 

4 every 50 students when a social worker is providing 

5 services to students with intensive needs. 

6 (2) ESEA AMENDMENTS.— 

7 (A) IN GENERAL.—Subpart 4 of part F of 

8 title IV of the Elementary and Secondary Edu9 cation Act of 1965 (20 U.S.C. 7291 et seq.) is 

10 amended by adding at the end the following: 

11 ‘‘SEC. 4645. GRANTS FOR SCHOOL SOCIAL WORKERS. 

12 ‘‘(a) GRANTS AUTHORIZED.— 

13 ‘‘(1) IN GENERAL.—From the amounts appro14 priated under subsection (g), the Secretary shall 

15 award grants to high-need local educational agencies 

16 to enable such agencies to retain school social work17 ers employed by such agencies or to hire additional 

18 school social workers. 

19 ‘‘(2) DURATION.—A grant awarded under this 

20 section shall be awarded for a period not to exceed 

21 4 years. 

22 ‘‘(3) SUPPLEMENT, NOT SUPPLANT.—Funds 

23 made available under this section shall be used to 

24 supplement, and not to supplant, other Federal, 


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1 State, or local funds used for hiring and retaining 

2 school social workers. 

3 ‘‘(b) APPLICATION.— 

4 ‘‘(1) IN GENERAL.—To be eligible to receive a 

5 grant under this section, a high-need local edu6 cational agency shall submit to the Secretary an ap7 plication at such time, in such manner, and con8 taining such information as the Secretary may re9 quire. 

10 ‘‘(2) CONTENTS.—An application submitted 

11 under paragraph (1) shall include an assurance that 

12 each school social worker who receives assistance 

13 under the grant will provide the services described in 

14 subsection (d), and a description of the specific serv15 ices to be provided by such social worker. 

16 ‘‘(c) USE OF FUNDS.—A high-need local educational 

17 agency receiving a grant under this section— 

18 ‘‘(1) shall use the grant— 

19 ‘‘(A) to achieve a ratio of not less than 1 

20 school social worker for every 250 students 

21 served by the agency, by— 

22 ‘‘(i) retaining school social workers 

23 employed by such agency; or 

24 ‘‘(ii)(I) employing additional school 

25 social workers; or 


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1 ‘‘(II) hiring contractors to serve as 

2 school social workers only in a case in 

3 which— 

4 ‘‘(aa) the local educational agen5 cy demonstrates to the Secretary that 

6 the agency— 

7 ‘‘(AA) has not been able to 

8 employ a sufficient number of 

9 school social workers under sub10 clause (I) to achieve such ratio 

11 despite strong and continuing ef12 forts to recruit and employ school 

13 social workers; and 

14 ‘‘(BB) hiring contractors is 

15 the only viable option to ensure 

16 students have adequate access to 

17 school social work services; and 

18 ‘‘(bb) each such contractor meets 

19 the requirements of subparagraphs 

20 (A) and (B) of subsection (h)(2); and 

21 ‘‘(B) to ensure that each school social 

22 worker who receives assistance under such 

23 grant provides the services described in sub24 section (d); and 


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1 ‘‘(2) may use the grant to reimburse school so2 cial workers who receive assistance under such grant 

3 for— 

4 ‘‘(A) in the case of a school served by the 

5 agency in which the majority of students are 

6 higher risk students, to hire or retain additional 

7 school social workers in accordance with clauses 

8 (i) and (ii) of paragraph (1)(A) to achieve a 

9 ratio of not less than 1 school social worker for 

10 every 50 students; 

11 ‘‘(B) travel expenses incurred during home 

12 visits and other school-related trips; 

13 ‘‘(C) any additional expenses incurred by 

14 such social workers in rendering any service de15 scribed in subsection (d); and 

16 ‘‘(D) the cost of clinical social work super17 vision for such social workers. 

18 ‘‘(d) RESPONSIBILITIES OF A SCHOOL SOCIAL WORK19 ER.—A school social worker who receives assistance under 

20 a grant under this section shall provide the following serv21 ices: 

22 ‘‘(1) Identifying high-need students in each 

23 school that the social worker serves, and targeting 

24 services provided at the school to such students. 


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1 ‘‘(2) Providing students in each school that the 

2 school social worker serves, social work services to 

3 promote school engagement and improve academic 

4 outcomes, including— 

5 ‘‘(A) counseling and crisis intervention; 

6 ‘‘(B) trauma-informed services; 

7 ‘‘(C) evidence-based educational, behav8 ioral, and mental health services (such as imple9 menting multi-tiered programs and practices, 

10 monitoring progress, and evaluating service ef11 fectiveness); 

12 ‘‘(D) addressing the social and emotional 

13 learning needs of students; 

14 ‘‘(E) promoting a school climate and cul15 ture conducive to student learning and teaching 

16 excellence (such as promoting effective school 

17 policies and administrative procedures, enhanc18 ing the professional capacity of school per19 sonnel, and facilitating engagement between 

20 student, family, school, and community); 

21 ‘‘(F) providing access to school-based and 

22 community based resources (such as promoting 

23 a continuum of services, mobilizing resources 

24 and promoting assets, and providing leadership, 

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1 nation, professional consultation, and con2 necting students and families to resource sys3 tems); 

4 ‘‘(G) working with students, families, 

5 schools, and communities to address barriers to 

6 educational attainment (such as homelessness 

7 and housing insecurity, lack of transportation, 

8 food insecurity, equity, social justice issues, ac9 cess to quality education, and school, family, 

10 and community risk factors); 

11 ‘‘(H) providing assistance to schools and 

12 teachers to design social-emotional, educational, 

13 behavioral, and mental health interventions; 

14 ‘‘(I) case management activities to coordi15 nate the delivery of and access to the appro16 priate social work services to the highest-need 

17 students; 

18 ‘‘(J) home visits to meet the family of stu19 dents in need of social work services in the 

20 home environment; 

21 ‘‘(K) supervising or coordinating district 

22 level school social work services; and 

23 ‘‘(L) other services the Secretary deter24 mines, in partnership with students, educators, 


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1 and community member voices are necessary to 

2 be carried out by such a social worker. 

3 ‘‘(e) GRANT RENEWAL.— 

4 ‘‘(1) IN GENERAL.—A grant awarded under 

5 this section may be renewed for additional periods 

6 with the same duration as the original grant period. 

7 ‘‘(2) CONTINUING ELIGIBILITY APPLICATION.— 

8 To be eligible for a renewal under this section a 

9 high-need local educational agency shall submit to 

10 the Secretary, for each renewal, a report on the 

11 progress of such agency in retaining and hiring 

12 school social workers to achieve the ratio of not less 

13 than 1 school social worker for every 250 students 

14 served by the agency, and shall include— 

15 ‘‘(A) a description of the staffing expan16 sion of school social workers funded through the 

17 original grant received under this section; and 

18 ‘‘(B) a description of the work conducted 

19 by such social workers for higher risk students. 

20 ‘‘(f) TECHNICAL ASSISTANCE.— 

21 ‘‘(1) IN GENERAL.—The Secretary shall provide 

22 technical assistance to high-need local educational 

23 agencies, including such agencies that do not have 

24 adequate staff, in applying for grants under this sec25 tion. 


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1 ‘‘(2) EXTENSION OF APPLICATION PERIOD.— 

2 The Secretary shall extend any application period 

3 for a grant under this section for any high-need local 

4 educational agency that— 

5 ‘‘(A) submits to the Secretary a written 

6 notification of the intent to apply for a grant 

7 under this section before requesting technical 

8 assistance under paragraph (1); and 

9 ‘‘(B) after submitting the notification 

10 under paragraph (1), requests such technical 

11 assistance. 

12 ‘‘(g) AUTHORIZATION FOR APPROPRIATIONS.—There 

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

14 $100,000,000 for each of fiscal years 2025 through 2029. 

15 ‘‘(h) DEFINITIONS.—In this section: 

16 ‘‘(1) HIGH-NEED LOCAL EDUCATIONAL AGEN17 CY.—The term ‘high-need local educational agency’ 

18 has the meaning given the term in section 200 of the 

19 Higher Education Act of 1965 (20 U.S.C. 1021). 

20 ‘‘(2) SCHOOL SOCIAL WORKER.—The term 

21 ‘school social worker’ means an individual who— 

22 ‘‘(A) has a graduate degree in social work 

23 from a social work program that is accredited 

24 by the Council on Social Work Education; and 


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1 ‘‘(B) meets all other State and local 

2 credentialing requirements for practicing as a 

3 social worker in an elementary school or sec4 ondary school.’’. 

5 (B) TABLE OF CONTENTS.—The table of 

6 contents in section 2 of the Elementary and 

7 Secondary Education Act of 1965 is amended 

8 by inserting after the item relating to section 

9 4644 the following: 

‘‘Sec. 4645. Grants for school social workers.’’. 

10 (b) NATIONAL TECHNICAL ASSISTANCE CENTER FOR

11 SCHOOL SOCIAL WORK.— 

12 (1) IN GENERAL.—The Secretary of Education, 

13 acting through the Assistant Secretary, shall estab14 lish an evaluation, documentation, dissemination, 

15 and technical assistance resource center to provide 

16 appropriate information, training, and technical as17 sistance to States, political subdivisions of States, 

18 federally recognized Indian tribes, Tribal organiza19 tions, institutions of higher education, State and 

20 local educational agencies, and individual students 

21 and educators with respect to hiring and retaining 

22 school social workers at elementary schools and sec23 ondary schools served by local educational agencies. 


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1 (2) RESPONSIBILITIES OF THE CENTER.—The 

2 center established under paragraph (1) shall conduct 

3 activities for the purpose of— 

4 (A) developing and continuing statewide or 

5 Tribal strategies for improving the effectiveness 

6 of the school social work workforce; 

7 (B) studying the costs and effectiveness of 

8 school social work programs at institutions of 

9 higher education to identify areas of improve10 ment and provide information on relevant issues 

11 of importance to State, Tribal, and national 

12 policymakers; 

13 (C) working with Federal agencies and 

14 other State, Tribal, and national stakeholders 

15 to collect, evaluate, and disseminate data re16 garding school social work ratios, outcomes and 

17 best practices of school-based mental health 

18 services, and the impact of expanding the num19 ber of school social workers within elementary 

20 schools and secondary schools; 

21 (D) establishing partnerships among na22 tional, State, Tribal, and local governments, 

23 and local educational agencies, institutions of 

24 higher education, non-profit organizations, and 


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1 State and national trade associations for the 

2 purposes of— 

3 (i) data collection and dissemination; 

4 (ii) establishing a school social work 

5 workforce development program; 

6 (iii) documenting the success of school 

7 social work methods on a national level; 

8 and 

9 (iv) conducting other activities deter10 mined appropriate by the Secretary. 

11 (3) DEFINITIONS.—In this subsection: 

12 (A) ESEA TERMS.—Except as otherwise 

13 provided, any term used in this subsection that 

14 is defined in section 8101 of the Elementary 

15 and Secondary Education Act of 1965 (20 

16 U.S.C. 7801) shall have the meaning given that 

17 term in such section. 

18 (B) SCHOOL SOCIAL WORKER.—The term 

19 ‘‘school social worker’’ has the meaning given 

20 the term in section 4645(h) of the Elementary 

21 and Secondary Education Act of 1965. 


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1 SEC. 6706. OPIOID GRANTS TO SUPPORT CAREGIVERS, KIN2 SHIP CARE FAMILIES, AND KINSHIP CARE3 GIVERS. 

4 (a) OPIOID GRANTS.—Section 1003(b)(4) of the 21st 

5 Century Cures Act (42 U.S.C. 290ee–3a(b)(4)) is amend6 ed— 

7 (1) by redesignating subparagraph (F) as sub8 paragraph (G); and 

9 (2) by inserting after subparagraph (E) the fol10 lowing: 

11 ‘‘(F) Supporting opioid abuse prevention 

12 and treatment services within a State provided 

13 by State and local agencies for children and 

14 caregivers, kinship care families, and kinship 

15 caregivers through— 

16 ‘‘(i) workforce recruitment and train17 ing; 

18 ‘‘(ii) health care services (including 

19 such services described in subparagraph 

20 (D)); and 

21 ‘‘(iii) foster and adoptive parent re22 cruitment and training.’’. 

23 (b) DEFINITIONS.—Section 1003(h) of the 21st Cen24 tury Cures Act (42 U.S.C. 290ee–3a(h)) is amended— 

25 (1) by redesignating paragraphs (2) through 

26 (4) as paragraphs (4) through (6), respectively; and 


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1 (2) by inserting after paragraph (1) the fol2 lowing: 

3 ‘‘(2) KINSHIP CARE FAMILY.—The term ‘kin4 ship care family’ means a family with a kinship care5 giver. 

6 ‘‘(3) KINSHIP CAREGIVER.—The term ‘kinship 

7 caregiver’ means a relative of a child by blood, mar8 riage, or adoption, who— 

9 ‘‘(A) lives with the child; 

10 ‘‘(B) is the primary caregiver of the child 

11 because the biological or adoptive parent of the 

12 child is unable or unwilling to serve as the pri13 mary caregiver of the child; and 

14 ‘‘(C) has a legal relationship to the child or 

15 is raising the child informally.’’. 

16 (c) AUTHORIZATION OF APPROPRIATIONS.—Section 

17 1003(i)(1) of the 21st Century Cures Act (42 U.S.C. 

18 290ee–3a(i)(1)) is amended by striking ‘‘2023 through 

19 2027’’ and inserting ‘‘2025 through 2029’’. 

20 (d) SET ASIDE.—Section 1003(i)(3) of the 21st Cen21 tury Cures Act (42 U.S.C. 290ee–3a(i)(3)) is amended by 

22 inserting before the period at the end ‘‘, and set aside 1 

23 percent to carry out subsection (b)(4)(F)’’. 


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1 SEC. 6707. SUBSTANCE USE AND MENTAL HEALTH SERV2 ICES ADMINISTRATION AND SUBAGENCIES. 

3 (a) SUBSTANCE USE AND MENTAL HEALTH SERV4 ICES ADMINISTRATION.—The Public Health Service Act 

5 (42 U.S.C. 201 et seq.) is amended— 

6 (1) in section 464H(c) (42 U.S.C. 285n(c)), 

7 section 464R(c) (42 U.S.C. 285p(c)), and sub8 sections (b) and (c)(1) of section 2303 (42 U.S.C. 

9 300cc–2), by striking ‘‘Administrator of the Sub10 stance Abuse and Mental Health Services Adminis11 tration’’ each place it appears and inserting ‘‘Assist12 ant Secretary for Mental Health and Substance 

13 Use’’; 

14 (2) in title V (42 U.S.C. 290aa et seq.)— 

15 (A) in the title heading, by striking 

16 ‘‘ABUSE’’ and inserting ‘‘USE’’; 

17 (B) in section 501 (42 U.S.C. 290aa)— 

18 (i) in the section heading, by striking 

19 ‘‘ABUSE’’ and inserting ‘‘USE’’; and 

20 (ii) in subsection (f)(4), by striking 

21 ‘‘Substance Abuse and Mental Health Ad22 ministration’’ and inserting ‘‘Substance 

23 Use and Mental Health Services Adminis24 tration’’; and 

25 (3) by striking ‘‘Substance Abuse and Mental 

26 Health Services Administration’’ each place it apVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 01107 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 pears and inserting ‘‘Substance Use and Mental 

2 Health Services Administration’’. 

3 (b) CENTER FOR SUBSTANCE USE SERVICES; CEN4 TER FOR SUBSTANCE USE PREVENTION SERVICES.— 

5 (1) IN GENERAL.—The Public Health Service 

6 Act (42 U.S.C. 201 et seq.) is amended— 

7 (A) in part B of title V (42 U.S.C. 290bb 

8 et seq.)— 

9 (i) in subpart 1, in the subpart head10 ing, by striking ‘‘Abuse Treatment’’ 

11 and inserting ‘‘Use Services’’; 

12 (ii) in subpart 2, in the subpart head13 ing, by striking ‘‘Abuse Prevention’’ 

14 and inserting ‘‘Use Prevention Serv15 ices’’; 

16 (iii) in section 507 (42 U.S.C. 290bb), 

17 in the section heading, by striking ‘‘ABUSE

18 TREATMENT’’ and inserting ‘‘USE SERV19 ICES’’; 

20 (iv) in section 513(a) (42 U.S.C. 

21 290bb–6(a)), in the subsection heading, by 

22 striking ‘‘ABUSE TREATMENT’’ and insert23 ing ‘‘USE SERVICES’’; and 

24 (v) in section 515 (42 U.S.C. 290bb– 

25 21), in the section heading, by striking 


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1 ‘‘ABUSE PREVENTION’’ and inserting 

2 ‘‘USE PREVENTION SERVICES’’; 

3 (B) in section 1932(b)(3) (42 U.S.C. 

4 300x–32(b)(3)), in the paragraph heading, by 

5 striking ‘‘ABUSE PREVENTION’’ and inserting 

6 ‘‘USE PREVENTION SERVICES’’; 

7 (C) in section 1935(b)(2) of the Public 

8 Health Service Act (42 U.S.C. 300x–35(b)(2)), 

9 in the paragraph heading, by striking ‘‘ABUSE

10 PREVENTION’’ and inserting ‘‘USE PREVENTION

11 SERVICES’’; 

12 (D) by striking ‘‘Center for Substance 

13 Abuse Treatment’’ each place it appears and in14 serting ‘‘Center for Substance Use Services’’; 

15 and 

16 (E) by striking ‘‘Center for Substance 

17 Abuse Prevention’’ each place it appears and 

18 inserting ‘‘Center for Substance Use Prevention 

19 Services’’. 

20 (c) AUTHORITIES.—The Secretary of Health and 

21 Human Services shall delegate to the Substance Use and 

22 Mental Health Services Administration, the Center for 

23 Substance Use Services, and the Center for Substance Use 

24 Prevention Services all duties and authorities that, as of 

25 the date of enactment of this Act, were vested in the SubVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 01109 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 stance Abuse and Mental Health Services Administration, 

2 the Center for Substance Abuse Treatment, and the Cen3 ter for Substance Abuse Prevention, respectively. 

4 (d) REFERENCES.— 

5 (1) IN GENERAL.—Except as provided in para6 graph (2), any reference in any law, regulation, map, 

7 document, paper, or other record of the United 

8 States— 

9 (A) to the Substance Abuse and Mental 

10 Health Services Administration shall be deemed 

11 to be a reference to the Substance Use and 

12 Mental Health Services Administration; 

13 (B) to the Center for Substance Abuse 

14 Treatment of such Administration shall be 

15 deemed to be a reference to the Center for Sub16 stance Use Services of such Administration; 

17 and 

18 (C) to the Center for Substance Abuse 

19 Prevention of such Administration shall be 

20 deemed to be a reference to the Center for Sub21 stance Use Prevention Services of such Admin22 istration. 

23 (2) EFFECT.—Paragraph (1) shall not be con24 strued to alter or affect section 6001(d) of the 21st 

25 Century Cures Act (42 U.S.C. 290aa note), proVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 01110 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 viding that a reference to the Administrator of the 

2 Substance Abuse and Mental Health Services Ad3 ministration shall be construed to be a reference to 

4 the Assistant Secretary for Mental Health and Sub5 stance Use. 

6 (3) REFERENCES TO SAMHSA.—Notwith7 standing this section or the amendments made by 

8 this section, the Secretary of Health and Human 

9 Services may continue to use the acronym 

10 ‘‘SAMHSA’’ to refer to the Substance Use and Men11 tal Health Services Administration in regulations, 

12 maps, documents, papers, and other records of the 

13 United States. 

14 TITLE VII—ADDRESSING HIGH15 IMPACT MINORITY DISEASES 

16 Subtitle A—Cancer 

17 SEC. 7001. LUNG CANCER MORTALITY REDUCTION. 

18 (a) SENSE OF CONGRESS CONCERNING INVESTMENT

19 IN LUNG CANCER RESEARCH.—It is the sense of the Con20 gress that— 

21 (1) lung cancer mortality reduction should be 

22 made a national public health priority; and 

23 (2) a comprehensive mortality reduction pro24 gram coordinated by the Secretary of Health and 


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1 Human Services is justified and necessary to ade2 quately address and reduce lung cancer mortality. 

3 (b) LUNG CANCER MORTALITY REDUCTION PRO4 GRAM.— 

5 (1) IN GENERAL.—Subpart 1 of part C of title 

6 IV of the Public Health Service Act (42 U.S.C. 285 

7 et seq.) is amended by adding at the end the fol8 lowing: 

9 ‘‘SEC. 417H. LUNG CANCER MORTALITY REDUCTION PRO10 GRAM. 

11 ‘‘(a) IN GENERAL.—Not later than 6 months after 

12 the date of the enactment of the Health Equity and Ac13 countability Act of 2024, the Secretary, in consultation 

14 with the Secretary of Defense, the Secretary of Veterans 

15 Affairs, the Director of the National Institutes of Health, 

16 the Director of the Centers for Disease Control and Pre17 vention, the Commissioner of Food and Drugs, the Admin18 istrator of the Centers for Medicare & Medicaid Services, 

19 the Director of the National Institute on Minority Health 

20 and Health Disparities, the Administrator of the Environ21 mental Protection Agency, and other members of the 

22 Lung Cancer Advisory Board established under section 

23 7001(d) of the Health Equity and Accountability Act of 

24 2024, shall implement a comprehensive program, to be 

25 known as the Lung Cancer Mortality Reduction Program, 


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1 to achieve a reduction of at least 25 percent in the mor2 tality rate of lung cancer by 2028. 

3 ‘‘(b) REQUIREMENTS.—The Program shall include at 

4 least the following: 

5 ‘‘(1) With respect to the National Institutes of 

6 Health— 

7 ‘‘(A) a strategic review and prioritization 

8 by the National Cancer Institute of research 

9 grants to achieve the goal specified in sub10 section (a); 

11 ‘‘(B) the provision of funds to enable the 

12 Airway Biology and Disease Branch of the Na13 tional Heart, Lung, and Blood Institute to ex14 pand its research programs to include pre15 dispositions to lung cancer, the interrelationship 

16 between lung cancer and other pulmonary and 

17 cardiac disease, and the diagnosis and treat18 ment of such diseases; 

19 ‘‘(C) the provision of funds to enable the 

20 National Institute of Biomedical Imaging and 

21 Bioengineering to expedite the development of 

22 computer-assisted diagnostic, surgical, treat23 ment, and drug-testing innovations to reduce 

24 lung cancer mortality, such as through expanVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 01113 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 sion of the Institute’s Quantum Grant Program 

2 and Image-Guided Interventions program; and 

3 ‘‘(D) the provision of funds to enable the 

4 National Institute of Environmental Health 

5 Sciences to implement research programs rel6 ative to the lung cancer incidence. 

7 ‘‘(2) With respect to the Food and Drug Ad8 ministration— 

9 ‘‘(A) activities under section 529B of the 

10 Federal Food, Drug, and Cosmetic Act; and 

11 ‘‘(B) activities under section 561 of the 

12 Federal Food, Drug, and Cosmetic Act to ex13 pand access to investigational drugs and devices 

14 for the diagnosis, monitoring, or treatment of 

15 lung cancer. 

16 ‘‘(3) With respect to the Centers for Disease 

17 Control and Prevention, the establishment of an 

18 early disease research and management program 

19 under section 1511. 

20 ‘‘(4) With respect to the Agency for Healthcare 

21 Research and Quality, the conduct of a biannual re22 view of lung cancer screening, diagnostic, and treat23 ment protocols, and the issuance of updated guide24 lines. 


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1 ‘‘(5) The promotion (including education) of 

2 lung cancer screening within minority and rural pop3 ulations and the study of the effectiveness of efforts 

4 to increase such screening. 

5 ‘‘(6) The cooperation and coordination of all 

6 minority and health disparity programs within the 

7 Department of Health and Human Services to en8 sure that all aspects of the Lung Cancer Mortality 

9 Reduction Program under this section adequately 

10 address the burden of lung cancer on minority and 

11 rural populations. 

12 ‘‘(7) The cooperation and coordination of all to13 bacco control and cessation programs within agen14 cies of the Department of Health and Human Serv15 ices to achieve the goals of the Lung Cancer Mor16 tality Reduction Program under this section with 

17 particular emphasis on the coordination of drug and 

18 other cessation treatments with early detection pro19 tocols.’’. 

20 (2) FEDERAL FOOD, DRUG, AND COSMETIC

21 ACT.—Subchapter B of chapter V of the Federal 

22 Food, Drug, and Cosmetic Act (21 U.S.C. 360aaa et 

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


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1 ‘‘SEC. 529B. DRUGS RELATING TO LUNG CANCER. 

2 ‘‘(a) IN GENERAL.—The provisions of this sub3 chapter shall apply to a drug described in subsection (b) 

4 to the same extent and in the same manner as such provi5 sions apply to a drug for a rare disease or condition (as 

6 defined in section 526). 

7 ‘‘(b) QUALIFIED DRUGS.—A drug described in this 

8 subsection is— 

9 ‘‘(1) a chemoprevention drug for precancerous 

10 conditions of the lung; 

11 ‘‘(2) a drug for targeted therapeutic treat12 ments, including any vaccine, for lung cancer; or 

13 ‘‘(3) a drug to curtail or prevent nicotine addic14 tion. 

15 ‘‘(c) BOARD.—The Board established under section 

16 7001(d) of the Health Equity and Accountability Act of 

17 2024 shall monitor the program implemented under this 

18 section.’’. 

19 (3) ACCESS TO UNAPPROVED THERAPIES.—Sec20 tion 561(e) of the Federal Food, Drug, and Cos21 metic Act (21 U.S.C. 360bbb(e)) is amended by in22 serting before the period the following: ‘‘and shall 

23 include expanding access to drugs under section 

24 529B, with substantial consideration being given to 

25 whether the totality of information available to the 

26 Secretary regarding the safety and effectiveness of 


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1 an investigational drug, as compared to the risk of 

2 morbidity and death from the disease, indicates that 

3 a patient may obtain more benefit than risk if treat4 ed with the drug’’. 

5 (4) CDC.—Title XV of the Public Health Serv6 ice Act (42 U.S.C. 300k et seq.) is amended by add7 ing at the end the following: 

8 ‘‘SEC. 1511. EARLY DISEASE RESEARCH AND MANAGEMENT 

9 PROGRAM. 

10 ‘‘The Secretary shall establish and implement an 

11 early disease research and management program targeted 

12 at the high incidence and mortality rates of lung cancer 

13 among minority and low-income populations.’’. 

14 (c) DEPARTMENT OF DEFENSE AND DEPARTMENT

15 OF VETERANS AFFAIRS.—The Secretary of Defense and 

16 the Secretary of Veterans Affairs, each in coordination 

17 with the Secretary of Health and Human Services, shall 

18 engage— 

19 (1) in the implementation within the Depart20 ment of Defense and the Department of Veterans 

21 Affairs, as the case may be, of an early detection 

22 and disease management research program for mem23 bers of the Armed Forces and veterans whose smok24 ing history and exposure to carcinogens during servVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 01117 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 ice on active duty in the Armed Forces has increased 

2 their risk for lung cancer; and 

3 (2) in the implementation of coordinated care 

4 programs for members of the Armed Forces and vet5 erans diagnosed with lung cancer. 

6 (d) LUNG CANCER ADVISORY BOARD.— 

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

8 Human Services shall convene a Lung Cancer Advi9 sory Board (referred to in this section as the 

10 ‘‘Board’’)— 

11 (A) to monitor the programs established 

12 under this section (and the amendments made 

13 by this section); and 

14 (B) to provide annual reports to the Con15 gress concerning benchmarks, expenditures, 

16 lung cancer statistics, and the public health im17 pact of such programs. 

18 (2) COMPOSITION.—The Board shall be com19 posed of— 

20 (A) the Secretary of Health and Human 

21 Services; 

22 (B) the Secretary of Defense; 

23 (C) the Secretary of Veterans Affairs; and 

24 (D) 2 representatives each from the fields 

25 of clinical medicine focused on lung cancer, 


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1 lung cancer research, imaging, drug develop2 ment, and lung cancer advocacy, to be ap3 pointed by the Secretary of Health and Human 

4 Services. 

5 (e) AUTHORIZATION OF APPROPRIATIONS.— 

6 (1) IN GENERAL.—To carry out this section 

7 (and the amendments made by this section), there 

8 are authorized to be appropriated $75,000,000 for 

9 fiscal year 2025 and such sums as may be necessary 

10 for each of fiscal years 2026 through 2028. 

11 (2) LUNG CANCER MORTALITY REDUCTION PRO12 GRAM.—The amounts appropriated under paragraph 

13 (1) shall be allocated as follows: 

14 (A) $25,000,000 for fiscal year 2025, and 

15 such sums as may be necessary for each of fis16 cal years 2026 through 2028, for the activities 

17 described in section 417H(b)(1)(B) of the Pub18 lic Health Service Act, as added by subsection 

19 (b); 

20 (B) $25,000,000 for fiscal year 2025, and 

21 such sums as may be necessary for each of fis22 cal years 2026 through 2028, for the activities 

23 described in section 417H(b)(1)(C) of the Pub24 lic Health Service Act; 


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1 (C) $10,000,000 for fiscal year 2025, and 

2 such sums as may be necessary for each of fis3 cal years 2026 through 2028, for the activities 

4 described in section 417H(b)(1)(D) of the Pub5 lic Health Service Act; and 

6 (D) $15,000,000 for fiscal year 2025, and 

7 such sums as may be necessary for each of fis8 cal years 2026 through 2028, for the activities 

9 described in section 417H(b)(3) of the Public 

10 Health Service Act. 

11 SEC. 7002. EXPANSION OF PROSTATE CANCER RESEARCH, 

12 OUTREACH, SCREENING, TESTING, ACCESS, 

13 AND TREATMENT EFFECTIVENESS. 

14 (a) PROSTATE CANCER COORDINATION AND EDU15 CATION.— 

16 (1) INTERAGENCY PROSTATE CANCER COORDI17 NATION AND EDUCATION TASK FORCE.—Not later 

18 than 180 days after the date of the enactment of 

19 this Act, the Secretary of Veterans Affairs, in co20 operation with the Secretary of Defense and the Sec21 retary of Health and Human Services, shall estab22 lish an Interagency Prostate Cancer Coordination 

23 and Education Task Force (in this section referred 

24 to as the ‘‘Prostate Cancer Task Force’’). 


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1 (2) DUTIES.—The Prostate Cancer Task Force 

2 shall— 

3 (A) develop a summary of advances in 

4 prostate cancer research supported or con5 ducted by Federal agencies relevant to the diag6 nosis, prevention, and treatment of prostate 

7 cancer, including psychosocial impairments re8 lated to prostate cancer treatment, and compile 

9 a list of best practices that warrant broader 

10 adoption in health care programs; 

11 (B) consider establishing, and advocating 

12 for, a guidance to enable physicians to allow 

13 screening of men who are age 74 or older, on 

14 a case-by-case basis, taking into account quality 

15 of life and family history of prostate cancer; 

16 (C) share and coordinate information on 

17 research and health care program activities by 

18 the Federal Government, including activities re19 lated to— 

20 (i) determining how to improve re21 search and health care programs, including 

22 psychosocial impairments related to pros23 tate cancer treatment; 


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1 (ii) identifying any gaps in the overall 

2 research inventory and in health care pro3 grams; 

4 (iii) identifying opportunities to pro5 mote translation of research into practice; 

6 and 

7 (iv) maximizing the effects of Federal 

8 Government efforts by identifying opportu9 nities for collaboration and leveraging of 

10 resources in research and health care pro11 grams that serve individuals who are sus12 ceptible to or diagnosed with prostate can13 cer; 

14 (D) develop a comprehensive interagency 

15 strategy and advise relevant Federal agencies in 

16 the solicitation of proposals for collaborative, 

17 multidisciplinary research and health care pro18 grams, including proposals to evaluate factors 

19 that may be related to the etiology of prostate 

20 cancer, that would— 

21 (i) result in innovative approaches to 

22 study emerging scientific opportunities or 

23 eliminate knowledge gaps in research to 

24 improve the prostate cancer research port25 folio of the Federal Government; and 


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1 (ii) outline key research questions, 

2 methodologies, and knowledge gaps; 

3 (E) develop a coordinated message related 

4 to screening and treatment for prostate cancer 

5 to be reflected in educational and beneficiary 

6 materials for Federal health programs as such 

7 materials are updated; and 

8 (F) not later than two years after the date 

9 of the establishment of the Prostate Cancer 

10 Task Force, submit to the expert advisory pan11 els appointed under paragraph (4) to be re12 viewed and returned within 30 days, and then 

13 within 90 days submitted to Congress, rec14 ommendations— 

15 (i) regarding any appropriate changes 

16 to research and health care programs, in17 cluding recommendations to improve the 

18 research portfolio of the Department of 

19 Veterans Affairs, the Department of De20 fense, the National Institutes of Health, 

21 and other Federal agencies to ensure that 

22 scientifically based strategic planning is 

23 implemented in support of research and 

24 health care program priorities; 


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1 (ii) designed to ensure that the re2 search and health care programs and ac3 tivities of the Department of Veterans Af4 fairs, the Department of Defense, the De5 partment of Health and Human Services, 

6 and other Federal agencies are free of un7 necessary duplication; 

8 (iii) regarding public participation in 

9 decisions relating to prostate cancer re10 search and health care programs to in11 crease the involvement of patient advo12 cates, community organizations, and med13 ical associations representing a broad geo14 graphical area; 

15 (iv) on how to best disseminate infor16 mation on prostate cancer research and 

17 progress achieved by health care programs; 

18 (v) on how to expand partnerships be19 tween public entities, including Federal 

20 agencies, and private entities to encourage 

21 collaborative, cross-cutting research and 

22 health care delivery; 

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1 section and recommending expansion of 

2 those efforts that have proved most prom3 ising while also ensuring against any con4 flicts in directives in law; 

5 (vii) identifying key priority action 

6 items from among the recommendations 

7 specified in clauses (i) through (vi); and 

8 (viii) with respect to the level of fund9 ing needed by each agency to implement 

10 such recommendations. 

11 (3) MEMBERS OF THE PROSTATE CANCER TASK

12 FORCE.—The Prostate Cancer Task Force shall be 

13 composed of representatives from such Federal agen14 cies as the head of each such applicable agency de15 termines necessary, so as to coordinate a uniform 

16 message relating to prostate cancer screening and 

17 treatment where appropriate, including representa18 tives of each of the following: 

19 (A) The Department of Veterans Affairs, 

20 including representatives of each relevant pro21 gram area of the Department of Veterans Af22 fairs. 

23 (B) The Prostate Cancer Research Pro24 gram of the Congressionally Directed Medical 


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1 Research Program of the Department of De2 fense. 

3 (C) The Department of Health and 

4 Human Services, including, at a minimum, rep5 resentatives of each of the following: 

6 (i) The National Institutes of Health. 

7 (ii) National research institutes and 

8 centers, including the National Cancer In9 stitute, the National Institute of Allergy 

10 and Infectious Diseases, and the Office of 

11 Minority Health. 

12 (iii) The Centers for Medicare & Med13 icaid Services. 

14 (iv) The Food and Drug Administra15 tion. 

16 (v) The Centers for Disease Control 

17 and Prevention. 

18 (vi) The Agency for Healthcare Re19 search and Quality. 

20 (vii) The Health Resources and Serv21 ices Administration. 

22 (4) APPOINTING EXPERT ADVISORY PANELS.— 

23 The Prostate Cancer Task Force shall appoint ex24 pert advisory panels, as the task force determines 


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1 appropriate, to provide input and concurrence 

2 from— 

3 (A) individuals and organizations from the 

4 medical, prostate cancer patient and advocate, 

5 research, and delivery communities with exper6 tise in prostate cancer diagnosis, treatment, 

7 and research, including practicing urologists, 

8 primary care providers, and others; and 

9 (B) individuals with expertise in education 

10 and outreach to underserved populations af11 fected by prostate cancer. 

12 (5) MEETINGS.—The Prostate Cancer Task 

13 Force shall convene not less frequently than twice 

14 each year, or more frequently as the Secretary of 

15 Veterans Affairs determines to be appropriate. 

16 (6) FEDERAL ADVISORY COMMITTEE ACT.—The 

17 Federal Advisory Committee Act (5 U.S.C. App.) 

18 shall apply to the Prostate Cancer Task Force. 

19 (7) SUNSET DATE.—The Prostate Cancer Task 

20 Force shall terminate on September 30, 2026. 

21 (b) PROSTATE CANCER RESEARCH.— 

22 (1) RESEARCH COORDINATION PROGRAM.— 

23 (A) IN GENERAL.—The Secretary of Vet24 erans Affairs, in coordination with the Sec25 retary of Defense and the Secretary of Health 


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1 and Human Services, shall establish and carry 

2 out a program to coordinate and intensify pros3 tate cancer research. 

4 (B) ELEMENTS.—The program established 

5 under subparagraph (A) shall— 

6 (i) develop advances in diagnostic and 

7 prognostic methods and tests, including 

8 biomarkers and an improved prostate can9 cer screening blood test, including improve10 ments or alternatives to the prostate spe11 cific antigen test and additional tests to 

12 distinguish indolent from aggressive dis13 ease; 

14 (ii) develop a better understanding of 

15 the etiology of the disease (including an 

16 analysis of lifestyle factors proven to be in17 volved in higher rates of prostate cancer, 

18 such as obesity and diet, and in different 

19 ethnic, racial, and socioeconomic groups, 

20 such as the African-American, Latino or 

21 Hispanic, and American Indian popu22 lations and men with a family history of 

23 prostate cancer) to improve prevention ef24 forts; 


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1 (iii) expand basic research into pros2 tate cancer, including studies of funda3 mental molecular and cellular mechanisms; 

4 (iv) identify and provide clinical test5 ing of novel agents for the prevention and 

6 treatment of prostate cancer; 

7 (v) establish clinical registries for 

8 prostate cancer; 

9 (vi) use the National Institute of Bio10 medical Imaging and Bioengineering and 

11 the National Cancer Institute for assess12 ment of appropriate imaging modalities; 

13 and 

14 (vii) address such other matters relat15 ing to prostate cancer research as may be 

16 identified by the Federal agencies partici17 pating in such program. 

18 (C) UNDERSERVED MINORITY GRANT PRO19 GRAM.— 

20 (i) IN GENERAL.—In carrying out the 

21 program established under subparagraph 

22 (A), the Secretary shall award grants to el23 igible entities— 


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1 (I) to carry out components of 

2 the research outlined in subparagraph 

3 (B); 

4 (II) to integrate and build upon 

5 existing knowledge gained from com6 parative effectiveness research; and 

7 (III) to recognize and address— 

8 (aa) the racial and ethnic 

9 disparities in the incidence and 

10 mortality rates of prostate cancer 

11 and men with a family history of 

12 prostate cancer; 

13 (bb) any barriers in access 

14 to care and participation in clin15 ical trials that are specific to ra16 cial, ethnic, and other under17 served minorities and men with a 

18 family history of prostate cancer; 

19 (cc) outreach and edu20 cational efforts to raise aware21 ness among the populations de22 scribed in item (bb); and 

23 (dd) appropriate access and 

24 utilization of imaging modalities. 


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1 (ii) ELIGIBLE ENTITY DEFINED.—In 

2 this subparagraph, the term ‘‘eligible enti3 ty’’ means any public, private, nonprofit, 

4 or for-profit organization that the Sec5 retary determines would be capable to con6 duct medical research and other require7 ments under this paragraph and is other8 wise eligible for research funding from the 

9 Federal Government. 

10 (2) PROSTATE CANCER ADVISORY BOARD.— 

11 (A) IN GENERAL.—There is established in 

12 the Office of the Chief Scientist of the Food 

13 and Drug Administration a Prostate Cancer 

14 Scientific Advisory Board. 

15 (B) DUTIES.—The board established under 

16 subparagraph (A) shall be responsible for accel17 erating real-time sharing of the latest research 

18 data and accelerating movement of new medi19 cines for the treatment of prostate cancer to 

20 patients. 

21 (c) TELEHEALTH AND RURAL ACCESS PILOT

22 PROJECTS.— 

23 (1) ESTABLISHMENT OF PILOT PROJECTS.— 

24 (A) IN GENERAL.—The Secretary of Vet25 erans Affairs, in cooperation with the Secretary 


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1 of Defense and the Secretary of Health and 

2 Human Services (referred to in this subsection 

3 collectively as the ‘‘Secretaries’’) shall establish 

4 four-year telehealth pilot projects for the pur5 pose of analyzing the clinical outcomes and 

6 cost-effectiveness associated with telehealth 

7 services in a variety of geographic areas that 

8 contain high proportions of medically under9 served populations, including African Ameri10 cans, Latinos or Hispanics, American Indians 

11 or Alaska Natives, and those in rural areas. 

12 (B) EFFICIENT AND EFFECTIVE CARE.— 

13 Pilot projects established under subparagraph 

14 (A) shall promote efficient use of specialist care 

15 through better coordination of primary care and 

16 physician extender teams in underserved areas 

17 and more effectively employ tumor boards to 

18 better counsel patients. 

19 (2) ELIGIBLE ENTITIES.— 

20 (A) IN GENERAL.—The Secretaries shall 

21 select eligible entities to participate in the pilot 

22 projects established under this subsection. 

23 (B) PRIORITY.—In selecting eligible enti24 ties to participate in the pilot projects under 

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1 ority to entities located in medically under2 served areas, particularly those that include Af3 rican Americans, Latinos and Hispanics, and 

4 facilities of the Indian Health Service, including 

5 facilities operated by the Indian Health Service, 

6 tribally operated facilities, and facilities admin7 istered by an Urban Indian organization (as de8 fined in section 4 of the Indian Health Care 

9 Improvement Act (25 U.S.C. 1603)) pursuant 

10 to title V of that Act (25 U.S.C. 1651 et seq.), 

11 and those in rural areas. 

12 (3) EVALUATION.—The Secretaries shall, 

13 through the pilot projects established under this sub14 section, evaluate— 

15 (A) the effective and economic delivery of 

16 care in diagnosing and treating prostate cancer 

17 with the use of telehealth services in medically 

18 underserved and Tribal areas including collabo19 rative uses of health professionals and integra20 tion of the range of telehealth and other tech21 nologies; 

22 (B) the effectiveness of improving the ca23 pacity of nonmedical providers and nonspecial24 ized medical providers to provide health services 

25 for prostate cancer in medically underserved 


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1 and Tribal areas, including the exploration of 

2 innovative medical home models with collabora3 tion between urologists, other relevant medical 

4 specialists, including oncologists, radiologists, 

5 and primary care teams, and coordination of 

6 care through the efficient use of primary care 

7 teams and physician extenders; and 

8 (C) the effectiveness of using telehealth 

9 services to provide prostate cancer treatment in 

10 medically underserved areas, including the use 

11 of tumor boards to facilitate better patient 

12 counseling. 

13 (4) REPORT.—Not later than one year after the 

14 completion of the pilot projects under this sub15 section, the Secretaries shall submit to Congress a 

16 report describing the outcomes of such pilot projects, 

17 including any cost savings and efficiencies realized, 

18 and providing recommendations, if any, for expand19 ing the use of telehealth services. 

20 (d) EDUCATION AND AWARENESS.— 

21 (1) CAMPAIGN.— 

22 (A) IN GENERAL.—The Secretary of Vet23 erans Affairs shall develop a national education 

24 campaign for prostate cancer. 


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1 (B) ELEMENTS.—The campaign developed 

2 under subparagraph (A) shall involve the use of 

3 written educational materials and public service 

4 announcements consistent with the findings of 

5 the Prostate Cancer Task Force under sub6 section (a) that are intended to encourage men 

7 to seek prostate cancer screening when appro8 priate. 

9 (2) RACIAL DISPARITIES AND THE POPULATION

10 OF MEN WITH A FAMILY HISTORY OF PROSTATE

11 CANCER.—In developing the campaign under para12 graph (1), the Secretary of Veterans Affairs shall 

13 ensure that educational materials and public service 

14 announcements used in the campaign are more read15 ily available in communities experiencing racial dis16 parities in the incidence and mortality rates of pros17 tate cancer and to men of any race classification 

18 with a family history of prostate cancer. 

19 (3) GRANTS.—In carrying out the campaign 

20 under this subsection, the Secretary of Veterans Af21 fairs shall award grants to nonprofit private entities 

22 to enable such entities to test alternative outreach 

23 and education strategies. 

24 (e) AUTHORIZATION OF APPROPRIATIONS.—There is 

25 authorized to be appropriated to carry out this section for 


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1 the period of fiscal years 2025 through 2029 an amount 

2 equal to the amount of savings for the Federal Govern3 ment projected to be achieved over such period by imple4 mentation of this section. 

5 SEC. 7003. PROSTATE RESEARCH, IMAGING, AND MEN’S 

6 EDUCATION. 

7 (a) RESEARCH AND DEVELOPMENT OF PROSTATE

8 CANCER IMAGING TECHNOLOGIES.— 

9 (1) EXPANSION OF RESEARCH.—The Secretary 

10 of Health and Human Services (referred to in this 

11 section as the ‘‘Secretary’’), acting through the Di12 rector of the National Institutes of Health and the 

13 Administrator of the Health Resources and Services 

14 Administration, and in consultation with the Sec15 retary of Defense, shall carry out a program to ex16 pand and intensify research to develop innovative 

17 advanced imaging technologies for prostate cancer 

18 detection, diagnosis, and treatment comparable to 

19 state-of-the-art mammography technologies. 

20 (2) EARLY STAGE RESEARCH.—In imple21 menting the program under paragraph (1), the Sec22 retary, acting through the Administrator of the 

23 Health Resources and Services Administration, shall 

24 carry out a grant program to encourage the early 

25 stages of research in prostate imaging to develop 


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1 and implement new ideas, proof of concepts, and 

2 pilot studies for high-risk technologic innovation in 

3 prostate cancer imaging that would have a high po4 tential impact for improving patient care, including 

5 individualized care, quality of life, and cost-effective6 ness. 

7 (3) LARGE SCALE LATER STAGE RESEARCH.— 

8 In implementing the program under paragraph (1), 

9 the Secretary, acting through the Director of the 

10 National Institutes of Health, shall utilize the Na11 tional Institute of Biomedical Imaging and Bio12 engineering and the National Cancer Institute for 

13 advanced stages of research in prostate imaging, in14 cluding technology development and clinical trials for 

15 projects determined by the Secretary to have dem16 onstrated promising preliminary results and proof of 

17 concept. 

18 (4) INTERDISCIPLINARY PRIVATE-PUBLIC PART19 NERSHIPS.—In developing the program under para20 graph (1), the Secretary, acting through the Admin21 istrator of the Health Resources and Services Ad22 ministration, shall establish interdisciplinary private23 public partnerships to develop and implement re24 search strategies for expedited innovation in imaging 


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1 and image-guided treatment and to conduct such re2 search. 

3 (5) RACIAL DISPARITIES.—In developing the 

4 program under paragraph (1), the Secretary shall 

5 recognize and address— 

6 (A) the racial disparities in the incidences 

7 of prostate cancer and mortality rates with re8 spect to such disease; and 

9 (B) any barriers in access to care and par10 ticipation in clinical trials that are specific to 

11 racial minorities. 

12 (6) AUTHORIZATION OF APPROPRIATIONS.— 

13 (A) IN GENERAL.—Subject to subpara14 graph (B), there is authorized to be appro15 priated to carry out this subsection, 

16 $100,000,000 for each of fiscal years 2025 

17 through 2029. 

18 (B) SPECIFIC ALLOCATIONS.—Of the 

19 amount authorized to be appropriated under 

20 subparagraph (A) for each of the fiscal years 

21 described in such subparagraph— 

22 (i) no less than 10 percent may be 

23 used to carry out the grant program under 

24 paragraph (2); and 


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1 (ii) no more than 1 percent may be 

2 used to carry out paragraph (4). 

3 (b) PUBLIC AWARENESS AND EDUCATION CAM4 PAIGN.— 

5 (1) NATIONAL CAMPAIGN.—The Secretary shall 

6 carry out a national campaign to increase the aware7 ness and knowledge of individuals in the United 

8 States with respect to the need for prostate cancer 

9 screening and for improved detection technologies. 

10 (2) REQUIREMENTS.—The national campaign 

11 conducted under this subsection shall include— 

12 (A) roles for the Health Resources Services 

13 Administration, the Office of Minority Health 

14 of the Department of Health and Human Serv15 ices, the Centers for Disease Control and Pre16 vention, and the Office of Minority Health and 

17 Health Equity of the Centers for Disease Con18 trol and Prevention; and 

19 (B) the development and distribution of 

20 written educational materials, and the develop21 ment and placing of public service announce22 ments, that are intended to encourage men to 

23 seek prostate cancer screening and to create 

24 awareness of the need for improved imaging 

25 technologies for prostate cancer screening and 


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1 diagnosis, including in-vitro blood testing and 

2 imaging technologies. 

3 (3) RACIAL DISPARITIES.—In developing the 

4 national campaign under paragraph (1), the Sec5 retary shall recognize and address— 

6 (A) the racial disparities in the incidences 

7 of prostate cancer and mortality rates with re8 spect to such disease; and 

9 (B) any barriers in access to care and par10 ticipation in clinical trials that are specific to 

11 racial minorities. 

12 (4) GRANTS.—The Secretary shall establish a 

13 program to award grants to nonprofit private enti14 ties to enable such entities to test alternative out15 reach and education strategies to increase the 

16 awareness and knowledge of individuals in the 

17 United States with respect to the need for prostate 

18 cancer screening and improved imaging technologies. 

19 (5) AUTHORIZATION OF APPROPRIATIONS.— 

20 There is authorized to be appropriated to carry out 

21 this subsection $10,000,000 for each of fiscal years 

22 2025 through 2029. 

23 (c) IMPROVING PROSTATE CANCER SCREENING

24 BLOOD TESTS.— 


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1 (1) IN GENERAL.—The Secretary, in coordina2 tion with the Secretary of Defense, shall support re3 search to develop an improved prostate cancer 

4 screening blood test using in-vitro detection. 

5 (2) AUTHORIZATION OF APPROPRIATIONS.— 

6 There is authorized to be appropriated to carry out 

7 this subsection, $20,000,000 for each of fiscal years 

8 2025 through 2029. 

9 (d) REPORTING AND COMPLIANCE.— 

10 (1) REPORT AND STRATEGY.—Not later than 

11 12 months after the date of the enactment of this 

12 Act, the Secretary shall submit to Congress a report 

13 that details the strategy of the Secretary for imple14 menting the requirements of this section and the 

15 status of such efforts. 

16 (2) FULL COMPLIANCE.—Not later than 36 

17 months after the date of the enactment of this Act, 

18 and annually thereafter, the Secretary shall submit 

19 to Congress a report that— 

20 (A) describes the research and development 

21 and public awareness and education campaigns 

22 funded under this section; 

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1 tion, proof of concept, and pilot studies are 

2 prioritized; 

3 (C) provides evidence that the Secretary 

4 recognizes and addresses any barriers in access 

5 to care and participation in clinical trials that 

6 are specific to racial minorities in the imple7 mentation of this section; 

8 (D) contains assurances that all the other 

9 provisions of this section are fully implemented; 

10 and 

11 (E) certifies compliance with the provisions 

12 of this section, or in the case of a Federal agen13 cy that has not complied with any of such pro14 visions, an explanation as to such failure to 

15 comply. 

16 SEC. 7004. PROSTATE CANCER DETECTION RESEARCH AND 

17 EDUCATION. 

18 (a) PLAN TO DEVELOP AND VALIDATE A TEST OR

19 TESTS FOR PROSTATE CANCER.— 

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

21 Human Services (referred to in this section as the 

22 ‘‘Secretary’’), acting through the Director of the Na23 tional Institutes of Health, shall establish an advi24 sory council on prostate cancer (referred to in this 

25 section as the ‘‘advisory council’’) to draft a plan for 


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1 the development and validation of an accurate test 

2 or tests, such as biomarkers or imaging, to detect 

3 and diagnose prostate cancer. 

4 (2) ADVISORY COUNCIL.— 

5 (A) MEMBERSHIP.— 

6 (i) FEDERAL MEMBERS.—The advi7 sory council shall be composed of the fol8 lowing experts: 

9 (I) A designee of the Centers for 

10 Disease Control and Prevention. 

11 (II) A designee of the Centers for 

12 Medicare & Medicaid Services. 

13 (III) A designee of the Office of 

14 the Director of the National Cancer 

15 Institute. 

16 (IV) A designee of the Director 

17 of the Department of Defense Con18 gressionally Directed Medical Re19 search Programs. 

20 (V) A designee of the Director of 

21 the National Institute of Biomedical 

22 Imaging and Bioengineering. 

23 (VI) A designee of the Director 

24 of the National Institute of General 

25 Medical Sciences. 


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1 (VII) A designee of the Director 

2 of the National Institute on Minority 

3 Health and Health Disparities. 

4 (VIII) A designee of the Director 

5 of the National Institutes of Health. 

6 (IX) A designee of the Commis7 sioner of Food and Drugs. 

8 (X) A designee of the Director of 

9 the Agency for Healthcare Research 

10 and Quality. 

11 (XI) A designee of the Director 

12 of the Telemedicine and Advanced 

13 Technology Research Center of the 

14 Department of Defense. 

15 (ii) NON-FEDERAL MEMBERS.—In ad16 dition to the members described in clause 

17 (i), the advisory council shall include 8 ex18 pert members from outside the Federal 

19 Government to be appointed by the Sec20 retary, which shall include— 

21 (I) 2 prostate cancer patient ad22 vocates; 

23 (II) 2 health care providers with 

24 a range of expertise and experience in 

25 prostate cancer; and 


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1 (III) 4 leading researchers with 

2 prostate cancer-related expertise in a 

3 range of clinical disciplines. 

4 (B) MEETINGS.—The advisory council 

5 shall meet quarterly and such meetings shall be 

6 open to the public. 

7 (C) ADVICE.—The advisory council shall 

8 advise the Secretary, or the Secretary’s des9 ignee. 

10 (D) ANNUAL REPORT.—Not later than 1 

11 year after the date of enactment of this Act, the 

12 advisory council shall provide to the Secretary, 

13 or the Secretary’s designee, and Congress— 

14 (i) an initial evaluation of all federally 

15 funded efforts in prostate cancer research 

16 relating to the development and validation 

17 of an accurate test or tests to detect and 

18 diagnose prostate cancer; 

19 (ii) a plan for the development and 

20 validation of a reliable test or tests for the 

21 detection and accurate diagnosis of pros22 tate cancer; and 

23 (iii) a set of standards for prostate 

24 cancer screening, developed in coordination 

25 with the United States Preventive Services 


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1 Task Force, to ensure that any tools for 

2 screening, detection, and diagnosis devel3 oped in accordance with the plan under 

4 clause (ii) will meet the requirements of 

5 the Task Force for recommendation as a 

6 proven preventive or diagnostic service. 

7 (E) TERMINATION.—The advisory council 

8 shall terminate on December 31, 2028. 

9 (3) FUNDING.—Notwithstanding any other pro10 vision of law, the Secretary may make available 

11 $1,000,000, from any unobligated amounts appro12 priated to the National Institutes of Health, for each 

13 of fiscal years 2025 through 2029 to carry out this 

14 subsection. 

15 (b) COORDINATION AND INTENSIFICATION OF PROS16 TATE CANCER RESEARCH.— 

17 (1) IN GENERAL.—The Director of the National 

18 Institutes of Health, in consultation with the Sec19 retary of Defense, shall coordinate and intensify re20 search in accordance with the plan provided under 

21 subsection (a)(2)(D)(ii), with particular attention 

22 provided to leveraging existing research to develop 

23 and validate a test or tests, such as biomarkers or 

24 imaging, to detect and accurately diagnose prostate 

25 cancer in order to improve quality of life for millions 


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1 of individuals in the United States, and decrease 

2 health care system costs. 

3 (2) FUNDING.—Notwithstanding any other pro4 vision of law, the Secretary may make available 

5 $30,000,000, from any unobligated amounts appro6 priated to the National Institutes of Health, for each 

7 of fiscal years 2025 through 2029 to carry out this 

8 subsection. 

9 SEC. 7005. NATIONAL PROSTATE CANCER COUNCIL. 

10 (a) NATIONAL PROSTATE CANCER COUNCIL.— 

11 (1) ESTABLISHMENT.—There is established in 

12 the Office of the Secretary of Health and Human 

13 Services (referred to in this section as the ‘‘Sec14 retary’’) the National Prostate Cancer Council on 

15 Screening, Early Detection, Assessment, and Moni16 toring of Prostate Cancer (referred to in this section 

17 as the ‘‘Council’’). 

18 (2) PURPOSE OF THE COUNCIL.—The Council 

19 shall— 

20 (A) develop and implement a national stra21 tegic plan for the accelerated creation, advance22 ment, and testing of diagnostic tools to improve 

23 screening, early detection, assessment, and 

24 monitoring of prostate cancer, including— 


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1 (i) early detection of aggressive pros2 tate cancer to save lives; 

3 (ii) monitoring of tumor response to 

4 treatment, including recurrence and pro5 gression; and 

6 (iii) accurate assessment and surveil7 lance of indolent disease to reduce unnec8 essary biopsies and treatment; 

9 (B) provide information and coordination 

10 of prostate cancer research and services across 

11 all Federal agencies; 

12 (C) review diagnostic tools and their over13 all effectiveness at screening, detecting, assess14 ing, and monitoring of prostate cancer; 

15 (D) evaluate all programs in prostate can16 cer that are in existence on the date of enact17 ment of this Act, including Federal budget re18 quests and approvals and public-private part19 nerships; 

20 (E) submit an annual report to the Sec21 retary and Congress on the creation and imple22 mentation of the national strategic plan under 

23 subparagraph (A); and 

24 (F) ensure the inclusion of men at high 

25 risk for prostate cancer, including men from 


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1 minority ethnic and racial populations and men 

2 who are least likely to receive care, in clinical, 

3 research, and service efforts, with the purpose 

4 of decreasing health disparities. 

5 (3) MEMBERSHIP.— 

6 (A) FEDERAL MEMBERS.—The Council 

7 shall be led by the Secretary or the Secretary’s 

8 designee and composed of the following experts: 

9 (i) Two representatives of the Na10 tional Institutes of Health, including 1 rep11 resentative of the National Institute of 

12 Biomedical Imaging and Bioengineering 

13 and 1 representative of the National Can14 cer Institute. 

15 (ii) A representative of the Centers 

16 for Disease Control and Prevention. 

17 (iii) A representative of the Centers 

18 for Medicare & Medicaid Services. 

19 (iv) A designee of the Director of the 

20 Department of Defense Congressionally 

21 Directed Medical Research Programs. 

22 (v) A designee of the Director of the 

23 Office of Minority Health. 

24 (vi) A representative of the Food and 

25 Drug Administration. 


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1 (vii) A representative of the Agency 

2 for Healthcare Research and Quality. 

3 (B) NON-FEDERAL MEMBERS.—In addi4 tion to the members described in subparagraph 

5 (A), the Council shall include 14 expert mem6 bers from outside the Federal Government, 

7 which shall include— 

8 (i) 6 prostate cancer patient advo9 cates, including— 

10 (I) 2 patient-survivors; 

11 (II) 2 caregivers of prostate can12 cer patients; and 

13 (III) 2 representatives from na14 tional prostate cancer disease organi15 zations that fund research or have 

16 demonstrated experience in providing 

17 assistance to patients, families, and 

18 medical professionals, including infor19 mation on health care options, edu20 cation, and referral; and 

21 (ii) 8 health care stakeholders with 

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1 ology, radiation oncology, urology, and pa2 thology. 

3 (4) MEETINGS.—The Council shall meet quar4 terly and meetings shall be open to the public. 

5 (5) ADVICE.—The Council shall advise the Sec6 retary, or the Secretary’s designee. 

7 (6) ANNUAL REPORT.—The Council shall sub8 mit annual reports, beginning not later than 1 year 

9 after the date of enactment of this Act, to the Sec10 retary or the Secretary’s designee and to Congress. 

11 The annual report shall include— 

12 (A) in the first year— 

13 (i) an evaluation of all federally fund14 ed efforts in prostate cancer research and 

15 gaps relating to the development and vali16 dation of diagnostic tools for prostate can17 cer; and 

18 (ii) recommendations for priority ac19 tions to expand, eliminate, coordinate, or 

20 condense programs based on the perform21 ance, mission, and purpose of the pro22 grams; and 

23 (B) annually thereafter for 5 years— 

24 (i) an outline for the development and 

25 implementation of a national research plan 


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1 for creation and validation of accurate di2 agnostic tools to improve prostate cancer 

3 care in accordance with paragraph (1); 

4 (ii) roles for the National Cancer In5 stitute, National Institute on Minority 

6 Health and Health Disparities, and the Of7 fice of Minority Health of the Department 

8 of Health and Human Services; 

9 (iii) an analysis of the disparities in 

10 the incidence and mortality rates of pros11 tate cancer in men at high risk of the dis12 ease, including individuals with family his13 tory, increasing age, or African-American 

14 heritage; and 

15 (iv) a review of the progress towards 

16 the realization of the proposed strategic 

17 plan. 

18 (7) TERMINATION.—The Council shall termi19 nate on December 31, 2027. 

20 SEC. 7006. IMPROVED MEDICAID COVERAGE FOR CERTAIN 

21 BREAST AND CERVICAL CANCER PATIENTS 

22 IN THE TERRITORIES. 

23 (a) ELIMINATION OF FUNDING LIMITATIONS.—Sec24 tion 1108(g)(4) of the Social Security Act (42 U.S.C. 

25 1308(g)(4)) is amended— 


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1 (1) by striking ‘‘paragraphs (1), (2), (3), and 

2 (4) of’’; and 

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

4 respect to fiscal years beginning with fiscal year 

5 2024, payment for medical assistance for individuals 

6 who are eligible for such assistance only on the basis 

7 of section 1902(a)(10)(A)(ii)(XVIII) shall not be 

8 taken into account in applying subsection (f) (as in9 creased in accordance with this subsection) to Puer10 to Rico, the Virgin Islands, Guam, the Northern 

11 Mariana Islands, or American Samoa for such fiscal 

12 year.’’. 

13 (b) APPLICATION OF ENHANCED FMAP FOR HIGH14 EST STATE.—Section 1905(b) of such Act (42 U.S.C. 

15 1396d(b)) is amended by adding at the end the following: 

16 ‘‘Notwithstanding the first sentence of this subsection, 

17 with respect to medical assistance described in clause (4) 

18 of such sentence that is furnished in Puerto Rico, the Vir19 gin Islands, Guam, the Northern Mariana Islands, or 

20 American Samoa in a fiscal year, the Federal medical as21 sistance percentage is equal to the highest such percentage 

22 applied under such clause for such fiscal year for any of 

23 the 50 States or the District of Columbia that provides 

24 such medical assistance for any portion of such fiscal 

25 year.’’. 


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

2 this section shall apply to payment for medical assistance 

3 for items and services furnished on or after October 1, 

4 2024. 

5 SEC. 7007. CANCER PREVENTION AND TREATMENT DEM6 ONSTRATION FOR ETHNIC AND RACIAL MI7 NORITIES. 

8 (a) DEMONSTRATION.— 

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

10 Human Services (in this section referred to as the 

11 ‘‘Secretary’’) shall, consistent with subsection (b), 

12 conduct demonstration projects for the purpose of 

13 developing models and evaluating methods that— 

14 (A) improve the quality of items and serv15 ices provided to target individuals in order to 

16 facilitate reduced disparities in early detection 

17 and treatment of cancer; 

18 (B) improve clinical outcomes, satisfaction, 

19 quality of life, appropriate use of items and 

20 services covered under the Medicare program 

21 under title XVIII of the Social Security Act (42 

22 U.S.C. 1395 et seq.), and referral patterns with 

23 respect to target individuals with cancer; 

24 (C) eliminate disparities in the rate of pre25 ventive cancer screening measures, such as Pap 


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1 smears, prostate cancer screenings, colon and 

2 colorectal cancer screenings, breast cancer 

3 screenings, and computed tomography scans, 

4 for lung cancer among target individuals; 

5 (D) promote collaboration with community6 based organizations to ensure cultural com7 petency of health care professionals and lin8 guistic access for target individuals with limited 

9 English proficiency; and 

10 (E) encourage the incorporation of commu11 nity health workers to increase the efficiency 

12 and appropriateness of cancer screening pro13 grams. 

14 (2) COMMUNITY HEALTH WORKER DEFINED.— 

15 In this section, the term ‘‘community health worker’’ 

16 includes a community health advocate, a lay health 

17 worker, a community health representative, a peer 

18 health promoter, a community health outreach work19 er, and a promotore de salud, who promotes health 

20 or nutrition within the community in which the indi21 vidual resides. 

22 (3) TARGET INDIVIDUAL DEFINED.—In this 

23 section, the term ‘‘target individual’’ means an indi24 vidual of a racial and ethnic minority group, as de25 fined in section 1707(g)(1) of the Public Health 


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1 Service Act (42 U.S.C. 300u–6(g)(1)), who is enti2 tled to benefits under part A, and enrolled under 

3 part B, of title XVIII of the Social Security Act. 

4 (b) PROGRAM DESIGN.— 

5 (1) INITIAL DESIGN.—Not later than 1 year 

6 after the date of the enactment of this Act, the Sec7 retary shall evaluate best practices in the private 

8 sector, community programs, and academic research 

9 of methods that reduce disparities among individuals 

10 of racial and ethnic minority groups in the preven11 tion and treatment of cancer and shall design the 

12 demonstration projects based on such evaluation. 

13 (2) NUMBER AND PROJECT AREAS.—Not later 

14 than 2 years after the date of the enactment of this 

15 Act, the Secretary shall implement at least 9 dem16 onstration projects, including the following: 

17 (A) Two projects, each of which shall tar18 get different ethnic subpopulations, for each ra19 cial and ethnic minority group described in 

20 clauses (i) through (vi) of section 1707(g)(1)(A) 

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

22 300u–6(g)(1)(A)). 

23 (B) One project within the Pacific Islands 

24 or United States insular areas. 

25 (C) At least 1 project in a rural area. 


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1 (D) At least 1 project in an inner-city 

2 area. 

3 (3) EXPANSION OF PROJECTS; IMPLEMENTA4 TION OF DEMONSTRATION PROJECT RESULTS.—The 

5 Secretary shall continue the demonstration projects 

6 and may expand the number of demonstration 

7 projects if the initial report under subsection (c) 

8 contains an evaluation that the demonstration 

9 projects— 

10 (A) reduce expenditures under the Medi11 care program under title XVIII of the Social 

12 Security Act (42 U.S.C. 1395 et seq.); or 

13 (B) do not increase expenditures under 

14 such Medicare program and reduce racial and 

15 ethnic health disparities in the quality of health 

16 care services provided to target individuals and 

17 increase satisfaction of Medicare beneficiaries 

18 and health care providers. 

19 (c) REPORT TO CONGRESS.— 

20 (1) IN GENERAL.—Not later than 2 years after 

21 the date the Secretary implements the initial dem22 onstration projects under this section, and bian23 nually thereafter, the Secretary shall submit to Con24 gress a report regarding the demonstration projects. 


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1 (2) CONTENT OF REPORT.—Each report under 

2 paragraph (1) shall include the following: 

3 (A) A description of the demonstration 

4 projects. 

5 (B) An evaluation of— 

6 (i) the cost-effectiveness of the dem7 onstration projects; 

8 (ii) the quality of the health care serv9 ices provided to target individuals under 

10 the demonstration projects; and 

11 (iii) beneficiary and health care pro12 vider satisfaction under the demonstration 

13 projects. 

14 (C) Any other information regarding the 

15 demonstration projects that the Secretary de16 termines to be appropriate. 

17 (d) WAIVER AUTHORITY.—The Secretary shall waive 

18 compliance with the requirements of title XVIII of the So19 cial Security Act (42 U.S.C. 1395 et seq.) to such extent 

20 and for such period as the Secretary determines is nec21 essary to conduct the demonstration projects under this 

22 section. 


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1 SEC. 7008. REDUCING CANCER DISPARITIES WITHIN MEDI2 CARE. 

3 (a) DEVELOPMENT OF MEASURES OF DISPARITIES

4 IN QUALITY OF CANCER CARE.— 

5 (1) DEVELOPMENT OF MEASURES.—The Sec6 retary of Health and Human Services (in this sec7 tion referred to as the ‘‘Secretary’’) shall enter into 

8 an agreement with an entity that specializes in de9 veloping quality measures for cancer care under 

10 which the entity shall develop a uniform set of meas11 ures to evaluate disparities in the quality of cancer 

12 care and annually update such set of measures. 

13 (2) MEASURES TO BE INCLUDED.—Such set of 

14 measures shall include, with respect to the treatment 

15 of cancer, measures of patient outcomes, the process 

16 for delivering medical care related to such treat17 ment, patient counseling and engagement in decision 

18 making, patient experience of care, resource use, and 

19 practice capabilities, such as care coordination. 

20 (b) ESTABLISHMENT OF REPORTING PROCESS.— 

21 (1) IN GENERAL.—The Secretary shall establish 

22 a reporting process that requires and provides for a 

23 method for health care providers specified under 

24 paragraph (2) to submit to the Secretary and make 

25 public data on the performance of such providers 

26 during each reporting period through use of the 


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1 measures developed pursuant to subsection (a). Such 

2 data shall be submitted in a form and manner and 

3 at a time specified by the Secretary. 

4 (2) SPECIFICATION OF PROVIDERS TO REPORT

5 ON MEASURES.—The Secretary shall specify the 

6 classes of Medicare providers of services and sup7 pliers, including hospitals, cancer centers, physi8 cians, primary care providers, and specialty pro9 viders, that will be required under such process to 

10 publicly report on the measures specified under sub11 section (a). 

12 (3) ASSESSMENT OF CHANGES.—Under such 

13 reporting process, the Secretary shall establish a for14 mat that assesses changes in both the absolute and 

15 relative disparities in cancer care over time. These 

16 measures shall be presented in an easily comprehen17 sible format, such as those presented in the final 

18 publications relating to Healthy People 2010 or the 

19 National Healthcare Disparities Report. 

20 (4) INITIAL IMPLEMENTATION.—The Secretary 

21 shall implement the reporting process under this 

22 subsection for reporting periods beginning not later 

23 than 6 months after the date that measures are first 

24 established under subsection (a). 


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1 Subtitle B—Viral Hepatitis and 

2 Liver Cancer Control and Pre3 vention 

4 SEC. 7101. BIENNIAL ASSESSMENT OF HHS HEPATITIS B 

5 AND HEPATITIS C PREVENTION, EDUCATION, 

6 RESEARCH, AND MEDICAL MANAGEMENT 

7 PLAN. 

8 Title III of the Public Health Service Act (42 U.S.C. 

9 241 et seq.) is amended— 

10 (1) by striking section 317N (42 U.S.C. 247b– 

11 15); and 

12 (2) by adding after part V the following: 

13 ‘‘PART W—BIENNIAL ASSESSMENT OF HHS HEPA14 TITIS B AND HEPATITIS C PREVENTION, EDU15 CATION, RESEARCH, AND MEDICAL MANAGE16 MENT PLAN 

17 ‘‘SEC. 399OO. BIENNIAL UPDATE OF THE PLAN. 

18 ‘‘(a) IN GENERAL.—The Secretary shall conduct a bi19 ennial assessment of the Secretary’s plan for the preven20 tion, control, and medical management of, and education 

21 and research relating to, hepatitis B and hepatitis C, for 

22 the purposes of— 

23 ‘‘(1) incorporating into such plan new knowl24 edge or observations relating to hepatitis B and hep25 atitis C (such as knowledge and observations that 


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1 may be derived from clinical, laboratory, and epide2 miological research and disease detection, preven3 tion, and surveillance outcomes); 

4 ‘‘(2) addressing gaps in the coverage or effec5 tiveness of the plan; and 

6 ‘‘(3) evaluating and, if appropriate, updating 

7 recommendations, guidelines, or educational mate8 rials of the Centers for Disease Control and Preven9 tion or the National Institutes of Health for health 

10 care providers or the public on viral hepatitis in 

11 order to be consistent with the plan. 

12 ‘‘(b) PUBLICATION OF NOTICE OF ASSESSMENTS.— 

13 Not later than October 1 of the first even-numbered year 

14 beginning after the date of the enactment of this part, 

15 and October 1 of each even-numbered year thereafter, the 

16 Secretary shall publish in the Federal Register a notice 

17 of the results of the assessments conducted under sub18 section (a). Such notice shall include— 

19 ‘‘(1) a description of any revisions to the plan 

20 referred to in subsection (a) as a result of the as21 sessment; 

22 ‘‘(2) an explanation of the basis for any such 

23 revisions, including the ways in which such revisions 

24 can reasonably be expected to further promote the 

25 original goals and objectives of the plan; and 


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1 ‘‘(3) in the case of a determination by the Sec2 retary that the plan does not need revision, an expla3 nation of the basis for such determination. 

4 ‘‘SEC. 399OO–1. ELEMENTS OF PROGRAM. 

5 ‘‘(a) EDUCATION AND AWARENESS PROGRAMS.—The 

6 Secretary, acting through the Director of the Centers for 

7 Disease Control and Prevention, the Administrator of the 

8 Health Resources and Services Administration, and the 

9 Assistant Secretary for Mental Health and Substance Use, 

10 and in accordance with the plan referred to in section 

11 399OO(a), shall implement programs to increase aware12 ness and enhance knowledge and understanding of hepa13 titis B and hepatitis C. Such programs shall include— 

14 ‘‘(1) the conduct of culturally and linguistically 

15 appropriate health education in primary and sec16 ondary schools, college campuses, public awareness 

17 campaigns, and community outreach activities (espe18 cially to the ethnic communities with high rates of 

19 chronic hepatitis B and chronic hepatitis C and 

20 other high-risk groups) to promote public awareness 

21 and knowledge about— 

22 ‘‘(A) the value of hepatitis A and hepatitis 

23 B immunization; 

24 ‘‘(B) risk factors, transmission, and pre25 vention of hepatitis B and hepatitis C; 


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1 ‘‘(C) the value of screening for the early 

2 detection of hepatitis B and hepatitis C; and 

3 ‘‘(D) options available for the treatment of 

4 chronic hepatitis B and chronic hepatitis C; 

5 ‘‘(2) the promotion of immunization programs 

6 that increase awareness and access to hepatitis A 

7 and hepatitis B vaccines for susceptible adults and 

8 children; 

9 ‘‘(3) the training of health care professionals 

10 regarding the importance of vaccinating individuals 

11 infected with hepatitis C and individuals who are at 

12 risk for hepatitis C infection against hepatitis A and 

13 hepatitis B; 

14 ‘‘(4) the training of health care professionals 

15 regarding the importance of vaccinating individuals 

16 chronically infected with hepatitis B and individuals 

17 who are at risk for chronic hepatitis B infection 

18 against the hepatitis A virus; 

19 ‘‘(5) the training of health care professionals 

20 and health educators to make them aware of the 

21 high rates of chronic hepatitis B and chronic hepa22 titis C in certain adult ethnic populations, and the 

23 importance of prevention, detection, and medical 

24 management of hepatitis B and hepatitis C and of 

25 liver cancer screening; 


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1 ‘‘(6) the development and distribution of health 

2 education curricula (including information relating 

3 to the special needs of individuals infected with or 

4 at risk of hepatitis B and hepatitis C, such as the 

5 importance of prevention and early intervention, reg6 ular monitoring, the recognition of psychosocial 

7 needs, appropriate treatment, and liver cancer 

8 screening) for individuals providing hepatitis B and 

9 hepatitis C counseling; and 

10 ‘‘(7) support for the implementation of the cur11 ricula described in paragraph (6) by State and local 

12 public health agencies. 

13 ‘‘(b) IMMUNIZATION, PREVENTION, AND CONTROL

14 PROGRAMS.— 

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

16 through the Director of the Centers for Disease 

17 Control and Prevention, shall support the integra18 tion of activities described in paragraph (3) into ex19 isting clinical and public health programs at State, 

20 local, territorial, and Tribal levels (including commu21 nity health clinics, programs for the prevention and 

22 treatment of HIV/AIDS, sexually transmitted infec23 tions, and substance use disorder, and programs for 

24 individuals in correctional settings). 


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1 ‘‘(2) COORDINATION OF DEVELOPMENT OF

2 FEDERAL SCREENING GUIDELINES.— 

3 ‘‘(A) REFERENCES.—For purposes of this 

4 subsection, the term ‘CDC Director’ means the 

5 Director of the Centers for Disease Control and 

6 Prevention, and the term ‘AHRQ Director’ 

7 means the Director of the Agency for 

8 Healthcare Research and Quality. 

9 ‘‘(B) AGENCY FOR HEALTHCARE RE10 SEARCH AND QUALITY.—Due to the rapidly 

11 evolving standard of care associated with diag12 nosing and treating viral hepatitis infection, the 

13 AHRQ Director shall convene the Preventive 

14 Services Task Force under section 915(a) to re15 view its recommendation for screening for HBV 

16 and HCV infection every 3 years. 

17 ‘‘(3) ACTIVITIES.— 

18 ‘‘(A) VOLUNTARY TESTING PROGRAMS.— 

19 ‘‘(i) IN GENERAL.—The Secretary 

20 shall establish a mechanism by which to 

21 support and promote the development of 

22 State, local, territorial, and Tribal vol23 untary hepatitis B and hepatitis C testing 

24 programs to screen the high-prevalence 


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1 populations to aid in the early identifica2 tion of chronically infected individuals. 

3 ‘‘(ii) CONFIDENTIALITY OF THE TEST

4 RESULTS.—The Secretary shall prohibit 

5 the use of the results of a hepatitis B or 

6 hepatitis C test conducted by a testing pro7 gram developed or supported under this 

8 subparagraph for any of the following: 

9 ‘‘(I) Issues relating to health in10 surance. 

11 ‘‘(II) To screen or determine 

12 suitability for employment. 

13 ‘‘(III) To discharge a person 

14 from employment. 

15 ‘‘(B) COUNSELING REGARDING VIRAL HEP16 ATITIS.—The Secretary shall support State, 

17 local, territorial, and Tribal programs in a wide 

18 variety of settings, including those providing 

19 primary and specialty health care services in 

20 nonprofit private and public sectors, to— 

21 ‘‘(i) provide individuals with ongoing 

22 risk factors for hepatitis B and hepatitis C 

23 infection with client-centered education 

24 and counseling which concentrates on— 


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1 ‘‘(I) promoting testing of individ2 uals that have been exposed to their 

3 blood, family members, and their sex4 ual partners; and 

5 ‘‘(II) changing behaviors that 

6 place individuals at risk for infection; 

7 ‘‘(ii) provide individuals chronically in8 fected with hepatitis B or hepatitis C with 

9 education, health information, and coun10 seling to reduce their risk of— 

11 ‘‘(I) dying from end-stage liver 

12 disease and liver cancer; and 

13 ‘‘(II) transmitting viral hepatitis 

14 to others; and 

15 ‘‘(iii) provide people chronically in16 fected with hepatitis B or hepatitis C who 

17 are pregnant or of childbearing age with 

18 culturally and linguistically appropriate 

19 health information, such as how to prevent 

20 hepatitis B perinatal infection, and to al21 leviate fears associated with pregnancy or 

22 raising a family. 

23 ‘‘(C) IMMUNIZATION.—The Secretary shall 

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1 grams to protect every child in the Nation and 

2 all susceptible adults, particularly those infected 

3 with hepatitis C and high-prevalence ethnic 

4 populations and other high-risk groups, from 

5 the risks of acute and chronic hepatitis B infec6 tion by— 

7 ‘‘(i) ensuring continued funding for 

8 hepatitis B vaccination for all children 18 

9 years of age or younger through the Vac10 cines for Children program; 

11 ‘‘(ii) ensuring that the recommenda12 tions of the Advisory Committee on Immu13 nization Practices of the Centers for Dis14 ease Control and Prevention are followed 

15 regarding hepatitis B vaccination for in16 fants, children, and adults; 

17 ‘‘(iii) requiring proof of hepatitis B 

18 vaccination for entry into public or private 

19 daycare, preschool, elementary school, sec20 ondary school, and institutions of higher 

21 education; 

22 ‘‘(iv) expanding the availability of 

23 hepatitis B vaccination for all adults to 

24 protect them from becoming acutely or 

25 chronically infected, including ethnic and 


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1 other populations with high prevalence 

2 rates of chronic hepatitis B infection; 

3 ‘‘(v) expanding the availability of hep4 atitis B vaccination for all adults, particu5 larly those of reproductive age (women and 

6 men less than 45 years of age), to protect 

7 them from the risk of hepatitis B infection; 

8 ‘‘(vi) ensuring the vaccination of indi9 viduals infected, or at risk for infection, 

10 with hepatitis C against hepatitis A, hepa11 titis B, and other infectious diseases, as 

12 appropriate, for which such individuals 

13 may be at increased risk; and 

14 ‘‘(vii) ensuring the vaccination of indi15 viduals infected, or at risk for infection, 

16 with hepatitis B against hepatitis A virus 

17 and other infectious diseases, as appro18 priate, for which such individuals may be 

19 at increased risk. 

20 ‘‘(D) MEDICAL REFERRAL.—The Secretary 

21 shall support State, local, territorial, and Tribal 

22 programs that support— 

23 ‘‘(i) referral of persons chronically in24 fected with hepatitis B or hepatitis C— 


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1 ‘‘(I) for medical evaluation to de2 termine the appropriateness for 

3 antiviral treatment to reduce the risk 

4 of progression to cirrhosis and liver 

5 cancer; and 

6 ‘‘(II) for ongoing medical man7 agement including regular monitoring 

8 of liver function and screening for 

9 liver cancer; and 

10 ‘‘(ii) referral of persons infected with 

11 acute or chronic hepatitis B infection or 

12 acute or chronic hepatitis C infection for 

13 drug and alcohol abuse treatment where 

14 appropriate. 

15 ‘‘(4) INCREASED SUPPORT FOR ADULT VIRAL

16 HEPATITIS PREVENTION COORDINATORS.—The Sec17 retary, acting through the CDC Director, shall pro18 vide increased support to adult viral hepatitis pre19 vention coordinators in State, local, territorial, and 

20 Tribal health departments in order to enhance the 

21 additional management, networking, and technical 

22 expertise needed to ensure successful integration of 

23 hepatitis B and hepatitis C prevention and control 

24 activities into existing public health programs. 

25 ‘‘(c) EPIDEMIOLOGICAL SURVEILLANCE.— 


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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 establish4 ment and maintenance of a national chronic and 

5 acute hepatitis B and hepatitis C surveillance pro6 gram, in order to identify— 

7 ‘‘(A) trends in the incidence of acute and 

8 chronic hepatitis B and acute and chronic hepa9 titis C; 

10 ‘‘(B) trends in the prevalence of acute and 

11 chronic hepatitis B and acute and chronic hepa12 titis C infection among groups that may be dis13 proportionately affected; and 

14 ‘‘(C) trends in liver cancer and end-stage 

15 liver disease incidence and deaths, caused by 

16 chronic hepatitis B and chronic hepatitis C in 

17 the high-risk ethnic populations. 

18 ‘‘(2) SEROPREVALENCE AND LIVER CANCER

19 STUDIES.—The Secretary, acting through the Direc20 tor of the Centers for Disease Control and Preven21 tion, shall prepare a report outlining the population22 based seroprevalence studies currently underway, fu23 ture planned studies, the criteria involved in deter24 mining which seroprevalence studies to conduct, 

25 defer, or suspend, and the scope of those studies, the 


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1 economic and clinical impact of hepatitis B and hep2 atitis C, and the impact of chronic hepatitis B and 

3 chronic hepatitis C infections on the quality of life. 

4 Not later than one year after the date of the enact5 ment of this part, the Secretary shall submit the re6 port to the Committee on Health, Education, Labor, 

7 and Pensions of the Senate and the Committee on 

8 Energy and Commerce of the House of Representa9 tives. 

10 ‘‘(3) CONFIDENTIALITY.—The Secretary shall 

11 not disclose any individually identifiable information 

12 identified under paragraph (1) or derived through 

13 studies under paragraph (2). 

14 ‘‘(d) RESEARCH.—The Secretary, acting through the 

15 Director of the Centers for Disease Control and Preven16 tion, the Director of the National Cancer Institute, and 

17 the Director of the National Institutes of Health, shall— 

18 ‘‘(1) conduct epidemiologic and community19 based research to develop, implement, and evaluate 

20 best practices for hepatitis B and hepatitis C pre21 vention especially in the ethnic populations with high 

22 rates of chronic hepatitis B and chronic hepatitis C 

23 and other high-risk groups; 

24 ‘‘(2) conduct research on hepatitis B and hepa25 titis C natural history, pathophysiology, improved 


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1 treatments and prevention (such as the hepatitis C 

2 vaccine), and noninvasive tests that help to predict 

3 the risk of progression to liver cirrhosis and liver 

4 cancer; 

5 ‘‘(3) conduct research that will lead to better 

6 noninvasive or blood tests to screen for liver cancer, 

7 and more effective treatments of liver cancer caused 

8 by chronic hepatitis B and chronic hepatitis C; and 

9 ‘‘(4) conduct research comparing the effective10 ness of screening, diagnostic, management, and 

11 treatment approaches for chronic hepatitis B, chron12 ic hepatitis C, and liver cancer in the affected com13 munities. 

14 ‘‘(e) UNDERSERVED AND DISPROPORTIONATELY AF15 FECTED POPULATIONS.—In carrying out this section, the 

16 Secretary shall provide expanded support for individuals 

17 with limited access to health education, testing, and health 

18 care services and groups that may be disproportionately 

19 affected by hepatitis B and hepatitis C. 

20 ‘‘(f) EVALUATION OF PROGRAM.—The Secretary 

21 shall develop benchmarks for evaluating the effectiveness 

22 of the programs and activities conducted under this sec23 tion and make determinations as to whether such bench24 marks have been achieved. 


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1 ‘‘SEC. 399OO–2. GRANTS. 

2 ‘‘(a) IN GENERAL.—The Secretary may award grants 

3 to, or enter into contracts or cooperative agreements with, 

4 States, political subdivisions of States, territories, Indian 

5 Tribes, or nonprofit entities that have special expertise re6 lating to hepatitis B, hepatitis C, or both, to carry out 

7 activities under this part. 

8 ‘‘(b) APPLICATION.—To be eligible for a grant, con9 tract, or cooperative agreement under subsection (a), an 

10 entity shall prepare and submit to the Secretary an appli11 cation at such time, in such manner, and containing such 

12 information as the Secretary may require. 

13 ‘‘SEC. 399OO–3. AUTHORIZATION OF APPROPRIATIONS. 

14 ‘‘There are authorized to be appropriated to carry out 

15 this part $90,000,000 for fiscal year 2025, $110,000,000 

16 for fiscal year 2026, $130,000,000 for fiscal year 2027, 

17 and $150,000,000 for fiscal year 2028.’’. 

18 SEC. 7102. LIVER CANCER AND DISEASE PREVENTION, 

19 AWARENESS, AND PATIENT TRACKING 

20 GRANTS. 

21 Subpart I of part D of title III of the Public Health 

22 Service Act (42 U.S.C. 254b et seq.) is amended by adding 

23 at the end the following: 


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1 ‘‘SEC. 330Q. LIVER CANCER AND DISEASE PREVENTION, 

2 AWARENESS, AND PATIENT TRACKING 

3 GRANTS. 

4 ‘‘(a) PREVENTION INITIATIVE GRANT PROGRAM.— 

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

6 through the Director of the Centers for Disease 

7 Control and Prevention, may award grants and 

8 enter into cooperative agreements with entities for 

9 the purpose of expanding and supporting— 

10 ‘‘(A) prevention activities (including pro11 viding screenings, vaccinations, or other pre12 ventative interventions) for conditions known to 

13 increase an individual’s risk of developing a 

14 major liver disease, such as liver cancer, hepa15 titis B, hepatitis C, nonalcoholic fatty liver dis16 ease, nonalcoholic steatohepatitis, and cirrhosis 

17 of the liver; 

18 ‘‘(B) activities relating to detection and 

19 provision of guidance for individuals at high 

20 risk for contracting liver cancer and other liver 

21 diseases; and 

22 ‘‘(C) viral hepatitis surveillance to provide 

23 for timely and accurate information regarding 

24 progress to eliminate viral hepatitis. 

25 ‘‘(2) REPORT.—An entity that receives a grant 

26 or cooperative agreement under paragraph (1) shall 


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1 submit to the Secretary, at a time specified by the 

2 Secretary, a report describing each activity carried 

3 out pursuant to such paragraph and evaluating the 

4 effectiveness of such activity in promoting prevention 

5 and treatment of liver cancer and other liver dis6 eases. 

7 ‘‘(3) AUTHORIZATION OF APPROPRIATIONS.— 

8 For purposes of carrying out this subsection, there 

9 is authorized to be appropriated $90,000,000 for 

10 each of fiscal years 2024 through 2028. 

11 ‘‘(b) AWARENESS INITIATIVE GRANT PROGRAM.— 

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

13 through the Director of the Centers for Disease 

14 Control and Prevention, may award grants to eligi15 ble entities for the purpose of raising awareness for 

16 liver cancer and other liver diseases, which may in17 clude the production, dissemination, and distribution 

18 of informational materials targeted towards commu19 nities and populations with a higher risk for devel20 oping liver cancer and other liver diseases. 

21 ‘‘(2) ELIGIBLE ENTITIES.—To be eligible to re22 ceive a grant under paragraph (1), an entity shall 

23 submit to the Secretary an application, at such time, 

24 in such manner, and containing such information as 

25 the Secretary may require, including a description of 


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1 how the entity, in disseminating information on liver 

2 cancer and other liver diseases pursuant to para3 graph (1), will— 

4 ‘‘(A) with respect to any community or 

5 population, consult with members of such com6 munity or population and provide such informa7 tion in a manner that is culturally and linguis8 tically appropriate for such community or popu9 lation; 

10 ‘‘(B) highlight the range of preventative 

11 measures and treatments available for liver can12 cer and other liver diseases; 

13 ‘‘(C) integrate information on available 

14 hepatitis B and hepatitis C testing programs 

15 into any liver cancer presentations carried out 

16 by the entity; and 

17 ‘‘(D) address communities and populations 

18 with a higher risk for contracting liver cancer 

19 and other liver diseases. 

20 ‘‘(3) PREFERENCE.—In awarding grants under 

21 paragraph (1), the Secretary shall give preference to 

22 entities that— 

23 ‘‘(A) work with a Federally qualified 

24 health center; 


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1 ‘‘(B) are community-based organizations; 

2 or 

3 ‘‘(C) serve communities and populations 

4 with a higher risk for contracting liver cancer 

5 and other liver diseases. 

6 ‘‘(4) REPORT.—An entity that receives a grant 

7 under paragraph (1) shall submit to the Secretary, 

8 at a time specified by the Secretary, a report de9 scribing each activity carried out pursuant to such 

10 paragraph and evaluating the effectiveness of such 

11 activity in raising awareness for liver cancer and 

12 other liver diseases. 

13 ‘‘(5) AUTHORIZATION OF APPROPRIATIONS.— 

14 For purposes of carrying out this subsection, there 

15 is authorized to be appropriated $10,000,000 for 

16 each of fiscal years 2025 through 2029.’’. 

17 Subtitle C—Acquired Bone Marrow 

18 Failure Diseases 

19 SEC. 7201. ACQUIRED BONE MARROW FAILURE DISEASES. 

20 (a) NATIONAL ACQUIRED BONE MARROW FAILURE

21 DISEASE REGISTRY.—Title III of the Public Health Serv22 ice Act (42 U.S.C. 241 et seq.) is amended by inserting 

23 after section 317W, as added by section 1009, the fol24 lowing: 


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1 ‘‘SEC. 317X. NATIONAL ACQUIRED BONE MARROW FAILURE 

2 DISEASE REGISTRY. 

3 ‘‘(a) ESTABLISHMENT OF REGISTRY.— 

4 ‘‘(1) IN GENERAL.—Not later than 6 months 

5 after the date of the enactment of this section, the 

6 Secretary, acting through the Director of the Cen7 ters for Disease Control and Prevention, shall— 

8 ‘‘(A) develop a system to collect data on 

9 acquired bone marrow failure diseases; and 

10 ‘‘(B) establish and maintain a national and 

11 publicly available registry, to be known as the 

12 National Acquired Bone Marrow Failure Dis13 ease Registry, in accordance with paragraph 

14 (3). 

15 ‘‘(2) RECOMMENDATIONS OF ADVISORY COM16 MITTEE.—In carrying out this subsection, the Sec17 retary shall take into consideration the recommenda18 tions of the Advisory Committee on Acquired Bone 

19 Marrow Failure Diseases established under sub20 section (b). 

21 ‘‘(3) PURPOSES OF REGISTRY.—The National 

22 Acquired Bone Marrow Failure Disease Registry 

23 shall— 

24 ‘‘(A) identify the incidence and prevalence 

25 of acquired bone marrow failure diseases in the 

26 United States; 


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1 ‘‘(B) be used to collect and store data on 

2 acquired bone marrow failure diseases, includ3 ing data concerning— 

4 ‘‘(i) the age, race or ethnicity, general 

5 geographic location, sex, and family history 

6 of individuals who are diagnosed with ac7 quired bone marrow failure diseases, and 

8 any other characteristics of such individ9 uals determined appropriate by the Sec10 retary; 

11 ‘‘(ii) the genetic and environmental 

12 factors that may be associated with devel13 oping acquired bone marrow failure dis14 eases; 

15 ‘‘(iii) treatment approaches for deal16 ing with acquired bone marrow failure dis17 eases; 

18 ‘‘(iv) outcomes for individuals treated 

19 for acquired bone marrow failure diseases, 

20 including outcomes for recipients of stem 

21 cell therapeutic products as contained in 

22 the database established pursuant to sec23 tion 379A; and 


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1 ‘‘(v) any other factors pertaining to 

2 acquired bone marrow failure diseases de3 termined appropriate by the Secretary; and 

4 ‘‘(C) be made available— 

5 ‘‘(i) to the general public; and 

6 ‘‘(ii) to researchers to facilitate fur7 ther research into the causes of, and treat8 ments for, acquired bone marrow failure 

9 diseases in accordance with standard prac10 tices of the Centers for Disease Control 

11 and Prevention. 

12 ‘‘(b) ADVISORY COMMITTEE.— 

13 ‘‘(1) ESTABLISHMENT.—Not later than 6 

14 months after the date of the enactment of this sec15 tion, the Secretary, acting through the Director of 

16 the Centers for Disease Control and Prevention, 

17 shall establish an advisory committee, to be known 

18 as the Advisory Committee on Acquired Bone Mar19 row Failure Diseases. 

20 ‘‘(2) MEMBERS.—The members of the Advisory 

21 Committee on Acquired Bone Marrow Failure Dis22 eases shall be appointed by the Secretary, acting 

23 through the Director of the Centers for Disease 

24 Control and Prevention, and shall include at least 

25 one representative from each of the following: 


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1 ‘‘(A) A national patient advocacy organiza2 tion with experience advocating on behalf of pa3 tients suffering from acquired bone marrow 

4 failure diseases. 

5 ‘‘(B) The National Institutes of Health, in6 cluding at least one representative from each 

7 of— 

8 ‘‘(i) the National Cancer Institute; 

9 ‘‘(ii) the National Heart, Lung, and 

10 Blood Institute; and 

11 ‘‘(iii) the Office of Rare Diseases. 

12 ‘‘(C) The Centers for Disease Control and 

13 Prevention. 

14 ‘‘(D) Clinicians with experience in— 

15 ‘‘(i) diagnosing or treating acquired 

16 bone marrow failure diseases; or 

17 ‘‘(ii) medical data registries. 

18 ‘‘(E) Epidemiologists who have experience 

19 with data registries. 

20 ‘‘(F) Publicly or privately funded research21 ers who have experience researching acquired 

22 bone marrow failure diseases. 

23 ‘‘(G) The entity operating the C.W. Bill 

24 Young Cell Transplantation Program estab25 lished pursuant to section 379 and the entity 


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1 operating the C.W. Bill Young Cell Transplan2 tation Program Outcomes Database. 

3 ‘‘(3) RESPONSIBILITIES.—The Advisory Com4 mittee on Acquired Bone Marrow Failure Diseases 

5 shall provide recommendations to the Secretary on 

6 the establishment and maintenance of the National 

7 Acquired Bone Marrow Failure Disease Registry, in8 cluding recommendations on the collection, mainte9 nance, and dissemination of data. 

10 ‘‘(4) PUBLIC AVAILABILITY.—The Secretary 

11 shall make the recommendations of the Advisory 

12 Committee on Acquired Bone Marrow Failure Dis13 ease publicly available. 

14 ‘‘(c) GRANTS.—The Secretary, acting through the 

15 Director of the Centers for Disease Control and Preven16 tion, may award grants to, and enter into contracts and 

17 cooperative agreements with, public or private nonprofit 

18 entities for the management of, as well as the collection, 

19 analysis, and reporting of data to be included in, the Na20 tional Acquired Bone Marrow Failure Disease Registry. 

21 ‘‘(d) DEFINITION.—In this section, the term ‘ac22 quired bone marrow failure disease’ means— 

23 ‘‘(1) myelodysplastic syndromes; 

24 ‘‘(2) aplastic anemia; 

25 ‘‘(3) paroxysmal nocturnal hemoglobinuria; 


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1 ‘‘(4) pure red cell aplasia; 

2 ‘‘(5) acute myeloid leukemia that has pro3 gressed from myelodysplastic syndromes; or 

4 ‘‘(6) large granular lymphocytic leukemia. 

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

6 is authorized to be appropriated to carry out this section 

7 $3,000,000 for each of fiscal years 2025 through 2029.’’. 

8 (b) PILOT STUDIES THROUGH THE AGENCY FOR

9 TOXIC SUBSTANCES AND DISEASE REGISTRY.— 

10 (1) PILOT STUDIES.—The Secretary of Health 

11 and Human Services, acting through the Director of 

12 the Agency for Toxic Substances and Disease Reg13 istry, shall conduct pilot studies to determine which 

14 environmental factors, including exposure to toxins, 

15 may cause acquired bone marrow failure diseases. 

16 (2) COLLABORATION WITH THE RADIATION IN17 JURY TREATMENT NETWORK.—In carrying out the 

18 directives of this section, the Secretary of Health 

19 and Human Services may collaborate with the Radi20 ation Injury Treatment Network of the C.W. Bill 

21 Young Cell Transplantation Program established 

22 pursuant to section 379 of the Public Health Service 

23 Act (42 U.S.C. 274k) to— 

24 (A) augment data for the pilot studies au25 thorized by this section; 


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1 (B) access technical assistance that may be 

2 provided by the Radiation Injury Treatment 

3 Network; or 

4 (C) perform joint research projects. 

5 (3) AUTHORIZATION OF APPROPRIATIONS.— 

6 There is authorized to be appropriated to carry out 

7 this subsection $1,000,000 for each of fiscal years 

8 2025 through 2029. 

9 (c) MINORITY-FOCUSED PROGRAMS ON ACQUIRED

10 BONE MARROW FAILURE DISEASES.—Title XVII of the 

11 Public Health Service Act (42 U.S.C. 300u et seq.) is 

12 amended by inserting after section 1707A the following: 

13 ‘‘SEC. 1707B. MINORITY-FOCUSED PROGRAMS ON AC14 QUIRED BONE MARROW FAILURE DISEASE. 

15 ‘‘(a) INFORMATION AND REFERRAL SERVICES.— 

16 ‘‘(1) IN GENERAL.—Not later than 6 months 

17 after the date of the enactment of this section, the 

18 Secretary, acting through the Deputy Assistant Sec19 retary for Minority Health, shall establish and co20 ordinate outreach and informational programs tar21 geted to minority populations affected by acquired 

22 bone marrow failure diseases. 

23 ‘‘(2) PROGRAM REQUIREMENTS.—Minority-fo24 cused outreach and informational programs author25 ized by this section at the National Minority Health 


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1 Resource Center supported under section 1707(b)(8) 

2 (including by means of the Center’s website, through 

3 appropriate locations such as the Center’s knowledge 

4 center, and through appropriate programs such as 

5 the Center’s resource persons network) and through 

6 minority health consultants located at each Depart7 ment of Health and Human Services regional of8 fice— 

9 ‘‘(A) shall make information about treat10 ment options and clinical trials for acquired 

11 bone marrow failure diseases publicly available; 

12 and 

13 ‘‘(B) shall provide referral services for 

14 treatment options and clinical trials. 

15 ‘‘(b) HISPANIC AND ASIAN-AMERICAN AND PACIFIC

16 ISLANDER OUTREACH.— 

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

18 through the Deputy Assistant Secretary for Minority 

19 Health, shall undertake a coordinated outreach ef20 fort to connect Hispanic, Asian-American, and Pa21 cific Islander communities with comprehensive serv22 ices focused on treatment of, and information about, 

23 acquired bone marrow failure diseases. 

24 ‘‘(2) COLLABORATION.—In carrying out this 

25 subsection, the Secretary may collaborate with public 


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1 health agencies, nonprofit organizations, community 

2 groups, and online entities to disseminate informa3 tion about treatment options and clinical trials for 

4 acquired bone marrow failure diseases. 

5 ‘‘(c) GRANTS AND COOPERATIVE AGREEMENTS.— 

6 ‘‘(1) IN GENERAL.—Not later than 6 months 

7 after the date of the enactment of this section, the 

8 Secretary, acting through the Deputy Assistant Sec9 retary for Minority Health, shall award grants to, or 

10 enter into cooperative agreements with, entities to 

11 perform research on acquired bone marrow failure 

12 diseases. 

13 ‘‘(2) REQUIREMENT.—Grants and cooperative 

14 agreements authorized by this subsection shall be 

15 awarded or entered into on a competitive, peer-re16 viewed basis. 

17 ‘‘(3) SCOPE OF RESEARCH.—Research funded 

18 under this subsection shall examine factors affecting 

19 the incidence of acquired bone marrow failure dis20 eases in minority populations. 

21 ‘‘(d) DEFINITION.—In this section, the term ‘ac22 quired bone marrow failure disease’ has the meaning given 

23 to such term in section 317X(d). 


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

2 is authorized to be appropriated to carry out this section 

3 $2,000,000 for each of fiscal years 2025 through 2029.’’. 

4 (d) DIAGNOSIS AND QUALITY OF CARE FOR AC5 QUIRED BONE MARROW FAILURE DISEASES.— 

6 (1) GRANTS.—The Secretary of Health and 

7 Human Services, acting through the Director of the 

8 Agency for Healthcare Research and Quality, shall 

9 award grants to entities to improve diagnostic prac10 tices and quality of care with respect to patients 

11 with acquired bone marrow failure diseases. 

12 (2) AUTHORIZATION OF APPROPRIATIONS.— 

13 There is authorized to be appropriated to carry out 

14 this subsection $2,000,000 for each of fiscal years 

15 2025 through 2029. 

16 (e) DEFINITION.—In this section, the term ‘‘acquired 

17 bone marrow failure disease’’ has the meaning given such 

18 term in section 317X(d) of the Public Health Service Act, 

19 as added by subsection (a). 


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1 Subtitle D—Cardiovascular Dis2 ease, Chronic Disease, Obesity, 

3 and Other Disease Issues 

4 SEC. 7301. GUIDELINES FOR DISEASE SCREENING FOR MI5 NORITY PATIENTS. 

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

7 Human Services (in this section referred to as the ‘‘Sec8 retary’’), acting through the Director of the Agency for 

9 Healthcare Research and Quality, shall convene a series 

10 of meetings to develop guidelines for disease screening for 

11 minority patient populations that have a higher than aver12 age risk for many chronic diseases and cancers. 

13 (b) PARTICIPANTS.—In convening meetings under 

14 subsection (a), the Secretary shall ensure that meeting 

15 participants include representatives of— 

16 (1) professional societies and associations; 

17 (2) minority health organizations; 

18 (3) health care researchers and providers, in19 cluding those with expertise in minority health; 

20 (4) Federal health agencies, including the Of21 fice of Minority Health, the National Institute on 

22 Minority Health and Health Disparities, and the 

23 National Institutes of Health; and 

24 (5) other experts as the Secretary determines 

25 appropriate. 


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1 (c) DISEASES.—Screening guidelines for minority 

2 populations shall be developed as appropriate under sub3 section (a) for— 

4 (1) hypertension; 

5 (2) hypercholesterolemia; 

6 (3) diabetes; 

7 (4) cardiovascular disease; 

8 (5) cancers, including breast, prostate, colon, 

9 cervical, and lung cancer; 

10 (6) other pulmonary problems including sleep 

11 apnea; 

12 (7) asthma; 

13 (8) kidney diseases; 

14 (9) eye diseases and disorders, including glau15 coma; 

16 (10) HIV/AIDS and sexually transmitted infec17 tions; 

18 (11) uterine fibroids; 

19 (12) autoimmune diseases, including lupus; 

20 (13) mental health conditions; 

21 (14) dental health conditions and oral diseases, 

22 including oral cancer; 

23 (15) environmental and related health illnesses 

24 and conditions; 

25 (16) sickle cell disease and sickle cell trait; 


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1 (17) violence and injury prevention and control; 

2 (18) genetic and related conditions; 

3 (19) heart disease and stroke; 

4 (20) tuberculosis; 

5 (21) chronic obstructive pulmonary disease; 

6 (22) musculoskeletal diseases, arthritis, and 

7 obesity; and 

8 (23) other diseases determined appropriate by 

9 the Secretary. 

10 (d) DISSEMINATION.—Not later than 2 years after 

11 the date of enactment of this Act, the Secretary shall pub12 lish and disseminate to health care provider organizations 

13 the guidelines developed under subsection (a). 

14 (e) AUTHORIZATION OF APPROPRIATIONS.—There 

15 are authorized to be appropriated to carry out this section 

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

17 2025 through 2029. 

18 SEC. 7302. CDC WISEWOMAN SCREENING PROGRAM. 

19 Section 1509 of the Public Health Service Act (42 

20 U.S.C. 300n–4a) is amended— 

21 (1) in subsection (a)— 

22 (A) by striking the heading and inserting 

23 ‘‘IN GENERAL.—’’; and 

24 (B) in the matter preceding paragraph (1), 

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1 lows through ‘‘purpose’’ and inserting the fol2 lowing: ‘‘may make grants to such States for 

3 the purpose’’; and 

4 (2) in subsection (d)(1), by striking ‘‘there are 

5 authorized’’ and all that follows through the period 

6 and inserting ‘‘there are authorized to be appro7 priated $23,000,000 for fiscal year 2025, 

8 $25,300,000 for fiscal year 2026, $27,800,000 for 

9 fiscal year 2027, $30,800,000 for fiscal year 2028, 

10 and $34,000,000 for fiscal year 2029.’’. 

11 SEC. 7303. REPORT ON CARDIOVASCULAR CARE FOR 

12 WOMEN AND MINORITIES. 

13 Part P of title III of the Public Health Service Act 

14 (42 U.S.C. 280g et seq.), as amended by section 

15 5201(c)(3), is amended by adding at the end the following: 

16 ‘‘SEC. 399V–10. REPORT ON CARDIOVASCULAR CARE FOR 

17 WOMEN AND MINORITIES. 

18 ‘‘Not later than September 30, 2024, and annually 

19 thereafter, the Secretary shall prepare and submit to Con20 gress a report on the quality of and access to care for 

21 women and minorities with heart disease, stroke, and 

22 other cardiovascular diseases. The report shall contain rec23 ommendations for eliminating disparities in, and improv24 ing the treatment of, heart disease, stroke, and other car25 diovascular diseases in women, racial and ethnic minoriVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 01193 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 ties, those for whom English is not their primary lan2 guage, and individuals with disabilities.’’. 

3 SEC. 7304. GAO REPORT ON STRUCTURAL AND SYSTEMIC 

4 FACTORS THAT PERPETUATE CARDIO5 VASCULAR DISPARITIES. 

6 (a) IN GENERAL.—Not later than September 30, 

7 2025, the Government Accountability Office shall prepare 

8 and submit a report to Congress that contains the results 

9 of an investigation of— 

10 (1) the structural and systemic factors that per11 petuate disparities in access to screenings, care, and 

12 treatment of cardiovascular disease; and 

13 (2) how care navigation, including community14 based health workers, can improve cardiovascular 

15 disease management and improve health outcomes. 

16 (b) CONTENTS.—The report shall— 

17 (1) identify the challenges and barriers facing 

18 healthcare providers and patients, which contribute 

19 to postponed, delayed, or suboptimal treatments for 

20 cardiovascular disease; 

21 (2) examine efforts by Federal agencies and 

22 Federal programs to improve screening and manage23 ment of patients with cardiovascular disease; 

24 (3) identify and examine existing quality meas25 ures from the Centers for Medicare & Medicaid 


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1 Services related to cholesterol management and 

2 whether these measures encourage providers and 

3 health systems to— 

4 (A) perform appropriate and timely low5 density-lipoprotein cholesterol (LDL-C) testing 

6 on patients at risk of a cardiovascular event; 

7 and 

8 (B) better manage patients’ elevated LDL9 C levels in concordance with clinical guidelines 

10 prescribing directives to ensure patients are 

11 progressing towards guideline-recommended 

12 LDL-C levels; 

13 (4) identify actions the Federal government 

14 could take to promote collaboration with community15 based organizations to ensure improvement in clin16 ical outcomes for patients with cardiovascular dis17 ease, including by building on recommendations 

18 from the Institutes of Medicine and the Centers for 

19 Disease Control to include community health work20 ers to improve health care delivery for underserved 

21 and high-risk communities; and 

22 (5) assess whether racial and ethnic minority 

23 groups, as defined in section 1707(g) of the Public 

24 Health Service Act (42 U.S.C. 300g–6(g)), have 

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1 tion drugs to treat or prevent cardiovascular disease 

2 by health insurance providers and, if so, identify the 

3 resulting impacts on cardiovascular disease medica4 tion adherence, morbidity, and mortality, as well as 

5 resulting postponed, delayed, or suboptimal treat6 ment prescribing for cardiovascular disease among 

7 racial and ethnic minorities. 

8 SEC. 7305. COVERAGE OF COMPREHENSIVE TOBACCO CES9 SATION SERVICES IN MEDICAID, CHIP, AND 

10 PRIVATE HEALTH INSURANCE. 

11 (a) REQUIRING MEDICAID COVERAGE OF COUN12 SELING AND PHARMACOTHERAPY FOR CESSATION OF TO13 BACCO USE AND TEMPORARY ENHANCED FMAP FOR

14 COVERAGE OF TOBACCO CESSATION SERVICES.—Section 

15 1905 of the Social Security Act (42 U.S.C. 1396d) is 

16 amended— 

17 (1) in subsection (a)(4), by striking ‘‘and (D)’’ 

18 and all that follows through ‘‘subsection (bb))’’ and 

19 inserting the following: ‘‘(D) counseling and 

20 pharmacotherapy for cessation of tobacco use by in21 dividuals who are eligible under the State plan (as 

22 defined in subsection (bb))’’; 

23 (2) in subsection (b), by inserting ‘‘(bb)(2),’’ 

24 after ‘‘(aa),’’; and 


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1 (3) by striking subsection (bb) and inserting 

2 the following: 

3 ‘‘(bb) COUNSELING AND PHARMACOTHERAPY FOR

4 CESSATION OF TOBACCO USE.— 

5 ‘‘(1) IN GENERAL.—For purposes of this title, 

6 the term ‘counseling and pharmacotherapy for ces7 sation of tobacco use by individuals who are eligible 

8 under the State plan’ means diagnostic, therapy, 

9 and counseling services and pharmacotherapy (in10 cluding the coverage of prescription and nonprescrip11 tion tobacco cessation agents approved by the Food 

12 and Drug Administration) for the cessation of to13 bacco use by individuals who use tobacco products or 

14 who are being treated for tobacco use that is fur15 nished— 

16 ‘‘(A) by or under the supervision of a phy17 sician; or 

18 ‘‘(B) by any other health care professional 

19 who— 

20 ‘‘(i) is legally authorized to furnish 

21 such services under State law (or the State 

22 regulatory mechanism provided by State 

23 law) of the State in which the services are 

24 furnished; and 


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1 ‘‘(ii) is authorized to receive payment 

2 for other services under this title or is des3 ignated by the Secretary for this purpose, 

4 which is recommended in the guideline entitled, 

5 ‘Treating Tobacco Use and Dependence: 2008 

6 Update: A Clinical Practice Guideline’ pub7 lished by the Public Health Service in May 

8 2008 (or any subsequent modification of such 

9 guideline) or is recommended for the cessation 

10 of tobacco use by the United States Preventive 

11 Services Task Force or any additional interven12 tion approved by the Food and Drug Adminis13 tration as safe and effective in helping smokers 

14 quit. 

15 ‘‘(2) TEMPORARY ENHANCED FMAP FOR COV16 ERAGE OF TOBACCO CESSATION SERVICES.—Not17 withstanding subsection (b), for calendar quarters 

18 occurring during the period beginning on the date of 

19 the enactment of this paragraph and ending 5 years 

20 after the date of enactment of this paragraph, the 

21 Federal medical assistance percentage with respect 

22 to amounts expended by a State for medical assist23 ance for counseling and pharmacotherapy for ces24 sation of tobacco use by individuals who are eligible 


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1 under the State plan (as defined in paragraph (1)) 

2 shall be equal to 90 percent.’’. 

3 (b) NO COST SHARING.— 

4 (1) IN GENERAL.—Subsections (a)(2) and 

5 (b)(2) of section 1916 of the Social Security Act (42 

6 U.S.C. 1396o), as amended by section 2007(d)(4), 

7 are each amended— 

8 (A) in subparagraph (B), by striking ‘‘, 

9 and counseling’’ and all that follows through 

10 ‘‘section 1905(bb)(2)(A)’’; 

11 (B) in subparagraph (J), by striking ‘‘or’’ 

12 after the comma; 

13 (C) in subparagraph (K), by striking ‘‘; 

14 and’’ and inserting ‘‘, or’’; and 

15 (D) by adding at the end the following new 

16 subparagraph: 

17 ‘‘(L) counseling and pharmacotherapy for 

18 cessation of tobacco use by individuals who are 

19 eligible under the State plan (as defined in sec20 tion 1905(bb)) and covered outpatient drugs (as 

21 defined in subsection (k)(2) of section 1927 and 

22 including nonprescription drugs described in 

23 subsection (d)(2) of such section) that are pre24 scribed for purposes of promoting tobacco cesVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 01199 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 sation in accordance with the guideline specified 

2 in section 1905(bb); and’’. 

3 (2) APPLICATION TO ALTERNATIVE COST SHAR4 ING.—Section 1916A(b)(3)(B) of the Social Security 

5 Act (42 U.S.C. 1396o–1(b)(3)(B)) is amended— 

6 (A) in clause (iii), by striking ‘‘, and coun7 seling and pharmacotherapy for cessation of to8 bacco use by pregnant women (as defined in 

9 section 1905(bb))’’; and 

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

11 clause: 

12 ‘‘(xv) Counseling and 

13 pharmacotherapy for cessation of tobacco 

14 use by individuals who are eligible under 

15 the State plan (as defined in section 

16 1905(bb)) and covered outpatient drugs 

17 (as defined in subsection (k)(2) of section 

18 1927 and including nonprescription drugs 

19 described in subsection (d)(2) of such sec20 tion) that are prescribed for purposes of 

21 promoting tobacco cessation in accordance 

22 with the guideline specified in section 

23 1905(bb).’’. 

24 (c) EXCEPTION FROM OPTIONAL RESTRICTION

25 UNDER MEDICAID PRESCRIPTION DRUG COVERAGE.— 


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1 Section 1927(d)(2)(F) of the Social Security Act (42 

2 U.S.C. 1396r–8(d)(2)(F)) is amended to read as follows: 

3 ‘‘(F) Nonprescription drugs, except, when 

4 recommended in accordance with the guideline 

5 referred to in section 1905(bb), agents ap6 proved by the Food and Drug Administration 

7 under the over-the-counter monograph process 

8 for purposes of promoting tobacco cessation.’’. 

9 (d) 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 5201(c)(2)(B), is amended— 

14 (1) in paragraph (87), by striking ‘‘and’’ at the 

15 end; 

16 (2) in paragraph (88), by striking the period at 

17 the end and inserting ‘‘; and’’; and 

18 (3) by inserting after paragraph (88) the fol19 lowing new paragraph: 

20 ‘‘(89) provide that the State will monitor and 

21 promote the use of comprehensive tobacco cessation 

22 services under the State plan (including conducting 

23 an outreach campaign to increase awareness of the 

24 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 (e) FEDERAL REIMBURSEMENT FOR OUTREACH

8 CAMPAIGN.—Section 1903(a) of the Social Security Act 

9 (42 U.S.C. 1396b(a)) is amended— 

10 (1) in paragraph (6)(B), by striking ‘‘plus’’ at 

11 the end; 

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

13 the end and inserting ‘‘; plus’’; and 

14 (3) by inserting after paragraph (7) the fol15 lowing new paragraph: 

16 ‘‘(8) with respect to the development, imple17 mentation, and evaluation of an outreach campaign 

18 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 for calendar quarters occurring during the pe17 riod beginning on the date of the enactment of 

18 this paragraph and ending on the date that is 

19 5 years after the date of enactment of this 

20 paragraph, an amount equal to 90 percent of 

21 the sums expended during each quarter which 

22 are attributable to such development, implemen23 tation, and evaluation, and for calendar quar24 ters succeeding such period, an amount equal to 

25 Federal medical assistance percentage deterVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 01203 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 mined under section 1905(b) of the sums ex2 pended during each quarter which are so attrib3 utable.’’. 

4 (f) NO PRIOR AUTHORIZATION FOR TOBACCO CES5 SATION DRUGS UNDER MEDICAID.—Section 1927(d) of 

6 the Social Security Act (42 U.S.C. 1396r–8(d)) is amend7 ed— 

8 (1) in paragraph (1)(A), by striking ‘‘A State’’ 

9 and inserting ‘‘Subject to paragraph (8), a State’’; 

10 and 

11 (2) by adding at the end the following new 

12 paragraph: 

13 ‘‘(8) NO PRIOR AUTHORIZATION PROGRAMS FOR

14 TOBACCO CESSATION DRUGS.—A State plan may not 

15 require, as a condition of coverage or payment for 

16 a covered outpatient drug, the approval of an agent 

17 to promote smoking cessation (including agents ap18 proved by the Food and Drug Administration) or to19 bacco cessation.’’. 

20 (g) EXCLUSION OF ENHANCED PAYMENTS FROM

21 TERRITORIAL CAPS.—Notwithstanding any other provi22 sion of law, for purposes of section 1108 of the Social Se23 curity Act (42 U.S.C. 1308), with respect to any addi24 tional amount paid to a territory as a result of the applicaVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 01204 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 tion of section 1905(bb)(2) of the Social Security Act (42 

2 U.S.C. 1396d(bb)(2))— 

3 (1) the limitation on payments to territories 

4 under subsections (f) and (g) of such section 1108 

5 shall not apply to such additional amounts; and 

6 (2) such additional amounts shall be dis7 regarded in applying such subsections. 

8 (h) REQUIRING CHIP COVERAGE OF COUNSELING

9 AND PHARMACOTHERAPY FOR CESSATION OF TOBACCO

10 USE.— 

11 (1) IN GENERAL.—Section 2103(c)(2) of the 

12 Social Security Act (42 U.S.C. 1397cc(c)(2)) is 

13 amended by adding at the end the following new 

14 subparagraph: 

15 ‘‘(D) Counseling and pharmacotherapy for 

16 cessation of tobacco use by individuals who are 

17 eligible under the State child health plan.’’. 

18 (2) COUNSELING AND PHARMACOTHERAPY FOR

19 CESSATION OF TOBACCO USE DEFINED.—Section 

20 2110(c) of the Social Security Act (42 U.S.C. 

21 1397jj(c)) is amended by adding at the end the fol22 lowing new paragraph: 

23 ‘‘(10) COUNSELING AND PHARMACOTHERAPY

24 FOR CESSATION OF TOBACCO USE.—The term ‘coun25 seling and pharmacotherapy for cessation of tobacco 


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1 use’ means diagnostic, therapy, and counseling serv2 ices and pharmacotherapy (including the coverage of 

3 prescription and nonprescription tobacco cessation 

4 agents approved by the Food and Drug Administra5 tion) for the cessation of tobacco use by individuals 

6 who use tobacco products or who are being treated 

7 for tobacco use that are furnished— 

8 ‘‘(A) by or under the supervision of a phy9 sician; or 

10 ‘‘(B) by any other health care professional 

11 who— 

12 ‘‘(i) is legally authorized to furnish 

13 such services under State law (or the State 

14 regulatory mechanism provided by State 

15 law) of the State in which the services are 

16 furnished; and 

17 ‘‘(ii) is authorized to receive payment 

18 for other services under this title or is des19 ignated by the Secretary for this purpose, 

20 which is recommended in the guideline entitled, 

21 ‘Treating Tobacco Use and Dependence: 2008 

22 Update: A Clinical Practice Guideline’ pub23 lished by the Public Health Service in May 

24 2008 (or any subsequent modification of such 

25 guideline) or is recommended for the cessation 


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1 of tobacco use by the United States Preventive 

2 Services Task Force or any additional interven3 tion approved by the Food and Drug Adminis4 tration as safe and effective in helping smokers 

5 quit.’’. 

6 (i) NO COST SHARING.—Section 2103(e) of the So7 cial Security Act (42 U.S.C. 1397cc(e)) is amended by 

8 adding at the end the following new paragraph: 

9 ‘‘(5) NO COST SHARING ON BENEFITS FOR

10 COUNSELING AND PHARMACOTHERAPY FOR CES11 SATION OF TOBACCO USE.—The State child health 

12 plan may not impose deductibles, coinsurance, or 

13 other cost sharing with respect to benefits for coun14 seling and pharmacotherapy for cessation of tobacco 

15 use (as defined in section 2110(c)(10)) and prescrip16 tion drugs that are covered under a State child 

17 health plan that are prescribed for purposes of pro18 moting tobacco cessation in accordance with the 

19 guideline specified in section 2110(c)(10)(B).’’. 

20 (j) EXCEPTION FROM OPTIONAL RESTRICTION

21 UNDER CHIP PRESCRIPTION DRUG COVERAGE.—Section 

22 2103 of the Social Security Act (42 U.S.C. 1397cc) is 

23 amended by adding at the end the following new sub24 section: 


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1 ‘‘(g) EXCEPTION FROM OPTIONAL RESTRICTION

2 UNDER CHIP PRESCRIPTION DRUG COVERAGE.—The 

3 State child health plan may exclude or otherwise restrict 

4 nonprescription drugs, except, in the case of— 

5 ‘‘(1) pregnant women when recommended in ac6 cordance with the guideline specified in section 

7 2110(c)(10)(B), agents approved by the Food and 

8 Drug Administration under the over-the-counter 

9 monograph process for purposes of promoting to10 bacco cessation; and 

11 ‘‘(2) individuals who are eligible under the 

12 State child health plan when recommended in ac13 cordance with the Guideline referred to in section 

14 2110(c)(10)(B), agents approved by the Food and 

15 Drug Administration under the over-the-counter 

16 monograph process for purposes of promoting to17 bacco cessation.’’. 

18 (k) STATE MONITORING AND PROMOTING OF COM19 PREHENSIVE TOBACCO CESSATION SERVICES UNDER

20 CHIP.—Section 2102 of the Social Security Act (42 

21 U.S.C. 1397bb) is amended by adding at the end the fol22 lowing new subsection: 

23 ‘‘(d) STATE MONITORING AND PROMOTING OF COM24 PREHENSIVE TOBACCO CESSATION SERVICES UNDER

25 CHIP.—A State child health plan shall include a descripVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 01208 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 tion of the procedures to be used by the State to monitor 

2 and promote the use of comprehensive tobacco cessation 

3 services under the State plan (including conducting an 

4 outreach campaign to increase awareness of the benefits 

5 of using such services) among— 

6 ‘‘(1) individuals entitled to medical assistance 

7 under the State child health plan who use tobacco 

8 products; and 

9 ‘‘(2) clinicians and others who provide services 

10 to individuals entitled to medical assistance under 

11 the State child health plan.’’. 

12 (l) FEDERAL REIMBURSEMENT FOR CHIP COV13 ERAGE AND OUTREACH CAMPAIGN.— 

14 (1) IN GENERAL.—Section 2105(a) of the So15 cial Security Act (42 U.S.C. 1397ee(a)) is amended 

16 by adding at the end the following new paragraph: 

17 ‘‘(5) FEDERAL REIMBURSEMENT FOR CHIP

18 COVERAGE OF COMPREHENSIVE TOBACCO CES19 SATION SERVICES AND OUTREACH CAMPAIGN.—In 

20 addition to the payments made under paragraph (1) 

21 for calendar quarters occurring during the period be22 ginning on the date of the enactment of this para23 graph and ending 5 years after such date, the Sec24 retary shall pay— 


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1 ‘‘(A) an amount equal to 90 percent of the 

2 sums expended during each quarter which are 

3 attributable to the cost of furnishing counseling 

4 and pharmacotherapy for cessation of tobacco 

5 use by individuals who are eligible under the 

6 State child health plan (net of any payments 

7 made to the State under paragraph (1) with re8 spect to such counseling and pharmacotherapy); 

9 plus 

10 ‘‘(B) an amount equal to 90 percent of the 

11 sums expended during each quarter which are 

12 attributable to the development, implementa13 tion, and evaluation of an outreach campaign 

14 to— 

15 ‘‘(i) increase awareness of comprehen16 sive tobacco cessation services covered in 

17 the State child health plan among— 

18 ‘‘(I) individuals who are likely to 

19 be eligible for medical assistance 

20 under the State child health plan; and 

21 ‘‘(II) clinicians and others who 

22 provide services to individuals who are 

23 likely to be eligible for medical assist24 ance under the State child health 

25 plan; and 


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1 ‘‘(ii) increase awareness of the bene2 fits of using comprehensive tobacco ces3 sation services covered in the State child 

4 health plan among— 

5 ‘‘(I) individuals who are likely to 

6 be eligible for medical assistance 

7 under the State child health plan; and 

8 ‘‘(II) clinicians and others who 

9 provide services to individuals who are 

10 likely to be eligible for medical assist11 ance under the State child health plan 

12 about the benefits of using com13 prehensive tobacco cessation serv14 ices.’’. 

15 (2) ADJUSTMENT OF CHIP ALLOTMENTS.—Sec16 tion 2104(m) of the Social Security Act (42 U.S.C. 

17 1397dd(m)) is amended— 

18 (A) in paragraph (2)(B), by striking ‘‘and 

19 (12)’’ and inserting ‘‘(12), and (13)’’; and 

20 (B) by adding at the end the following new 

21 paragraph: 

22 ‘‘(13) ADJUSTING ALLOTMENTS TO ACCOUNT

23 FOR FEDERAL PAYMENTS FOR CHIP COVERAGE OF

24 COMPREHENSIVE TOBACCO CESSATION SERVICES

25 AND OUTREACH CAMPAIGN.—If a State (including 


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1 the District of Columbia and each commonwealth 

2 and territory) receives a payment for a fiscal year 

3 under section 2105(a)(5), the allotment determined 

4 for the State for such fiscal year shall be increased 

5 by the amount of such payment.’’. 

6 (m) NO PRIOR AUTHORIZATION FOR TOBACCO CES7 SATION DRUGS UNDER CHIP.—Section 2103 of the So8 cial Security Act (42 U.S.C. 1397cc), as amended by sub9 section (h), is further amended— 

10 (1) in subsection (c)(2)(A), by inserting ‘‘(in ac11 cordance with subsection (h))’’ after ‘‘Coverage of 

12 prescription drugs’’; and 

13 (2) by adding at the end the following new sub14 section: 

15 ‘‘(h) NO PRIOR AUTHORIZATION PROGRAMS FOR TO16 BACCO CESSATION DRUGS.—A State child health plan 

17 may not require, as a condition of coverage or payment 

18 for prescription drugs, the approval of an agent to pro19 mote smoking cessation (including agents approved by the 

20 Food and Drug Administration) or tobacco cessation.’’. 

21 (n) COMPREHENSIVE COVERAGE OF TOBACCO CES22 SATION COVERAGE IN PRIVATE HEALTH INSURANCE.— 

23 Section 2713 of the Public Health Service Act (42 U.S.C. 

24 300gg–13) is amended by adding at the end the following: 


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1 ‘‘(d) NO PRIOR AUTHORIZATION.—A group health 

2 plan and a health insurance issuer offering group or indi3 vidual health insurance coverage shall not impose any 

4 prior authorization requirement for tobacco cessation 

5 counseling and pharmacotherapy that has in effect a rat6 ing of ‘A’ or ‘B’ in the current recommendations of the 

7 United States Preventive Services Task Force.’’. 

8 (o) RULE OF CONSTRUCTION.—None of the amend9 ments made by this section shall be construed to limit cov10 erage of any counseling or pharmacotherapy for individ11 uals under 18 years of age. 

12 (p) EFFECTIVE DATE.—The amendments made by 

13 this section shall take effect on the first day of the first 

14 fiscal year that begins on or after the date of enactment 

15 of this Act. 

16 SEC. 7306. CLINICAL RESEARCH FUNDING FOR ORAL 

17 HEALTH. 

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

19 Human Services shall expand and intensify the conduct 

20 and support of the research activities of the National In21 stitutes of Health and the National Institute of Dental 

22 and Craniofacial Research to improve the oral health of 

23 the population through the prevention and management 

24 of oral diseases and conditions. 


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1 (b) INCLUDED RESEARCH ACTIVITIES.—Research 

2 activities under subsection (a) shall include— 

3 (1) comparative effectiveness research and clin4 ical disease management research addressing early 

5 childhood cancer and oral cancer; and 

6 (2) awarding of grants and contracts to support 

7 the training and development of health services re8 searchers, comparative effectiveness researchers, and 

9 clinical researchers whose research improves the oral 

10 health of the population. 

11 SEC. 7307. GUIDE ON EVIDENCE-BASED STRATEGIES FOR 

12 PUBLIC HEALTH DEPARTMENT OBESITY PRE13 VENTION PROGRAMS. 

14 (a) DEVELOPMENT AND DISSEMINATION OF AN EVI15 DENCE-BASED STRATEGIES GUIDE.—The Secretary of 

16 Health and Human Services (referred to in this section 

17 as the ‘‘Secretary’’), acting through the Director of the 

18 Centers for Disease Control and Prevention, not later than 

19 2 years after the date of enactment of this Act, shall— 

20 (1) develop a guide on evidence-based strategies 

21 for State, territorial, and local health departments to 

22 use to build and maintain effective obesity preven23 tion and reduction programs, and, in consultation 

24 with stakeholders that have expertise in Tribal 

25 health, a guide on such evidence-based strategies 


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1 with respect to Indian Tribes and Tribal organiza2 tions for such Indian Tribes and Tribal organiza3 tions to use for such purpose, both of which guides 

4 shall— 

5 (A) describe an integrated program struc6 ture for implementing interventions proven to 

7 be effective in preventing and reducing the inci8 dence of obesity; and 

9 (B) recommend— 

10 (i) optimal resources, including staff11 ing and infrastructure, for promoting nu12 trition and obesity prevention and reduc13 tion; and 

14 (ii) strategies for effective obesity pre15 vention programs for State and local 

16 health departments, Indian Tribes, and 

17 Tribal organizations, including strategies 

18 related to— 

19 (I) the application of evidence20 based and evidence-informed practices 

21 to prevent and reduce obesity rates; 

22 (II) the development, implemen23 tation, and evaluation of obesity pre24 vention and reduction strategies for 

25 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 in section 4 

10 of the Indian Self-Determination and Education Assist11 ance Act (25 U.S.C. 5304). 

12 SEC. 7308. STEPHANIE TUBBS JONES UTERINE FIBROID RE13 SEARCH AND EDUCATION ACT. 

14 (a) RESEARCH WITH RESPECT TO UTERINE

15 FIBROIDS.— 

16 (1) RESEARCH.—The Secretary of Health and 

17 Human Services (referred to in this section as the 

18 ‘‘Secretary’’) shall expand, intensify, and coordinate 

19 programs for the conduct and support of research 

20 with respect to uterine fibroids. 

21 (2) ADMINISTRATION AND COORDINATION.— 

22 The Secretary shall carry out the conduct and sup23 port of research pursuant to paragraph (1), in co24 ordination with the appropriate institutes, offices, 

25 and centers of the National Institutes of Health and 


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1 any other relevant Federal agency, as determined by 

2 the Director of the National Institutes of Health. 

3 (3) AUTHORIZATION OF APPROPRIATIONS.—For 

4 the purpose of carrying out this subsection, there 

5 are authorized to be appropriated $30,000,000 for 

6 each of fiscal years 2025 through 2029. 

7 (b) RESEARCH WITH RESPECT TO MEDICAID COV8 ERAGE OF UTERINE FIBROIDS TREATMENT.— 

9 (1) RESEARCH.—The Secretary (or the Sec10 retary’s designee) shall establish a research data11 base, or expand an existing research database, to 

12 collect data on services furnished to individuals diag13 nosed with uterine fibroids under a State plan (or a 

14 waiver of such a plan) under the Medicaid program 

15 under title XIX of the Social Security Act (42 

16 U.S.C. 1396 et seq.) or under a State child health 

17 plan (or a waiver of such a plan) under the Chil18 dren’s Health Insurance Program under title XXI of 

19 such Act (42 U.S.C. 1397aa et seq.) for the treat20 ment of such fibroids for purposes of assessing the 

21 frequency at which such individuals are furnished 

22 such services. 

23 (2) REPORT.— 

24 (A) IN GENERAL.—Not later than 2 years 

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1 retary shall submit to Congress a report on the 

2 amount of Federal and State expenditures with 

3 respect to services furnished for the treatment 

4 of uterine fibroids under State plans (or waivers 

5 of such plans) under the Medicaid program 

6 under such title XIX and State child health 

7 plans (or waivers of such plans) under the Chil8 dren’s Health Insurance Program under such 

9 title XXI. 

10 (B) COORDINATION.—The Secretary shall 

11 coordinate the development and submission of 

12 the report required under paragraph (1) with 

13 any other relevant Federal agency, as deter14 mined by the Secretary. 

15 (c) EDUCATION AND DISSEMINATION OF INFORMA16 TION WITH RESPECT TO UTERINE FIBROIDS.— 

17 (1) UTERINE FIBROIDS PUBLIC EDUCATION

18 PROGRAM.—The Secretary shall develop and dis19 seminate to the public information regarding uterine 

20 fibroids, including information on— 

21 (A) the awareness, incidence, and preva22 lence of uterine fibroids among individuals, in23 cluding all minority individuals; 

24 (B) the elevated risk for minority individ25 uals to develop uterine fibroids; and 


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1 (C) the availability, as medically appro2 priate, of the range of treatment options for 

3 symptomatic uterine fibroids, including non4 hysterectomy treatments and procedures. 

5 (2) DISSEMINATION OF INFORMATION.—The 

6 Secretary may disseminate information under para7 graph (1) directly or through arrangements with 

8 intra-agency initiatives, nonprofit organizations, con9 sumer groups, institutions of higher education (as 

10 defined in section 101 of the Higher Education Act 

11 of 1965 (20 U.S.C. 1001)), or Federal, State, or 

12 local public private partnerships. 

13 (3) AUTHORIZATION OF APPROPRIATIONS.—For 

14 the purpose of carrying out this subsection, there 

15 are authorized to be appropriated such sums as may 

16 be necessary for each of fiscal years 2025 through 

17 2029. 

18 (d) INFORMATION TO HEALTH CARE PROVIDERS

19 WITH RESPECT TO UTERINE FIBROIDS.— 

20 (1) DISSEMINATION OF INFORMATION.—The 

21 Secretary shall, in consultation and in accordance 

22 with guidelines from relevant medical societies, work 

23 with health care-related specialty societies and 

24 health systems to promote evidence-based care for 

25 individuals with fibroids. Such efforts shall include 


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1 minority individuals who have an elevated risk to de2 velop uterine fibroids and the range of available op3 tions for the treatment of symptomatic uterine 

4 fibroids, including non-hysterectomy drugs and de5 vices approved under the Federal Food, Drug, and 

6 Cosmetic Act (21 U.S.C. 301 et seq.). 

7 (2) AUTHORIZATION OF APPROPRIATIONS.—For 

8 the purpose of carrying out this subsection, there 

9 are authorized to be appropriated such sums as may 

10 be necessary for each of fiscal years 2025 through 

11 2029. 

12 (e) DEFINITION.—In this section, the term ‘‘minority 

13 individuals’’ means individuals who are members of a ra14 cial and ethnic minority group, as defined in section 

15 1707(g) of the Public Health Service Act (42 U.S.C. 

16 300u–6(g)). 

17 Subtitle E—HIV/AIDS 

18 SEC. 7401. STATEMENT OF POLICY. 

19 It is the policy of the United States to achieve an 

20 AIDS-free generation, and to— 

21 (1) expand access to lifesaving antiretroviral 

22 therapy for people living with HIV and immediately 

23 link people to continuous and coordinated high-qual24 ity care when they learn they are living with HIV; 


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1 (2) expand targeted efforts to prevent HIV in2 fection using a combination of effective, evidence3 based approaches, including routine HIV screening, 

4 and universal access to HIV prevention tools, includ5 ing preexposure prophylaxis, in communities dis6 proportionately impacted by HIV, particularly com7 munities of color; 

8 (3) ensure laws, policies, and regulations do not 

9 impede access to prevention, treatment, and care for 

10 people living with HIV or disproportionately im11 pacted by HIV; 

12 (4) accelerate research for more efficacious HIV 

13 prevention and treatments, tools, a cure, and a vac14 cine; and 

15 (5) respect the human rights and dignity of 

16 persons living with HIV. 

17 SEC. 7402. ADDITIONAL FUNDING FOR AIDS DRUG ASSIST18 ANCE PROGRAM TREATMENTS. 

19 Section 2623 of the Public Health Service Act (42 

20 U.S.C. 300ff–31b) is amended by adding at the end the 

21 following: 

22 ‘‘(c) ADDITIONAL FUNDING FOR AIDS DRUG AS23 SISTANCE PROGRAM TREATMENTS.—In addition to 

24 amounts otherwise authorized to be appropriated for car25 rying out this subpart, there are authorized to be approVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 01222 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 priated such sums as may be necessary to carry out sec2 tions 2612(b)(3)(B) and 2616 for each of fiscal years 

3 2025 through 2028.’’. 

4 SEC. 7403. ENHANCING THE NATIONAL HIV SURVEILLANCE 

5 SYSTEM. 

6 (a) GRANTS.—The Secretary of Health and Human 

7 Services, acting through the Director of the Centers for 

8 Disease Control and Prevention, shall make grants to 

9 States to support integration of public health surveillance 

10 systems into all electronic health records in order to allow 

11 rapid communications between the clinical setting and 

12 health departments, by means that include— 

13 (1) providing technical assistance and policy 

14 guidance to State and local health departments, clin15 ical providers, and other agencies serving individuals 

16 with HIV to improve the interoperability of data sys17 tems relevant to monitoring HIV care and sup18 portive services; 

19 (2) capturing longitudinal data pertaining to 

20 the initiation and ongoing prescription or dispensing 

21 of antiretroviral therapy for individuals diagnosed 

22 with HIV (such as through pharmacy-based report23 ing); 

24 (3) obtaining information— 


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1 (A) on a voluntary basis, on sexual orienta2 tion and gender identity; and 

3 (B) on sources of coverage (or the lack of 

4 coverage) for medical treatment (including cov5 erage through the Medicaid program under title 

6 XIX of the Social Security Act (42 U.S.C. 1396 

7 et seq.), the Medicare program under title 

8 XVIII of such Act (42 U.S.C. 1395 et seq.), the 

9 program under title XXVI of the Public Health 

10 Service Act (42 U.S.C. 300ff–11 et seq.; com11 monly referred to as the ‘‘Ryan White HIV/ 

12 AIDS Program’’), other public funding, private 

13 insurance, and health maintenance organiza14 tions); and 

15 (4) obtaining and using current geographic 

16 markers of residence (such as current address, ZIP 

17 Code, partial ZIP Code, and census block). 

18 (b) PRIVACY AND SECURITY SAFEGUARDS.—In car19 rying out this section, the Secretary of Health and Human 

20 Services shall ensure that appropriate privacy and security 

21 safeguards are met to prevent unauthorized disclosure of 

22 protected health information and compliance with the 

23 HIPAA privacy and security law (as defined in section 

24 3009 of the Public Health Service Act (42 U.S.C. 300jj– 

25 19)) and other relevant laws and regulations. 


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1 (c) PROHIBITION AGAINST IMPROPER USE OF

2 DATA.—No grant under this section may be used to allow 

3 or facilitate the collection or use of surveillance or clinical 

4 data or records— 

5 (1) for punitive measures of any kind, civil or 

6 criminal, against the subject of such data or records; 

7 or 

8 (2) for imposing any requirement or restriction 

9 with respect to an individual without the individual’s 

10 written consent. 

11 (d) AUTHORIZATION OF APPROPRIATIONS.—To carry 

12 out this section, there are authorized to be appropriated 

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

14 2025 through 2028. 

15 SEC. 7404. EVIDENCE-BASED STRATEGIES FOR IMPROVING 

16 LINKAGE TO, AND RETENTION IN, APPRO17 PRIATE CARE. 

18 (a) STRATEGIES.—The Secretary of Health and 

19 Human Services, in collaboration with the Director of the 

20 Centers for Disease Control and Prevention, the Assistant 

21 Secretary for Mental Health and Substance Use, the Di22 rector of the Office of AIDS Research, the Administrator 

23 of the Health Resources and Services Administration, and 

24 the Administrator of the Centers for Medicare & Medicaid 

25 Services, shall— 


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1 (1) identify evidence-based strategies most ef2 fective at addressing the multifaceted issues that im3 pede disease status awareness with respect to HIV/ 

4 AIDS and linkage to, and retention in, appropriate 

5 care, taking into consideration health care systems 

6 issues, clinic and provider issues, and individual psy7 chosocial, environmental, and other contextual fac8 tors; 

9 (2) support the wide-scale implementation of 

10 the evidence-based strategies identified pursuant to 

11 paragraph (1), including through incorporating such 

12 strategies into health care coverage supported by the 

13 Medicaid program under title XIX of the Social Se14 curity Act (42 U.S.C. 1396 et seq.), the program 

15 under title XXVI of the Public Health Service Act 

16 (42 U.S.C. 300ff–11 et seq.; commonly referred to 

17 as the ‘‘Ryan White HIV/AIDS Program’’), and 

18 health plans purchased through an Exchange estab19 lished under title I of the Patient Protection and Af20 fordable Care Act (Public Law 111–148); and 

21 (3) not later than 1 year after the date of the 

22 enactment of this Act, submit a report to the Con23 gress on the status of activities under paragraphs 

24 (1) and (2). 


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1 (b) 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 2025 

4 through 2028. 

5 SEC. 7405. IMPROVING ENTRY INTO, AND RETENTION IN, 

6 CARE AND ANTIRETROVIRAL ADHERENCE 

7 FOR PERSONS WITH HIV. 

8 (a) SENSE OF CONGRESS.—It is the sense of Con9 gress that AIDS research has led to scientific advance10 ments that have— 

11 (1) saved the lives of millions of people living 

12 with HIV; 

13 (2) prevented millions of individuals from re14 ceiving new diagnoses of HIV; and 

15 (3) had broad benefits that extend far beyond 

16 helping people at risk for, or living with, HIV. 

17 (b) IN GENERAL.—The Secretary of Health and 

18 Human Services, acting through the Director of the Na19 tional Institutes of Health, shall expand, intensify, and co20 ordinate operational and translational research and other 

21 activities of the National Institutes of Health regarding 

22 methods— 

23 (1) to increase adoption of evidence-based ad24 herence strategies within HIV care and treatment 

25 programs; 


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1 (2) to increase HIV testing and case detection 

2 rates; 

3 (3) to reduce HIV-related health disparities; 

4 (4) to ensure that research to improve adher5 ence to HIV care and treatment programs address 

6 the unique concerns of women; 

7 (5) to integrate HIV prevention and care serv8 ices with mental health and substance use preven9 tion and treatment delivery systems; 

10 (6) to increase knowledge on the implementa11 tion of preexposure prophylaxis (referred to in this 

12 section as ‘‘PrEP’’), including with respect to— 

13 (A) who can benefit most from PrEP; 

14 (B) how to provide PrEP safely and effi15 ciently; 

16 (C) how to integrate PrEP with other es17 sential prevention methods such as condoms; 

18 and 

19 (D) how to ensure high levels of adherence; 

20 and 

21 (7) to increase knowledge of ‘‘undetectable and 

22 untransmittable’’, when a person living with HIV 

23 who is on antiretroviral therapy and is durably 

24 virally suppressed (defined as having a consistent 


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1 viral load of less than 200 copies/ml) cannot sexually 

2 transmit HIV. 

3 (c) AUTHORIZATION OF APPROPRIATIONS.—To carry 

4 out this section, there are authorized to be appropriated 

5 such sums as may be necessary for fiscal years 2025 

6 through 2028. 

7 SEC. 7406. SERVICES TO REDUCE HIV/AIDS IN RACIAL AND 

8 ETHNIC MINORITY COMMUNITIES. 

9 (a) IN GENERAL.—For the purpose of reducing new 

10 HIV diagnoses in racial and ethnic minority communities, 

11 the Secretary of Health and Human Services, acting 

12 through the Deputy Assistant Secretary for Minority 

13 Health, may make grants to public health agencies and 

14 faith-based organizations to conduct— 

15 (1) outreach activities related to HIV preven16 tion and testing activities; 

17 (2) HIV prevention activities; 

18 (3) HIV testing activities; and 

19 (4) public health education campaigns on ac20 cessing HIV prevention medication. 

21 (b) 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 2025 

24 through 2028. 


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1 SEC. 7407. MINORITY AIDS INITIATIVE. 

2 (a) EXPANDED FUNDING.—The Secretary of Health 

3 and Human Services, in collaboration with the Deputy As4 sistant Secretary for Minority Health, the Director of the 

5 Centers for Disease Control and Prevention, the Adminis6 trator of the Health Resources and Services Administra7 tion, and the Assistant Secretary for Mental Health and 

8 Substance Use, shall provide funds and carry out activities 

9 to expand the Minority AIDS Initiative. 

10 (b) USE OF FUNDS.—The additional funds made 

11 available under this section may be used, through the Mi12 nority AIDS Initiative, to support the following activities: 

13 (1) Providing technical assistance and infra14 structure support to reduce HIV/AIDS in minority 

15 populations. 

16 (2) Increasing minority populations’ access to 

17 HIV prevention and care services. 

18 (3) Building strong community programs and 

19 partnerships to address HIV prevention and the 

20 health care needs of specific racial and ethnic minor21 ity populations. 

22 (c) PRIORITY INTERVENTIONS.—Within the racial 

23 and ethnic minority populations referred to in subsection 

24 (b), priority in conducting intervention services shall be 

25 given to— 

26 (1) men who have sex with men; 


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1 (2) youth; 

2 (3) persons who engage in intravenous drug 

3 abuse; 

4 (4) women; 

5 (5) homeless individuals; 

6 (6) individuals incarcerated or in the penal sys7 tem; 

8 (7) transgender individuals; and 

9 (8) nonbinary individuals. 

10 (d) AUTHORIZATION OF APPROPRIATIONS.—For car11 rying out this section, there are authorized to be appro12 priated $610,000,000 for fiscal year 2025 and such sums 

13 as may be necessary for each of fiscal years 2026 through 

14 2029. 

15 SEC. 7408. HEALTH CARE PROFESSIONALS TREATING INDI16 VIDUALS WITH HIV. 

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

18 Human Services, acting through the Administrator of the 

19 Health Resources and Services Administration, shall ex20 pand, intensify, and coordinate workforce initiatives of the 

21 Health Resources and Services Administration to increase 

22 the capacity of the health workforce focusing primarily on 

23 HIV to meet the demand for culturally competent care, 

24 and may award grants for any of the following: 


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1 (1) Development of curricula for training pri2 mary care providers in HIV/AIDS prevention and 

3 care, including routine HIV testing. 

4 (2) Support to expand access to culturally and 

5 linguistically accessible benefits counselors, trained 

6 peer navigators, and mental and behavioral health 

7 professionals with expertise in HIV. 

8 (3) Training health care professionals to pro9 vide care to individuals living with HIV. 

10 (4) Development by grant recipients under title 

11 XXVI of the Public Health Service Act (42 U.S.C. 

12 300ff–11 et seq.; commonly referred to as the ‘‘Ryan 

13 White HIV/AIDS Program’’) and other persons, of 

14 policies for providing culturally relevant and sen15 sitive treatment to individuals living with HIV, with 

16 particular emphasis on treatment to racial and eth17 nic minorities, men who have sex with men, and 

18 women, young people, and children living with HIV. 

19 (5) Development and implementation of pro20 grams to increase the use of telehealth to respond to 

21 HIV-specific health care needs in rural and minority 

22 communities, with particular emphasis given to 

23 medically underserved communities and insular 

24 areas. 


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1 (6) Evaluating interdisciplinary medical pro2 vider care team models that promote high-quality 

3 care, with particular emphasis on care to racial and 

4 ethnic minorities. 

5 (7) Training health care professionals to make 

6 them aware of the high rates of chronic hepatitis B 

7 and chronic hepatitis C in adult racial and ethnic 

8 minority populations, and the importance of preven9 tion, detection, and medical management of hepatitis 

10 B and hepatitis C and of liver cancer screening. 

11 (8) Development of curricula for training pri12 mary care providers that HIV and tuberculosis are 

13 significant mutual comorbidities, and that a patient 

14 who tests positive for one disease should be offered 

15 and encouraged to receive testing for the other. 

16 (b) AUTHORIZATION OF APPROPRIATIONS.—To carry 

17 out this section, there are authorized to be appropriated 

18 such sums as may be necessary for fiscal years 2025 

19 through 2028. 

20 SEC. 7409. HIV/AIDS PROVIDER LOAN REPAYMENT PRO21 GRAM. 

22 (a) IN GENERAL.—The Secretary may enter into an 

23 agreement with any physician, nurse practitioner, or phy24 sician assistant under which— 


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1 (1) the physician, nurse practitioner, or physi2 cian assistant agrees to serve as a medical provider 

3 for a period of not less than 2 years— 

4 (A) at a Ryan White-funded or title X5 funded facility with a critical shortage of doc6 tors (as determined by the Secretary); or 

7 (B) in an area with a high incidence of 

8 HIV/AIDS; and 

9 (2) the Secretary agrees to make payments in 

10 accordance with subsection (b) on the professional 

11 education loans of the physician, nurse practitioner, 

12 or physician assistant. 

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 physician, nurse 

17 practitioner, or physician assistant for whom the 

18 payments are to be made of the first year of the 

19 service specified in the agreement entered into with 

20 the Secretary under subsection (a), the Secretary 

21 shall pay 30 percent of the principal of and the in22 terest on the individual’s professional education 

23 loans. 

24 (2) Upon completion by the physician, nurse 

25 practitioner, or physician assistant of the second 


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1 year of such service, the Secretary shall pay another 

2 30 percent of the principal of and the interest on 

3 such loans. 

4 (3) Upon completion by that individual of a 

5 third year of such service, the Secretary shall pay 

6 another 25 percent of the principal of and the inter7 est on such loans. 

8 (c) APPLICABILITY OF CERTAIN PROVISIONS.—Sub9 part III of part D of title III of the Public Health Service 

10 Act (42 U.S.C. 254l et seq.) shall, except as inconsistent 

11 with this section, apply to the program carried out under 

12 this section in the same manner and to the same extent 

13 as such provisions apply to the National Health Service 

14 Corps loan repayment program. 

15 (d) REPORTS.—Not later than 18 months after the 

16 date of the enactment of this Act, and annually thereafter, 

17 the Secretary shall prepare and submit to Congress a re18 port describing the program carried out under this section, 

19 including statements regarding the following: 

20 (1) The number of physicians, nurse practi21 tioners, and physician assistants enrolled in the pro22 gram. 

23 (2) The number and amount of loan repay24 ments provided through the program. 


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1 (3) The placement location of loan repayment 

2 recipients at facilities described in subsection (a)(1). 

3 (4) The default rate on such loans and actions 

4 required. 

5 (5) The amount of outstanding default funds 

6 with respect to such loans. 

7 (6) To the extent that it can be determined, the 

8 reason for the default on such a loan. 

9 (7) The demographics of individuals partici10 pating in the program. 

11 (8) An evaluation of the overall costs and bene12 fits of the program. 

13 (e) DEFINITIONS.—In this section: 

14 (1) HIV/AIDS.—The term ‘‘HIV/AIDS’’ means 

15 human immunodeficiency virus and acquired im16 mune deficiency syndrome. 

17 (2) NURSE PRACTITIONER.—The term ‘‘nurse 

18 practitioner’’ means a registered nurse who has com19 pleted an accredited graduate degree program in ad20 vanced nurse practice and has successfully passed a 

21 national certification exam. 

22 (3) PHYSICIAN.—The term ‘‘physician’’ means 

23 a graduate of a school of medicine who has com24 pleted postgraduate training in general or pediatric 

25 medicine. 


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1 (4) PHYSICIAN ASSISTANT.—The term ‘‘physi2 cian assistant’’ means a medical provider who com3 pleted an accredited physician assistant training pro4 gram and successfully passed the Physician Assist5 ant National Certifying Examination. 

6 (5) PROFESSIONAL EDUCATION LOAN.—The 

7 term ‘‘professional education loan’’— 

8 (A) means a loan that is incurred for the 

9 cost of attendance (including tuition, other rea10 sonable educational expenses, and reasonable 

11 living costs) at a school of medicine, school of 

12 nursing, or physician assistant training pro13 gram; and 

14 (B) includes only the portion of the loan 

15 that is outstanding on the date the physician, 

16 nurse practitioner, or physician assistant in17 volved begins the service specified in the agree18 ment under subsection (a). 

19 (6) RYAN WHITE-FUNDED.—The term ‘‘Ryan 

20 White-funded’’ means, with respect to a facility, re21 ceiving funds under title XXVI of the Public Health 

22 Service Act (42 U.S.C. 300ff–11 et seq.). 

23 (7) SECRETARY.—The term ‘‘Secretary’’ means 

24 the Secretary of Health and Human Services. 


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1 (8) SCHOOL OF MEDICINE.—The term ‘‘school 

2 of medicine’’ has the meaning given to that term in 

3 section 799B of the Public Health Service Act (42 

4 U.S.C. 295p). 

5 (9) TITLE X-FUNDED.—The term ‘‘title X-fund6 ed’’ means, with respect to a facility, receiving funds 

7 under title X of the Public Health Service Act (42 

8 U.S.C. 300 et seq.). 

9 (f) AUTHORIZATION OF APPROPRIATIONS.—To carry 

10 out this section, there are authorized to be appropriated 

11 such sums as may be necessary for fiscal years 2025 

12 through 2028. 

13 SEC. 7410. DENTAL EDUCATION LOAN REPAYMENT PRO14 GRAM. 

15 (a) IN GENERAL.—The Secretary may enter into an 

16 agreement with any dentist under which— 

17 (1) the dentist agrees to serve as a dentist for 

18 a period of not less than 2 years at a facility with 

19 a critical shortage of dentists (as determined by the 

20 Secretary) in an area with a high incidence of HIV/ 

21 AIDS; and 

22 (2) the Secretary agrees to make payments in 

23 accordance with subsection (b) on the dental edu24 cation loans of the dentist. 


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1 (b) MANNER OF PAYMENTS.—The payments de2 scribed in subsection (a) shall be made by the Secretary 

3 as follows: 

4 (1) Upon completion by the dentist for whom 

5 the payments are to be made of the first year of the 

6 service specified in the agreement entered into with 

7 the Secretary under subsection (a), the Secretary 

8 shall pay 30 percent of the principal of and the in9 terest on the dental education loans of the dentist. 

10 (2) Upon completion by the dentist of the sec11 ond year of such service, the Secretary shall pay an12 other 30 percent of the principal of and the interest 

13 on such loans. 

14 (3) Upon completion by that individual of a 

15 third year of such service, the Secretary shall pay 

16 another 25 percent of the principal of and the inter17 est on such loans. 

18 (c) APPLICABILITY OF CERTAIN PROVISIONS.—Sub19 part III of part D of title III of the Public Health Service 

20 Act (42 U.S.C. 254l et seq.) shall, except as inconsistent 

21 with this section, apply to the program carried out under 

22 this section in the same manner and to the same extent 

23 as such provisions apply to the National Health Service 

24 Corps Loan Repayment Program. 


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1 (d) REPORTS.—Not later than 18 months after the 

2 date of the enactment of this Act, and annually thereafter, 

3 the Secretary shall prepare and submit to the Congress 

4 a report describing the program carried out under this sec5 tion, including statements regarding the following: 

6 (1) The number of dentists enrolled in the pro7 gram. 

8 (2) The number and amount of loan repay9 ments provided through the program. 

10 (3) The placement location of loan repayment 

11 recipients at facilities described in subsection (a)(1). 

12 (4) The default rate on such loans and actions 

13 required. 

14 (5) The amount of outstanding default funds 

15 with respect to such loans. 

16 (6) To the extent that it can be determined, the 

17 reason for the default on such a loan. 

18 (7) The demographics of individuals partici19 pating in the program. 

20 (8) An evaluation of the overall costs and bene21 fits of the program. 

22 (e) DEFINITIONS.—In this section: 

23 (1) DENTAL EDUCATION LOAN.—The term 

24 ‘‘dental education loan’’— 


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1 (A) means a loan that is incurred for the 

2 cost of attendance (including tuition, other rea3 sonable educational expenses, and reasonable 

4 living costs) at a school of dentistry; and 

5 (B) includes only the portion of the loan 

6 that is outstanding on the date the dentist in7 volved begins the service specified in the agree8 ment under subsection (a). 

9 (2) DENTIST.—The term ‘‘dentist’’ means a 

10 graduate of a school of dentistry who has completed 

11 postgraduate training in general or pediatric den12 tistry. 

13 (3) HIV/AIDS.—The term ‘‘HIV/AIDS’’ means 

14 human immunodeficiency virus and acquired im15 mune deficiency syndrome. 

16 (4) SCHOOL OF DENTISTRY.—The term ‘‘school 

17 of dentistry’’ has the meaning given to that term in 

18 section 799B of the Public Health Service Act (42 

19 U.S.C. 295p). 

20 (5) SECRETARY.—The term ‘‘Secretary’’ means 

21 the Secretary of Health and Human Services. 

22 (f) AUTHORIZATION OF APPROPRIATIONS.—To carry 

23 out this section, there are authorized to be appropriated 

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

25 2025 through 2028. 


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1 SEC. 7411. REDUCING NEW HIV INFECTIONS AMONG IN2 JECTING DRUG USERS. 

3 (a) SENSE OF CONGRESS.—It is the sense of Con4 gress that providing sterile syringes and sterilized equip5 ment to injecting drug users substantially reduces risk of 

6 HIV infection, increases the probability that they will ini7 tiate drug treatment, and does not increase drug use. 

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

9 Human Services may provide grants and technical assist10 ance for the purpose of reducing the rate of HIV infections 

11 among injecting drug users through a comprehensive 

12 package of services for such users, including the provision 

13 of sterile syringes, education and outreach, access to infec14 tious disease testing, overdose prevention, and treatment 

15 for drug dependence. 

16 (c) AUTHORIZATION OF APPROPRIATIONS.—To carry 

17 out this section, there are authorized to be appropriated 

18 such sums as may be necessary for fiscal years 2025 

19 through 2028. 

20 SEC. 7412. REPORT ON IMPACT OF HIV/AIDS IN VULNER21 ABLE POPULATIONS. 

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

23 Human Services shall submit to Congress and the Presi24 dent an annual report on the impact of HIV/AIDS for 

25 racial and ethnic minority communities, women, and youth 

26 aged 24 and younger. 


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1 (b) CONTENTS.—The report under subsection (a) 

2 shall include information on the— 

3 (1) progress that has been made in reducing 

4 the impact of HIV/AIDS in such communities; 

5 (2) opportunities that exist to make additional 

6 progress in reducing the impact of HIV/AIDS in 

7 such communities; 

8 (3) challenges that may impede such additional 

9 progress; and 

10 (4) Federal funding necessary to achieve sub11 stantial reductions in HIV/AIDS in racial and ethnic 

12 minority communities. 

13 SEC. 7413. NATIONAL HIV/AIDS OBSERVANCE DAYS. 

14 (a) NATIONAL OBSERVANCE DAYS.—It is the sense 

15 of Congress that national observance days highlighting the 

16 impact of HIV on communities of color include the fol17 lowing: 

18 (1) National Black HIV/AIDS Awareness Day. 

19 (2) National Latino AIDS Awareness Day. 

20 (3) National Asian and Pacific Islander HIV/ 

21 AIDS Awareness Day. 

22 (4) National Native American HIV/AIDS 

23 Awareness Day. 

24 (5) National Youth HIV/AIDS Awareness Day. 


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1 (b) CALL TO ACTION.—It is the sense of Congress 

2 that the President should call on members of communities 

3 of color— 

4 (1) to become involved at the local community 

5 level in HIV testing, policy, and advocacy; 

6 (2) to become aware, engaged, and empowered 

7 on the HIV epidemic within their communities; and 

8 (3) to urge members of their communities to re9 duce risk factors, practice safe sex and other preven10 tive measures, be tested for HIV, and seek care 

11 when appropriate. 

12 SEC. 7414. REVIEW OF ALL FEDERAL AND STATE LAWS, 

13 POLICIES, AND REGULATIONS REGARDING 

14 THE CRIMINAL PROSECUTION OF INDIVID15 UALS FOR HIV-RELATED OFFENSES. 

16 (a) SENSE OF CONGRESS REGARDING LAWS OR REG17 ULATIONS DIRECTED AT PEOPLE LIVING WITH HIV.— 

18 It is the sense of Congress that Federal and State laws, 

19 policies, and regulations regarding people living with 

20 HIV— 

21 (1) should not place unique or additional bur22 dens on such individuals solely as a result of their 

23 HIV status; and 


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1 (2) should instead demonstrate a public health2 oriented, evidence-based, medically accurate, and 

3 contemporary understanding of— 

4 (A) the multiple factors that lead to HIV 

5 transmission; 

6 (B) the relative risk of demonstrated HIV 

7 transmission routes; 

8 (C) the current health implications of liv9 ing with HIV; 

10 (D) the associated benefits of treatment 

11 and support services for people living with HIV; 

12 and 

13 (E) the impact of punitive HIV-specific 

14 laws, policies, regulations, and judicial prece15 dents and decisions on public health, on people 

16 living with or affected by HIV, and on their 

17 families and communities. 

18 (b) REVIEW OF FEDERAL AND STATE LAWS.— 

19 (1) REVIEW OF FEDERAL AND STATE LAWS.— 

20 (A) IN GENERAL.—Not later than 90 days 

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

22 Attorney General, the Secretary of Health and 

23 Human Services, and the Secretary of Defense 

24 acting jointly (in this section referred to as the 

25 ‘‘designated officials’’) shall initiate a national 


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1 review of Federal and State laws, including the 

2 Uniform Code of Military Justice (referred to in 

3 this section as the ‘‘UCMJ’’), policies, regula4 tions, and judicial precedents and decisions re5 garding criminal and related civil commitment 

6 cases involving people living with HIV/AIDS. 

7 (B) CONSULTATION.—In carrying out the 

8 review under subparagraph (A), the designated 

9 officials shall seek to include diverse participa10 tion from, and consultation with, each of the 

11 following: 

12 (i) Each State. 

13 (ii) State attorneys general (or their 

14 representatives). 

15 (iii) State public health officials (or 

16 their representatives). 

17 (iv) State judicial and court system 

18 officers, including judges, district attor19 neys, prosecutors, defense attorneys, law 

20 enforcement, and correctional officers. 

21 (v) Members of the United States 

22 Armed Forces, including members of other 

23 Federal services subject to the UCMJ. 

24 (vi) People living with HIV/AIDS, 

25 particularly those who have been subject to 


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1 HIV-related prosecution or who are from 

2 minority communities whose members have 

3 been disproportionately subject to HIV4 specific arrests and prosecution. 

5 (vii) Legal advocacy and HIV/AIDS 

6 service organizations that work with people 

7 living with HIV/AIDS. 

8 (viii) Nongovernmental health organi9 zations that work on behalf of people living 

10 with HIV/AIDS, including syringe services 

11 programs, LGBTQ-focused health organi12 zations, and organizations who serve peo13 ple who engage in sex work. 

14 (ix) Trade organizations or associa15 tions representing persons or entities de16 scribed in clauses (i) through (vii). 

17 (C) RELATION TO OTHER REVIEWS.—In 

18 carrying out the review under subparagraph 

19 (A), the designated officials may utilize other 

20 existing reviews of criminal and related civil 

21 commitment cases involving people living with 

22 HIV, including any such review conducted by 

23 any Federal or State agency or any public 

24 health, legal advocacy, or trade organization or 

25 association if the designated officials determines 


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1 that such reviews were conducted in accordance 

2 with the principles set forth in subsection (a). 

3 (2) REPORT.—Not later than 180 days after 

4 initiating the review required under paragraph (1), 

5 the Attorney General shall transmit to the Congress 

6 and make publicly available a report containing the 

7 results of the review, which includes the following: 

8 (A) For each State and for the UCMJ, a 

9 summary of the relevant laws, policies, regula10 tions, and judicial precedents and decisions re11 garding criminal cases involving people living 

12 with HIV, including the following: 

13 (i) A determination of whether such 

14 laws, policies, regulations, and judicial 

15 precedents and decisions place any unique 

16 or additional burdens upon people living 

17 with HIV. 

18 (ii) A determination of whether such 

19 laws, policies, regulations, and judicial 

20 precedents and decisions demonstrate a 

21 public health-oriented, evidence-based, 

22 medically accurate, and contemporary un23 derstanding of— 

24 (I) the multiple factors that lead 

25 to HIV transmission; 


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1 (II) the relative risk of HIV 

2 transmission routes, including that a 

3 person that has an undetectable viral 

4 load cannot transmit HIV; 

5 (III) the current health implica6 tions of living with HIV, including 

7 data disaggregated by race and eth8 nicity; 

9 (IV) the current status of pro10 viding protection to people who en11 gage in survival sex work against 

12 whom condom possession has been 

13 used as evidence of intent to commit 

14 a crime; 

15 (V) States that have the classi16 fication of mandatory sex offenders; 

17 (VI) the associated benefits of 

18 treatment and support services for 

19 people living with HIV; and 

20 (VII) the impact of punitive 

21 HIV-specific laws and policies on pub22 lic health, on people living with or af23 fected by HIV, and on their families 

24 and communities, including people 

25 who are in abusive, dependent, violent, 


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1 or nonconsensual relationships and 

2 are unable to both negotiate the use 

3 of condoms and status disclosure. 

4 (iii) An analysis of the public health 

5 and legal implications of such laws, poli6 cies, regulations, and judicial precedents 

7 and decisions, including an analysis of the 

8 consequences of having a similar penal 

9 scheme applied to comparable situations 

10 involving other communicable diseases. 

11 (iv) An analysis of the proportionality 

12 of punishments imposed under HIV-spe13 cific laws, policies, regulations, and judicial 

14 precedents, taking into consideration pen15 alties attached to violation of State laws 

16 against similar degrees of endangerment or 

17 harm, such as driving while intoxicated or 

18 transmission of other communicable dis19 eases, or more serious harms, such as ve20 hicular manslaughter offenses. 

21 (B) An analysis of common elements 

22 shared between State laws, policies, regulations, 

23 and judicial precedents. 

24 (C) A set of best practice recommendations 

25 directed to State governments, including State 


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1 attorneys general, public health officials, and 

2 judicial officers, in order to ensure that laws, 

3 policies, regulations, and judicial precedents re4 garding people living with HIV are in accord5 ance with the principles set forth in subsection 

6 (a). 

7 (D) Recommendations for adjustments to 

8 the UCMJ, including discontinuing the use of a 

9 service member’s HIV diagnosis as the basis for 

10 prosecution, enhanced penalties, or discharge 

11 from military service, in order to ensure that 

12 laws, policies, regulations, and judicial prece13 dents regarding people living with HIV are in 

14 accordance with the principles set forth in sub15 section (a). Such recommendations should in16 clude any necessary and appropriate changes to 

17 ‘‘Orders to Follow Preventative Medicine Re18 quirements’’. 

19 (3) GUIDANCE.—Not later than 90 days after 

20 the date of the release of the report required by 

21 paragraph (2), the Attorney General and the Sec22 retary of Health and Human Services shall jointly 

23 develop and publicly release updated guidance for 

24 States based on the set of best practice rec25 ommendations required under paragraph (2)(C) in 


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1 order to assist States dealing with criminal and re2 lated civil commitment cases regarding people living 

3 with HIV. 

4 (4) MONITORING AND EVALUATION SYSTEM.— 

5 Not later than 60 days after the date of the release 

6 of the guidance required under paragraph (3), the 

7 Attorney General and the Secretary of Health and 

8 Human Services shall jointly establish an integrated 

9 monitoring and evaluation system that includes, 

10 where appropriate, objective and quantifiable per11 formance goals and indicators to measure progress 

12 toward statewide implementation in each State of 

13 the best practice recommendations required under 

14 paragraph (2)(C). 

15 (5) MODERNIZATION OF FEDERAL LAWS, POLI16 CIES, AND REGULATIONS.—Not later than 90 days 

17 after the date of the release of the report required 

18 under paragraph (2), the designated officials shall 

19 develop and transmit to the President and the Con20 gress, and make publicly available, such proposals as 

21 may be necessary to implement adjustments to Fed22 eral laws, policies, or regulations, including the 

23 UCMJ, based on the recommendations required 

24 under paragraph (2)(D), either through Executive 

25 order or through changes to statutory law. 


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1 (c) RULE OF CONSTRUCTION.—Nothing in this sec2 tion shall be construed to discourage the prosecution of 

3 individuals who intentionally transmit or attempt to trans4 mit HIV to another individual. 

5 (d) NO ADDITIONAL APPROPRIATIONS AUTHOR6 IZED.—This section shall not be construed to increase the 

7 amount of appropriations that are authorized to be appro8 priated for any fiscal year. 

9 SEC. 7415. EXPANDING SUPPORT FOR CONDOMS IN PRIS10 ONS. 

11 (a) SENSE OF CONGRESS REGARDING DISTRIBUTION

12 OF SEXUAL BARRIER PROTECTION DEVICES IN STATE

13 PRISON SYSTEMS.—It is the sense of the Congress that 

14 States shall allow for the legal distribution of sexual bar15 rier protection devices in State correctional facilities to re16 duce the prevalence and spread of STIs in those facilities. 

17 (b) AUTHORITY TO ALLOW COMMUNITY ORGANIZA18 TIONS TO PROVIDE STI COUNSELING, STI PREVENTION

19 EDUCATION, AND SEXUAL BARRIER PROTECTION DE20 VICES IN FEDERAL CORRECTIONAL FACILITIES.— 

21 (1) DIRECTIVE TO ATTORNEY GENERAL.—Not 

22 later than 30 days after the date of enactment of 

23 this Act, the Attorney General shall direct the Direc24 tor of the Bureau of Prisons to allow community or25 ganizations to, in accordance with all relevant FedVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 01253 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 eral laws and regulations that govern visitation in 

2 Federal correctional facilities— 

3 (A) distribute sexual barrier protection de4 vices in Federal correctional facilities; and 

5 (B) engage in STI counseling and STI pre6 vention education in Federal correctional facili7 ties. 

8 (2) INFORMATION REQUIREMENT.—Any com9 munity organization permitted to distribute sexual 

10 barrier protection devices under paragraph (1) shall 

11 ensure that the individuals to whom the devices are 

12 distributed are informed about the proper use and 

13 disposal of sexual barrier protection devices in ac14 cordance with established public health practices. 

15 Any community organization conducting STI coun16 seling or STI prevention education under paragraph 

17 (1) shall offer comprehensive sexuality education. 

18 (3) POSSESSION OF DEVICE PROTECTED.—A 

19 Federal correctional facility may not, because of the 

20 possession or use of a sexual barrier protection de21 vice— 

22 (A) take adverse action against an incar23 cerated individual; or 

24 (B) consider possession or use as evidence 

25 of prohibited activity for the purpose of any 


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1 Federal correctional facility administrative pro2 ceeding. 

3 (4) IMPLEMENTATION.—The Attorney General 

4 and the Director of the Bureau of Prisons shall im5 plement this section according to established public 

6 health practices in a manner that protects the 

7 health, safety, and privacy of incarcerated individ8 uals and of correctional facility staff. 

9 (c) SURVEY OF AND REPORT ON CORRECTIONAL FA10 CILITY PROGRAMS AIMED AT REDUCING THE SPREAD OF

11 STIS.— 

12 (1) SURVEY.—Not later than 180 days after 

13 the date of enactment of this Act, and annually 

14 thereafter for 5 years, the Attorney General, after 

15 consulting with the Secretary of Health and Human 

16 Services, State officials, and community organiza17 tions, shall, to the maximum extent practicable, con18 duct a survey of all Federal and State correctional 

19 facilities, to determine the following: 

20 (A) COUNSELING, TREATMENT, AND SUP21 PORTIVE SERVICES.—Whether the correctional 

22 facility— 

23 (i) requires incarcerated individuals to 

24 participate in counseling, treatment, and 

25 supportive services related to STIs; or 


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1 (ii) offers such programs to incarcer2 ated individuals. 

3 (B) ACCESS TO SEXUAL BARRIER PROTEC4 TION DEVICES.—Whether incarcerated individ5 uals can— 

6 (i) possess sexual barrier protection 

7 devices; 

8 (ii) purchase sexual barrier protection 

9 devices; 

10 (iii) purchase sexual barrier protection 

11 devices at a reduced cost; or 

12 (iv) obtain sexual barrier protection 

13 devices without cost. 

14 (C) INCIDENCE OF SEXUAL VIOLENCE.— 

15 The incidence of sexual violence and assault 

16 committed by incarcerated individuals and by 

17 correctional facility staff. 

18 (D) PREVENTION EDUCATION OFFERED.— 

19 The type of prevention education, information, 

20 or training offered to incarcerated individuals 

21 and correctional facility staff regarding sexual 

22 violence and the spread of STIs, including 

23 whether such education, information, or train24 ing— 


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1 (i) constitutes comprehensive sexuality 

2 education; 

3 (ii) is compulsory for new incarcerated 

4 individuals and for new correctional facility 

5 staff; and 

6 (iii) is offered on an ongoing basis. 

7 (E) STI TESTING.—Whether the correc8 tional facility tests incarcerated individuals for 

9 STIs or gives them the option to undergo such 

10 testing— 

11 (i) at intake; 

12 (ii) on a regular basis; and 

13 (iii) prior to release. 

14 (F) STI TEST RESULTS.—The number of 

15 incarcerated individuals who are tested for STIs 

16 and the outcome of such tests at each correc17 tional facility, disaggregated to include results 

18 for— 

19 (i) the type of STI tested for; 

20 (ii) the race and ethnicity of an indi21 vidual tested; 

22 (iii) the age of an individual tested; 

23 and 

24 (iv) the gender of the individual test25 ed. 


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1 (G) PRERELEASE REFERRAL POLICY.— 

2 Whether incarcerated individuals are informed 

3 prior to release about STI-related services or 

4 other health services in their communities, in5 cluding free and low-cost counseling and treat6 ment options. 

7 (H) PRERELEASE REFERRALS MADE.— 

8 The number of referrals to community-based 

9 organizations or public health facilities offering 

10 STI-related or other health services provided to 

11 incarcerated individuals prior to release, and 

12 the type of counseling or treatment for which 

13 the referral was made. 

14 (I) REINSTATEMENT OF MEDICAID BENE15 FITS.—Whether— 

16 (i) the correctional facility assists in17 carcerated individuals that were enrolled in 

18 the State Medicaid program prior to their 

19 incarceration in reinstating their enroll20 ment upon release; and 

21 (ii) such individuals receive referrals 

22 as described in subparagraph (G) to enti23 ties that accept the State Medicaid pro24 gram, including, if applicable— 


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1 (I) the number of such individ2 uals, including those diagnosed with 

3 HIV, that have been reinstated; 

4 (II) a list of obstacles to rein5 stating enrollment or to making deter6 minations of eligibility for reinstate7 ment, if any; and 

8 (III) the number of individuals 

9 denied enrollment. 

10 (J) OTHER ACTIONS TAKEN.—Whether the 

11 correctional facility has taken any other action, 

12 in conjunction with community organizations or 

13 otherwise, to reduce the prevalence and spread 

14 of STIs in that facility. 

15 (2) PRIVACY.—In conducting the survey under 

16 paragraph (1), the Attorney General shall not re17 quest or retain the identity of any individual who 

18 has sought or been offered counseling, treatment, 

19 testing, or prevention education information regard20 ing an STI (including information about sexual bar21 rier protection devices), or who has tested positive 

22 for an STI. 

23 (3) REPORT.— 

24 (A) IN GENERAL.—The Attorney General 

25 shall transmit to Congress and make publicly 


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1 available the results of the survey required 

2 under paragraph (1), both for the United 

3 States as a whole and disaggregated as to each 

4 State and each correctional facility. 

5 (B) DEADLINES.—To the maximum extent 

6 possible, the Attorney General shall— 

7 (i) issue the first report under sub8 paragraph (A) not later than 1 year after 

9 the date of enactment of this Act; and 

10 (ii) issue reports under subparagraph 

11 (A) annually thereafter for 5 years. 

12 (d) STRATEGY.— 

13 (1) DIRECTIVE TO ATTORNEY GENERAL.—The 

14 Attorney General, in consultation with the Secretary 

15 of Health and Human Services, State officials, and 

16 community organizations, shall develop and imple17 ment a 5-year strategy to reduce the prevalence and 

18 spread of STIs in Federal and State correctional fa19 cilities. To the maximum extent possible, the strat20 egy shall be developed, transmitted to Congress, and 

21 made publicly available not later than 180 days after 

22 the transmission of the first report required under 

23 subsection (c)(3). 


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1 (2) CONTENTS OF STRATEGY.—The strategy 

2 developed under paragraph (1) shall include the fol3 lowing: 

4 (A) PREVENTION EDUCATION.—A plan for 

5 improving prevention education, information, 

6 and training offered to incarcerated individuals 

7 and correctional facility staff, including infor8 mation and training on sexual violence and the 

9 spread of STIs, and comprehensive sexuality 

10 education. 

11 (B) SEXUAL BARRIER PROTECTION DEVICE

12 ACCESS.—A plan for expanding access to sexual 

13 barrier protection devices in correctional facili14 ties. 

15 (C) SEXUAL VIOLENCE REDUCTION.—A 

16 plan for reducing the incidence of sexual vio17 lence among incarcerated individuals and cor18 rectional facility staff. 

19 (D) COUNSELING AND SUPPORTIVE SERV20 ICES.—A plan for expanding access to coun21 seling and supportive services related to STIs in 

22 correctional facilities. 

23 (E) TESTING.—A plan for testing incarcer24 ated individuals for STIs during intake, during 


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1 regular health exams, and prior to release 

2 that— 

3 (i) is conducted in accordance with 

4 guidelines established by the Centers for 

5 Disease Control and Prevention; 

6 (ii) includes pretest counseling; 

7 (iii) requires that incarcerated individ8 uals are notified of their option to decline 

9 testing at any time; 

10 (iv) requires that incarcerated individ11 uals are confidentially notified of their test 

12 results in a timely manner; and 

13 (v) ensures that incarcerated individ14 uals testing positive for STIs receive post15 test counseling, care, treatment, and sup16 portive services. 

17 (F) TREATMENT.—A plan for ensuring 

18 that correctional facilities have the necessary 

19 medicine and equipment to treat and monitor 

20 STIs and for ensuring that incarcerated indi21 viduals living with or testing positive for STIs 

22 receive and have access to care and treatment 

23 services. 

24 (G) STRATEGIES FOR DEMOGRAPHIC

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1 menting culturally appropriate, sensitive, and 

2 specific strategies to reduce the spread of STIs 

3 among demographic groups heavily impacted by 

4 STIs. 

5 (H) LINKAGES WITH COMMUNITIES AND

6 FACILITIES.—A plan for establishing and 

7 strengthening linkages to local community and 

8 health facilities that— 

9 (i) provide counseling, testing, care, 

10 and treatment services; 

11 (ii) may receive individuals recently 

12 released from incarceration who are living 

13 with STIs; and 

14 (iii) accept payment through the State 

15 Medicaid program. 

16 (I) ENROLLMENT IN STATE MEDICAID

17 PROGRAMS.—Plans to ensure that— 

18 (i) incarcerated individuals who were 

19 enrolled in their State Medicaid program 

20 prior to incarceration in a correctional fa21 cility are automatically reenrolled in such 

22 program upon their release; and 

23 (ii) incarcerated individuals who were 

24 not enrolled in their State Medicaid pro25 gram prior to incarceration, and who are 


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1 diagnosed with HIV while incarcerated in 

2 a correctional facility, are automatically 

3 enrolled in such program upon their re4 lease. 

5 (J) OTHER PLANS.—Any other plans de6 veloped by the Attorney General for reducing 

7 the spread of STIs or improving the quality of 

8 health care in correctional facilities. 

9 (K) MONITORING SYSTEM.—A monitoring 

10 system that establishes performance goals re11 lated to reducing the prevalence and spread of 

12 STIs in correctional facilities and which, where 

13 feasible, expresses such goals in quantifiable 

14 form. 

15 (L) MONITORING SYSTEM PERFORMANCE

16 INDICATORS.—Performance indicators that 

17 measure or assess the achievement of the per18 formance goals described in subparagraph (K). 

19 (M) COST ESTIMATE.—A detailed estimate 

20 of the funding necessary to implement the 

21 strategy at the Federal and State levels for all 

22 5 years, including the amount of funds required 

23 by community organizations to implement the 

24 parts of the strategy in which they take part. 


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1 (3) REPORT.—Not later than 1 year after the 

2 date of the enactment of this Act, and annually 

3 thereafter, the Attorney General shall transmit to 

4 Congress and make publicly available an annual 

5 progress report regarding the implementation and 

6 effectiveness of the strategy described in paragraph 

7 (1). The progress report shall include an evaluation 

8 of the implementation of the strategy using the mon9 itoring system and performance indicators provided 

10 for in subparagraphs (K) and (L) of paragraph (2). 

11 (e) AUTHORIZATION OF APPROPRIATIONS.— 

12 (1) IN GENERAL.—There are authorized to be 

13 appropriated such sums as may be necessary to 

14 carry out this section for each of fiscal years 2025 

15 through 2029. 

16 (2) AVAILABILITY OF FUNDS.—Amounts made 

17 available under paragraph (1) are authorized to re18 main available until expended. 

19 (f) DEFINITIONS.—In this section: 

20 (1) COMMUNITY ORGANIZATION.—The term 

21 ‘‘community organization’’ means a public health 

22 care facility or a nonprofit organization that pro23 vides health- or STI-related services according to es24 tablished public health standards. 


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1 (2) COMPREHENSIVE SEXUALITY EDUCATION.— 

2 The term ‘‘comprehensive sexuality education’’ 

3 means sexuality education— 

4 (A) that includes information about absti5 nence and about the proper use and disposal of 

6 sexual barrier protection devices; and 

7 (B) that is— 

8 (i) evidence based; 

9 (ii) medically accurate; 

10 (iii) age and developmentally appro11 priate; 

12 (iv) gender and identity sensitive; 

13 (v) culturally and linguistically appro14 priate; and 

15 (vi) structured to promote critical 

16 thinking, self-esteem, respect for others, 

17 and the development of healthy attitudes 

18 and relationships. 

19 (3) CORRECTIONAL FACILITY.—The term ‘‘cor20 rectional facility’’ means any prison, penitentiary, 

21 adult detention facility, juvenile detention facility, 

22 jail, or other facility to which individuals may be 

23 sent after conviction of a crime or act of juvenile de24 linquency within the United States. 


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1 (4) INCARCERATED INDIVIDUAL.—The term 

2 ‘‘incarcerated individual’’ means any individual who 

3 is serving a sentence in a correctional facility after 

4 conviction of a crime. 

5 (5) SEXUAL BARRIER PROTECTION DEVICE.— 

6 The term ‘‘sexual barrier protection device’’ means 

7 any physical device approved, cleared, or otherwise 

8 authorized by the Food and Drug Administration 

9 that has not been tampered with and which reduces 

10 the probability of STI transmission or infection be11 tween sexual partners, including female condoms, 

12 male condoms, and dental dams. 

13 (6) SEXUALLY TRANSMITTED INFECTION.—The 

14 term ‘‘sexually transmitted infection’’ or ‘‘STI’’ 

15 means any disease or infection that is commonly 

16 transmitted through sexual activity, including HIV, 

17 gonorrhea, chlamydia, syphilis, genital herpes, viral 

18 hepatitis, and human papillomavirus. 

19 (7) STATE.—The term ‘‘State’’ includes the 

20 District of Columbia, American Samoa, the Com21 monwealth of the Northern Mariana Islands, Guam, 

22 Puerto Rico, and the United States Virgin Islands. 

23 (8) STATE MEDICAID PROGRAM.—The term 

24 ‘‘State Medicaid program’’ means the State plan (or 


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1 a waiver of such plan) under title XIX of the Social 

2 Security Act (42 U.S.C. 1396 et seq.). 

3 SEC. 7416. AUTOMATIC REINSTATEMENT OR ENROLLMENT 

4 IN MEDICAID FOR PEOPLE WHO TEST POSI5 TIVE FOR HIV BEFORE REENTERING COMMU6 NITIES. 

7 (a) IN GENERAL.—Section 1902(e) of the Social Se8 curity Act (42 U.S.C. 1396a(e)) is amended by adding at 

9 the end the following: 

10 ‘‘(17) ENROLLMENT OF EX-OFFENDERS.— 

11 ‘‘(A) AUTOMATIC ENROLLMENT OR REIN12 STATEMENT.— 

13 ‘‘(i) IN GENERAL.—The State plan 

14 shall provide for the automatic enrollment 

15 or reinstatement of enrollment of an eligi16 ble individual— 

17 ‘‘(I) if such individual is sched18 uled to be released from a public insti19 tution due to the completion of sen20 tence, not less than 30 days prior to 

21 the scheduled date of the release; and 

22 ‘‘(II) if such individual is to be 

23 released from a public institution on 

24 parole or on probation, as soon as 

25 possible after the date on which the 


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1 determination to release such indi2 vidual was made, and before the date 

3 such individual is released. 

4 ‘‘(ii) EXCEPTION.—If a State makes a 

5 determination that an individual is not eli6 gible to be enrolled under the State plan— 

7 ‘‘(I) on or before the date by 

8 which the individual would be enrolled 

9 under clause (i), such clause shall not 

10 apply to such individual; or 

11 ‘‘(II) after such date, the State 

12 may terminate the enrollment of such 

13 individual. 

14 ‘‘(B) RELATIONSHIP OF ENROLLMENT TO

15 PAYMENT FOR SERVICES.— 

16 ‘‘(i) IN GENERAL.—Subject to sub17 paragraph (A)(ii), an eligible individual 

18 who is enrolled, or whose enrollment is re19 instated, under subparagraph (A) shall be 

20 eligible for all services for which medical 

21 assistance is provided under the State plan 

22 after the date that the eligible individual is 

23 released from the public institution. 

24 ‘‘(ii) RELATIONSHIP TO PAYMENT

25 PROHIBITION FOR INMATES.—No provision 


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1 of this paragraph may be construed to per2 mit payment for care or services for which 

3 payment is excluded under subdivision (A) 

4 following the last numbered paragraph of 

5 section 1905(a). 

6 ‘‘(C) TREATMENT OF CONTINUOUS ELIGI7 BILITY.— 

8 ‘‘(i) SUSPENSION FOR INMATES.—Any 

9 period of continuous eligibility under this 

10 title shall be suspended on the date an in11 dividual enrolled under this title becomes 

12 an inmate of a public institution (except as 

13 a patient of a medical institution). 

14 ‘‘(ii) DETERMINATION OF REMAINING

15 PERIOD.—Notwithstanding any changes to 

16 State law related to continuous eligibility 

17 during the time that an individual is an in18 mate of a public institution (except as a 

19 patient of a medical institution), subject to 

20 clause (iii), with respect to an eligible indi21 vidual who was subject to a suspension 

22 under clause (i), on the date that such in23 dividual is released from a public institu24 tion the suspension of continuous eligibility 

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1 riod that is equal to the time remaining in 

2 the period of continuous eligibility for such 

3 individual on the date that such period was 

4 suspended under such clause. 

5 ‘‘(iii) EXCEPTION.—If a State makes 

6 a determination that an individual is not 

7 eligible to be enrolled under the State 

8 plan— 

9 ‘‘(I) on or before the date that 

10 the suspension of continuous eligibility 

11 is lifted under clause (ii), such clause 

12 shall not apply to such individual; or 

13 ‘‘(II) after such date, the State 

14 may terminate the enrollment of such 

15 individual. 

16 ‘‘(D) AUTOMATIC ENROLLMENT OR REIN17 STATEMENT OF ENROLLMENT DEFINED.—For 

18 purposes of this paragraph, the term ‘automatic 

19 enrollment or reinstatement of enrollment’ 

20 means that the State determines eligibility for 

21 medical assistance under the State plan without 

22 a program application from, or on behalf of, the 

23 eligible individual, but an individual can only be 

24 automatically enrolled in the State Medicaid 

25 plan if the individual affirmatively consents to 


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1 being enrolled through affirmation in writing, 

2 by telephone, orally, through electronic signa3 ture, or through any other means specified by 

4 the Secretary. 

5 ‘‘(E) ELIGIBLE INDIVIDUAL DEFINED.— 

6 For purposes of this paragraph, the term ‘eligi7 ble individual’ means an individual who is an 

8 inmate of a public institution (except as a pa9 tient in a medical institution)— 

10 ‘‘(i) who was enrolled under the State 

11 plan for medical assistance immediately be12 fore becoming an inmate of such an insti13 tution; or 

14 ‘‘(ii) who is diagnosed with human im15 munodeficiency virus.’’. 

16 (b) SUPPLEMENTAL FUNDING FOR STATE IMPLE17 MENTATION OF AUTOMATIC REINSTATEMENT OF MED18 ICAID BENEFITS.— 

19 (1) IN GENERAL.—Subject to paragraph (3), 

20 with respect to a State, for each of the first 4 cal21 endar quarters in which the State plan meets the re22 quirements of paragraph (17) of section 1902(e) of 

23 the Social Security Act (42 U.S.C. 1396a(e)) (as 

24 added by subsection (a)), the Federal matching pay25 ments (including payments based on the Federal 


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1 medical assistance percentage) made to such State 

2 under section 1903 of the Social Security Act (42 

3 U.S.C. 1396b) for the State expenditures described 

4 in paragraph (2) shall be increased by 5 percentage 

5 points. 

6 (2) EXPENDITURES.—The expenditures de7 scribed in this paragraph are the following: 

8 (A) Expenditures for which payment is 

9 available under section 1903 of the Social Secu10 rity Act (42 U.S.C. 1396b) and which are at11 tributable to strengthening the State’s enroll12 ment and administrative resources for the pur13 pose of improving processes for enrolling (or re14 instating the enrollment of) eligible individuals 

15 (as such term is defined in subparagraph (E) of 

16 paragraph (16) of section 1902(e) of the Social 

17 Security Act (42 U.S.C. 1396a(e)) (as amended 

18 by subsection (a))). 

19 (B) Expenditures for medical assistance 

20 (as such term is defined in section 1905(a) of 

21 the Social Security Act (42 U.S.C. 1396d(a))) 

22 provided to such eligible individuals. 

23 (3) REQUIREMENTS; LIMITATION.— 

24 (A) REPORT.—A State is not eligible for 

25 an increase in its Federal matching payments 


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1 under paragraph (1) unless the State agrees to 

2 submit to the Secretary of Health and Human 

3 Services, and make publicly available, a report 

4 that contains the information required under 

5 paragraph (4) by the end of the 1-year period 

6 during which the State receives increased Fed7 eral matching payments in accordance with that 

8 paragraph. 

9 (B) MAINTENANCE OF ELIGIBILITY.— 

10 (i) IN GENERAL.—Subject to clause 

11 (ii), a State is not eligible for an increase 

12 in its Federal matching payments under 

13 paragraph (1) if eligibility standards, 

14 methodologies, or procedures under its 

15 State plan under title XIX of the Social 

16 Security Act (42 U.S.C. 1396 et seq.), or 

17 waiver of such a plan, are more restrictive 

18 than the eligibility standards, methodolo19 gies, or procedures, respectively, under 

20 such plan or waiver as in effect on the date 

21 of enactment of this Act. 

22 (ii) STATE REINSTATEMENT OF ELIGI23 BILITY PERMITTED.—A State that has re24 stricted eligibility standards, methodolo25 gies, or procedures under its State plan 


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1 under title XIX of the Social Security Act 

2 (42 U.S.C. 1396 et seq.), or a waiver of 

3 such plan, after the date of enactment of 

4 this Act, is no longer ineligible under 

5 clause (i) beginning with the first calendar 

6 quarter in which the State has reinstated 

7 eligibility standards, methodologies, or pro8 cedures that are no more restrictive than 

9 the eligibility standards, methodologies, or 

10 procedures, respectively, under such plan 

11 (or waiver) as in effect on such date. 

12 (C) LIMITATION OF MATCHING PAYMENTS

13 TO 100 PERCENT.—In no case shall an increase 

14 in Federal matching payments under paragraph 

15 (1) result in Federal matching payments that 

16 exceed 100 percent of State expenditures. 

17 (4) REQUIRED REPORT INFORMATION.—The in18 formation that is required in the report under para19 graph (3)(A) shall include— 

20 (A) the results of an evaluation of the im21 pact of the implementation of the requirements 

22 of paragraph (17) of section 1902(e) of the So23 cial Security Act (42 U.S.C. 1396a(e)) on im24 proving the State’s processes for enrolling indiVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 01275 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 viduals who are released from public institu2 tions under the State Medicaid plan; 

3 (B) the number of individuals who were 

4 automatically enrolled (or whose enrollment was 

5 reinstated) under such paragraph during the 1- 

6 year period during which the State received in7 creased payments under this subsection; and 

8 (C) any other information that is required 

9 by the Secretary of Health and Human Serv10 ices. 

11 (c) EFFECTIVE DATE.— 

12 (1) IN GENERAL.—Except as provided in para13 graph (2), the amendments made by subsection (a) 

14 shall take effect 180 days after the date of the en15 actment of this Act. 

16 (2) RULE FOR CHANGES REQUIRING STATE

17 LEGISLATION.—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 requirement imposed by the amendments 

24 made by subsection (a), the State plan shall not be 

25 regarded as failing to comply with the requirements 


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1 of such title solely on the basis of its failure to meet 

2 this additional requirement 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 the enactment of this 

6 Act. For purposes of the previous sentence, in the 

7 case of a State that has a 2-year legislative session, 

8 each year of such session shall be deemed to be a 

9 separate regular session of the State legislature. 

10 SEC. 7417. STOP HIV IN PRISON. 

11 (a) HIV POLICY.—The Director of the Bureau of 

12 Prisons (referred to in this section as the ‘‘Director’’) shall 

13 develop a comprehensive policy to provide HIV testing, 

14 treatment, and prevention for inmates within the correc15 tional setting and upon reentry. 

16 (b) PURPOSE.—The purposes of the policy required 

17 to be developed under subsection (a) shall be as follows: 

18 (1) To stop the spread of HIV among inmates. 

19 (2) To protect guards and other personnel at 

20 correctional facilities from HIV infection. 

21 (3) To provide comprehensive medical treat22 ment to inmates who are living with HIV. 

23 (4) To promote HIV awareness and prevention 

24 among inmates. 


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1 (5) To encourage inmates to take personal re2 sponsibility for their health. 

3 (6) To reduce the risk that inmates will trans4 mit HIV to other persons in the community fol5 lowing their release from a correctional facility. 

6 (c) CONSULTATION.—The Director shall consult with 

7 appropriate officials of the Department of Health and 

8 Human Services, the Office of National Drug Control Pol9 icy, the Office of National AIDS Policy, and the Centers 

10 for Disease Control and Prevention regarding the develop11 ment of the policy required under subsection (a). 

12 (d) TIME LIMIT.—Not later than 1 year after the 

13 date of enactment of this Act, the Director shall draft ap14 propriate regulations to implement the policy required to 

15 be developed under subsection (a). 

16 (e) REQUIREMENTS FOR POLICY.—The policy re17 quired to be developed under subsection (a) shall provide 

18 for the following: 

19 (1) TESTING AND COUNSELING UPON IN20 TAKE.— 

21 (A) Health care personnel shall provide 

22 routine HIV testing to all inmates as a part of 

23 a comprehensive medical examination imme24 diately following admission to a facility. Health 

25 care personnel need not provide routine HIV 


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1 testing to an inmate who is transferred to a fa2 cility from another facility if the inmate’s med3 ical records are transferred with the inmate and 

4 indicate that the inmate has been tested pre5 viously. 

6 (B) With respect to all inmates admitted 

7 to a facility prior to the effective date of the 

8 policy— 

9 (i) health care personnel shall provide 

10 routine HIV testing by not later than 180 

11 days after such effective date; and 

12 (ii) HIV testing described in clause (i) 

13 may be performed in conjunction with 

14 other health services provided to these in15 mates by health care personnel. 

16 (C) All HIV tests under this paragraph 

17 shall comply with the opt-out provision under 

18 paragraph (9). 

19 (2) PRE-TEST AND POST-TEST COUNSELING.— 

20 Health care personnel shall provide confidential pre21 test and post-test counseling to all inmates who are 

22 tested for HIV. Counseling may be included with 

23 other general health counseling provided to inmates 

24 by health care personnel. 

25 (3) HIV PREVENTION EDUCATION.— 


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1 (A) Health care personnel shall improve 

2 HIV awareness through frequent educational 

3 programs for all inmates. HIV educational pro4 grams may be provided by community-based or5 ganizations, local health departments, and in6 mate peer educators. 

7 (B) HIV educational materials shall be 

8 made available to all inmates at orientation, at 

9 health care clinics, at regular educational pro10 grams, and prior to release. Both written and 

11 audiovisual materials shall be made available to 

12 all inmates. 

13 (C)(i) The HIV educational programs and 

14 materials under this paragraph shall include in15 formation on— 

16 (I) modes of transmission, including 

17 transmission through tattooing, sexual con18 tact, and intravenous drug use; 

19 (II) prevention methods; 

20 (III) treatment; and 

21 (IV) disease progression. 

22 (ii) The programs and materials shall be 

23 culturally sensitive, written or designed for low24 literacy levels, available in a variety of lan25 guages, and present scientifically accurate inVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 01280 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 formation in a clear and understandable man2 ner. 

3 (4) HIV TESTING UPON REQUEST.— 

4 (A) Health care personnel shall allow in5 mates to obtain HIV tests upon request once 

6 per year or whenever an inmate has a reason to 

7 believe the inmate may have been exposed to 

8 HIV. Health care personnel shall, both orally 

9 and in writing, inform inmates, during orienta10 tion and periodically throughout incarceration, 

11 of their right to obtain HIV tests. 

12 (B) Health care personnel shall encourage 

13 inmates to request HIV tests if the inmate is 

14 sexually active, has been raped, uses intra15 venous drugs, receives a tattoo, or if the inmate 

16 is concerned that the inmate may have been ex17 posed to HIV. 

18 (C) An inmate’s request for an HIV test 

19 shall not be considered an indication that the 

20 inmate has put themselves at risk of infection 

21 or committed a violation of the rules of the cor22 rectional facility. 

23 (5) HIV TESTING OF PREGNANT WOMAN.— 


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1 (A) Health care personnel shall provide 

2 routine HIV testing to all inmates who become 

3 pregnant. 

4 (B) All HIV tests under this paragraph 

5 shall comply with the opt-out provision under 

6 paragraph (9). 

7 (6) COMPREHENSIVE TREATMENT.— 

8 (A) Health care personnel shall provide all 

9 inmates who test positive for HIV— 

10 (i) timely, comprehensive medical 

11 treatment; 

12 (ii) confidential counseling on man13 aging their medical condition and pre14 venting its transmission to other persons; 

15 and 

16 (iii) voluntary partner notification 

17 services. 

18 (B) Health care provided under this para19 graph shall be consistent with Department of 

20 Health and Human Services guidelines and 

21 standard medical practice. Health care per22 sonnel shall discuss treatment options, the im23 portance of adherence to antiretroviral therapy, 

24 and the side effects of medications with inmates 

25 receiving treatment. 


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1 (C) Health care personnel and pharmacy 

2 personnel shall ensure that the facility for3 mulary contains all Food and Drug Administra4 tion-approved medications necessary to provide 

5 comprehensive treatment for inmates living with 

6 HIV, and that the facility maintains adequate 

7 supplies of such medications to meet inmates’ 

8 medical needs. Health care personnel and phar9 macy personnel shall also develop and imple10 ment automatic renewal systems for these medi11 cations to prevent interruptions in care. 

12 (D) Correctional staff, health care per13 sonnel, and pharmacy personnel shall develop 

14 and implement distribution procedures to en15 sure timely and confidential access to medica16 tions. 

17 (7) PROTECTION OF CONFIDENTIALITY.— 

18 (A) Health care personnel shall develop 

19 and implement procedures to ensure the con20 fidentiality of inmate tests, diagnoses, and 

21 treatment. Health care personnel and correc22 tional staff shall receive regular training on the 

23 implementation of these procedures. Penalties 

24 for violations of inmate confidentiality by health 


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1 care personnel or correctional staff shall be 

2 specified and strictly enforced. 

3 (B) HIV testing, counseling, and treat4 ment shall be provided in a confidential setting 

5 where other routine health services are provided 

6 and in a manner that allows the inmate to re7 quest and obtain these services as routine med8 ical services. 

9 (8) TESTING, COUNSELING, AND REFERRAL

10 PRIOR TO REENTRY.— 

11 (A) Health care personnel shall provide 

12 routine HIV testing to all inmates not earlier 

13 than 90 days prior to their release and reentry 

14 into the community. Inmates who are already 

15 known to be infected need not be tested again. 

16 This requirement may be waived if an inmate’s 

17 release occurs without sufficient notice to the 

18 Director to allow health care personnel to per19 form a routine HIV test and notify the inmate 

20 of the results. 

21 (B) All HIV tests under this paragraph 

22 shall comply with the opt-out provision under 

23 paragraph (9). 

24 (C) With respect to all inmates who test 

25 positive for HIV and all inmates who already 


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1 are known to have HIV, health care personnel 

2 shall provide— 

3 (i) confidential prerelease counseling 

4 on managing their medical condition in the 

5 community, accessing appropriate treat6 ment and services in the community, and 

7 preventing the transmission of their condi8 tion to family members and other persons 

9 in the community; 

10 (ii) referrals to appropriate health 

11 care providers and social service agencies 

12 in the community that meet the inmate’s 

13 individual needs, including voluntary part14 ner notification services and prevention 

15 counseling services for people living with 

16 HIV; and 

17 (iii) a 30-day supply of any medically 

18 necessary medications the inmate is cur19 rently receiving. 

20 (9) OPT-OUT PROVISION.—Inmates shall have 

21 the right to refuse routine HIV testing. Inmates 

22 shall be informed both orally and in writing of this 

23 right. Oral and written disclosure of this right may 

24 be included with other general health information 

25 and counseling provided to inmates by health care 


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1 personnel. If an inmate refuses a routine test for 

2 HIV, health care personnel shall make a note of the 

3 inmate’s refusal in the inmate’s confidential medical 

4 records. However, the inmate’s refusal shall not be 

5 considered a violation of the rules of the correctional 

6 facility or result in disciplinary action. 

7 (10) EXCLUSION OF TESTS PERFORMED UNDER

8 SECTION 4014(b) FROM THE DEFINITION OF ROU9 TINE HIV TESTING.—HIV testing of an inmate 

10 under section 4014(b) of title 18, United States 

11 Code, is not routine HIV testing for the purposes of 

12 the opt-out provision under paragraph (9). Health 

13 care personnel shall document the reason for testing 

14 under section 4014(b) of title 18, United States 

15 Code, in the inmate’s confidential medical records. 

16 (11) TIMELY NOTIFICATION OF TEST RE17 SULTS.—Health care personnel shall provide timely 

18 notification to inmates of the results of HIV tests. 

19 (f) CHANGES IN EXISTING LAW.— 

20 (1) SCREENING IN GENERAL.—Section 4014(a) 

21 of title 18, United States Code, is amended— 

22 (A) by striking ‘‘for a period of 6 months 

23 or more’’; 

24 (B) by striking ‘‘, as appropriate,’’; and 


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1 (C) by striking ‘‘if such individual is deter2 mined to be at risk for infection with such virus 

3 in accordance with the guidelines issued by the 

4 Bureau of Prisons relating to infectious disease 

5 management.’’ and inserting ‘‘unless the indi6 vidual declines. The Attorney General shall also 

7 cause such individual to be so tested before re8 lease from that incarceration unless the indi9 vidual declines.’’. 

10 (2) INADMISSIBILITY OF HIV TEST RESULTS IN

11 CIVIL AND CRIMINAL PROCEEDINGS.—Section 

12 4014(d) of title 18, United States Code, is amended 

13 by inserting ‘‘or under section 7417 of the Health 

14 Equity and Accountability Act of 2024’’ after 

15 ‘‘under this section’’. 

16 (3) SCREENING AS PART OF ROUTINE SCREEN17 ING.—Section 4014(e) of title 18, United States 

18 Code, is amended by adding at the end the fol19 lowing: ‘‘Such rules shall also provide that the initial 

20 test under this section be performed as part of the 

21 routine health screening conducted at intake.’’. 

22 (g) REPORTING REQUIREMENTS.— 

23 (1) REPORT ON HEPATITIS, LIVER, AND OTHER

24 DISEASES.—Not later than 1 year after the date of 

25 enactment of this Act, the Director shall submit to 


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1 Congress a report on the policies and procedures of 

2 the Bureau of Prisons to provide testing, treatment, 

3 and prevention education programs for hepatitis, 

4 liver failure, and other liver-related diseases trans5 mitted through sexual activity, intravenous drug use, 

6 or other means. The Director shall consult with ap7 propriate officials of the Department of Health and 

8 Human Services, the Office of National Drug Con9 trol Policy, the Office of National AIDS Policy, and 

10 the Centers for Disease Control and Prevention re11 garding the development of this report. 

12 (2) ANNUAL REPORTS.— 

13 (A) GENERALLY.—Not later than 2 years 

14 after the date of enactment of this Act, and an15 nually thereafter, the Director submit to Con16 gress a report on the incidence among inmates 

17 of diseases transmitted through sexual activity 

18 and intravenous drug use. 

19 (B) MATTERS PERTAINING TO VARIOUS

20 DISEASES.—Each report under subparagraph 

21 (A) shall discuss— 

22 (i) the incidence among inmates of 

23 HIV, hepatitis, and other diseases trans24 mitted through sexual activity and intra25 venous drug use; and 


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1 (ii) updates on the testing, treatment, 

2 and prevention education programs for 

3 these diseases conducted by the Bureau of 

4 Prisons. 

5 (C) MATTERS PERTAINING TO HIV

6 ONLY.—Each report under subparagraph (A) 

7 shall also include— 

8 (i) the number of inmates who tested 

9 positive for HIV upon intake; 

10 (ii) the number of inmates who tested 

11 positive for HIV prior to reentry; 

12 (iii) the number of inmates who were 

13 not tested for HIV prior to reentry because 

14 they were released without sufficient no15 tice; 

16 (iv) the number of inmates who opted 

17 out of taking an HIV test; 

18 (v) the number of inmates who were 

19 tested under section 4014(b) of title 18, 

20 United States Code; and 

21 (vi) the number of inmates under 

22 treatment for HIV. 

23 (D) CONSULTATION.—The Director shall 

24 consult with appropriate officials of the Depart25 ment of Health and Human Services, the Office 


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1 of National Drug Control Policy, the Office of 

2 National AIDS Policy, and the Centers for Dis3 ease Control and Prevention regarding the de4 velopment of each report under subparagraph 

5 (A). 

6 SEC. 7418. TRANSFER OF FUNDS FOR IMPLEMENTATION OF 

7 ENDING THE HIV EPIDEMIC: A PLAN FOR 

8 AMERICA. 

9 Title II of the Public Health Service Act (42 U.S.C. 

10 202 et seq.) is amended by inserting after section 241 (42 

11 U.S.C. 238j) the following: 

12 ‘‘SEC. 241A. TRANSFER OF FUNDS FOR IMPLEMENTATION 

13 OF NATIONAL HIV/AIDS STRATEGY. 

14 ‘‘(a) TRANSFER AUTHORIZATION.—Of the discre15 tionary appropriations made available to the Department 

16 of Health and Human Services for any fiscal year for pro17 grams and activities that, as determined by the Secretary, 

18 pertain to HIV, the Secretary may transfer up to 1 per19 cent of such appropriations to the Office of the Assistant 

20 Secretary for Health for implementation of the Ending the 

21 HIV Epidemic: A Plan for America. 

22 ‘‘(b) CONGRESSIONAL NOTIFICATION.—Not less than 

23 30 days before making any transfer under this section, 

24 the Secretary shall give notice of the transfer to the Con25 gress. 


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1 ‘‘(c) DEFINITIONS.—In this section, the term ‘End2 ing the HIV Epidemic: A Plan for America’ means the 

3 initiative of the Department of Health and Human Serv4 ices that seeks to reduce the number of new HIV infec5 tions in the United States by 75 percent by 2025, and 

6 then by at least 90 percent by 2030, for an estimated 

7 250,000 total HIV infections averted.’’. 

8 SEC. 7419. PrEP ACCESS AND COVERAGE. 

9 (a) COVERAGE OF HIV TESTING AND PREVENTION

10 SERVICES.— 

11 (1) PRIVATE INSURANCE.— 

12 (A) IN GENERAL.—Section 2713(a) of the 

13 Public Health Service Act (42 U.S.C. 300gg– 

14 13(a)) is amended— 

15 (i) in paragraph (2), by striking ‘‘; 

16 and’’ and inserting a semicolon; 

17 (ii) in paragraph (3), by striking the 

18 period and inserting a semicolon; 

19 (iii) in paragraph (4), by striking the 

20 period and inserting a semicolon; 

21 (iv) in paragraph (5), by striking the 

22 period and inserting ‘‘; and’’; and 

23 (v) by adding at the end the following: 

24 ‘‘(6) any prescription drug approved by the 

25 Food and Drug Administration for the prevention of 


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1 HIV (other than a drug subject to preauthorization 

2 requirements consistent with section 2729A), admin3 istrative fees for such drugs, laboratory and other 

4 diagnostic procedures associated with the use of 

5 such drugs, and clinical follow-up and monitoring, 

6 including any related services recommended in cur7 rent United States Public Health Service clinical 

8 practice guidelines, without limitation.’’. 

9 (B) PROHIBITION ON PREAUTHORIZATION

10 REQUIREMENTS.—Subpart II of part A of title 

11 XXVII of the Public Health Service Act (42 

12 U.S.C. 300gg–11 et seq.) is amended by adding 

13 at the end the following: 

14 ‘‘SEC. 2729A. PROHIBITION ON PREAUTHORIZATION RE15 QUIREMENTS WITH RESPECT TO CERTAIN 

16 SERVICES. 

17 ‘‘A group health plan or a health insurance issuer of18 fering group or individual health insurance coverage shall 

19 not impose any preauthorization requirements with re20 spect to coverage of the services described in section 

21 2713(a)(1)(E), except that a plan or issuer may impose 

22 preauthorization requirements with respect to coverage of 

23 a particular drug approved under section 505(c) of the 

24 Federal Food, Drug, and Cosmetic Act or section 351(a) 

25 of this Act if such plan or issuer provides coverage without 


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1 any preauthorization requirements for a drug that is ther2 apeutically equivalent.’’. 

3 (2) COVERAGE UNDER FEDERAL EMPLOYEES

4 HEALTH BENEFITS PROGRAM.—Section 8904 of title 

5 5, United States Code, is amended by adding at the 

6 end the following: 

7 ‘‘(c) Any health benefits plan offered under this chap8 ter shall include benefits for, and may not impose any cost 

9 sharing requirements for, any prescription drug approved 

10 by the Food and Drug Administration for the prevention 

11 of HIV, administrative fees for such drugs, laboratory and 

12 other diagnostic procedures associated with the use of 

13 such drugs, and clinical follow-up and monitoring, includ14 ing any related services recommended in current United 

15 States Public Health Service clinical practice guidelines, 

16 without limitation.’’. 

17 (3) MEDICAID.— 

18 (A) IN GENERAL.—Section 1905 of the So19 cial Security Act (42 U.S.C. 1396d), as amend20 ed by section 5406(g), is amended— 

21 (i) in subsection (a)(4)— 

22 (I) by striking ‘‘; and (G)’’ and 

23 inserting ‘‘; (G)’’; and 


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1 (II) by striking the semicolon at 

2 the end and inserting ‘‘; and (H) HIV 

3 prevention services;’’; and 

4 (ii) by adding at the end the following 

5 new subsection: 

6 ‘‘(rr) HIV PREVENTION SERVICES.—For purposes of 

7 subsection (a)(4)(H), the term ‘HIV prevention services’ 

8 means prescription drugs for the prevention of HIV acqui9 sition, administrative fees for such drugs, laboratory and 

10 other diagnostic procedures associated with the use of 

11 such drugs, and clinical follow-up and monitoring, includ12 ing any related services recommended in current United 

13 States Public Health Service clinical practice guidelines, 

14 without limitation.’’. 

15 (B) NO COST-SHARING.—Title XIX of the 

16 Social Security Act (42 U.S.C. 1396 et seq.) is 

17 amended— 

18 (i) in section 1916, by inserting ‘‘HIV 

19 prevention services described in section 

20 1905(a)(4)(H),’’ after ‘‘section 

21 1905(a)(4)(C),’’ each place it appears; and 

22 (ii) in section 1916A(b)(3)(B), as 

23 amended by section 7305, by adding at the 

24 end the following new clause: 


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1 ‘‘(xvi) HIV prevention services de2 scribed in section 1905(a)(4)(H).’’. 

3 (C) INCLUSION IN BENCHMARK COV4 ERAGE.—Section 1937(b)(7) of the Social Secu5 rity Act (42 U.S.C. 1396u–7(b)(7)) is amend6 ed— 

7 (i) in the paragraph header, by insert8 ing ‘‘AND HIV PREVENTION SERVICES’’ 

9 after ‘‘SUPPLIES’’; and 

10 (ii) by striking ‘‘includes for any indi11 vidual described in section 1905(a)(4)(C), 

12 medical assistance for family planning 

13 services and supplies in accordance with 

14 such section’’ and inserting ‘‘includes med15 ical assistance for HIV prevention services 

16 described in section 1905(a)(4)(H), and in17 cludes, for any individual described in sec18 tion 1905(a)(4)(H), medical assistance for 

19 family planning services and supplies in ac20 cordance with such section’’. 

21 (4) CHIP.— 

22 (A) IN GENERAL.—Section 2103 of the So23 cial Security Act (42 U.S.C. 1397cc), as 

24 amended by section 2007(d)(5), is amended— 


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1 (i) in subsection (a), by striking 

2 ‘‘through (13)’’ and inserting ‘‘through 

3 (14)’’; and 

4 (ii) in subsection (c), by adding at the 

5 end the following new paragraph: 

6 ‘‘(14) HIV PREVENTION SERVICES.—Regard7 less of the type of coverage elected by a State under 

8 subsection (a), the child health assistance provided 

9 for a targeted low-income child, and, in the case of 

10 a State that elects to provide pregnancy-related as11 sistance pursuant to section 2112, the pregnancy-re12 lated assistance provided for a targeted low-income 

13 pregnant woman (as such terms are defined for pur14 poses of such section), shall include coverage of HIV 

15 prevention services (as defined in section 

16 1905(rr)).’’. 

17 (B) NO COST-SHARING.—Section 

18 2103(e)(2) of the Social Security Act (42 

19 U.S.C. 1397cc(e)(2)) is amended by inserting 

20 ‘‘HIV prevention services described in sub21 section (c)(14),’’ before ‘‘or for pregnancy-re22 lated assistance’’. 

23 (C) EFFECTIVE DATE.— 

24 (i) IN GENERAL.—Subject to clause 

25 (ii), the amendments made by paragraph 


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1 (3) and this paragraph shall take effect on 

2 January 1, 2025. 

3 (ii) DELAY PERMITTED IF STATE LEG4 ISLATION REQUIRED.—In the case of a 

5 State plan approved under title XIX or 

6 XXI of the Social Security Act which the 

7 Secretary of Health and Human Services 

8 determines requires State legislation (other 

9 than legislation appropriating funds) in 

10 order for the plan to meet the additional 

11 requirements imposed by this subsection, 

12 the State plan shall not be regarded as 

13 failing to comply with the requirements of 

14 such title solely on the basis of the failure 

15 of the plan to meet such additional re16 quirements before the 1st day of the 1st 

17 calendar quarter beginning after the close 

18 of the 1st regular session of the State leg19 islature that ends after the 1-year period 

20 beginning with the date of the enactment 

21 of this Act. For purposes of the preceding 

22 sentence, in the case of a State that has a 

23 2-year legislative session, each year of the 

24 session is deemed to be a separate regular 

25 session of the State legislature. 


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1 (5) COVERAGE AND ELIMINATION OF COST2 SHARING UNDER MEDICARE.— 

3 (A) COVERAGE OF HIV PREVENTION SERV4 ICES UNDER PART B.— 

5 (i) COVERAGE.— 

6 (I) IN GENERAL.—Section 

7 1861(s)(2) of the Social Security Act 

8 (42 U.S.C. 1395x(s)(2)), as amended 

9 by section 4251(c)(1) and 6101(a)(1), 

10 is amended— 

11 (aa) by striking ‘‘and’’ at 

12 the end of subparagraph (KK); 

13 (bb) by inserting ‘‘and’’ at 

14 the end of subparagraph (LL); 

15 and 

16 (cc) by adding at the end 

17 the following new subparagraph: 

18 ‘‘(MM) HIV prevention services (as defined in 

19 subsection (ppp));’’. 

20 (II) DEFINITION.—Section 1861 

21 of the Social Security Act (42 U.S.C. 

22 1395x), as amended by sections 

23 2007(b), 4221(a), 4251(c)(2), and 

24 6101(a)(2), is amended by adding at 

25 the end the following new subsection: 


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1 ‘‘(rrr) HIV PREVENTION SERVICES.—The term ‘HIV 

2 prevention services’ means— 

3 ‘‘(1) drugs or biologicals approved by the Food 

4 and Drug Administration for the prevention of HIV; 

5 ‘‘(2) administrative fees for such drugs; 

6 ‘‘(3) laboratory and other diagnostic procedures 

7 associated with the use of such drugs; and 

8 ‘‘(4) clinical follow-up and monitoring, including 

9 any related services recommended in current United 

10 States Public Health Service clinical practice guide11 lines, without limitation.’’. 

12 (ii) ELIMINATION OF COINSURANCE.— 

13 Section 1833(a)(1) of the Social Security 

14 Act (42 U.S.C. 1395l(a)(1)), as amended 

15 by sections 4251(c)(3) and 6101(a)(4), is 

16 amended— 

17 (I) by striking ‘‘and’’ before 

18 ‘‘(JJ)’’; and 

19 (II) by inserting before the semi20 colon at the end the following: ‘‘and 

21 (KK) with respect to HIV prevention 

22 services (as defined in section 

23 1861(rrr)), the amount paid shall be 

24 100 percent of (i) except as provided 

25 in clause (ii), the lesser of the actual 


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1 charge for the service or the amount 

2 determined under the fee schedule 

3 that applies to such services under 

4 this part, and (ii) in the case of such 

5 services that are covered OPD serv6 ices (as defined in subsection 

7 (t)(1)(B)), the amount determined 

8 under subsection (t)’’. 

9 (iii) EXEMPTION FROM PART B DE10 DUCTIBLE.—Section 1833(b) of the Social 

11 Security Act (42 U.S.C. 1395l(b)) is 

12 amended— 

13 (I) in paragraph (12), by striking 

14 ‘‘section 1861(s)(10)(A),, and’’ and 

15 inserting ‘‘section 1861(s)(10)(A),’’; 

16 (II) in paragraph (13), by strik17 ing ‘‘section 1861(n)..’’ and inserting 

18 ‘‘section 1861(n), and (14) such de19 ductible shall not apply with respect 

20 to HIV prevention services (as defined 

21 in section 1861(rrr).’’. 

22 (iv) EFFECTIVE DATE.—The amend23 ments made by this subparagraph shall 

24 apply to items and services furnished on or 

25 after January 1, 2025. 


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1 (B) ELIMINATION OF COST-SHARING FOR

2 DRUGS FOR THE PREVENTION OF HIV UNDER

3 PART D.— 

4 (i) IN GENERAL.—Section 1860D–2 

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

6 1395w–102) is amended— 

7 (I) in subsection (b)— 

8 (aa) in paragraph (1)(A), in 

9 the matter preceding clause (i), 

10 by striking ‘‘(8) and (9)’’ and in11 serting ‘‘(8), (9), and (10)’’; 

12 (bb) in paragraph (2)(A), in 

13 subparagraph (A), in the matter 

14 preceding clause (i), by striking 

15 ‘‘(8) and (9)’’ and inserting ‘‘(8), 

16 (9), and (10)’’; and 

17 (cc) by adding at the end 

18 the following new paragraph: 

19 ‘‘(10) ELIMINATION OF COST-SHARING FOR

20 DRUGS FOR THE PREVENTION OF HIV.—For plan 

21 years beginning on or after January 1, 2025, with 

22 respect to a covered part D drug that is for the pre23 vention of HIV— 

24 ‘‘(A) the deductible under paragraph (1) 

25 shall not apply; and 


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1 ‘‘(B) there shall be no coinsurance or other 

2 cost-sharing under this part with respect to 

3 such drug.’’; and 

4 (II) in subsection (c), by adding 

5 at the end the following new para6 graph: 

7 ‘‘(7) TREATMENT OF COST-SHARING FOR

8 DRUGS FOR THE PREVENTION OF HIV.—The cov9 erage is in accordance with subsection (b)(10).’’. 

10 (ii) CONFORMING AMENDMENTS TO

11 COST-SHARING FOR LOW-INCOME INDIVID12 UALS.—Section 1860D–14(a)(1)(D) of the 

13 Social Security Act (42 U.S.C. 1395w– 

14 114(a)(1)(D)) is amended in each of 

15 clauses (ii) and (iii), by striking ‘‘para16 graph (6)’’ and inserting ‘‘paragraph (6) 

17 and section 1860D–2(b)(10)’’. 

18 (6) COVERAGE OF HIV PREVENTION TREAT19 MENT BY DEPARTMENT OF VETERANS AFFAIRS.— 

20 (A) ELIMINATION OF MEDICATION COPAY21 MENTS.—Section 1722A(a) of title 38, United 

22 States Code, is amended by adding at the end 

23 the following new paragraph: 

24 ‘‘(5) Paragraph (1) does not apply to a medication 

25 for the prevention of HIV.’’. 


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1 (B) ELIMINATION OF HOSPITAL CARE AND

2 MEDICAL SERVICES COPAYMENTS.—Section 

3 1710 of such title is amended— 

4 (i) in subsection (f)— 

5 (I) by redesignating paragraph 

6 (5) as paragraph (6); and 

7 (II) by inserting after paragraph 

8 (4) the following new paragraph (5): 

9 ‘‘(5) A veteran shall not be liable to the United States 

10 under this subsection for any amounts for laboratory and 

11 other diagnostic procedures associated with the use of any 

12 prescription drug approved by the Food and Drug Admin13 istration for the prevention of HIV, administrative fees for 

14 such drugs, or for laboratory or other diagnostic proce15 dures associated with the use of such drugs, or clinical 

16 follow-up and monitoring, including any related services 

17 recommended in current United States Public Health 

18 Service clinical practice guidelines, without limitation.’’; 

19 and 

20 (ii) in subsection (g)(3), by adding at 

21 the end the following new subparagraph: 

22 ‘‘(C) Any prescription drug approved by the 

23 Food and Drug Administration for the prevention of 

24 HIV, administrative fees for such drugs, laboratory 

25 and other diagnostic procedures associated with the 


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1 use of such drugs, and clinical follow-up and moni2 toring, including any related services recommended 

3 in current United States Public Health Service clin4 ical practice guidelines, without limitation.’’. 

5 (C) INCLUSION AS PREVENTIVE HEALTH

6 SERVICE.—Section 1701(9) of such title is 

7 amended— 

8 (i) in subparagraph (K), by striking ‘‘; 

9 and’’ and inserting a semicolon; 

10 (ii) by redesignating subparagraph 

11 (L) as subparagraph (M); and 

12 (iii) by inserting after subparagraph 

13 (K) the following new subparagraph (L): 

14 ‘‘(L) any prescription drug approved by 

15 the Food and Drug Administration for the pre16 vention of HIV, administrative fees for such 

17 drugs, laboratory and other diagnostic proce18 dures associated with the use of such drugs, 

19 and clinical follow-up and monitoring, including 

20 any related services recommended in current 

21 United States Public Health Service clinical 

22 practice guidelines, without limitation; and’’. 

23 (7) COVERAGE OF HIV PREVENTION TREAT24 MENT BY DEPARTMENT OF DEFENSE.— 


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1 (A) IN GENERAL.—Chapter 55 of title 10, 

2 United States Code, is amended by inserting 

3 after section 1079c the following new section: 

4 ‘‘§ 1079d. Coverage of HIV prevention treatment 

5 ‘‘(a) IN GENERAL.—The Secretary of Defense shall 

6 ensure coverage under the TRICARE program of HIV 

7 prevention treatment described in subsection (b) for any 

8 beneficiary under section 1074(a) of this title. 

9 ‘‘(b) HIV PREVENTION TREATMENT DESCRIBED.— 

10 HIV prevention treatment described in this subsection in11 cludes any prescription drug approved by the Food and 

12 Drug Administration for the prevention of HIV, adminis13 trative fees for such drugs, laboratory and other diagnostic 

14 procedures associated with the use of such drugs, and clin15 ical follow-up and monitoring, including any related serv16 ices recommended in current United States Public Health 

17 Service clinical practice guidelines, without limitation. 

18 ‘‘(c) NO COST-SHARING.—Notwithstanding section 

19 1075, 1075a, or 1074g(a)(6) of this title or any other pro20 vision of law, there is no cost-sharing requirement for HIV 

21 prevention treatment covered under this section.’’. 

22 (B) CLERICAL AMENDMENT.—The table of 

23 sections at the beginning of such chapter is 

24 amended by inserting after the item relating to 

25 section 1079c the following new item: 

‘‘1079d. Coverage of HIV prevention treatment.’’. 


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1 (8) INDIAN HEALTH SERVICE TESTING, MONI2 TORING, AND PRESCRIPTION DRUGS FOR THE PRE3 VENTION OF HIV.—Title II of the Indian Health 

4 Care Improvement Act is amended by inserting after 

5 section 223 (25 U.S.C. 1621v) the following: 

6 ‘‘SEC. 224. TESTING, MONITORING, AND PRESCRIPTION 

7 DRUGS FOR THE PREVENTION OF HIV. 

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

9 the Service, Indian tribes, and tribal organizations, shall 

10 provide, without limitation, funding for any prescription 

11 drug approved by the Food and Drug Administration for 

12 the prevention of human immunodeficiency virus (com13 monly known as ‘HIV’), administrative fees for that drug, 

14 laboratory and other diagnostic procedures associated with 

15 the use of that drug, and clinical follow-up and moni16 toring, including any related services recommended in cur17 rent Public Health Service clinical practice guidelines. 

18 ‘‘(b) AUTHORIZATION OF APPROPRIATIONS.—There 

19 are authorized to be appropriated such sums as are nec20 essary to carry out this section.’’. 

21 (9) EFFECTIVE DATE.—The amendments made 

22 by paragraphs (1), (2), (5), (6), (7), and (8) shall 

23 take effect with respect to plan years beginning on 

24 or after January 1, 2025. 


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1 (b) PROHIBITION ON DENIAL OF COVERAGE OR IN2 CREASE IN PREMIUMS OF LIFE, DISABILITY, OR LONG3 TERM CARE INSURANCE FOR INDIVIDUALS TAKING

4 MEDICATION FOR THE PREVENTION OF HIV ACQUISI5 TION.— 

6 (1) PROHIBITION.—Notwithstanding any other 

7 provision of law, it shall be unlawful to— 

8 (A) decline or limit coverage of a person 

9 under any life insurance policy, disability insur10 ance policy, or long-term care insurance policy, 

11 on account of the individual taking medication 

12 for the purpose of preventing the acquisition of 

13 HIV; 

14 (B) preclude an individual from taking 

15 medication for the purpose of preventing the ac16 quisition of HIV as a condition of receiving a 

17 life insurance policy, disability insurance policy, 

18 or long-term care insurance policy; 

19 (C) consider whether an individual is tak20 ing medication for the purpose of preventing 

21 the acquisition of HIV in determining the pre22 mium rate for coverage of such individual under 

23 a life insurance policy, disability insurance pol24 icy, or long-term care insurance policy; or 


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1 (D) otherwise discriminate in the offering, 

2 issuance, cancellation, amount of such coverage, 

3 price, or any other condition of a life insurance 

4 policy, disability insurance policy, or long-term 

5 care insurance policy for an individual, based 

6 solely and without any additional actuarial risks 

7 upon whether the individual is taking medica8 tion for the purpose of preventing the acquisi9 tion of HIV. 

10 (2) ENFORCEMENT.—A State insurance regu11 lator may take such actions to enforce paragraph (1) 

12 as are specifically authorized under the laws of such 

13 State. 

14 (3) DEFINITIONS.—In this subsection: 

15 (A) DISABILITY INSURANCE POLICY.—The 

16 term ‘‘disability insurance policy’’ means a con17 tract under which an entity promises to pay a 

18 person a sum of money in the event that an ill19 ness or injury resulting in a disability prevents 

20 such person from working. 

21 (B) LIFE INSURANCE POLICY.—The term 

22 ‘‘life insurance policy’’ means a contract under 

23 which an entity promises to pay a designated 

24 beneficiary a sum of money upon the death of 

25 the insured. 


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1 (C) LONG-TERM CARE INSURANCE POL2 ICY.—The term ‘‘long-term care insurance pol3 icy’’ means a contract for which the only insur4 ance protection provided under the contract is 

5 coverage of qualified long-term care services (as 

6 defined in section 7702B(c) of the Internal 

7 Revenue Code of 1986). 

8 (c) PATIENT CONFIDENTIALITY.—The Secretary of 

9 Health and Human Services shall amend the regulations 

10 promulgated under section 264(c) of the Health Insurance 

11 Portability and Accountability Act of 1996 (42 U.S.C. 

12 1320d–2 note), as necessary, to ensure that individuals 

13 are able to access the benefits described in section 

14 2713(a)(1)(E) of the Public Health Service Act under a 

15 family plan without any other individual enrolled in such 

16 family plan, including a primary subscriber or policyholder 

17 of such plan, being informed of such use of such benefits. 

18 (d) PRE-EXPOSURE PROPHYLAXIS AND POST-EXPO19 SURE PROPHYLAXIS FUNDING.—Part P of title III of the 

20 Public Health Service Act (42 U.S.C. 280g et seq.), as 

21 amended by section 7303, is amended by adding at the 

22 end the following: 


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1 ‘‘SEC. 399V–11. PRE-EXPOSURE PROPHYLAXIS AND POST-EX2 POSURE PROPHYLAXIS FUNDING. 

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

4 date of enactment of this section, the Secretary shall es5 tablish a program that awards grants to States, terri6 tories, Indian Tribes, and directly eligible entities for the 

7 establishment and support of pre-exposure prophylaxis 

8 (referred to in this section as ‘PrEP’) and post-exposure 

9 prophylaxis (referred to in this section as ‘PEP’) HIV pro10 grams. 

11 ‘‘(b) APPLICATIONS.—To be eligible to receive a 

12 grant under subsection (a), a State, territory, Indian 

13 Tribe, or directly eligible entity shall— 

14 ‘‘(1) submit an application to the Secretary at 

15 such time, in such manner, and containing such in16 formation as the Secretary may require, including a 

17 plan describing how any funds awarded will be used 

18 to increase access to PrEP for uninsured and under19 insured individuals and reduce disparities in access 

20 to PrEP and PEP for uninsured and underinsured 

21 individuals and reduce disparities in access to PrEP 

22 and PEP; and 

23 ‘‘(2) appoint a PrEP and PEP grant adminis24 trator to manage the program. 

25 ‘‘(c) DIRECTLY ELIGIBLE ENTITY.—For purposes of 

26 this section, the term ‘directly eligible entity’— 


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1 ‘‘(1) means a Federally qualified health center 

2 or other nonprofit entity engaged in providing PrEP 

3 and PEP information and services; and 

4 ‘‘(2) may include— 

5 ‘‘(A) a Federally qualified health center 

6 (as defined in section 1861(aa)(4) of the Social 

7 Security Act (42 U.S.C. 1395x(aa)(4))); 

8 ‘‘(B) a family planning grantee (other than 

9 States) funded under section 1001 of the Public 

10 Health Service Act (42 U.S.C. 300); 

11 ‘‘(C) a rural health clinic (as defined in 

12 section 1861(aa)(2) of the Social Security Act 

13 (42 U.S.C. 1395x(aa)(2))); 

14 ‘‘(D) a health facility operated by or pur15 suant to a contract with the Indian Health 

16 Service; 

17 ‘‘(E) a community-based organization, clin18 ic, hospital, or other health facility that pro19 vides services to individuals at risk for or living 

20 with HIV; and 

21 ‘‘(F) a nonprofit private entity providing 

22 comprehensive primary care to populations at 

23 risk of HIV, including faith-based and commu24 nity-based organizations. 


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1 ‘‘(d) AWARDS.—In determining whether to award a 

2 grant, and the grant amount for each grant awarded, the 

3 Secretary shall consider the grant application and the 

4 need for PrEP and PEP services in the area, the number 

5 of uninsured and underinsured individuals in the area, and 

6 how the State, territory, or Indian Tribe coordinates 

7 PrEP and PEP activities with the directly funded entity, 

8 if the State, territory, or Indian Tribe applies for the 

9 funds. 

10 ‘‘(e) USE OF FUNDS.— 

11 ‘‘(1) IN GENERAL.—Any State, territory, Indian 

12 Tribe, or directly eligible entity that is awarded 

13 funds under subsection (a) shall use such funds for 

14 eligible PrEP and PEP expenses. 

15 ‘‘(2) ELIGIBLE PREP EXPENSES.—The Sec16 retary shall publish a list of expenses that qualify as 

17 eligible PrEP and PEP expenses for purposes of this 

18 section, which shall include— 

19 ‘‘(A) any prescription drug approved by 

20 the Food and Drug Administration for the pre21 vention of HIV, administrative fees for such 

22 drugs, laboratory and other diagnostic proce23 dures associated with the use of such drugs, 

24 and clinical follow-up and monitoring, including 

25 any related services recommended in current 


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1 United States Public Health Service clinical 

2 practice guidelines, without limitation; 

3 ‘‘(B) outreach and public education activi4 ties directed toward populations overrepresented 

5 in the domestic HIV epidemic that increase 

6 awareness about the existence of PrEP and 

7 PEP, provide education about access to and 

8 health care coverage of PrEP and PEP, PrEP 

9 and PEP adherence programs, and counter 

10 stigma associated with the use of PrEP and 

11 PEP; and 

12 ‘‘(C) outreach activities directed toward 

13 physicians and other providers that provide 

14 education about PrEP and PEP. 

15 ‘‘(f) REPORT TO CONGRESS.—The Secretary shall, in 

16 each of the first 5 years beginning one year after the date 

17 of the enactment of this section, submit to Congress, and 

18 make public on the internet website of the Department 

19 of Health and Human Services, a report on the impact 

20 of any grants provided to States, territories, and Indian 

21 Tribes and directly eligible entities for the establishment 

22 and support of pre-exposure prophylaxis programs under 

23 this section. 

24 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—To 

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1 priated such sums as may be necessary for each of fiscal 

2 years 2025 through 2030.’’. 

3 (e) CLARIFICATION.—This section, including the 

4 amendments made by this section, shall apply notwith5 standing any other provision of law, including Public Law 

6 103–141. 

7 (f) PRIVATE RIGHT OF ACTION.—Any person ag8 grieved by a violation of this section, including the amend9 ments made by this section, may commence a civil action 

10 in an appropriate United States District Court or other 

11 court of competent jurisdiction to obtain relief as allowed 

12 by law as either an individual or member of a class. If 

13 the plaintiff is the prevailing party in such an action, the 

14 court shall order the defendant to pay the costs and rea15 sonable attorney fees of the plaintiff. 

16 Subtitle F—Diabetes 

17 SEC. 7501. RESEARCH, TREATMENT, AND EDUCATION. 

18 Subpart 3 of part C of title IV of the Public Health 

19 Service Act (42 U.S.C. 285c et seq.) is amended by adding 

20 at the end the following: 

21 ‘‘SEC. 434B. DIABETES IN MINORITY POPULATIONS. 

22 ‘‘(a) IN GENERAL.—The Director of NIH shall ex23 pand, intensify, and support ongoing research and other 

24 activities with respect to prediabetes and diabetes, particu25 larly type 2, in minority populations. 


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1 ‘‘(b) RESEARCH.— 

2 ‘‘(1) DESCRIPTION.—Research under subsection 

3 (a) shall include investigation into— 

4 ‘‘(A) the causes of diabetes, including so5 cioeconomic, geographic, clinical, environmental, 

6 genetic, and other factors that may contribute 

7 to increased rates of diabetes in minority popu8 lations; and 

9 ‘‘(B) the causes of increased incidence of 

10 diabetes complications in minority populations, 

11 and possible interventions to decrease such inci12 dence. 

13 ‘‘(2) INCLUSION OF MINORITY PARTICIPANTS.— 

14 In conducting and supporting research described in 

15 subsection (a), the Director of NIH shall seek to in16 clude minority participants as study subjects in clin17 ical trials. 

18 ‘‘(c) REPORT; COMPREHENSIVE PLAN.— 

19 ‘‘(1) IN GENERAL.—The Diabetes Mellitus 

20 Interagency Coordinating Committee shall— 

21 ‘‘(A) prepare and submit to Congress, not 

22 later than 6 months after the date of enactment 

23 of this section, a report on Federal research 

24 and public health activities with respect to 


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1 prediabetes and diabetes in minority popu2 lations; and 

3 ‘‘(B) develop and submit to Congress, not 

4 later than 1 year after the date of enactment of 

5 this section, an effective and comprehensive 

6 Federal plan (including all appropriate Federal 

7 health programs) to address prediabetes and di8 abetes in minority populations. 

9 ‘‘(2) CONTENTS.—The report under paragraph 

10 (1)(A) shall at minimum address each of the fol11 lowing: 

12 ‘‘(A) Research on diabetes and prediabetes 

13 in minority populations, including such research 

14 on— 

15 ‘‘(i) genetic, behavioral, socio16 economic, and environmental factors; 

17 ‘‘(ii) prevention of diabetes within 

18 these populations and which of the popu19 lations have individuals at increased risk of 

20 developing diabetes; 

21 ‘‘(iii) prevention of complications 

22 among individuals in these populations who 

23 have already developed diabetes; and 


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1 ‘‘(iv) barriers to health care access 

2 and diabetes treatment within populations 

3 at increased risk of developing diabetes. 

4 ‘‘(B) Surveillance and data collection on 

5 diabetes and prediabetes in minority popu6 lations, including with respect to— 

7 ‘‘(i) efforts to better determine the 

8 prevalence of diabetes among Asian-Amer9 ican and Pacific Islander subgroups; and 

10 ‘‘(ii) efforts to coordinate data collec11 tion on the American Indian population. 

12 ‘‘(C) Community-based interventions to ad13 dress diabetes and prediabetes targeting minor14 ity populations, including— 

15 ‘‘(i) the evidence base for such inter16 ventions; 

17 ‘‘(ii) the cultural appropriateness of 

18 such interventions; and 

19 ‘‘(iii) efforts to educate the public on 

20 the causes and consequences of diabetes. 

21 ‘‘(D) Education and training programs for 

22 health professionals (including community 

23 health workers) on the prevention and manage24 ment of diabetes and its related complications 

25 that is supported by the Health Resources and 


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1 Services Administration, including such pro2 grams supported by— 

3 ‘‘(i) the National Health Service 

4 Corps; or 

5 ‘‘(ii) the community health centers 

6 program under section 330. 

7 ‘‘(d) EDUCATION.—The Director of NIH shall— 

8 ‘‘(1) through the National Institute on Minority 

9 Health and Health Disparities and the National Di10 abetes Education Program— 

11 ‘‘(A) make grants to programs funded 

12 under section 464z–4 for the purpose of estab13 lishing a medical education program for health 

14 care professionals to be more involved in weight 

15 counseling, obesity research, nutrition, and 

16 shared decision making; and 

17 ‘‘(B) provide for the participation of mi18 nority health professionals in diabetes-focused 

19 research programs; and 

20 ‘‘(2) make grants to programs that establish a 

21 professional pipeline that will increase the participa22 tion of minority individuals in diabetes-focused 

23 health fields by expanding Minority Access to Re24 search Careers program internships and mentoring 

25 opportunities for the purposes of recruitment. 


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1 ‘‘(e) DEFINITIONS.—For purposes of this section: 

2 ‘‘(1) DIABETES MELLITUS INTERAGENCY CO3 ORDINATING COMMITTEE.—The ‘Diabetes Mellitus 

4 Interagency Coordinating Committee’ means the Di5 abetes Mellitus Interagency Coordinating Committee 

6 established under section 429. 

7 ‘‘(2) MINORITY POPULATION.—The term ‘mi8 nority population’ means a racial and ethnic minor9 ity group, as defined in section 1707.’’. 

10 SEC. 7502. RESEARCH, EDUCATION, AND OTHER ACTIVI11 TIES. 

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

13 (42 U.S.C. 243 et seq.), as amended by section 7201, is 

14 amended by inserting after section 317X the following: 

15 ‘‘SEC. 317Y. DIABETES IN MINORITY POPULATIONS. 

16 ‘‘(a) RESEARCH AND OTHER ACTIVITIES.— 

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

18 through the Director of the Centers for Disease 

19 Control and Prevention, shall conduct and support 

20 research and public health activities with respect to 

21 diabetes in minority populations. 

22 ‘‘(2) CERTAIN ACTIVITIES.—Activities under 

23 paragraph (1) regarding diabetes in minority popu24 lations shall include the following: 


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1 ‘‘(A) Further enhancing the National 

2 Health and Nutrition Examination Survey by 

3 oversampling Asian Americans, Native Hawai4 ians, and Pacific Islanders in appropriate geo5 graphic areas to better determine the preva6 lence of diabetes in such populations as well as 

7 to improve the data collection of diabetes pene8 tration disaggregated into major ethnic groups 

9 within such populations. The Secretary shall en10 sure that any such oversampling does not re11 duce the oversampling of other minority popu12 lations including African-American and Latino 

13 populations. 

14 ‘‘(B) Through the Division of Diabetes 

15 Translation— 

16 ‘‘(i) providing for prevention research 

17 to better understand how to influence 

18 health care systems changes to improve 

19 quality of care being delivered to such pop20 ulations; 

21 ‘‘(ii) carrying out model demonstra22 tion projects to design, implement, and 

23 evaluate effective diabetes prevention and 

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1 lations, including culturally appropriate 

2 community-based interventions; 

3 ‘‘(iii) developing and implementing a 

4 strategic plan to reduce diabetes in minor5 ity populations through applied research to 

6 reduce disparities and culturally and lin7 guistically appropriate community-based 

8 interventions; 

9 ‘‘(iv) supporting, through the national 

10 diabetes prevention program under section 

11 399V–3, diabetes prevention program sites 

12 in underserved regions highly impacted by 

13 diabetes; and 

14 ‘‘(v) implementing, through the na15 tional diabetes prevention program under 

16 section 399V–3, a demonstration program 

17 developing new metrics measuring health 

18 outcomes related to diabetes that can be 

19 stratified by specific minority populations. 

20 ‘‘(b) EDUCATION.—The Secretary, acting through 

21 the Director of the Centers for Disease Control and Pre22 vention, shall direct the Division of Diabetes Translation 

23 to conduct and support both programs to educate the pub24 lic on diabetes in minority populations and programs to 


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1 educate minority populations about the causes and effects 

2 of diabetes. 

3 ‘‘(c) DIABETES; HEALTH PROMOTION, PREVENTION

4 INITIATIVES, AND ACCESS.—The Secretary, acting 

5 through the Director of the Centers for Disease Control 

6 and Prevention and the National Diabetes Education Pro7 gram, shall conduct and support programs to educate spe8 cific minority populations through culturally appropriate 

9 and linguistically appropriate information campaigns and 

10 initiatives about prevention of, and managing, diabetes. 

11 ‘‘(d) DEFINITION.—For purposes of this section, the 

12 term ‘minority population’ means a racial and ethnic mi13 nority group, as defined in section 1707.’’. 

14 SEC. 7503. PROGRAMS TO EDUCATE HEALTH PROVIDERS 

15 ON THE CAUSES AND EFFECTS OF DIABETES 

16 IN MINORITY POPULATIONS. 

17 Part P of title III of the Public Health Service Act 

18 (42 U.S.C. 280g et seq.), as amended by section 7419(d), 

19 is amended by adding at the end the following: 

20 ‘‘SEC. 399V–12 PROGRAMS TO EDUCATE HEALTH PRO21 VIDERS ON THE CAUSES AND EFFECTS OF DI22 ABETES IN MINORITY POPULATIONS. 

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

24 the Administrator of the Health Resources and Services 

25 Administration, shall conduct and support programs deVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 01322 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 scribed in subsection (b) to educate health professionals 

2 on the causes and effects of diabetes in minority popu3 lations. 

4 ‘‘(b) PROGRAMS.—Programs described in this sub5 section, with respect to education on diabetes in minority 

6 populations, shall include the following: 

7 ‘‘(1) Giving priority, under the primary care 

8 training and enhancement program under section 

9 747— 

10 ‘‘(A) to awarding grants to focus on or ad11 dress diabetes; and 

12 ‘‘(B) to adding minority populations to the 

13 list of vulnerable populations that should be 

14 served by such grants. 

15 ‘‘(2) Providing additional funds for the Health 

16 Careers Opportunity Program and the Centers of 

17 Excellence to partner with the Office of Minority 

18 Health under section 1707 and the National Insti19 tutes of Health to strengthen programs for career 

20 opportunities focused on diabetes treatment and care 

21 within underserved regions highly impacted by dia22 betes. 

23 ‘‘(3) Developing a diabetes focus within, and 

24 providing additional funds for, the National Health 

25 Service Corps scholarship program— 


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1 ‘‘(A) to place individuals in areas that are 

2 disproportionately affected by diabetes and to 

3 provide diabetes treatment and care in such 

4 areas; and 

5 ‘‘(B) to provide such individuals continuing 

6 medical education specific to diabetes care.’’. 

7 SEC. 7504. RESEARCH, EDUCATION, AND OTHER ACTIVITIES 

8 REGARDING DIABETES IN AMERICAN INDIAN 

9 POPULATIONS. 

10 Part P of title III of the Public Health Service Act 

11 (42 U.S.C. 280g et seq.), as amended by section 7503, 

12 is amended by adding at the end the following: 

13 ‘‘SEC. 399V–13. RESEARCH, EDUCATION, AND OTHER ACTIVI14 TIES REGARDING DIABETES IN AMERICAN IN15 DIAN POPULATIONS. 

16 ‘‘In addition to activities under sections 317X, 399V– 

17 12, and 434B, the Secretary, acting through the Indian 

18 Health Service and in collaboration with other appropriate 

19 Federal agencies, shall— 

20 ‘‘(1) conduct and support research and other 

21 activities with respect to diabetes; and 

22 ‘‘(2) coordinate the collection of data on clini23 cally and culturally appropriate diabetes treatment, 

24 care, prevention, and services by health care profes25 sionals to the American Indian population.’’. 


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1 SEC. 7505. UPDATED REPORT ON HEALTH DISPARITIES. 

2 The Secretary of Health and Human Services shall 

3 seek to enter into an arrangement with the National Acad4 emy of Medicine under which the National Academy will— 

5 (1) not later than 1 year after the date of en6 actment of this Act, submit to Congress an updated 

7 version of the 2003 report entitled ‘‘Unequal Treat8 ment: Confronting Racial and Ethnic Disparities in 

9 Health Care’’; and 

10 (2) in such updated version, address how racial 

11 and ethnic health disparities have changed since the 

12 publication of the original report. 

13 Subtitle G—Lung Disease 

14 SEC. 7601. ASTHMA-RELATED ACTIVITIES OF THE CENTERS 

15 FOR DISEASE CONTROL AND PREVENTION. 

16 Section 317I of the Public Health Service Act (42 

17 U.S.C. 247b–10) is amended to read as follows: 

18 ‘‘SEC. 317I. ASTHMA-RELATED ACTIVITIES OF THE CENTERS 

19 FOR DISEASE CONTROL AND PREVENTION. 

20 ‘‘(a) PROGRAM FOR PROVIDING INFORMATION AND

21 EDUCATION TO THE PUBLIC.—The Secretary, acting 

22 through the Director of the Centers for Disease Control 

23 and Prevention, shall collaborate with State and local 

24 health departments to conduct activities, including the 

25 provision of information and education to the public, re26 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 data among people with 

23 asthma to monitor the impact on health and 

24 quality of life; 


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1 ‘‘(B) surveillance of health care facilities; 

2 and 

3 ‘‘(C) collection of data not containing indi4 vidually identifiable information from electronic 

5 health records or other electronic communica6 tions; 

7 ‘‘(2) compile and annually publish data regard8 ing the prevalence and incidence of childhood asth9 ma, the child mortality rate, and the number of hos10 pital admissions and emergency department visits by 

11 children associated with asthma nationally and in 

12 each State and at the county level by age, sex, race, 

13 and ethnicity, as well as lifetime and current preva14 lence; and 

15 ‘‘(3) compile and annually publish data regard16 ing the prevalence and incidence of adult asthma, 

17 the adult mortality rate, and the number of hospital 

18 admissions and emergency department visits by 

19 adults associated with asthma nationally and in each 

20 State and at the county level by age, sex, race, eth21 nicity, industry, and occupation, as well as lifetime 

22 and current prevalence. 

23 ‘‘(d) COORDINATION OF DATA COLLECTION.—The 

24 Director of the Centers for Disease Control and Preven25 tion, in conjunction with State and local health departVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 01327 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 ments, shall coordinate data collection activities under 

2 paragraphs (2) and (3) of subsection (c) so as to maximize 

3 comparability of results. 

4 ‘‘(e) COLLABORATION.— 

5 ‘‘(1) IN GENERAL.—The Centers for Disease 

6 Control and Prevention may collaborate with na7 tional, State, and local nonprofit organizations to 

8 provide information and education about asthma, 

9 and to strengthen such collaborations when possible. 

10 ‘‘(2) SPECIFIC ACTIVITIES.—The Director of 

11 the Centers for Disease Control and Prevention, act12 ing through the Division of Population Health of the 

13 Centers, may expand activities relating to asthma 

14 with non-Federal partners, especially State-level en15 tities. 

16 ‘‘(f) REPORTS TO CONGRESS.— 

17 ‘‘(1) IN GENERAL.—Not later than 3 years 

18 after the date of the enactment of the Health Equity 

19 and Accountability Act of 2024, and once 2 years 

20 thereafter, the Secretary shall, in consultation with 

21 patient groups, nonprofit organizations, medical so22 cieties, and other relevant governmental and non23 governmental entities, submit to Congress a report 

24 that— 


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1 ‘‘(A) catalogs, with respect to asthma pre2 vention, management, and surveillance— 

3 ‘‘(i) the activities of the Federal Gov4 ernment, including an assessment of the 

5 progress of the Federal Government and 

6 States, with respect to achieving the goals 

7 of the Healthy People 2030 initiative; and 

8 ‘‘(ii) the activities of other entities 

9 that participate in the program under this 

10 section, including nonprofit organizations, 

11 patient advocacy groups, and medical soci12 eties; and 

13 ‘‘(B) makes recommendations for the fu14 ture direction of asthma activities, in consulta15 tion with researchers from the National Insti16 tutes of Health and other member bodies of the 

17 Asthma Disparities Subcommittee, including— 

18 ‘‘(i) a description of how the Federal 

19 Government may improve its response to 

20 asthma, including identifying any barriers 

21 that may exist; 

22 ‘‘(ii) a description of how the Federal 

23 Government may continue, expand, and 

24 improve its private-public partnerships 


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1 with respect to asthma, including identi2 fying any barriers that may exist; 

3 ‘‘(iii) identification of steps that may 

4 be taken to reduce the— 

5 ‘‘(I) morbidity, mortality, and 

6 overall prevalence of asthma; 

7 ‘‘(II) financial burden of asthma 

8 on society; 

9 ‘‘(III) burden of asthma on dis10 proportionately affected areas, par11 ticularly those in medically under12 served populations (as defined in sec13 tion 330(b)(3)); and 

14 ‘‘(IV) burden of asthma as a 

15 chronic disease that can be worsened 

16 by environmental exposures; 

17 ‘‘(iv) the identification of programs 

18 and policies that have achieved the steps 

19 described under clause (iii), and steps that 

20 may be taken to expand such programs 

21 and policies to benefit larger populations; 

22 and 

23 ‘‘(v) recommendations for future re24 search and interventions. 

25 ‘‘(2) SUBSEQUENT REPORTS.— 


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1 ‘‘(A) CONGRESSIONAL REQUEST.—During 

2 the 5-year period following the submission of 

3 the second report under paragraph (1), the Sec4 retary shall submit updates and revisions of the 

5 report upon the request of the Congress. 

6 ‘‘(B) FIVE-YEAR REEVALUATION.—At the 

7 end of the 5-year period referred to in subpara8 graph (A), the Secretary shall— 

9 ‘‘(i) evaluate the analyses and rec10 ommendations made in previous reports; 

11 and 

12 ‘‘(ii) determine whether an additional 

13 report is needed and if so submit such an 

14 updated report to the Congress, including 

15 appropriate recommendations. 

16 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS FUND17 ING.—In addition to any other authorization of appropria18 tions that is available to the Centers for Disease Control 

19 and Prevention for the purpose of carrying out this sec20 tion, there is authorized to be appropriated to such Cen21 ters $65,000,000 for the period of fiscal years 2025 

22 through 2029 for the purpose of carrying out this sec23 tion.’’. 


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1 SEC. 7602. INFLUENZA AND PNEUMONIA VACCINATION 

2 CAMPAIGN. 

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

4 Human Services shall— 

5 (1) enhance the annual campaign by the De6 partment of Health and Human Services to increase 

7 the number of people vaccinated each year for influ8 enza and pneumonia; and 

9 (2) include in such campaign the use of written 

10 educational materials, public service announcements, 

11 physician education, and any other means which the 

12 Secretary determines effective. 

13 (b) MATERIALS AND ANNOUNCEMENTS.—In carrying 

14 out the annual campaign described in subsection (a), the 

15 Secretary of Health and Human Services shall ensure 

16 that— 

17 (1) educational materials and public service an18 nouncements are readily and widely available in 

19 communities experiencing disparities in the incidence 

20 and mortality rates of influenza and pneumonia; and 

21 (2) the campaign uses targeted, culturally ap22 propriate messages and messengers to reach under23 served communities. 

24 (c) 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 2025 through 2029. 

3 SEC. 7603. CHRONIC OBSTRUCTIVE PULMONARY DISEASE. 

4 (a) IN GENERAL.—The Director of the Centers for 

5 Disease Control and Prevention shall conduct, support, 

6 and expand public health strategies and prevention, diag7 nosis, surveillance, and public and professional awareness 

8 activities regarding chronic obstructive pulmonary disease. 

9 (b) CHRONIC DISEASE PREVENTION PROGRAMS.— 

10 The Director of the National Heart, Lung, and Blood In11 stitute shall carry out the following: 

12 (1) Conduct public education and awareness ac13 tivities with patient and professional organizations 

14 to stimulate earlier diagnosis and improve patient 

15 outcomes from treatment of chronic obstructive pul16 monary disease. To the extent known and relevant, 

17 such public education and awareness activities shall 

18 reflect differences in chronic obstructive pulmonary 

19 disease by cause (tobacco, environmental, occupa20 tional, biological, and genetic) and include a focus 

21 on outreach to undiagnosed and, as appropriate, mi22 nority populations. 

23 (2) Supplement and expand upon the activities 

24 of the National Heart, Lung, and Blood Institute by 

25 making grants to nonprofit organizations, State and 


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1 local jurisdictions, and Indian Tribes for the purpose 

2 of reducing the burden of chronic obstructive pul3 monary disease, especially in disproportionately im4 pacted communities, through public health interven5 tions and related activities. 

6 (3) Coordinate with the Centers for Disease 

7 Control and Prevention, the Indian Health Service, 

8 the Health Resources and Services Administration, 

9 and the Department of Veterans Affairs to develop 

10 pilot programs to demonstrate best practices for the 

11 diagnosis and management of chronic obstructive 

12 pulmonary disease. 

13 (4) Develop improved techniques and identify 

14 best practices, in coordination with the Secretary of 

15 Veterans Affairs, for assisting chronic obstructive 

16 pulmonary disease patients to successfully stop 

17 smoking, including identification of subpopulations 

18 with different needs. Initiatives under this para19 graph may include research to determine whether 

20 successful smoking cessation strategies are different 

21 for chronic obstructive pulmonary disease patients 

22 compared to such strategies for patients with other 

23 chronic diseases. 


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1 (c) ENVIRONMENTAL AND OCCUPATIONAL HEALTH

2 PROGRAMS.—The Director of the Centers for Disease 

3 Control and Prevention shall— 

4 (1) support research into the environmental and 

5 occupational causes and biological mechanisms that 

6 contribute to chronic obstructive pulmonary disease; 

7 and 

8 (2) develop and disseminate public health inter9 ventions that will lessen the impact of environmental 

10 and occupational causes of chronic obstructive pul11 monary disease. 

12 (d) DATA COLLECTION.—Not later than 180 days 

13 after the date of enactment of this Act, the Director of 

14 the National Heart, Lung, and Blood Institute and the 

15 Director of the Centers for Disease Control and Preven16 tion, acting jointly, shall assess the depth and quality of 

17 information on chronic obstructive pulmonary disease that 

18 is collected in surveys and population studies conducted 

19 by the Centers for Disease Control and Prevention, includ20 ing whether there are additional opportunities for informa21 tion to be collected in the National Health and Nutrition 

22 Examination Survey, the National Health Interview Sur23 vey, and the Behavioral Risk Factors Surveillance System 

24 surveys. 


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1 (e) AUTHORIZATION OF APPROPRIATIONS.—There 

2 are authorized to be appropriated to carry out this section 

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

4 2025 through 2029. 

5 Subtitle H—Tuberculosis 

6 SEC. 7701. UNITED STATES GOVERNMENT ASSISTANCE TO 

7 COMBAT TUBERCULOSIS. 

8 Section 104B of the Foreign Assistance Act of 1961 

9 (22 U.S.C. 2151b–3) is amended to read as follows: 

10 ‘‘SEC. 104B. ASSISTANCE TO COMBAT TUBERCULOSIS. 

11 ‘‘(a) POLICY.— 

12 ‘‘(1) IN GENERAL.—It is a major objective of 

13 the foreign assistance program of the United States 

14 to help end the TB public health emergency through 

15 accelerated actions— 

16 ‘‘(A) to support the diagnosis and treat17 ment of all adults and children with all forms 

18 of TB; and 

19 ‘‘(B) to prevent new TB infections from 

20 occurring. 

21 ‘‘(2) SUPPORT FOR GLOBAL PLANS AND OBJEC22 TIVES.—In countries in which the United States 

23 Government has established foreign assistance pro24 grams under this Act, particularly in countries with 

25 the highest burden of TB and other countries with 


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1 high rates of infection and transmission of TB, it is 

2 the policy of the United States— 

3 ‘‘(A) to support the objectives of the World 

4 Health Organization End TB Strategy, includ5 ing its goals— 

6 ‘‘(i) to reduce TB deaths by 95 per7 cent by 2035; 

8 ‘‘(ii) to reduce the TB incidence rate 

9 by 90 percent by 2035; and 

10 ‘‘(iii) to reduce the number of families 

11 facing catastrophic health costs due to TB 

12 by 100 percent by 2035; 

13 ‘‘(B) to support the Stop TB Partnership’s 

14 Global Plan to End TB 2023–2030, including 

15 by providing support for— 

16 ‘‘(i) developing and using innovative 

17 new technologies and therapies to increase 

18 active case finding and rapidly diagnose 

19 and treat children and adults with all 

20 forms of TB, alleviate suffering, and en21 sure TB treatment completion; 

22 ‘‘(ii) expanding diagnosis and treat23 ment in line with the goals established by 

24 the Political Declaration of the High-Level 


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1 Meeting of the General Assembly on the 

2 Fight Against Tuberculosis, including— 

3 ‘‘(I) successfully treating 

4 40,000,000 people with active TB by 

5 2023, including 3,500,000 children, 

6 and 1,500,000 people with drug-re7 sistant TB; and 

8 ‘‘(II) diagnosing and treating la9 tent tuberculosis infection, in support 

10 of the global goal of providing preven11 tive therapy to at least 30,000,000 

12 people by 2023, including 4,000,000 

13 children younger than 5 years of age, 

14 20,000,000 household contacts of peo15 ple affected by TB, and 6,000,000 

16 people living with HIV; 

17 ‘‘(iii) ensuring high-quality TB care 

18 by closing gaps in care cascades, imple19 menting continuous quality improvement 

20 at all levels of care, and providing related 

21 patient support; and 

22 ‘‘(iv) sustainable procurements of TB 

23 commodities to avoid interruptions in sup24 ply, the procurement of commodities of un25 known quality, or payment of excessive 


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1 commodity costs in countries impacted by 

2 TB; and 

3 ‘‘(C) to ensure, to the greatest extent prac4 ticable, that United States funding supports ac5 tivities that simultaneously emphasize— 

6 ‘‘(i) the development of comprehensive 

7 person-centered programs, including diag8 nosis, treatment, and prevention strategies 

9 to ensure that— 

10 ‘‘(I) all people sick with TB re11 ceive quality diagnosis and treatment 

12 through active case finding; and 

13 ‘‘(II) people at high risk for TB 

14 infection are found and treated with 

15 preventive therapies in a timely man16 ner; 

17 ‘‘(ii) robust TB infection control prac18 tices are implemented in all congregate set19 tings, including hospitals and prisons; 

20 ‘‘(iii) the deployment of diagnostic 

21 and treatment capacity— 

22 ‘‘(I) in areas with the highest TB 

23 burdens; and 


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1 ‘‘(II) for highly at-risk and im2 poverished populations, including pa3 tient support services; 

4 ‘‘(iv) program monitoring and evalua5 tion based on critical TB indicators, in6 cluding indicators relating to infection con7 trol, the numbers of patients accessing TB 

8 treatment and patient support services, 

9 and preventative therapy for those at risk, 

10 including all close contacts, and treatment 

11 outcomes for all forms of TB; 

12 ‘‘(v) training and engagement of 

13 health care workers on the use of new di14 agnostic tools and therapies as they be15 come available, and increased support for 

16 training frontline health care workers to 

17 support expanded TB active case finding, 

18 contact tracing, and patient support serv19 ices; 

20 ‘‘(vi) coordination with domestic agen21 cies and organizations to support an ag22 gressive research agenda to develop vac23 cines as well as new tools to diagnose, 

24 treat, and prevent TB globally; 


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1 ‘‘(vii) linkages with the private sector 

2 on— 

3 ‘‘(I) research and development of 

4 a vaccine, and on new tools for diag5 nosis and treatment of TB; 

6 ‘‘(II) improving current tools for 

7 diagnosis and treatment of TB, in8 cluding telehealth solutions for pre9 vention and treatment; and 

10 ‘‘(III) training healthcare profes11 sionals on use of the newest and most 

12 effective diagnostic and therapeutic 

13 tools; 

14 ‘‘(viii) the reduction of barriers to 

15 care, including stigma and treatment and 

16 diagnosis costs, including through— 

17 ‘‘(I) training health workers; 

18 ‘‘(II) sensitizing policy makers; 

19 ‘‘(III) requiring that all relevant 

20 grants and funding agreements in21 clude access and affordability provi22 sions; 

23 ‘‘(IV) supporting education and 

24 empowerment campaigns for TB pa25 tients regarding local TB services; 


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1 ‘‘(V) monitoring barriers to ac2 cessing TB services; and 

3 ‘‘(VI) increasing support for pa4 tient-led and community-led TB out5 reach efforts; 

6 ‘‘(ix) support for country-level, sus7 tainable accountability mechanisms and ca8 pacity to measure progress and ensure that 

9 commitments made by governments and 

10 relevant stakeholders are met; and 

11 ‘‘(x) support for the integration of TB 

12 diagnosis, treatment, and prevention activi13 ties into primary health care, as appro14 priate. 

15 ‘‘(b) DEFINITIONS.—In this section: 

16 ‘‘(1) APPROPRIATE CONGRESSIONAL COMMIT17 TEES.—The term ‘appropriate congressional com18 mittees’ means the Committee on Foreign Relations 

19 of the Senate and the Committee on Foreign Affairs 

20 of the House of Representatives. 

21 ‘‘(2) END TB STRATEGY.—The term ‘End TB 

22 Strategy’ means the strategy to eliminate TB that 

23 was approved by the World Health Assembly in May 

24 2014, and is described in ‘The End TB Strategy: 


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1 Global Strategy and Targets for Tuberculosis Pre2 vention, Care and Control After 2015’. 

3 ‘‘(3) GLOBAL ALLIANCE FOR TUBERCULOSIS

4 DRUG DEVELOPMENT.—The term ‘Global Alliance 

5 for Tuberculosis Drug Development’ means the pub6 lic-private partnership that bring together leaders in 

7 health, science, philanthropy, and private industry to 

8 devise new approaches to TB. 

9 ‘‘(4) GLOBAL TUBERCULOSIS DRUG FACIL10 ITY.—The term ‘Global Tuberculosis Drug Facility’ 

11 means the initiative of the Stop Tuberculosis Part12 nership to increase access to the most advanced, af13 fordable, quality-assured TB drugs and diagnostics. 

14 ‘‘(5) MDR–TB.—The term ‘MDR–TB’ means 

15 multi-drug-resistant TB. 

16 ‘‘(6) STOP TUBERCULOSIS PARTNERSHIP.—The 

17 term ‘Stop Tuberculosis Partnership’ means the 

18 partnership of 1,600 organizations (including inter19 national and technical organizations, government 

20 programs, research and funding agencies, founda21 tions, nongovernmental organizations, civil society 

22 and community groups, and the private sector), do23 nors, including the United States, high TB burden 

24 countries, multilateral agencies, and nongovern25 mental and technical agencies, which is governed by 


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1 the Stop TB Partnership Coordinating Board and 

2 hosted by a United Nations entity, committed to 

3 short- and long-term measures required to control 

4 and eventually eliminate TB as a public health prob5 lem in the world. 

6 ‘‘(7) XDR–TB.—The term ‘XDR–TB’ means 

7 extensively drug-resistant TB. 

8 ‘‘(c) AUTHORIZATION.—To carry out this section, the 

9 President is authorized, consistent with section 104(c), to 

10 furnish assistance, on such terms and conditions as the 

11 President may determine, for the prevention, treatment, 

12 control, and elimination of TB. 

13 ‘‘(d) GOALS.—In consultation with the appropriate 

14 congressional committees, the President shall establish 

15 goals, based on the policy and indicators described in sub16 section (a), for— 

17 ‘‘(1) United States TB programs to detect, 

18 cure, and prevent all forms of TB globally for the 

19 period between 2023 and 2030 that are aligned with 

20 the End TB Strategy’s 2030 targets and the 

21 USAID’s Global Tuberculosis (TB) Strategy 2023– 

22 2030; and 

23 ‘‘(2) updating the National Action Plan for 

24 Combating Multidrug-Resistant Tuberculosis. 

25 ‘‘(e) COORDINATION.— 


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1 ‘‘(1) IN GENERAL.—In carrying out this sec2 tion, the President shall coordinate with the World 

3 Health Organization, the Stop TB Partnership, the 

4 Global Fund to Fight AIDS, Tuberculosis, and Ma5 laria, and other organizations with respect to the de6 velopment and implementation of a comprehensive 

7 global TB response program. 

8 ‘‘(2) BILATERAL ASSISTANCE.—In providing bi9 lateral assistance under this section, the President, 

10 acting through the Administrator of the United 

11 States Agency for International Development, 

12 shall— 

13 ‘‘(A) catalyze support for research and de14 velopment of new tools to prevent, diagnose, 

15 treat, and control TB worldwide, particularly to 

16 reduce the incidence of, and mortality from, all 

17 forms of drug-resistant TB; 

18 ‘‘(B) ensure United States programs and 

19 activities focus on finding individuals with ac20 tive TB disease and provide quality diagnosis 

21 and treatment, including through digital health 

22 solutions, and reaching those at high risk with 

23 preventive therapy; and 

24 ‘‘(C) ensure coordination among relevant 

25 United States Government agencies, including 


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1 the Department of State, the Centers for Dis2 ease Control and Prevention, the National In3 stitutes of Health, the Biomedical Advanced 

4 Research and Development Authority, the Food 

5 and Drug Administration, the National Science 

6 Foundation, the Department of Defense 

7 (through its Congressionally Directed Medical 

8 Research Programs), and other relevant Fed9 eral departments and agencies that engage in 

10 international TB activities— 

11 ‘‘(i) to ensure accountability and 

12 transparency; 

13 ‘‘(ii) to reduce duplication of efforts; 

14 and 

15 ‘‘(iii) to ensure appropriate integra16 tion and coordination of TB services into 

17 other United States-supported health pro18 grams. 

19 ‘‘(f) PRIORITY TO END TB STRATEGY.—In fur20 nishing assistance under subsection (c), the President 

21 shall prioritize— 

22 ‘‘(1) building and strengthening TB pro23 grams— 

24 ‘‘(A) to increase the diagnosis and treat25 ment of everyone who is sick with TB; and 


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1 ‘‘(B) to ensure that such individuals have 

2 access to quality diagnosis and treatment; 

3 ‘‘(2) direct, high-quality integrated services for 

4 all forms of TB, as described by the World Health 

5 Organization, which call for the coordination of ac6 tive case finding, treatment of all forms of TB dis7 ease and infection, patient support, and TB preven8 tion; 

9 ‘‘(3) treating individuals co-infected with HIV 

10 and other co-morbidities, and other individuals with 

11 TB who may be at risk of stigma; 

12 ‘‘(4) strengthening the capacity of health sys13 tems to detect, prevent, and treat TB, including 

14 MDR–TB and XDR–TB, as described in the latest 

15 international guidance related to TB; 

16 ‘‘(5) researching and developing innovative 

17 diagnostics, drug therapies, and vaccines, and pro18 gram-based research; 

19 ‘‘(6) support for the Stop Tuberculosis Partner20 ship’s Global Drug Facility, the Global Alliance for 

21 Tuberculosis Drug Development, and other organiza22 tions promoting the development of new products 

23 and drugs for TB; and 

24 ‘‘(7) ensuring that TB programs can serve as 

25 key platforms for supporting national respiratory 


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1 pandemic response against existing and new infec2 tious respiratory disease. 

3 ‘‘(g) ASSISTANCE FOR THE WORLD HEALTH ORGA4 NIZATION AND THE STOP TUBERCULOSIS PARTNER5 SHIP.—In carrying out this section, the President, acting 

6 through the Administrator of the United States Agency 

7 for International Development, is authorized— 

8 ‘‘(1) to provide resources to the World Health 

9 Organization and the Stop Tuberculosis Partnership 

10 to improve the capacity of countries with high bur11 dens or rates of TB and other affected countries to 

12 implement the End TB Strategy, the Stop TB Glob13 al Plan to End TB, their own national strategies 

14 and plans, other global efforts to control MDR–TB 

15 and XDR–TB; and 

16 ‘‘(2) to leverage the contributions of other do17 nors for the activities described in paragraph (1). 

18 ‘‘(h) ANNUAL REPORT ON TB ACTIVITIES.—Not 

19 later than December 15 of each year until the earlier of 

20 the date on which the goals specified in subsection 

21 (a)(2)(A) are met or the last day of 2030, the President 

22 shall submit an annual report to the appropriate congres23 sional committees that describes United States foreign as24 sistance to control TB and the impact of such efforts, in25 cluding— 


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1 ‘‘(1) the number of individuals with active TB 

2 disease that were diagnosed and treated, including 

3 the rate of treatment completion and the number re4 ceiving patient support; 

5 ‘‘(2) the number of persons with MDR–TB and 

6 XDR–TB that were diagnosed and treated, includ7 ing the rate of completion, in countries receiving 

8 United States bilateral foreign assistance for TB 

9 control programs; 

10 ‘‘(3) the number of people trained by the 

11 United States Government in TB surveillance and 

12 control; 

13 ‘‘(4) the number of individuals with active TB 

14 disease identified as a result of engagement with the 

15 private sector and other nongovernmental partners 

16 in countries receiving United States bilateral foreign 

17 assistance for TB control programs; 

18 ‘‘(5) a description of the collaboration and co19 ordination of United States anti-TB efforts with the 

20 World Health Organization, the Stop TB Partner21 ship, the Global Fund to Fight AIDS, Tuberculosis 

22 and Malaria, and other major public and private en23 tities; 

24 ‘‘(6) a description of the collaboration and co25 ordination among the United States Agency for 


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1 International Development and other United States 

2 departments and agencies, including the Centers for 

3 Disease Control and Prevention and the Office of 

4 the Global AIDS Coordinator, for the purposes of 

5 combating TB and, as appropriate, its integration 

6 into primary care; 

7 ‘‘(7) the constraints on implementation of pro8 grams posed by health workforce shortages, health 

9 system limitations, barriers to digital health imple10 mentation, other challenges to successful implemen11 tation, and strategies to address such constraints; 

12 ‘‘(8) a breakdown of expenditures for patient 

13 services supporting TB diagnosis, treatment, and 

14 prevention, including procurement of drugs and 

15 other commodities, drug management, training in di16 agnosis and treatment, health systems strengthening 

17 that directly impacts the provision of TB services, 

18 and research; and 

19 ‘‘(9) for each country, and when practicable, 

20 each project site receiving bilateral United States as21 sistance for the purpose of TB prevention, treat22 ment, and control— 

23 ‘‘(A) a description of progress toward the 

24 adoption and implementation of the most recent 

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1 prove diagnosis, treatment, and prevention of 

2 TB for adults and children, disaggregated by 

3 sex, including the proportion of health facilities 

4 that have adopted the latest World Health Or5 ganization guidelines on strengthening moni6 toring systems and preventative, diagnostic, and 

7 therapeutic methods, including the use of rapid 

8 diagnostic tests and orally administered TB 

9 treatment regimens; 

10 ‘‘(B) the number of individuals screened 

11 for TB disease and the number evaluated for 

12 TB infection using active case finding outside 

13 of health facilities; 

14 ‘‘(C) the number of individuals with active 

15 TB disease that were diagnosed and treated, in16 cluding the rate of treatment completion and 

17 the number receiving patient support; 

18 ‘‘(D) the number of adults and children, 

19 including people with HIV and close contacts, 

20 who are evaluated for TB infection, the number 

21 of adults and children started on treatment for 

22 TB infection, and the number of adults and 

23 children completing such treatment, 

24 disaggregated by sex and, as possible, income or 

25 wealth quintile; 


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1 ‘‘(E) the establishment of effective TB in2 fection control in all relevant congregant set3 tings, including hospitals, clinics, and prisons; 

4 ‘‘(F) a description of progress in imple5 menting measures to reduce TB incidence, in6 cluding actions— 

7 ‘‘(i) to expand active case finding and 

8 contact tracing to reach vulnerable groups; 

9 and 

10 ‘‘(ii) to expand TB preventive ther11 apy, engagement of the private sector, and 

12 diagnostic capacity; 

13 ‘‘(G) a description of progress to expand 

14 diagnosis, prevention, and treatment for all 

15 forms of TB, including in pregnant women, 

16 children, and individuals and groups at greater 

17 risk of TB, including migrants, prisoners, min18 ers, people exposed to silica, and people living 

19 with HIV/AIDS, disaggregated by sex; 

20 ‘‘(H) the rate of successful completion of 

21 TB treatment for adults and children, 

22 disaggregated by sex, and the number of indi23 viduals receiving support for treatment comple24 tion; 


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1 ‘‘(I) the number of people, disaggregated 

2 by sex, receiving treatment for MDR–TB, the 

3 proportion of those treated with the latest regi4 mens endorsed by the World Health Organiza5 tion, factors impeding scale up of such treat6 ment, and a description of progress to expand 

7 community-based MDR–TB care; 

8 ‘‘(J) a description of TB commodity pro9 curement challenges, including shortages, 

10 stockouts, or failed tenders for TB drugs or 

11 other commodities; 

12 ‘‘(K) the proportion of health facilities 

13 with specimen referral linkages to quality diag14 nostic networks, including established testing 

15 sites and reference labs, to ensure maximum ac16 cess and referral for second line drug resistance 

17 testing, and a description of the turnaround 

18 time for test results; 

19 ‘‘(L) the number of people trained by the 

20 United States Government to deliver high-qual21 ity TB diagnostic, preventative, monitoring, 

22 treatment, and care services; 

23 ‘‘(M) a description of how supported activi24 ties are coordinated with— 


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1 ‘‘(i) country national TB plans and 

2 strategies; and 

3 ‘‘(ii) TB control efforts supported by 

4 the Global Fund to Fight AIDS, Tuber5 culosis, and Malaria, and other inter6 national assistance programs and funds, 

7 including in the areas of program develop8 ment and implementation; and 

9 ‘‘(N) for the first 3 years of the report re10 quired under this subsection, a description of 

11 the progress in recovering from the negative im12 pact of COVID–19 on TB, including— 

13 ‘‘(i) whether there has been the devel14 opment and implementation of a com15 prehensive plan to recover TB activities 

16 from diversion of resources; 

17 ‘‘(ii) the continued use of bidirectional 

18 TB–COVID testing; and 

19 ‘‘(iii) progress on increased diagnosis 

20 and treatment of active TB. 

21 ‘‘(i) ANNUAL REPORT ON TB RESEARCH AND DE22 VELOPMENT.—The President, acting through the Admin23 istrator of the United States Agency for International De24 velopment, and in coordination with the National Insti25 tutes of Health, the Centers for Disease Control and PreVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 01354 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 vention, the Biomedical Advanced Research and Develop2 ment Authority, the Food and Drug Administration, the 

3 National Science Foundation, and the Office of the Global 

4 AIDS Coordinator, shall submit to the appropriate con5 gressional committees until 2030 an annual report that— 

6 ‘‘(1) describes the current progress and chal7 lenges to the development of new tools for the pur8 pose of TB prevention, treatment, and control; 

9 ‘‘(2) identifies critical gaps and emerging prior10 ities for research and development, including for 

11 rapid and point-of-care diagnostics, shortened treat12 ments and prevention methods, telehealth solutions 

13 for prevention and treatment, and vaccines; and 

14 ‘‘(3) describes research investments by type, 

15 funded entities, and level of investment. 

16 ‘‘(j) EVALUATION REPORT.—Not later than 3 years 

17 after the date of the enactment of the Health Equity and 

18 Accountability Act of 2024, and 5 years thereafter, the 

19 Comptroller General of the United States shall submit a 

20 report to the appropriate congressional committees that 

21 evaluates the performance and impact on TB prevention, 

22 diagnosis, treatment, and care efforts that are supported 

23 by United States bilateral assistance funding, including 

24 recommendations for improving such programs.’’. 


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1 Subtitle I—Osteoarthritis and 

2 Musculoskeletal Diseases 

3 SEC. 7801. OSTEOARTHRITIS AND OTHER MUSCULO4 SKELETAL HEALTH-RELATED ACTIVITIES OF 

5 THE CENTERS FOR DISEASE CONTROL AND 

6 PREVENTION. 

7 (a) EDUCATION AND AWARENESS ACTIVITIES.—The 

8 Secretary of Health and Human Services, acting through 

9 the Director of the Centers for Disease Control and Pre10 vention, shall direct the National Center for Chronic Dis11 ease Prevention and Health Promotion to conduct and ex12 pand the Health Community Program and Arthritis Pro13 gram to educate the public on— 

14 (1) the causes of, preventive health actions for, 

15 and effects of arthritis, lupus, and other musculo16 skeletal conditions in minority patient populations; 

17 and 

18 (2) the effects of such conditions on other 

19 comorbidities including obesity, hypertension, and 

20 cardiovascular disease. 

21 (b) PROGRAMS ON ARTHRITIS AND MUSCULO22 SKELETAL CONDITIONS.—Education and awareness pro23 grams of the Centers for Disease Control and Prevention 

24 on arthritis and other musculoskeletal conditions in minor25 ity communities shall— 


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1 (1) be culturally and linguistically appropriate 

2 to minority patients, targeting musculoskeletal 

3 health promotion and prevention programs of each 

4 major ethnic group, including— 

5 (A) Native Americans and Alaska Natives; 

6 (B) Asian Americans; 

7 (C) African Americans and Blacks; 

8 (D) Hispanic and Latino Americans; and 

9 (E) Native Hawaiians and Pacific Island10 ers; and 

11 (2) include public awareness campaigns directed 

12 toward these patient populations that emphasize the 

13 importance of musculoskeletal health, physical activ14 ity, diet and healthy lifestyle, and weight reduction 

15 for overweight and obese patients. 

16 (c) AUTHORIZATION OF APPROPRIATIONS.—To carry 

17 out this section, there are authorized to be appropriated 

18 such sums as are necessary for fiscal year 2025 and each 

19 subsequent fiscal year. 

20 SEC. 7802. GRANTS FOR COMPREHENSIVE OSTEO21 ARTHRITIS AND MUSCULOSKELETAL DIS22 EASE HEALTH EDUCATION WITHIN HEALTH 

23 PROFESSIONS SCHOOLS. 

24 (a) PROGRAM AUTHORIZED.—The Secretary of 

25 Health and Human Services (in this section referred to 


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1 as the ‘‘Secretary’’), in coordination with the Secretary of 

2 Education, shall award grants, on a competitive basis, to 

3 academic health science centers, health professions 

4 schools, and institutions of higher education to enable 

5 such centers, schools, and institutions to provide people 

6 with comprehensive education on arthritis and musculo7 skeletal health, particularly— 

8 (1) obesity-related musculoskeletal diseases; 

9 (2) arthritis and osteoarthritis; 

10 (3) arthritis and musculoskeletal health dispari11 ties; and 

12 (4) the relationship between arthritis and mus13 culoskeletal diseases and metabolic activity, psycho14 logical health, and comorbidities such as diabetes, 

15 cardiovascular disease, lupus, and hypertension. 

16 (b) DURATION.—Grants awarded under this section 

17 shall be for a period of 5 years. 

18 (c) APPLICATIONS.—An academic health science cen19 ter, health professions school, or institution of higher edu20 cation seeking a grant under this section shall submit an 

21 application to the Secretary at such time, in such manner, 

22 and containing such information as the Secretary may re23 quire. 


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1 (d) PRIORITY.—In awarding grants under this sec2 tion, the Secretary shall give priority to an institution of 

3 higher education that— 

4 (1) has an enrollment of needy students, as de5 fined in section 318(b) of the Higher Education Act 

6 of 1965 (20 U.S.C. 1059e(b)); 

7 (2) is a Hispanic-serving institution, as defined 

8 in section 502(a) of such Act (20 U.S.C. 1101a(a)); 

9 (3) is a Tribal College or University, as defined 

10 in section 316(b) of such Act (20 U.S.C. 1059c(b)); 

11 (4) is an Alaska Native-serving institution, as 

12 defined in section 317(b) of such Act (20 U.S.C. 

13 1059d(b)); 

14 (5) is a Native Hawaiian-serving institution, as 

15 defined in section 317(b) of such Act (20 U.S.C. 

16 1059d(b)); 

17 (6) is a Predominately Black Institution, as de18 fined in section 318(b) of such Act (20 U.S.C. 

19 1059e(b)); 

20 (7) is a Native American-serving, nontribal in21 stitution, as defined in section 319(b) of such Act 

22 (20 U.S.C. 1059f(b)); 

23 (8) is an Asian American and Native American 

24 Pacific Islander-serving institution, as defined in 

25 section 320(b) of such Act (20 U.S.C. 1059g(b)); or 


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1 (9) is a minority institution, as defined in sec2 tion 365 of such Act (20 U.S.C. 1067k), with an en3 rollment of needy students, as defined in section 312 

4 of such Act (20 U.S.C. 1058). 

5 (e) USES OF FUNDS.—An academic health science 

6 center, health professions school, or institution of higher 

7 education receiving a grant under this section may use the 

8 grant funds to integrate issues relating to comprehensive 

9 arthritis and musculoskeletal health into the academic or 

10 support sectors of the center, school, or institution in 

11 order to reach a large number of students, by carrying 

12 out 1 or more of the following activities: 

13 (1) Developing educational content for issues 

14 relating to comprehensive arthritis and musculo15 skeletal health education that will be incorporated 

16 into first-year orientation or core courses. 

17 (2) Creating innovative technology-based ap18 proaches to deliver arthritis and musculoskeletal 

19 health education to students, faculty, and staff. 

20 (3) Developing and employing peer-outreach 

21 and education programs to generate discussion, edu22 cate, and raise awareness among students about 

23 issues relating to arthritis and musculoskeletal 

24 health disorders, and their relationship to diabetes, 


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1 hypertension, cardiovascular disease, psychological 

2 health, and other comorbid conditions. 

3 (f) REPORT TO CONGRESS.— 

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

5 the date of the enactment of this Act, and annually 

6 thereafter for a period of 5 years, the Secretary shall 

7 prepare and submit to the appropriate committees of 

8 Congress a report on the activities to provide health 

9 professions students with comprehensive arthritis 

10 and musculoskeletal health education funded under 

11 this section. 

12 (2) REPORT ELEMENTS.—The report described 

13 in paragraph (1) shall include information about— 

14 (A) the number of entities that are receiv15 ing a grant under this section; 

16 (B) the specific activities supported by 

17 grants under this section; 

18 (C) the number of students served by pro19 grams supported by grants under this section; 

20 and 

21 (D) the status of evaluations of such pro22 grams. 

23 (g) DEFINITION OF INSTITUTION OF HIGHER EDU24 CATION.—In this section, the term ‘‘institution of higher 

25 education’’ has the meaning given such term in section 


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1 101 of the Higher Education Act of 1965 (20 U.S.C. 

2 1001). 

3 Subtitle J—Sleep and Circadian 

4 Rhythm Disorders 

5 SEC. 7901. SLEEP AND CIRCADIAN RHYTHM DISORDERS RE6 SEARCH ACTIVITIES OF THE NATIONAL IN7 STITUTES OF HEALTH. 

8 (a) IN GENERAL.—The Director of the National In9 stitutes of Health, acting through the Director of the Na10 tional Heart, Lung, and Blood Institute, shall— 

11 (1) continue to expand research activities ad12 dressing sleep health disparities; and 

13 (2) continue implementation of the NIH Sleep 

14 Disorders Research Plan across all institutes and 

15 centers of the National Institutes of Health to im16 prove treatment and prevention of sleep health dis17 parities. 

18 (b) REQUIRED RESEARCH ACTIVITIES.—In con19 ducting or supporting research relating to sleep and circa20 dian rhythm, the Director of the National Heart, Lung, 

21 and Blood Institute shall— 

22 (1) advance epidemiology and clinical research 

23 to achieve a more complete understanding of dispari24 ties in domains of sleep health and across population 


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1 subgroups for which cardiovascular and metabolic 

2 health disparities exist, including— 

3 (A) prevalence and severity of sleep apnea; 

4 (B) habitual sleep duration; 

5 (C) sleep timing and regularity; and 

6 (D) insomnia; 

7 (2) develop study designs and analytical ap8 proaches to explain and predict multilevel and life9 course determinants of sleep health and to elucidate 

10 the sleep-related causes of cardiovascular and meta11 bolic health disparities across the age spectrum, in12 cluding such determinants and causes that are— 

13 (A) environmental; 

14 (B) biological or genetic; 

15 (C) psychosocial; 

16 (D) societal; 

17 (E) political; or 

18 (F) economic; 

19 (3) determine the contribution of sleep impair20 ments such as sleep apnea, insufficient sleep dura21 tion, irregular sleep schedules, and insomnia to un22 explained disparities in cardiovascular and metabolic 

23 risk and disease outcomes; 

24 (4) develop study designs, data sampling and 

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1 mize understanding of mediating and moderating 

2 factors, and feedback mechanisms coupling sleep to 

3 cardiovascular and metabolic health disparities; 

4 (5) advance research to understand cultural 

5 and linguistic barriers (on the person, provider, or 

6 system level) to access to care, medical diagnosis, 

7 and treatment of sleep disorders in diverse popu8 lation groups; 

9 (6) develop and test multilevel interventions (in10 cluding sleep health education in diverse commu11 nities) to reduce disparities in sleep health that will 

12 impact the ability to improve disparities in cardio13 vascular and metabolic risk or disease; 

14 (7) create opportunities to integrate sleep and 

15 health disparity science by strategically utilizing re16 sources (involving existing or anticipated cohorts) 

17 and exchanging scientific data and ideas (including 

18 through cross-over into scientific meetings); and 

19 (8) enhance the diversity and foster career de20 velopment of young investigators involved in sleep 

21 and health disparities science. 

22 (c) AUTHORIZATION OF APPROPRIATIONS.—To carry 

23 out this section, there are authorized to be appropriated 

24 such sums as may be necessary for fiscal year 2025 and 

25 each subsequent fiscal year. 


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1 SEC. 7902. 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) REQUIRED SURVEILLANCE AND EDUCATION

11 AWARENESS ACTIVITIES.—In conducting or supporting 

12 research relating to sleep and circadian rhythm disorders 

13 surveillance and education awareness activities, the Direc14 tor of the Centers for Disease Control and Prevention 

15 shall— 

16 (1) ensure that such activities are culturally 

17 and linguistically appropriate to minority patients, 

18 targeting sleep and circadian rhythm health pro19 motion and prevention programs of each major eth20 nic group, including— 

21 (A) Native Americans and Alaska Natives; 

22 (B) Asian Americans; 

23 (C) African Americans and Blacks; 

24 (D) Hispanic and Latino-Americans; and 

25 (E) Native Hawaiians and Pacific Island26 ers; 


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1 (2) collect and compile national and State sur2 veillance data on sleep disorders health disparities; 

3 (3) continue to develop and implement new 

4 sleep questions in public health surveillance systems 

5 to increase public awareness of sleep health and 

6 sleep disorders and their impact on health; 

7 (4) publish monthly reports highlighting geo8 graphic, racial, and ethnic disparities in sleep health, 

9 as well as relationships between insufficient sleep 

10 and chronic disease, health risk behaviors, and other 

11 outcomes as determined necessary by the Director; 

12 and 

13 (5) include public awareness campaigns that in14 form patient populations from major ethnic groups 

15 about the prevalence of sleep and circadian rhythm 

16 disorders and emphasize the importance of sleep 

17 health. 

18 (c) AUTHORIZATION OF APPROPRIATIONS.—To carry 

19 out this section, there are authorized to be appropriated 

20 such sums as may be necessary for fiscal year 2025 and 

21 each subsequent fiscal year. 


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1 SEC. 7903. GRANTS FOR COMPREHENSIVE SLEEP AND CIR2 CADIAN HEALTH EDUCATION WITHIN 

3 HEALTH PROFESSIONS SCHOOLS. 

4 (a) PROGRAM AUTHORIZED.—The Secretary of 

5 Health and Human Services (referred to in this section 

6 as the ‘‘Secretary’’), in coordination with the Secretary of 

7 Education, shall award grants, on a competitive basis, to 

8 academic health science centers, health professions 

9 schools, and institutions of higher education to enable 

10 such centers, schools, and institutions to provide people 

11 with comprehensive education on sleep and circadian 

12 health, particularly— 

13 (1) poor sleep health; 

14 (2) sleep disorders; 

15 (3) sleep health disparities; and 

16 (4) the relationship between sleep and circadian 

17 health on metabolic activity, neurological activity, 

18 comorbidities, and other diseases. 

19 (b) DURATION.—Grants awarded under this section 

20 shall be for a period of 5 years. 

21 (c) APPLICATIONS.—An academic health science cen22 ter, health professions school, or institution of higher edu23 cation seeking a grant under this section shall submit an 

24 application to the Secretary at such time, in such manner, 

25 and containing such information as the Secretary may re26 quire. 


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1 (d) PRIORITY.—In awarding grants under this sec2 tion, the Secretary shall give priority to an institution of 

3 higher education that— 

4 (1) has an enrollment of needy students, as de5 fined in section 318(b) of the Higher Education Act 

6 of 1965 (20 U.S.C. 1059e(b)); 

7 (2) is a Hispanic-serving institution, as defined 

8 in section 502(a) of such Act (20 U.S.C. 1101a(a)); 

9 (3) is a Tribal College or University, as defined 

10 in section 316(b) of such Act (20 U.S.C. 1059c(b)); 

11 (4) is an Alaska Native-serving institution, as 

12 defined in section 317(b) of such Act (20 U.S.C. 

13 1059d(b)); 

14 (5) is a Native Hawaiian-serving institution, as 

15 defined in section 317(b) of such Act (20 U.S.C. 

16 1059d(b)); 

17 (6) is a Predominately Black Institution, as de18 fined in section 318(b) of such Act (20 U.S.C. 

19 1059e(b)); 

20 (7) is a Native American-serving, nontribal in21 stitution, as defined in section 319(b) of such Act 

22 (20 U.S.C. 1059f(b)); 

23 (8) is an Asian American and Native American 

24 Pacific Islander-serving institution, as defined in 

25 section 320(b) of such Act (20 U.S.C. 1059g(b)); or 


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1 (9) is a minority institution, as defined in sec2 tion 365 of such Act (20 U.S.C. 1067k), with an en3 rollment of needy students, as defined in section 312 

4 of such Act (20 U.S.C. 1058). 

5 (e) USES OF FUNDS.—An academic health science 

6 center, health professions school, or institution of higher 

7 education receiving a grant under this section may use the 

8 grant funds to integrate issues relating to comprehensive 

9 sleep and circadian health into the academic or support 

10 sectors of the center, school, or institution, in order to 

11 reach a large number of students, by carrying out 1 or 

12 more of the following activities: 

13 (1) Developing educational content for issues 

14 relating to comprehensive sleep and circadian health 

15 education that will be incorporated into first-year 

16 orientation or core courses. 

17 (2) Creating innovative technology-based ap18 proaches to deliver sleep health education to stu19 dents, faculty, and staff. 

20 (3) Developing and employing peer-outreach 

21 and education programs to generate discussion, edu22 cate, and raise awareness among students about 

23 issues relating to poor quality sleep, sleep and circa24 dian disorders, and the role sleep health plays in 

25 other diseases and comorbidities. 


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1 (f) REPORT TO CONGRESS.— 

2 (1) IN GENERAL.—Not later than 1 year after 

3 the date of the enactment of this Act, and annually 

4 thereafter for a period of 5 years, the Secretary shall 

5 prepare and submit to the appropriate committees of 

6 Congress a report on the activities to provide health 

7 professions students with comprehensive sleep and 

8 circadian health education funded under this section. 

9 (2) REPORT ELEMENTS.—The report described 

10 in paragraph (1) shall include information about— 

11 (A) the number of entities that are receiv12 ing a grant under this section; 

13 (B) the specific activities supported by 

14 grants under this section; 

15 (C) the number of students served by pro16 grams supported by grants under this section; 

17 and 

18 (D) the status of evaluations of programs 

19 supported by such grants. 

20 (g) DEFINITION OF INSTITUTION OF HIGHER EDU21 CATION.—In this section, the term ‘‘institution of higher 

22 education’’ has the meaning given such term in section 

23 101 of the Higher Education Act of 1965 (20 U.S.C. 

24 1001). 


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1 SEC. 7904. REPORT ON IMPACT OF SLEEP AND CIRCADIAN 

2 HEALTH DISORDERS IN VULNERABLE AND 

3 RACIAL/ETHNIC POPULATIONS. 

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 submit to Congress and the Presi7 dent a report on the impact of sleep and circadian health 

8 disorders for racial and ethnic minority communities and 

9 other vulnerable populations. 

10 (b) CONTENTS.—The report under subsection (a) 

11 shall include information on the— 

12 (1) progress that has been made in reducing 

13 the impact of sleep and circadian health disorders in 

14 such communities and populations; 

15 (2) opportunities that exist to make additional 

16 progress in reducing the impact of sleep and circa17 dian health disorders in such communities and popu18 lations; 

19 (3) challenges that may impede such additional 

20 progress; and 

21 (4) Federal funding necessary to achieve sub22 stantial reductions in sleep and circadian health dis23 orders in racial and ethnic minority communities. 


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1 Subtitle K—Kidney Disease Re2 search, Surveillance, Preven3 tion, and Treatment 

4 SEC. 7901A. KIDNEY DISEASE RESEARCH IN MINORITY POP5 ULATIONS. 

6 (a) IN GENERAL.— 

7 (1) RESEARCH AND TRAINING CENTERS.—Sec8 tion 431(c)(3) of the Public Health Service Act (42 

9 U.S.C. 285c–5(c)(3)) is amended— 

10 (A) in subparagraph (B), by striking 

11 ‘‘and’’ at the end; 

12 (B) in subparagraph (C), by striking 

13 ‘‘and’’ at the end; and 

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

15 ‘‘(D) improving data science through im16 provement in bioinformatics, data integration, 

17 and data sharing; 

18 ‘‘(E) defining the chronic kidney disease 

19 mechanism and identifying new therapeutic tar20 gets for chronic kidney disease using specific 

21 tools, including mapping the genetic architec22 ture of kidney function and disease and trans23 lating genetic maps to disease-causing genes 

24 and mechanisms, especially among minority 

25 populations; 


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1 ‘‘(F) improving models of human disease 

2 including better humanized animal models, im3 proved reproducibility, and functional character4 ization of kidney organoids, and accelerating 

5 the development of in vivo imaging technologies; 

6 and 

7 ‘‘(G) developing cell-specific drug delivery 

8 systems and gene editing, including targeted 

9 systems for the delivery of therapeutic com10 pounds to specific kidney compartments or cell 

11 types and accelerating the implementation of 

12 gene editing and gene therapy for the treatment 

13 of kidney diseases in vivo; and’’. 

14 (2) INCLUSION OF MINORITY PARTICIPANTS.— 

15 In conducting and supporting research described in 

16 the amendment made by paragraph (1), the Director 

17 of the National Institutes of Health shall work with 

18 the Director of the National Institute on Minority 

19 Health and Health Disparities to improve the num20 ber of minority participants as study subjects in 

21 clinical trials. Such work may include— 

22 (A) developing and sustaining clinical trial 

23 consortia that can recruit patients with chronic 

24 kidney disease to ensure adequate capacity for 


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1 assessment of kidney outcomes and increase the 

2 enrollment of underrepresented populations; 

3 (B) encouraging the use of novel designs in 

4 clinical trials to enhance the recruitment and 

5 retention of underrepresented populations which 

6 will enhance the generalizability of study find7 ings; 

8 (C) supporting outreach initiatives that in9 corporate acknowledgment of both historical 

10 and current grounds for participation reluc11 tance, and that prioritize demonstrating trust12 worthiness, in order to enhance the ability to 

13 promote and effectively convey the benefits of 

14 clinical research participation; 

15 (D) completing clinical trials that test 

16 interventions to improve patient quality of life 

17 and address patient-reported outcomes; and 

18 (E) encouraging inclusion of persons with 

19 chronic kidney disease in clinical trials of treat20 ments for nonkidney diseases. 

21 (b) REPORT; COMPREHENSIVE PLAN.—Section 429 

22 of the Public Health Services Act (42 U.S.C. 285c–3) is 

23 amended by adding at the end the following: 

24 ‘‘(c) REPORT BY KIDNEY, UROLOGIC, AND HEMATO25 LOGIC DISEASES COORDINATING COMMITTEE.— 


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1 ‘‘(1) IN GENERAL.—The Kidney, Urologic, and 

2 Hematologic Diseases Coordinating Committee, in 

3 coordination with the Chronic Kidney Disease Initia4 tive at the Centers for Disease Control and Preven5 tion, shall— 

6 ‘‘(A) prepare and submit to the Congress, 

7 not later than 6 months after the date of enact8 ment of this subsection, a report on Federal re9 search and public health activities with respect 

10 to kidney disease in minority populations; and 

11 ‘‘(B) develop and submit to the Congress, 

12 the Secretary, the Director of the National In13 stitutes of Health, and the Advisory Board es14 tablished under section 430 for the diseases for 

15 which the Committee was established, not later 

16 than 1 year after the date of enactment of this 

17 subsection, an effective and comprehensive Fed18 eral plan (including all appropriate Federal 

19 health programs) to address kidney disease in 

20 minority populations. 

21 ‘‘(2) CONTENTS.—The report under paragraph 

22 (1)(A) shall at minimum address each of the fol23 lowing: 

24 ‘‘(A) Research on kidney disease in minor25 ity populations, including such research on— 


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1 ‘‘(i) genetic, behavioral, and environ2 mental factors; 

3 ‘‘(ii) prevention and complications 

4 among individuals within these populations 

5 who have already developed kidney disease; 

6 ‘‘(iii) the delivery of evidenced-based 

7 care for all chronic kidney disease stages, 

8 especially in underrepresented and under9 served populations; 

10 ‘‘(iv) expanding support for a root11 cause analysis approach to disparities, in12 cluding causes, detection, and management 

13 of chronic kidney disease for underserved 

14 populations; 

15 ‘‘(v) developing research teams that 

16 engage with community organizations to 

17 develop and implement interventions which 

18 halt or delay development and progression 

19 of chronic kidney disease; and 

20 ‘‘(vi) continued support of observa21 tional studies of kidney disease measures 

22 and outcomes. 

23 ‘‘(B) Surveillance and data collection on 

24 kidney disease in minority populations, includ25 ing with respect to— 


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1 ‘‘(i) efforts to better determine the 

2 prevalence of kidney disease among Asian3 American and Pacific Islander subgroups; 

4 and 

5 ‘‘(ii) efforts to coordinate data collec6 tion on the American Indian population. 

7 ‘‘(C) Community-based interventions to ad8 dress kidney disease targeting minority popu9 lations, including— 

10 ‘‘(i) the evidence bases for such inter11 ventions; 

12 ‘‘(ii) the cultural appropriateness of 

13 such interventions; and 

14 ‘‘(iii) efforts to educate the public on 

15 the causes and consequences of kidney dis16 ease. 

17 ‘‘(D) Education and training programs for 

18 health professionals (including community 

19 health workers) on the prevention and manage20 ment of kidney disease and its related complica21 tions that are supported by the Health Re22 sources and Services Administration, including 

23 such programs supported by the Bureau of 

24 Health Workforce, the Bureau of Primary 


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1 Health Care, and the Health Systems Bureau. 

2 This shall include— 

3 ‘‘(i) identification of effective strate4 gies to increase implementation of proven 

5 therapies to slow chronic kidney disease in6 cidence and progression, especially in high7 risk underrepresented populations; and 

8 ‘‘(ii) identification of effective practice 

9 improvement strategies in large and small 

10 health systems to reduce chronic kidney 

11 disease incidence and progression.’’. 

12 SEC. 7901A–1. KIDNEY DISEASE ACTION PLAN. 

13 (a) IN GENERAL.—The Director of the Centers for 

14 Disease Control and Prevention shall conduct, support, 

15 and expand public health strategies, prevention, diagnosis, 

16 surveillance, and public and professional awareness activi17 ties regarding kidney disease. 

18 (b) NATIONAL ACTION PLAN.— 

19 (1) DEVELOPMENT.—Pursuant to section 426 

20 of the Public Health Service Act (42 U.S.C. 285c), 

21 not later than 2 years after the date of the enact22 ment of this Act, the Director of the National Insti23 tute of Diabetes and Digestive and Kidney Diseases, 

24 in consultation with the Director of the National In25 stitute on Minority Health and Health Disparities 


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1 and the Director of the Centers for Disease Control 

2 and Prevention, shall develop a national action plan 

3 to address kidney disease in the United States with 

4 participation from patients, caregivers, health pro5 fessionals, patient advocacy organizations, research6 ers, providers, public health professionals, and other 

7 stakeholders. 

8 (2) CONTENTS.—At a minimum, such plan 

9 shall include recommendations for— 

10 (A) public health interventions for the pur11 pose of implementation of the national plan; 

12 (B) biomedical, health services, and public 

13 health research on kidney disease; and 

14 (C) inclusion of kidney disease in the 

15 health data collections of all Federal agencies. 

16 (c) KIDNEY DISEASE PREVENTION PROGRAMS.—The 

17 Director of the Centers for Disease Control and Preven18 tion, through the Chronic Kidney Disease Initiative, shall 

19 carry out the following: 

20 (1) Conduct public education and awareness ac21 tivities with patient and professional organizations 

22 to stimulate earlier diagnosis and improve patient 

23 outcomes from treatment of kidney disease. To the 

24 extent known and relevant, such public education 

25 and awareness activities shall reflect differences in 


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1 kidney disease by cause (such as hypertension, dia2 betes, lupus nephritis, COVID–19, and polycystic 

3 kidney disease) and include a focus on outreach to 

4 undiagnosed and, as appropriate, minority popu5 lations. 

6 (2) Supplement and expand upon the activities 

7 of the Centers for Disease Control and Prevention 

8 by making grants to nonprofit organizations, State 

9 and local jurisdictions, and Indian Tribes for the 

10 purpose of reducing the burden of kidney disease, 

11 especially in disproportionately impacted commu12 nities, through public health interventions and re13 lated activities. 

14 (3) Coordinate with the National Institute of 

15 Diabetes and Digestive and Kidney Diseases, the In16 dian Health Service, the Health Resources and Serv17 ices Administration, and the Department of Vet18 erans Affairs to develop pilot programs to dem19 onstrate best practices for the diagnosis and man20 agement of kidney disease. 

21 (4) Develop improved techniques and identify 

22 best practices, in coordination with the Secretary of 

23 Veterans Affairs, for assisting kidney disease pa24 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 2025, $1,000,000 for fiscal year 

20 2026, $1,000,000 for fiscal year 2027, $1,000,000 for fis21 cal year 2028, and $1,000,000 for fiscal year 2029. 


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1 SEC. 7901A–2. PROVIDING FOR STAFF-ASSISTED HOME DI2 ALYSIS FOR CERTAIN HEMODIALYSIS AND 

3 PERITONEAL DIALYSIS PATIENTS. 

4 (a) IN GENERAL.—Section 1881(b)(14) of the Social 

5 Security Act (42 U.S.C. 1395rr(b)(14)) is amended by 

6 adding at the end the following new subparagraph: 

7 ‘‘(J)(i) With respect to staff-assisted home 

8 dialysis (as defined in clause (iv)(IV)) furnished 

9 on or after the date that is 1 year after the 

10 date of the enactment of this subparagraph, 

11 subject to the succeeding provisions of this sub12 paragraph, the Secretary shall increase the sin13 gle payment that would otherwise apply under 

14 this paragraph for renal dialysis services by the 

15 add-on payment amount established pursuant 

16 to clause (iii). 

17 ‘‘(ii)(I) Subject to subclause (II), staff-as18 sisted home dialysis may only be furnished— 

19 ‘‘(aa) with respect to an initializing 

20 patient (as defined in clause (iv)(I)) or a 

21 returning patient (as defined in clause 

22 (iv)(III)), for a period of up to 90 days, re23 ferred to as the ‘initial period’, which may 

24 be extended as determined necessary by 

25 the care team of the individual in not more 

26 than 2 intervals of up to 30 days each, 


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1 each of which is referred to as an ‘ex2 tended interval’; and 

3 ‘‘(bb) with respect to a temporary as4 sistance patient (as defined in clause 

5 (iv)(V)), for any 30-day period as deter6 mined necessary by the care team of the 

7 individual, notwithstanding whether such 

8 an individual receives any routine dialysis 

9 respite care during such period. 

10 ‘‘(II) Notwithstanding subclause (I), staff11 assisted home dialysis may be furnished for as 

12 long as the Secretary determines appropriate to 

13 an individual who— 

14 ‘‘(aa) is blind; 

15 ‘‘(bb) has a cognitive or neurological 

16 impairment (including a stroke, Alz17 heimer’s Disease, dementia, amyotrophic 

18 lateral sclerosis, or any other impairment 

19 determined by the Secretary); or 

20 ‘‘(cc) has any other illness or injury 

21 that reduces mobility (including cerebral 

22 palsy, spinal cord injuries, an injury or ill23 ness that requires the individual to be on 

24 a ventilator, or any other illness or injury 

25 determined by the Secretary). 


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1 ‘‘(iii) The Secretary shall, by regulation, 

2 establish an add-on payment amount for staff3 assisted home dialysis to determine the 

4 amounts payable to a qualified provider (as de5 fined in clause (iv)(II)) for assisting in the fur6 nishing of staff-assisted home dialysis on a fre7 quency as determined by the Secretary and in 

8 consultation with clinicians, patients, and care 

9 partners to ensure maximum patient choice, ac10 cess, and flexibility. In establishing the add-on 

11 payment under this clause, the Secretary shall 

12 consult with stakeholders, including providers of 

13 renal dialysis services, individuals receiving 

14 home dialysis, qualified providers, private insur15 ance payers, and Medicare Advantage plans 

16 under part C. 

17 ‘‘(iv) In this subparagraph: 

18 ‘‘(I) The term ‘initializing patient’ 

19 means an individual who initiates a home 

20 dialysis modality, including home hemo21 dialysis and peritoneal dialysis. 

22 ‘‘(II) The term ‘qualified provider’ 

23 means a trained professional (as deter24 mined by the Secretary, including a regVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 01384 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 istered or licensed practical nurse and a 

2 certified patient care technician) who— 

3 ‘‘(aa) furnishes renal dialysis 

4 services; 

5 ‘‘(bb) meets requirements (as de6 termined by the Secretary) that en7 sure competency in patient care and 

8 modality usage; and 

9 ‘‘(cc) during a period described 

10 in clause (ii)(I), provides in-person as11 sistance to an individual for an appro12 priate number of dialysis sessions, as 

13 determined by the care team of the in14 dividual based on the needs of the in15 dividual, caregiver availability, pre16 scription, and mode of home dialysis. 

17 ‘‘(III) The term ‘returning patient’ 

18 means an individual who is returning to 

19 home dialysis after a period of hospitaliza20 tion or other non-home dialysis modality. 

21 ‘‘(IV)(aa) The term ‘staff-assisted 

22 home dialysis’ means dialysis furnished by 

23 the individual in a home, residence, or 

24 other approved setting with the assistance 

25 of a qualified provider, the frequency of 


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1 which is determined by the qualified pro2 vider in coordination with the individual, 

3 the care partner, and the care team of the 

4 individual and outlined in a patient plan of 

5 care. 

6 ‘‘(bb) In this subclause, the term ‘care 

7 partner’ means a friend or family member 

8 who is designated by the individual who is 

9 trained to assist the individual with the 

10 furnishing of home dialysis. 

11 ‘‘(cc) In this subclause, the term ‘pa12 tient plan of care’ has the meaning given 

13 such term in section 494.90 of title 42, 

14 Code of Federal Regulations (or any suc15 cessor regulations). 

16 ‘‘(V) The term ‘temporary assistance 

17 patient’ means an individual who is receiv18 ing home dialysis and is temporarily un19 able to perform functions necessary to self20 furnish unassisted home dialysis due to ill21 ness, injury, caregiver unavailability, or 

22 other temporary circumstances not to ex23 ceed 30 days.’’. 

24 (b) PATIENT EDUCATION AND TRAINING RELATING

25 TO STAFF-ASSISTED HOME DIALYSIS.— 


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1 (1) IN GENERAL.—Section 1881(b)(5) of the 

2 Social Security Act (42 U.S.C. 1395rr(b)(5)) is 

3 amended— 

4 (A) in subparagraph (C), by striking at the 

5 end ‘‘and’’; 

6 (B) in subparagraph (D), by striking the 

7 period at the end and inserting a semicolon; 

8 and 

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

10 subparagraphs: 

11 ‘‘(E) educate individuals on the oppor12 tunity to receive staff-assisted home dialysis (as 

13 defined in paragraph (14)(J)(iv)(IV)) during 

14 the periods described in paragraph (14)(J)(ii); 

15 and 

16 ‘‘(F) provide for registered or licensed 

17 nurses, certified patient care technicians, or 

18 other qualified providers (as determined by a 

19 physician) to train individuals and their care 

20 partners in skills and procedures needed to fur21 nish staff-assisted home dialysis, including— 

22 ‘‘(i) in a group-training environment 

23 with other individuals and their care part24 ners when appropriate and in accordance 

25 with Federal regulations (concerning the 


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1 privacy of individually identifiable health 

2 information) promulgated under section 

3 264(c) of the Health Insurance Portability 

4 and Accountability Act of 1996; 

5 ‘‘(ii) via telehealth (following an initial 

6 period of in-person competency training, in 

7 accordance with standards specified by the 

8 Secretary); 

9 ‘‘(iii) through interdisciplinary team 

10 training (as described in the interpretive 

11 guidance relating to tag number V590 of 

12 ‘Advance Copy—End Stage Renal Disease 

13 (ESRD) Program Interpretive Guidance 

14 Version 1.1’ (published on October 3, 

15 2008)); and 

16 ‘‘(iv) in the home or residence of an 

17 individual, in a dialysis facility, in a stand18 alone training facility, or the place in 

19 which the individual has been approved to 

20 perform home dialysis by the care team.’’. 

21 (2) EFFECTIVE DATE.—The amendments made 

22 by this subsection shall take effect on the date that 

23 is 1 year after the date of the enactment of this Act. 

24 (c) OTHER PROVISIONS.— 


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1 (1) ANTI-KICKBACK STATUTE.—Section 

2 1128B(b)(3) of the Social Security Act (42 U.S.C. 

3 1320a–7b(b)(3)) is amended— 

4 (A) by moving subparagraphs (J) and (K) 

5 2 ems to the left; 

6 (B) in subparagraph (K), by striking 

7 ‘‘and’’ at the end; 

8 (C) in subparagraph (L), by striking the 

9 period at the end and inserting ‘‘; and’’; and 

10 (D) by adding at the end the following new 

11 subparagraph: 

12 ‘‘(M) any remuneration relating to the fur13 nishing of staff-assisted home dialysis (as defined in 

14 section 1881(b)(14)(J)(iv)(IV)).’’. 

15 (2) STUDY.—Not later than 2 years after the 

16 date of the enactment of this Act, the Secretary of 

17 Health and Human Services (in this section referred 

18 to as the ‘‘Secretary’’) shall submit, to the Com19 mittee on Finance of the Senate and the Committees 

20 on Energy and Commerce and Ways and Means of 

21 the House of Representatives, a report that— 

22 (A) examines racial disparities in the utili23 zation of home dialysis (as defined in section 

24 1881(b)(14)(J)(iv)(IV) of the Social Security 

25 Act (42 U.S.C. 1395rr(b)(14)(J)(iv)(IV)), as 


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1 added by subsection (a)), and makes rec2 ommendations on how to improve access to 

3 home dialysis for communities of color; 

4 (B) examines coverage for, and utilization 

5 of, home dialysis in rural communities, and 

6 makes recommendations on how to improve ac7 cess to home dialysis for such rural commu8 nities; and 

9 (C) analyzes clinical and quality of life out10 comes for patients, disaggregated by geographic 

11 and demographic indicators, who receive dif12 ferent dialysis modalities, including staff-as13 sisted home dialysis, unassisted home dialysis, 

14 and dialysis furnished in a facility. 

15 (3) PATIENT DECISION TOOL.—Not later than 

16 December 31, 2025, for the purposes of section 

17 1881(b)(14)(J) of the Social Security Act (42 

18 U.S.C. 1395rr(b)(14)(J)), as added by subsection 

19 (a), the Secretary shall convene a patient panel to 

20 develop a patient-centered decision tool to assist di21 alysis patients in evaluating their lifestyle and goals 

22 and in choosing the dialysis setting and modality. 

23 Such tool shall include an acknowledgment that the 

24 patient is capable of home dialysis and wants home 

25 dialysis, if that is the modality such patient chooses. 


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1 (4) PATIENT QUALITY OF LIFE METRIC.—Sec2 tion 1881(h)(2)(A)(iv) of the Social Security Act (42 

3 U.S.C. 1395rr(h)(2)(A)(iv)) is amended— 

4 (A) in subclause (II), by striking ‘‘and’’ at 

5 the end; 

6 (B) in subclause (III), by striking the pe7 riod at the end and inserting ‘‘; and’’; and 

8 (C) by adding at the end the following new 

9 subclause: 

10 ‘‘(IV) patient quality of life for 

11 all individuals utilizing dialysis re12 gardless of modality, with the intent 

13 of measuring and improving patient 

14 quality of life on dialysis.’’. 

15 SEC. 7901A–3. INCREASING KIDNEY TRANSPLANTS IN MI16 NORITY POPULATIONS. 

17 (a) IN GENERAL.—The Director of the National In18 stitutes of Health shall expand, intensify, and support on19 going research and other activities with respect to kidney 

20 transplants in minority populations. 

21 (b) CMS DATA COLLECTION AND REPORTING.—The 

22 Centers for Medicare & Medicaid Services shall collect and 

23 report annual data on dialysis facility and nephrologist 

24 performance on transplant referral, with an emphasis on 

25 data relating to patients of color. 


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1 (c) OPTN DATA COLLECTION AND REPORTING.— 

2 The Organ Procurement and Transplantation Network 

3 shall collect and the Scientific Registry of Transplant Re4 cipients shall report annual data, broken down by demo5 graphic and socioeconomic characteristics, on individual 

6 transplant center performance as it relates to patients re7 ferred, evaluated, waitlisted, and successfully trans8 planted. 

9 (d) TRANSPLANT CENTER DATA.—Each organ trans10 plant center shall report on the percent of appropriate 

11 waitlisted patients (including socioeconomic and demo12 graphic data) giving and receiving annual informed con13 sent for offers for suboptimal kidneys (such as kidneys 

14 with a kidney donor profile index of greater than 85 per15 cent or kidney age 50 with diabetes, or age greater than 

16 60). 

17 (e) ORGAN PROCUREMENT ORGANIZATION DATA.— 

18 Each organ procurement organization shall report annual 

19 data on referrals, refusals (patient or doctor), and accept20 ance of organs by hospital, ZIP Code, race, ethnicity, and 

21 age strata except as prohibited by need for confidentiality. 

22 (f) DATA TRANSPARENCY FOR PATIENTS.—Each 

23 organ transplant center shall provide to each patient of 

24 such center, on an annual basis— 


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1 (1) the number of times an organ was offered 

2 to the patient, declined, and transplanted into an3 other patient from organs within a 500-mile radius; 

4 and 

5 (2) the number of times an organ was offered 

6 to and declined for the patient from a low-risk donor 

7 which was subsequently transplanted into another 

8 patient. 

9 (g) IMPROVED TRANSPLANTATION EDUCATION.— 

10 The Centers for Medicare & Medicaid Services shall certify 

11 a nonbiased, third-party organization to accredit organ 

12 transplant education. 

13 (h) RESEARCH.—Research under subsection (a) shall 

14 include investigation into— 

15 (1) the causes of lower rates of kidney trans16 plants in minority populations, including socio17 economic, geographic, clinical, environmental, ge18 netic, and other factors that may contribute to lower 

19 rates of kidney transplants in minority populations; 

20 and 

21 (2) possible interventions to increase kidney 

22 transplants. 

23 (i) REPORT; COMPREHENSIVE PLAN.— 

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

25 Human Services shall— 


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1 (A) prepare and submit to the Congress, 

2 not later than 6 months after the date of enact3 ment of this section, a report on Federal re4 search and public health activities with respect 

5 to kidney transplants as a treatment for end6 stage renal disease in minority populations; and 

7 (B) develop and submit to the Congress, 

8 not later than 1 year after the date of enact9 ment of this section, an effective and com10 prehensive Federal plan (including all appro11 priate Federal health programs) to increase the 

12 number of kidney transplants in minority popu13 lations. 

14 (2) CONTENTS.—The report under paragraph 

15 (1)(A) shall at a minimum address each of the fol16 lowing: 

17 (A) Research on kidney transplants in mi18 nority populations, including such research on 

19 financial, insurance coverage, genetic, behav20 ioral, and environmental factors. 

21 (B) Surveillance and data collection on 

22 kidney transplants in minority populations, in23 cluding with respect to— 

24 (i) efforts to increase kidney trans25 plants among Asian-American and Pacific 


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1 Islander subgroups with end-stage renal 

2 disease; and 

3 (ii) efforts to increase kidney trans4 plants in the American Indian population. 

5 (C) Community-based efforts to increase 

6 kidney transplants targeting minority popu7 lations, including— 

8 (i) the evidence base for such in9 creases; 

10 (ii) the cultural appropriateness of 

11 such increases; and 

12 (iii) efforts to educate the public on 

13 kidney transplants. 

14 (D) Education and training programs for 

15 health professionals (including community 

16 health workers) on the kidney transplants that 

17 are supported by the Health Resources and 

18 Services Administration, including such pro19 grams supported by the Bureau of Health 

20 Workforce, the Bureau of Primary Health Care, 

21 and the Health Systems Bureau. 

22 SEC. 7901A–4. ENVIRONMENTAL AND OCCUPATIONAL 

23 HEALTH PROGRAMS. 

24 The Director of the Centers for Disease Control and 

25 Prevention shall— 


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1 (1) support research into the environmental and 

2 occupational causes and biological mechanisms that 

3 contribute to kidney disease; and 

4 (2) develop and disseminate public health inter5 ventions that will lessen the impact of environmental 

6 and occupational causes of kidney disease. 

7 SEC. 7901A–5. UNDERSTANDING THE TREATMENT PAT8 TERNS ASSOCIATED WITH PROVIDING CARE 

9 AND TREATMENT OF KIDNEY FAILURE IN MI10 NORITY POPULATIONS. 

11 (a) STUDY.—The Secretary of Health and Human 

12 Services (in this section referred to as the ‘‘Secretary’’) 

13 shall conduct a study on treatment patterns associated 

14 with providing care, under the Medicare program under 

15 title XVIII of the Social Security Act (42 U.S.C. 1395 

16 et seq.), under the Medicaid program under title XIX of 

17 such Act (42 U.S.C. 1396 et seq.), and through private 

18 health insurance, to minority populations that are dis19 proportionately affected by kidney failure. 

20 (b) REPORT.—Not later than 1 year after the date 

21 of the enactment of this Act, the Secretary shall submit 

22 to Congress a report on the study conducted under sub23 section (a), together with such recommendations as the 

24 Secretary determines to be appropriate. 


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1 SEC. 7901A–6. ENCOURAGING KIDNEY CARE WORKFORCE IN 

2 UNDERSERVED AREAS. 

3 (a) DEFINITION OF PRIMARY HEALTH SERVICES.— 

4 Section 331(a)(3)(D) of the Public Health Service Act (42 

5 U.S.C. 254d(a)(3)(D)) is amended by inserting ‘‘nephrol6 ogy,’’ after ‘‘dentistry,’’. 

7 (b) NATIONAL HEALTH SERVICE CORPS SCHOLAR8 SHIP PROGRAM.—Section 338A(a)(2) of the Public Health 

9 Service Act (42 U.S.C. 254l(a)(2)) is amended by insert10 ing ‘‘, which may include kidney health professionals’’ be11 fore the period at the end. 

12 (c) NATIONAL HEALTH SERVICE CORPS LOAN RE13 PAYMENT PROGRAM.—Section 338B(a)(2) of the Public 

14 Health Service Act (42 U.S.C. 254l–1(a)(2)) is amended 

15 by inserting ‘‘, which may include kidney health profes16 sionals’’ before the period at the end. 

17 SEC. 7901A–7. THE JACK REYNOLDS MEMORIAL MEDIGAP 

18 EXPANSION ACT; MEDIGAP COVERAGE FOR 

19 BENEFICIARIES WITH END-STAGE RENAL DIS20 EASE. 

21 (a) GUARANTEED AVAILABILITY OF MEDIGAP POLI22 CIES TO ALL ESRD MEDICARE BENEFICIARIES.— 

23 (1) IN GENERAL.—Section 1882(s) of the So24 cial Security Act (42 U.S.C. 1395ss(s)) is amend25 ed— 

26 (A) in paragraph (2)— 


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1 (i) in subparagraph (A), by striking 

2 ‘‘is 65’’ and all that follows through the 

3 period at the end and inserting the fol4 lowing: ‘‘is— 

5 ‘‘(i) 65 years of age or older and is en6 rolled for benefits under part B; or 

7 ‘‘(ii) is entitled to benefits under 226A(b) 

8 and is enrolled for benefits under part B.’’; and 

9 (ii) in subparagraph (D), in the mat10 ter preceding clause (i), by inserting ‘‘(or 

11 is entitled to benefits under 226A(b))’’ 

12 after ‘‘is 65 years of age or older’’; and 

13 (B) in paragraph (3)(B)— 

14 (i) in clause (ii), by inserting ‘‘(or is 

15 entitled to benefits under 226A(b))’’ after 

16 ‘‘is 65 years of age or older’’; and 

17 (ii) in clause (vi), by inserting ‘‘(or 

18 under 226A(b))’’ after ‘‘at age 65’’. 

19 (2) EFFECTIVE DATE.—The amendments made 

20 by paragraph (1) shall apply to Medicare supple21 mental policies effective on or after January 1, 

22 2025. 

23 (b) ADDITIONAL ENROLLMENT PERIOD FOR CER24 TAIN INDIVIDUALS.— 

25 (1) ONE-TIME ENROLLMENT PERIOD.— 


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1 (A) IN GENERAL.—In the case of an indi2 vidual described in paragraph (2), the Secretary 

3 of Health and Human Services shall establish a 

4 one-time enrollment period during which such 

5 an individual may enroll in any Medicare sup6 plemental policy under section 1882 of the So7 cial Security Act (42 U.S.C. 1395ss) of the in8 dividual’s choosing. 

9 (B) ENROLLMENT PERIOD.—The enroll10 ment period established under subparagraph 

11 (A) shall begin on January 1, 2025, and shall 

12 end June 30, 2025. 

13 (2) INDIVIDUAL DESCRIBED.—An individual de14 scribed in this paragraph is an individual who— 

15 (A) is entitled to hospital insurance bene16 fits under part A of title XVIII of the Social 

17 Security Act (42 U.S.C. 1395c et seq.) or under 

18 section 226A(b) of such Act (42 U.S.C. 426– 

19 1(b)); 

20 (B) is enrolled for benefits under part B of 

21 such title XVIII (42 U.S.C. 1395j et seq.); and 

22 (C) would not, but for the provisions of, 

23 and amendments made by, subsection (a) be eli24 gible for the guaranteed issue of a Medicare 

25 supplemental policy under paragraph (2) or (3) 


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1 of section 1882(s) of such Act (42 U.S.C. 

2 1395ss(s)). 

3 Subtitle L—Diversity in Clinical 

4 Trials 

5 SEC. 7901B. FDA REVIEW OF CLINICAL TRIAL BEST PRAC6 TICES. 

7 The Commissioner of Food and Drugs shall— 

8 (1) aggregate information on the accumulated 

9 experience of sponsors of drugs that develop and 

10 execute clinical trial diversity plans during drug de11 velopment; 

12 (2) include in such aggregated information an 

13 analysis from the perspectives of the Food and Drug 

14 Administration and such sponsors of which actions 

15 worked or which did not work to enhance clinical 

16 trial diversity; 

17 (3) not later than September 30, 2025, convene 

18 a public meeting, including representatives from the 

19 regulated industry and patient organizations, to dis20 cuss findings and recommendations for specific ac21 tions that have led to measurable improvements in 

22 the representation of racial and ethnic populations 

23 in clinical research; and 

24 (4) not later than September 30, 2026, update 

25 the guidance of the Food and Drug Administration 


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1 titled ‘‘Enhancing the Diversity of Clinical Trial 

2 Populations—Eligibility Criteria, Enrollment Prac3 tices, and Trial Designs’’ to align such guidance 

4 with findings and recommendations that were dis5 cussed at the meeting under paragraph (3). 

6 SEC. 7901B–1. DIVERSIFYING INVESTIGATIONS VIA EQUI7 TABLE RESEARCH STUDIES FOR EVERYONE 

8 TRIALS ACT. 

9 (a) ENCOURAGEMENT OF CLINICAL TRIAL ENROLL10 MENT BY RACIALLY AND ETHNICALLY DIVERSE POPU11 LATIONS.— 

12 (1) NO COST PROVISION OF DIGITAL HEALTH

13 TECHNOLOGIES.—The free provision of digital 

14 health technologies by drug or device manufacturers 

15 to their clinical trial participants shall not be consid16 ered a violation of section 1128A of the Social Secu17 rity Act (commonly known as the ‘‘Civil Monetary 

18 Penalties Law’’) (42 U.S.C. 1320a–7a), section 

19 1128B of the Social Security Act (42 U.S.C. 1320a– 

20 7b), or sections 3729 through 3733 of title 31, 

21 United States Code (commonly known as the ‘‘False 

22 Claims Act’’), provided that— 

23 (A) the use of digital health technologies 

24 will facilitate in any phase of clinical develop25 ment the inclusion of diversity of patient popuVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 01401 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 lations, such as underrepresented racial and 

2 ethnic minorities, low-income populations, and 

3 the elderly; 

4 (B) the digital health technologies will fa5 cilitate individuals’ participation, or are nec6 essary to such participation; 

7 (C) all features of the digital health tech8 nologies that are unrelated to use in the clinical 

9 trial are disabled or only allowed to remain acti10 vated to model real-world usage of the digital 

11 technology; and 

12 (D) the clinical trial sponsor requires par13 ticipants to return, purchase, or disable the dig14 ital health technologies by the conclusion of the 

15 trial. 

16 (2) GRANTS AND CONTRACTS.— 

17 (A) IN GENERAL.—The Secretary of 

18 Health and Human Services (in this section re19 ferred to as the ‘‘Secretary’’) may issue grants 

20 to, and enter into contracts with, entities to 

21 support community education, outreach, and re22 cruitment activities for clinical trials with re23 spect to drugs, including vaccines for diseases 

24 or conditions which have a disproportionate im25 pact on underrepresented populations (including 


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1 on racial and ethnic minority populations), in2 cluding for the diagnosis, prevention, or treat3 ment of COVID–19. Such activities may in4 clude— 

5 (i) working with community clinical 

6 trial sites, including community health cen7 ters, academic health centers, and other fa8 cilities; 

9 (ii) training health care personnel in10 cluding potential clinical trial investigators, 

11 with a focus on significantly increasing the 

12 number of underrepresented racial and 

13 ethnic minority health care personnel who 

14 are clinical trial investigators at the com15 munity sites for ongoing clinical trials; 

16 (iii) engaging community stakeholders 

17 to encourage participation in clinical trials, 

18 especially in underrepresented racial and 

19 ethnic minority communities; and 

20 (iv) fostering partnerships with com21 munity-based organizations serving under22 represented racial and ethnic minority pop23 ulations, including labor organizations and 

24 frontline health care workers. 


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1 (B) PRIORITY FOR GRANT AND CONTRACT

2 AWARDS.—In awarding grants and contracts 

3 under this paragraph, the Secretary shall 

4 prioritize entities that— 

5 (i) develop educational, recruitment, 

6 and training materials in multiple lan7 guages; or 

8 (ii) undertake clinical trial outreach 

9 efforts in more diverse racial and ethnic 

10 communities that are traditionally under11 represented in clinical trials, such as Trib12 al areas. 

13 (C) AUTHORIZATION OF APPROPRIA14 TIONS.—There is authorized to be appropriated 

15 for fiscal years 2025 and 2026 such sums as 

16 may be necessary to carry out this paragraph. 

17 (b) CLARIFICATION THAT CERTAIN REMUNERATION

18 RELATED TO PARTICIPATION IN CLINICAL TRIALS DOES

19 NOT CONSTITUTE REMUNERATION UNDER THE FED20 ERAL CIVIL MONEY PENALTIES LAW.— 

21 (1) IN GENERAL.—Section 1128A(i)(6)(F) of 

22 the Social Security Act (42 U.S.C. 1320a– 

23 7a(i)(6)(F)) is amended by inserting ‘‘(including re24 muneration offered or transferred to an individual to 

25 promote the participation in an approved clinical 


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1 trial, as defined in subsection (d) of the first section 

2 2709 of the Public Health Service Act (42 U.S.C. 

3 300gg–8) (relating to coverage for individuals par4 ticipating in approved clinical trials), as so des5 ignated by section 1563(c)(10)(C) of the Patient 

6 Protection and Affordable Care Act, that is reg7 istered with the database of clinical trials main8 tained by the National Library of Medicine (or any 

9 successor database), so long as such remuneration 

10 facilitates equitable inclusion of patients from all rel11 evant demographic and socioeconomic populations 

12 and is related to patient participation in the ap13 proved clinical trial)’’ after ‘‘promotes access to 

14 care’’. 

15 (2) EFFECTIVE DATE.—The amendment made 

16 by paragraph (1) shall apply to remuneration pro17 vided on or after the date of the enactment of this 

18 Act. 

19 (c) NATIONAL ACADEMY OF MEDICINE STUDY.— 

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

21 enter into an arrangement with the National Acad22 emy of Medicine under which the National Academy 

23 agrees to study and propose a design for a national 

24 interoperable data platform to improve access to 


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1 health data, and other relevant data needs, during 

2 public health emergencies. 

3 (2) REPORT.—The arrangement under para4 graph (1) shall provide that the National Academy 

5 of Medicine, not later than 180 days after the date 

6 of enactment of this Act, shall submit a report to 

7 the Secretary and Congress on the results of the 

8 study under paragraph (1) and the design proposed 

9 based on such study. 

10 SEC. 7901B–2. CLINICAL TRIAL DIVERSITY. 

11 (a) DIVERSITY REQUIREMENTS FOR APPLICATIONS

12 FOR FEDERAL FUNDING FOR CLINICAL TRIALS.— 

13 (1) APPLICATIONS.—Beginning on the date of 

14 the enactment of this Act, the Secretary of Health 

15 and Human Services, acting through the Director of 

16 the National Institutes of Health (in this subsection 

17 referred to as the ‘‘Secretary’’), shall require that an 

18 entity seeking to conduct a clinical trial investigating 

19 a drug or device (as those terms are defined in sec20 tion 201 of the Federal Food, Drug, and Cosmetic 

21 Act (21 U.S.C. 321)) or biological product (as de22 fined in section 351(i) of the Public Health Service 

23 Act (42 U.S.C. 262(i))) that is funded by the Na24 tional Institutes of Health and conducted at any na25 tional research institute or national center, submit 


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1 an application (or renewal thereof) for such funding 

2 that includes— 

3 (A) clear and measurable goals for the re4 cruitment and retention of participants that re5 flect— 

6 (i) the race, ethnicity, age, and gender 

7 or sex of patients with the disease or con8 dition being investigated; or 

9 (ii) the race, ethnicity, age, and gen10 der or sex of the general population of the 

11 United States if the prevalence of the dis12 ease or condition is not known; 

13 (B) a rationale for the goals specified 

14 under subparagraph (A) that specifies— 

15 (i) how investigators will calculate the 

16 number of participants for each population 

17 category that reflect the population groups 

18 specified in subparagraph (A); and 

19 (ii) strategies that will be used to en20 roll and retain participants across the dif21 ferent racial, ethnic, age, and gender or 

22 sex categories; 

23 (C) a detailed plan for how the clinical 

24 trial will achieve the goals specified under sub25 paragraph (A) that specifies— 


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1 (i) the requirements for researchers, 

2 in conducting the trial to analyze the popu3 lation groups specified in subparagraph 

4 (A) separately; 

5 (ii) the role of community partners or 

6 community institutional review boards in 

7 reviewing the plans; and 

8 (iii) how the trial will recruit a study 

9 population that is— 

10 (I) in proportion to the preva11 lence of the disease or condition in 

12 such groups relative to the prevalence 

13 of the disease or condition in the over14 all population of the United States; 

15 (II) in sufficient numbers to ob16 tain clinically and statistically mean17 ingful determinations of the safety 

18 and effectiveness of the drug being 

19 studied in the respective race, eth20 nicity, age, and gender or sex groups; 

21 and 

22 (III) consistent with the guidance 

23 under section 505(b)(1) of the Fed24 eral Food, Drug, and Cosmetic Act 

25 (21 U.S.C. 355(b)(1)) and guidance 


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1 issued by the National Institutes of 

2 Health on the inclusion of women and 

3 minorities in clinical trials; 

4 (D) the entity’s plan for implementing, or 

5 an explanation of why the entity cannot imple6 ment, alternative clinical trial follow-up require7 ments that are less burdensome for trial partici8 pants, such as— 

9 (i) requiring fewer follow-up visits; 

10 (ii) allowing phone follow-up or home 

11 visits by nurse trial coordinators (in lieu of 

12 in-person visits by patients); 

13 (iii) allowing for online follow-up op14 tions; 

15 (iv) permitting the patient’s primary 

16 care provider to perform some of the fol17 low-up visit requirements and to reimburse 

18 the patient for any out-of-pocket costs in19 curred by the patient for such follow-up 

20 visits; 

21 (v) allowing for weekend hours for re22 quired follow-up visits; 

23 (vi) allowing virtual or telemedicine 

24 visits; 


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1 (vii) use of wearable technology to 

2 record key health parameters; and 

3 (viii) use of alternate labs or imaging 

4 centers, which may be closer to the resi5 dence of the patients participating in the 

6 trial; and 

7 (E) the entity’s education and training re8 quirements for researchers and other individ9 uals conducting or supporting the clinical trial 

10 with respect to diversity and health inequities in 

11 underrepresented populations, including a re12 quirement to consult with, and review materials 

13 made available by, such committees, task forces, 

14 and working groups other entities the Secretary 

15 determines are appropriate, including the fol16 lowing: 

17 (i) The Equity Committee of the Na18 tional Institutes of Health. 

19 (ii) The National Advisory Council on 

20 Minority Health and Health Disparities. 

21 (iii) The Advisory Committee on Re22 search on Women’s Health. 

23 (iv) The Sexual & Gender Minority 

24 Research Coordinating Committee of the 

25 National Institutes of Health. 


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1 (v) The Tribal Health Research Co2 ordinating Committee of the National In3 stitutes of Health. 

4 (2) TERMS.— 

5 (A) IN GENERAL.—As a condition on the 

6 receipt of funding through the National Insti7 tutes of Health, as described in paragraph (1), 

8 with respect to a clinical trial, the sponsor of 

9 the clinical trial shall agree to terms requiring 

10 that— 

11 (i) the aggregate demographic infor12 mation of trial participants be shared on 

13 an annual basis with the Secretary while 

14 participant recruitment and data collection 

15 in such trial is ongoing, and that such in16 formation is provided with respect to— 

17 (I) underrepresented populations, 

18 including populations grouped by race, 

19 ethnicity, age, sex, gender identity 

20 and expression, geographic region, 

21 primary written and spoken language, 

22 disability status, sexual orientation, 

23 socioeconomic status, occupation, and 

24 other relevant factors; and 


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1 (II) such populations that reflect 

2 the prevalence of the disease or condi3 tion that is the subject of the clinical 

4 trial involved (as available and as ap5 propriate to the scientific objective for 

6 the study, as determined by the Direc7 tor of the National Institutes of 

8 Health); 

9 (ii) the sponsor submits to the pro10 gram officer and grants management spe11 cialist of the specific National Institutes of 

12 Health national research institute or na13 tional center, as frequently as such officer 

14 or specialist determines necessary, the re15 tention rate of participants in the clinical 

16 trial, disaggregated by race, ethnicity, gen17 der or sex, and age; 

18 (iii) both the clinical trial researchers 

19 and the applicant reviewers complete edu20 cation and training programs on diversity 

21 in clinical trials; and 

22 (iv) at the conclusion of the trial, the 

23 sponsor submits to the Secretary the num24 ber of participants in the trial, 


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1 disaggregated by race, ethnicity, age, and 

2 gender or sex. 

3 (B) PRIVACY PROTECTIONS.—Any data 

4 shared under subparagraph (A) may not in5 clude any individually identifiable information 

6 or protected health information with respect to 

7 clinical trial participants and shall only be dis8 closed to the extent allowed under Federal pri9 vacy laws. 

10 (3) EXCEPTION.—In lieu of submitting an ap11 plication under paragraph (1) and documentation of 

12 goals as required by subparagraph (A) of such para13 graph, an applicant may provide reasoning (other 

14 than cost) for why the recruitment of each of the 

15 population groups specified in subparagraph (A) of 

16 paragraph (1) is not necessary and why such re17 cruitment is not scientifically justified or possible. 

18 (4) PUBLICATION.—The Secretary shall— 

19 (A) publish on a public website of the Na20 tional Institutes of Health, upon receipt of an 

21 application to which paragraph (1) applies or 

22 reasoning under paragraph (3)— 

23 (i) a summary of the disease being 

24 targeted in the clinical trial that is the 

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1 lence of such disease across race, ethnicity, 

2 gender or sex, age, and clinical trial rep3 resentation in each such category; 

4 (ii) the goals specified in such applica5 tion, as required by paragraph (1)(A); or 

6 (iii) the reasoning described in para7 graph (3); and 

8 (B) ensure that, in publishing information 

9 relating to an application or reasoning under 

10 subparagraph (A), the design of the study in11 volved is not disclosed. 

12 (5) REMEDIATION.— 

13 (A) IN GENERAL.—In the case of a clinical 

14 trial subject to paragraph (1) that fails to meet 

15 the condition specified pursuant to paragraph 

16 (1) by such date as may be agreed upon by the 

17 sponsor of the trial and the program officer and 

18 grants management specialist of the specific 

19 National Institutes of Health national research 

20 institute or national center, the Secretary shall 

21 require the sponsor of that clinical trial, not 

22 later than 60 days after such date occurs— 

23 (i) to develop, in consultation with the 

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1 uals who are members of relevant demo2 graphic groups specified in paragraph 

3 (1)(A), a strategic plan to increase partici4 pation in such clinical trial of such individ5 uals; and 

6 (ii) to submit to the Secretary, such 

7 strategic plan. 

8 (B) PUBLICATION.—The Secretary shall 

9 make publicly available on the website of the 

10 National Institutes of Health, the strategic plan 

11 received under subparagraph (A) as soon as 

12 possible after receipt. The Secretary shall en13 sure that, in publishing such plan under the 

14 preceding sentence, the design of the study in15 volved is not disclosed. 

16 (C) IMPLEMENTATION.—The sponsor of 

17 the clinical trial that is the subject of the stra18 tegic plan published under subparagraph (B), 

19 shall, not later than 60 days after such date as 

20 may be agreed upon by the sponsor of the trial 

21 and the appropriate program officer and grants 

22 management specialist of the National Insti23 tutes of Health, implement the strategic plan. 

24 (D) TECHNICAL ASSISTANCE.—The Sec25 retary may provide technical assistance to a 


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1 sponsor of a clinical trial, as necessary for the 

2 sponsor to meet the requirements of subpara3 graph (C). 

4 (6) PENALTIES IN CASE OF FAILURE OF REME5 DIATION.— 

6 (A) IN GENERAL.—In the case of a clinical 

7 trial subject to paragraph (1) that, after the 

8 close of the 60-day period specified in para9 graph (5)(C), continues to fail to meet the con10 dition specified pursuant to paragraph (1)(A), 

11 the Secretary shall— 

12 (i) hold the noncompeting continu13 ation of funding received through the grant 

14 involved; 

15 (ii) apply specific conditions on the 

16 award of funds to such sponsor to conduct 

17 such clinical trial; or 

18 (iii) terminate such funding. 

19 (B) WAIVER.— 

20 (i) IN GENERAL.—In the case of a 

21 clinical trial subject to the penalty under 

22 subparagraph (A) that fails to meet the 

23 condition referred to in such subpara24 graph, the sponsor of such clinical trial 

25 may, prior to the conclusion of the 60-day 


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1 period referred to in subparagraph (A), 

2 submit an application to the relevant pro3 gram officer and grants specialist request4 ing a waiver of such condition. Such an ap5 plication shall specify reasoning for why 

6 the recruitment of each of the population 

7 groups specified in subparagraph (A) of 

8 paragraph (1) is not necessary or why such 

9 recruitment is not scientifically justified or 

10 possible. 

11 (ii) REVIEW.—Not later than 30 days 

12 after a date agreed upon by the sponsor of 

13 the trial and the appropriate program offi14 cer and grants management specialist of 

15 the National Institutes of Health, the Sec16 retary shall— 

17 (I) complete the review of such 

18 application; and 

19 (II) make a determination to ap20 prove or deny the application. 

21 (iii) NO ADDITIONAL PENALTIES.—No 

22 additional penalties may be applied with 

23 respect to a sponsor of a clinical trial 

24 under subparagraph (A) during the 30-day 

25 period specified in clause (ii). 


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1 (C) TERMINATION OF FUNDING.—In the 

2 case of a clinical trial described in subpara3 graph (B)(i), the Secretary may elect to termi4 nate funding described in paragraph (1) for the 

5 clinical trial if no request for a waiver under 

6 subparagraph (B) is received by the conclusion 

7 60-day period referred to in subparagraph (A). 

8 (7) WAIVER FOR CERTAIN CLINICAL TRIALS.— 

9 (A) IN GENERAL.—In the case of a clinical 

10 trial that received funding through the National 

11 Institutes of Health and is ongoing as of the 

12 date of the enactment of this Act, the sponsor 

13 of such clinical trial is exempt from the require14 ments of (and associated penalties imposed by) 

15 this section. 

16 (B) REPORT.—The Secretary shall include 

17 in the triennial report required to be submitted 

18 under section 403 of the Public Health Service 

19 Act (42 U.S.C. 283), a list of all clinical trials 

20 receiving funding through the National Insti21 tutes of Health— 

22 (i) that requested and received waiv23 ers under this subsection; or 


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1 (ii) with respect to which funding has 

2 been terminated pursuant to this sub3 section. 

4 (8) NONDISCRIMINATION.—Section 1557 of the 

5 Patient Protection and Affordable Care Act (42 

6 U.S.C. 18116) shall apply with respect to a clinical 

7 trial subject to paragraph (1). 

8 (b) ELIMINATING COST BARRIERS.— 

9 (1) STUDY ON MODERNIZATION OF HUMAN

10 SUBJECT REGULATIONS.—Not later than 2 years 

11 after the date of the enactment of this Act, the Sec12 retary of Health and Human Services, acting 

13 through the Director of the National Institutes of 

14 Health (referred to in this subsection as the ‘‘Sec15 retary’’), shall conduct and complete a study on— 

16 (A) the need for review of human subject 

17 regulations specified in part 46 of title 45, Code 

18 of Federal Regulations (or successor regula19 tions), and related guidance; 

20 (B) the modernization of such regulations 

21 and guidance to establish updated guidelines for 

22 reimbursement of out-of-pocket expenses of 

23 human subjects, compensation of human sub24 jects for time spent participating in the clinical 


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1 trial, and incentives for recruitment of human 

2 subjects; and 

3 (C) the need for updated safe harbor rules 

4 under section 1001.952 of title 42, Code of 

5 Federal Regulations (or successor regulations) 

6 and section 1128B of the Social Security Act 

7 (commonly referred to as the Federal Anti8 Kickback Statute (42 U.S.C. 1320a–7b)) with 

9 respect to the assistance provided under this 

10 subsection. 

11 (2) REIMBURSEMENT FOR COSTS ASSOCIATED

12 WITH CLINICAL TRIAL PARTICIPATION.—As a condi13 tion on receipt of any funding provided through the 

14 National Institutes of Health to conduct a clinical 

15 trial investigating a drug or device (as those terms 

16 are defined in section 201 of the Federal Food, 

17 Drug, and Cosmetic Act (21 U.S.C. 321)) or biologi18 cal product (as defined in section 351(i) of the Pub19 lic Health Service Act (42 U.S.C. 262(i))), the Sec20 retary shall require that the sponsor of such clinical 

21 trial— 

22 (A) works with institutional review boards 

23 and program officers of the National Institutes 

24 of Health to determine when reimbursement for 


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1 the costs associated with clinical trial participa2 tion is warranted; and 

3 (B) subject to paragraph (3), provides to 

4 clinical trial participants reimbursement for ex5 penses (using funds other than funds supplied 

6 through the National Institutes of Health) in7 curred as a result of that participation, which 

8 may include— 

9 (i) missed or forgone salary; 

10 (ii) language assistance, including in11 terpreter services; 

12 (iii) food expenses; 

13 (iv) childcare expenses; 

14 (v) lodging expenses; 

15 (vi) transportation expenses; or 

16 (vii) other expenses as identified by 

17 the participant, subject to review by the 

18 clinical trial sponsor, at its discretion, on a 

19 case-by-case basis. 

20 (3) PROVISION OF COSTS ASSOCIATED WITH

21 CLINICAL TRIAL PARTICIPATION.— 

22 (A) APPLICATION AND DOCUMENTA23 TION.— 

24 (i) IN GENERAL.—A sponsor of a clin25 ical trial to which subsection (a)(1) applies, 


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1 may require that, in order to receive reim2 bursement as described in paragraph (2), a 

3 participant complete an application and 

4 share with the sponsor such documentation 

5 of expenses described in such paragraph, 

6 as the sponsor may require. 

7 (ii) TIMING.—Not later than 30 days 

8 after the date on which a sponsor of a clin9 ical trial receives an application under 

10 clause (i), the sponsor shall— 

11 (I) review the application; and 

12 (II) provide for reimbursement of 

13 eligible expenses documented in such 

14 application, as determined at the dis15 cretion of the clinical trial sponsor on 

16 a case-by-case basis. 

17 (B) ENFORCEMENT.—A sponsor of a clin18 ical trial to which subsection (a)(1) applies, 

19 shall submit on an annual basis, as part of the 

20 progress reports submitted to the Secretary 

21 pursuant to section 402(j) of the Public Health 

22 Service Act (42 U.S.C. 282(j)), during the data 

23 collection period of the clinical trial, to the Sec24 retary an accounting of the reimbursements 


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1 made to clinical trial participants under sub2 paragraph (A). Such data shall— 

3 (i) include relevant aggregate data 

4 with respect to each population group spec5 ified in subsection (a)(2)(A)(i) when such 

6 data will not compromise the identities of 

7 study participants and in a manner con8 sistent with applicable privacy protections; 

9 and 

10 (ii) not later than 6 months after re11 ceipt by the Secretary, be published on a 

12 public website of the National Institutes of 

13 Health. 

14 (c) PUBLIC AWARENESS AND EDUCATION CAM15 PAIGN.— 

16 (1) NATIONAL CAMPAIGN.—The Secretary of 

17 Health and Human Services, acting through the Di18 rector of the National Institutes of Health and the 

19 Commissioner of Food and Drugs (referred to in 

20 this subsection as the ‘‘Secretary’’), in consultation 

21 with the stakeholders specified in paragraph (5), 

22 shall carry out a national campaign to increase the 

23 awareness and knowledge of individuals in the 

24 United States with respect to the need for diverse 


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1 clinical trials among the demographic groups identi2 fied pursuant to subsection (a)(1)(A). 

3 (2) REQUIREMENTS.—The national campaign 

4 conducted shall include— 

5 (A) the development and distribution of 

6 written educational materials, and the develop7 ment and placing of public service announce8 ments, that are intended to encourage individ9 uals who are members of the demographic 

10 groups identified pursuant to subsection 

11 (a)(2)(A)(i)(I) to seek to participate in clinical 

12 trials; 

13 (B) such efforts as are reasonable and nec14 essary to ensure meaningful access by con15 sumers with limited English proficiency; 

16 (C) the development and distribution of 

17 best practices and training for recruiting under18 represented study populations, including a 

19 method for sharing such best practices among 

20 clinical trial sponsors, providers, community21 based organizations who assist with recruit22 ment, and with the public; and 

23 (D) the conduct of focus groups to better 

24 understand the concerns and fears of certain 


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1 underrepresented groups who may be reluctant 

2 to participate in clinical trials. 

3 (3) HEALTH INEQUITIES.—In developing the 

4 national campaign under paragraph (1), the Sec5 retary shall recognize and address— 

6 (A) health inequities among individuals 

7 who are members of the population groups 

8 specified in subsection (a)(2)(A)(i) with respect 

9 to access to care and participation in clinical 

10 trials; and 

11 (B) any barriers in access to care and par12 ticipation in clinical trials that are specific to 

13 individuals who are members of such groups. 

14 (4) GRANTS.—The Secretary shall establish a 

15 program to award grants to nonprofit private enti16 ties, including community-based organizations and 

17 faith communities, institutions of higher education 

18 eligible to receive funds under section 371 of the 

19 Higher Education Act of 1965 (20 U.S.C. 1067q) 

20 and national organizations that serve underrep21 resented populations and community pharmacies to 

22 enable such entities— 

23 (A) to test alternative outreach and edu24 cation strategies to increase the awareness and 

25 knowledge of individuals in the United States, 


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1 with respect to the need for diverse clinical 

2 trials that reflect the race, ethnicity, age, and 

3 gender or sex of patients with the disease or 

4 condition being investigated; and 

5 (B) to cover administrative costs of such 

6 entities in assisting in diversifying clinical trials 

7 subject to subsection (a). 

8 (5) STAKEHOLDERS SPECIFIED.—The stake9 holders specified in this paragraph are the following: 

10 (A) Representatives of the Health Re11 sources Services Administration, the Office of 

12 Minority Health of the Department of Health 

13 and Human Services, the Centers for Disease 

14 Control and Prevention, and the National Insti15 tutes of Health. 

16 (B) Community-based resources and advo17 cates. 

18 (6) AUTHORIZATION OF APPROPRIATIONS.— 

19 There is authorized to be appropriated to carry out 

20 this subsection $10,000,000 for each of fiscal years 

21 2025 through 2029. 

22 (d) DEFINITIONS.—In this section: 

23 (1) CLINICAL TRIAL.—The term ‘‘clinical trial’’ 

24 means a research study in which one or more human 

25 subjects are prospectively assigned to one or more 


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1 interventions (which may include placebo or other 

2 control) to evaluate the effects of those interventions 

3 on health-related biomedical or behavioral outcomes. 

4 (2) SPONSOR.—The term ‘‘sponsor’’ has the 

5 meaning given such term in section 50.3 of title 21, 

6 Code of Federal Regulations (or successor regula7 tions). 

8 SEC. 7901B–3. PATIENT EXPERIENCE DATA. 

9 (a) POLICY.—Section 569C of the Federal Food, 

10 Drug, and Cosmetic Act (21 U.S.C. 360bbb–8c) is amend11 ed— 

12 (1) by redesignating subsections (b) and (c) as 

13 subsections (c) and (d), respectively; and 

14 (2) by inserting after subsection (a) the fol15 lowing: 

16 ‘‘(b) COLLECTION, SUBMISSION, AND USE OF

17 DATA.— 

18 ‘‘(1) IN GENERAL.—The Secretary shall— 

19 ‘‘(A) for any drug for which an exemption 

20 is granted for investigational use under section 

21 505(i) of this Act or section 351(a) of the Pub22 lic Health Service Act, require the sponsor of 

23 the drug to collect standardized patient experi24 ence data as part of the clinical trials conducted 

25 pursuant to such exemption; 


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1 ‘‘(B) require any application for the ap2 proval or licensing of such drug under section 

3 505(b) of this Act or section 351(a) of the Pub4 lic Health Service Act to include— 

5 ‘‘(i) the standardized patient experi6 ence data so collected; and 

7 ‘‘(ii) such related information as the 

8 Secretary may require; and 

9 ‘‘(C) consider patient experience data and 

10 related information that is submitted pursuant 

11 to subparagraph (B) in deciding whether to ap12 prove or license, as applicable, the drug in13 volved. 

14 ‘‘(2) APPLICABILITY.—Paragraph (1) applies 

15 only with respect to drugs for which a request for 

16 an exemption described in paragraph (1)(A) is sub17 mitted on or after the date of the enactment of the 

18 Health Equity and Accountability Act of 2024, or an 

19 application under section 505(b) of this Act or sec20 tion 351(a) of the Public Health Service Act is filed, 

21 as applicable, on or after the day that is 2 years 

22 after the date of the enactment of the Health Equity 

23 and Accountability Act of 2024.’’. 

24 (b) REGULATIONS.—Not later than 1 year after the 

25 date of the enactment of this Act, the Secretary of Health 


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1 and Human Services, acting through the Commissioner of 

2 Food and Drugs, shall promulgate final regulations to im3 plement section 569C(b) of the Federal Food, Drug, and 

4 Cosmetic Act, as added by this section. 

5 Subtitle M—Additional Provisions 

6 Addressing High-Impact Minor7 ity Diseases 

8 SEC. 7901C. MEDICARE COVERAGE OF MULTI-CANCER 

9 EARLY DETECTION SCREENING TESTS. 

10 (a) COVERAGE.—Section 1861 of the Social Security 

11 Act (42 U.S.C. 1395x), as amended by sections 2007, 

12 4221, 4251, 6101, and 7419, is amended— 

13 (1) in subsection (s)(2)— 

14 (A) in subparagraph (LL), by striking 

15 ‘‘and’’ at the end; 

16 (B) by inserting ‘‘and’’ at the end of sub17 paragraph (MM); and 

18 (C) by adding at the end the following new 

19 subparagraph: 

20 ‘‘(NN) multi-cancer early detection screen21 ing tests (as defined in subsection (sss));’’; and 

22 (2) by adding at the end the following new sub23 section: 

24 ‘‘(sss) MULTI-CANCER EARLY DETECTION SCREEN25 ING TESTS.—The term ‘multi-cancer early detection 


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1 screening test’ means any of the following tests, approved 

2 or cleared by the Food and Drug Administration, fur3 nished to an individual for the purpose of early detection 

4 of cancer across many cancer types (as categorized in the 

5 Annual Report to the Nation on the Status of Cancer 

6 issued by the National Cancer Institute): 

7 ‘‘(1) A genomic sequencing blood or blood prod8 uct test that includes the analysis of cell-free nucleic 

9 acids. 

10 ‘‘(2) Such other equivalent tests (which are 

11 based on urine or another sample of biological mate12 rial) as the Secretary determines appropriate.’’. 

13 (b) PAYMENT AND FREQUENCY LIMIT.— 

14 (1) PAYMENT UNDER FEE SCHEDULE.—Section 

15 1833(h) of the Social Security Act (42 U.S.C. 

16 1395l(h)) is amended— 

17 (A) in paragraph (1)(A), by inserting after 

18 ‘‘(including’’ the following: ‘‘multi-cancer early 

19 detection screening tests under section 

20 1861(sss) and including’’; and 

21 (B) by adding at the end the following new 

22 paragraph: 

23 ‘‘(10) No payment may be made under this 

24 part for a multi-cancer early detection screening test 

25 (as defined in section 1861(sss)) for an individual if 


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1 such a test was furnished to the individual during 

2 the previous 11 months.’’. 

3 (2) CONFORMING AMENDMENT.—Section 

4 1862(a) of the Social Security Act (42 U.S.C. 

5 1395y(a)) is amended— 

6 (A) in paragraph (1)— 

7 (i) in subparagraph (O), by striking 

8 ‘‘and’’ at the end; 

9 (ii) in subparagraph (P), by striking 

10 the semicolon at the end and inserting ‘‘, 

11 and’’; and 

12 (iii) by adding at the end the fol13 lowing new subparagraph: 

14 ‘‘(Q) in the case of multi-cancer early detection 

15 screening tests (as defined in section 1861(sss)), 

16 which are performed more frequently than is covered 

17 under section 1833(h)(10);’’; and 

18 (B) in paragraph (7), by striking ‘‘or (P)’’ 

19 and inserting ‘‘(P), or (Q)’’. 

20 (c) RULE OF CONSTRUCTION RELATING TO OTHER

21 CANCER SCREENING TESTS.—Nothing in this section, in22 cluding the amendments made by this section, shall be 

23 construed— 

24 (1) in the case of an individual who undergoes 

25 a multi-cancer early detection screening test, to afVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 01431 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 fect coverage under part B for other cancer screen2 ing tests covered under this section, such as screen3 ing tests for breast, cervical, colorectal, lung, or 

4 prostate cancer; or 

5 (2) in the case of an individual who undergoes 

6 another cancer screening test, to affect coverage for 

7 a multi-cancer early detection screening test or the 

8 use of such a test as a diagnostic or confirmatory 

9 test for a result of the other cancer screening test. 

10 SEC. 7901C–1. AMPUTATION REDUCTION AND COMPASSION 

11 ACT. 

12 (a) PERIPHERAL ARTERY DISEASE EDUCATION PRO13 GRAM.—Part P of title III of the Public Health Service 

14 Act (42 U.S.C. 280g et seq.), as amended by section 7504, 

15 is amended by adding at the end the following: 

16 ‘‘SEC. 399V–14. PERIPHERAL ARTERY DISEASE EDUCATION 

17 PROGRAM. 

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

19 through the Director of the Centers for Disease Control 

20 and Prevention, in collaboration with the Administrator 

21 of the Centers for Medicare & Medicaid Services and the 

22 Administrator of the Health Resources and Services Ad23 ministration, shall establish and coordinate a peripheral 

24 artery disease education program to support, develop, and 

25 implement educational initiatives and outreach strategies 


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1 that inform health care professionals and the public about 

2 the existence of peripheral artery disease and methods to 

3 reduce amputations related to such disease, particularly 

4 with respect to at-risk populations. 

5 ‘‘(b) AUTHORIZATION OF APPROPRIATIONS.—There 

6 is authorized to be appropriated to carry out this section 

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

8 2025 through 2029.’’. 

9 (b) MEDICARE COVERAGE OF PERIPHERAL ARTERY

10 DISEASE SCREENING TESTS FURNISHED TO AT-RISK

11 BENEFICIARIES WITHOUT IMPOSITION OF COST SHARING

12 REQUIREMENTS.— 

13 (1) IN GENERAL.—Section 1861 of the Social 

14 Security Act (42 U.S.C. 1395x), as amended by sec15 tions 2007, 4221, 4251, 6101, 7419, and 7901C, is 

16 amended— 

17 (A) in subsection (s)(2)— 

18 (i) in subparagraph (MM), by striking 

19 ‘‘and’’ at the end; 

20 (ii) in subparagraph (NN), by striking 

21 the period at the end and inserting ‘‘; 

22 and’’; and 

23 (iii) by adding at the end the fol24 lowing new subparagraph: 


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1 ‘‘(OO) peripheral artery disease screening 

2 tests furnished to at-risk beneficiaries (as such 

3 terms are defined in subsection (ttt)).’’; and 

4 (B) by adding at the end the following new 

5 subsection: 

6 ‘‘(ttt) PERIPHERAL ARTERY DISEASE SCREENING

7 TEST; AT-RISK BENEFICIARY.—(1) The term ‘peripheral 

8 artery disease screening test’ means— 

9 ‘‘(A) noninvasive physiologic studies of extrem10 ity arteries (commonly referred to as ankle-brachial 

11 index testing); 

12 ‘‘(B) arterial duplex scans of lower extremity 

13 arteries vascular; and 

14 ‘‘(C) such other items and services as the Sec15 retary determines, in consultation with relevant 

16 stakeholders, to be appropriate for screening for pe17 ripheral artery disease for at-risk beneficiaries. 

18 ‘‘(2) The term ‘at-risk beneficiary’ means an indi19 vidual entitled to, or enrolled for, benefits under part A 

20 and enrolled for benefits under part B— 

21 ‘‘(A) who is 65 years of age or older; 

22 ‘‘(B) who is at least 50 years of age but not 

23 older than 64 years of age with risk factors for ath24 erosclerosis (such as diabetes mellitus, a history of 


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1 smoking, hyperlipidemia, and hypertension) or a 

2 family history of peripheral artery disease; 

3 ‘‘(C) who is younger than 50 years of age with 

4 diabetes mellitus and 1 additional risk factor for 

5 atherosclerosis; or 

6 ‘‘(D) with a known atherosclerotic disease in 

7 another vascular bed such as coronary, carotid, sub8 clavian, renal, or mesenteric artery stenosis, or ab9 dominal aortic aneurysm. 

10 ‘‘(3) The Secretary shall, in consultation with appro11 priate organizations, establish standards regarding the 

12 frequency for peripheral artery disease screening tests de13 scribed in subsection (s)(2)(OO) for purposes of coverage 

14 under this title.’’. 

15 (2) INCLUSION OF PERIPHERAL ARTERY DIS16 EASE SCREENING TESTS IN INITIAL PREVENTIVE

17 PHYSICAL EXAMINATION.—Section 1861(ww)(2) of 

18 the Social Security Act (42 U.S.C. 1395x(ww)(2)) is 

19 amended— 

20 (A) in subparagraph (N), by moving the 

21 margins of such subparagraph 2 ems to the 

22 left; 

23 (B) by redesignating subparagraph (O) as 

24 subparagraph (P); and 


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1 (C) by inserting after subparagraph (N) 

2 the following new subparagraph: 

3 ‘‘(O) Peripheral artery disease screening 

4 tests furnished to at-risk beneficiaries (as such 

5 terms are defined in subsection (ttt)).’’. 

6 (3) PAYMENT.— 

7 (A) IN GENERAL.—Section 1833(a) of the 

8 Social Security Act (42 U.S.C. 1395l(a)), as 

9 amended by sections 4251(c)(3), 6101(a)(4), 

10 and 7419, is amended— 

11 (i) in paragraph (1)— 

12 (I) in subparagraph (N), by in13 serting ‘‘and other than peripheral ar14 tery disease screening tests furnished 

15 to at-risk beneficiaries (as such terms 

16 are defined in section 1861(ttt))’’ 

17 after ‘‘other than personalized preven18 tion plan services (as defined in sec19 tion 1861(hhh)(1))’’; 

20 (II) by striking ‘‘and’’ before 

21 ‘‘(KK)’’; and 

22 (III) by inserting before the 

23 semicolon at the end the following: ‘‘, 

24 and (LL) with respect to peripheral 

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1 nished to at-risk beneficiaries (as such 

2 terms are defined in section 

3 1861(ttt)), the amount paid shall be 

4 100 percent of the lesser of the actual 

5 charge for the services or the amount 

6 determined under the payment basis 

7 determined under section 1848’’; and 

8 (ii) in paragraph (2)— 

9 (I) in subparagraph (G), by 

10 striking ‘‘and’’ at the end; 

11 (II) in subparagraph (H), by in12 serting ‘‘ and’’ at the end; and 

13 (III) by inserting after subpara14 graph (H) the following new subpara15 graph: 

16 ‘‘(I) with respect to peripheral artery disease 

17 screening tests (as defined in paragraph (1) of sec18 tion 1861(ttt)) furnished by an outpatient depart19 ment of a hospital to at-risk beneficiaries (as defined 

20 in paragraph (2) of such section), the amount deter21 mined under paragraph (1)(EE),’’. 

22 (B) NO DEDUCTIBLE.—Section 1833(b) of 

23 the Social Security Act (42 U.S.C. 1395l(b)), as 

24 amended by section 7419(a)(5)(A)(iii), is 

25 amended, in the first sentence— 


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1 (i) by striking ‘‘and’’ before ‘‘(14)’’; 

2 and 

3 (ii) by inserting ‘‘, and (15) such de4 ductible shall not apply with respect to pe5 ripheral artery disease screening tests fur6 nished to at-risk beneficiaries (as such 

7 terms are defined in section 1861(ttt))’’ 

8 before the period at the end. 

9 (C) EXCLUSION FROM PROSPECTIVE PAY10 MENT SYSTEM FOR HOSPITAL OUTPATIENT DE11 PARTMENT SERVICES.—Section 

12 1833(t)(1)(B)(iv) of the Social Security Act (42 

13 U.S.C. 1395l(t)(1)(B)(iv)) is amended— 

14 (i) by striking ‘‘, or personalized’’ and 

15 inserting ‘‘, personalized’’; and 

16 (ii) by inserting ‘‘, or peripheral ar17 tery disease screening tests furnished to 

18 at-risk beneficiaries (as such terms are de19 fined in section 1861(ttt))’’ after ‘‘person20 alized prevention plan services (as defined 

21 in section 1861(hhh)(1))’’. 

22 (D) PAYMENT UNDER PHYSICIAN FEE

23 SCHEDULE.—Section 1848(j)(3) of the Social 

24 Security Act (42 U.S.C. 1395w–4(j)(3)), as 


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1 amended by section 4251(c)(4), is amended by 

2 inserting ‘‘, (2)(OO),’’ after ‘‘(2)(KK)’’. 

3 (4) EXCLUSION FROM COVERAGE AND MEDI4 CARE AS SECONDARY PAYER FOR TESTS PERFORMED

5 MORE FREQUENTLY THAN ALLOWED.—Section 

6 1862(a)(1) of the Social Security Act (42 U.S.C. 

7 1395y(a)(1)), as amended by subsection (b)(2), is 

8 amended— 

9 (A) in subparagraph (P), by striking 

10 ‘‘and’’ at the end; 

11 (B) in subparagraph (Q), by striking the 

12 semicolon at the end and inserting ‘‘, and’’; and 

13 (C) by adding at the end the following new 

14 subparagraph: 

15 ‘‘(R) in the case of peripheral artery dis16 ease screening tests furnished to at-risk bene17 ficiaries (as such terms are defined in section 

18 1861(ttt)), which are performed more fre19 quently than is covered under such section;’’. 

20 (5) AUTHORITY TO MODIFY OR ELIMINATE COV21 ERAGE OF CERTAIN PREVENTIVE SERVICES.—Sec22 tion 1834(n) of the Social Security Act (42 U.S.C. 

23 1395m(n)) is amended— 

24 (A) by redesignating subparagraphs (A) 

25 and (B) of paragraph (1) as clauses (i) and (ii), 


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1 respectively, and moving the margins of such 

2 clauses, as so redesignated, 2 ems to the right; 

3 (B) by redesignating paragraphs (1) and 

4 (2) as subparagraphs (A) and (B), respectively, 

5 and moving the margins of such subparagraphs, 

6 as so redesignated, 2 ems to the right; 

7 (C) by striking ‘‘CERTAIN PREVENTIVE

8 SERVICES’’ and all that follows through ‘‘any 

9 other provision of this title’’ and inserting: 

10 ‘‘CERTAIN PREVENTIVE SERVICES.— 

11 ‘‘(1) IN GENERAL.—Notwithstanding any other 

12 provision of this title’’; and 

13 (D) by adding at the end the following new 

14 paragraph: 

15 ‘‘(2) INAPPLICABILITY.—The Secretarial au16 thority described in paragraph (1) shall not apply 

17 with respect to preventive services described in sec18 tion 1861(ww)(2)(O).’’. 

19 (6) EFFECTIVE DATE.—The amendments made 

20 by this subsection shall apply with respect to items 

21 and services furnished on or after January 1, 2025. 

22 (c) MEDICAID COVERAGE OF PERIPHERAL ARTERY

23 DISEASE SCREENING TESTS FURNISHED TO AT-RISK

24 BENEFICIARIES WITHOUT IMPOSITION OF COST SHARING

25 REQUIREMENTS.— 


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1 (1) IN GENERAL.—Section 1905 of the Social 

2 Security Act (42 U.S.C. 1396d) as amended by sec3 tion 7419(a)(3)(A)(ii), is amended— 

4 (A) in subsection (a)— 

5 (i) by redesignating paragraph (34) as 

6 paragraph (35); 

7 (ii) in paragraph (33), by striking 

8 ‘‘and’’ after the semicolon; and 

9 (iii) by inserting after paragraph (33) 

10 the following new paragraph: 

11 ‘‘(34) peripheral artery disease screening tests 

12 furnished to at-risk beneficiaries (as such terms are 

13 defined in subsection (ss)); and’’; and 

14 (B) by adding at the end the following new 

15 subsection: 

16 ‘‘(ss) PERIPHERAL ARTERY DISEASE SCREENING

17 TEST; AT-RISK BENEFICIARY.— 

18 ‘‘(1) PERIPHERAL ARTERY DISEASE SCREENING

19 TEST.—The term ‘peripheral artery disease screen20 ing test’ means— 

21 ‘‘(A) noninvasive physiologic studies of ex22 tremity arteries (commonly referred to as ankle23 brachial index testing); 

24 ‘‘(B) arterial duplex scans of lower extrem25 ity arteries vascular; and 


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1 ‘‘(C) such other items and services as the 

2 Secretary determines, in consultation with rel3 evant stakeholders, to be appropriate for 

4 screening for peripheral artery disease for at5 risk beneficiaries. 

6 ‘‘(2) AT-RISK BENEFICIARY.—The term ‘at-risk 

7 beneficiary’ means an individual enrolled under a 

8 State plan (or a waiver of such plan)— 

9 ‘‘(A) who is 65 years of age or older; 

10 ‘‘(B) who is at least 50 years of age but 

11 not older than 64 years of age with risk factors 

12 for atherosclerosis (such as diabetes mellitus, a 

13 history of smoking, hyperlipidemia, and hyper14 tension) or a family history of peripheral artery 

15 disease; 

16 ‘‘(C) who is younger than 50 years of age 

17 with diabetes mellitus and one additional risk 

18 factor for atherosclerosis; or 

19 ‘‘(D) with a known atherosclerotic disease 

20 in another vascular bed such as coronary, ca21 rotid, subclavian, renal, or mesenteric artery 

22 stenosis, or abdominal aortic aneurysm. 

23 ‘‘(3) FREQUENCY.—The Secretary shall, in con24 sultation with appropriate organizations, establish 

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1 tery disease screening tests described in subsection 

2 (a)(34) for purposes of coverage under a State plan 

3 under this title.’’. 

4 (2) NO COST SHARING.— 

5 (A) IN GENERAL.—Subsections (a)(2) and 

6 (b)(2) of section 1916 of the Social Security 

7 Act (42 U.S.C. 1396o), as amended by section 

8 7305(b)(1), are each amended— 

9 (i) in subparagraph (J), by striking 

10 ‘‘or’’ after the comma at the end; 

11 (ii) in subparagraph (K), by striking 

12 ‘‘; and’’ and inserting ‘‘, or’’; and 

13 (iii) by adding at the end the fol14 lowing new subparagraph: 

15 ‘‘(L) peripheral artery disease 

16 screening tests furnished to at-risk 

17 beneficiaries (as such terms are de18 fined in section 1905(hh)); and’’. 

19 (B) APPLICATION TO ALTERNATIVE COST

20 SHARING.—Section 1916A(b)(3)(B) of the So21 cial Security Act (42 U.S.C. 1396o– 

22 1(b)(3)(B)), as amended by section 7305(b)(2), 

23 is amended by adding at the end the following 

24 new clause: 


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1 ‘‘(xv) Peripheral artery disease screen2 ing tests furnished to at-risk beneficiaries 

3 (as such terms are defined in section 

4 1905(qq)).’’. 

5 (3) MANDATORY COVERAGE.—Section 

6 1902(a)(10)(A) of the Social Security Act (42 

7 U.S.C. 1396a(a)(10)(A)), as amended by section 

8 2007(d)(2), is amended by striking ‘‘and (32)’’ and 

9 inserting ‘‘(32), and (34)’’. 

10 (d) REQUIREMENT FOR GROUP HEALTH PLANS AND

11 HEALTH INSURANCE ISSUERS OFFERING GROUP OR IN12 DIVIDUAL HEALTH INSURANCE COVERAGE TO PROVIDE

13 COVERAGE FOR PERIPHERAL ARTERY DISEASE SCREEN14 ING TESTS FURNISHED TO AT-RISK ENROLLEES WITH15 OUT IMPOSITION OF COST SHARING REQUIREMENTS.— 

16 (1) IN GENERAL.—Section 2713 of the Public 

17 Health Service Act (42 U.S.C. 300gg–13) is amend18 ed— 

19 (A) by amending subsection (a), as amend20 ed by section 7419(a)(1)(A), to read as follows: 

21 ‘‘(a) COVERAGE OF PREVENTIVE HEALTH SERV22 ICES.— 

23 ‘‘(1) IN GENERAL.—A group health plan and a 

24 health insurance issuer offering group or individual 

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1 vide coverage for and shall not impose any cost shar2 ing requirements for— 

3 ‘‘(A) evidence-based items or services that 

4 have in effect a rating of ‘A’ or ‘B’ in the cur5 rent recommendations of the United States Pre6 ventive Services Task Force; 

7 ‘‘(B) immunizations that have in effect a 

8 recommendation from the Advisory Committee 

9 on Immunization Practices of the Centers for 

10 Disease Control and Prevention with respect to 

11 the individual involved; 

12 ‘‘(C) with respect to infants, children, and 

13 adolescents, evidence-informed preventive care 

14 and screenings provided for in the comprehen15 sive guidelines supported by the Health Re16 sources and Services Administration; 

17 ‘‘(D) with respect to women, such addi18 tional preventive care and screenings not de19 scribed in subparagraph (A) as provided for in 

20 comprehensive guidelines supported by the 

21 Health Resources and Services Administration 

22 for purposes of this subparagraph; 

23 ‘‘(E) any prescription drug approved by 

24 the Food and Drug Administration for the pre25 vention of HIV (other than a drug subject to 


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1 preauthorization requirements consistent with 

2 section 2729A), administrative fees for such 

3 drugs, laboratory and other diagnostic proce4 dures associated with the use of such drugs, 

5 and clinical follow-up and monitoring, including 

6 any related services recommended in current 

7 United States Public Health Service clinical 

8 practice guidelines, without limitation; and 

9 ‘‘(F) with respect to at-risk enrollees, pe10 ripheral artery disease screening tests. 

11 ‘‘(2) FREQUENCY.—The Secretary, in consulta12 tion with appropriate organizations, shall establish 

13 standards regarding the frequency for peripheral ar14 tery disease screening tests for purposes of coverage 

15 under this section. 

16 ‘‘(3) CLARIFICATION REGARDING BREAST CAN17 CER SCREENING, MAMMOGRAPHY, AND PREVENTION

18 RECOMMENDATIONS.—For the purposes of this Act, 

19 and for the purposes of any other provision of law, 

20 the current recommendations of the United States 

21 Preventive Services Task Force regarding breast 

22 cancer screening, mammography, and prevention 

23 shall be considered the most current other than 

24 those issued in or around November 2009. 

25 ‘‘(4) DEFINITIONS.—In this subsection: 


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1 ‘‘(A) AT-RISK ENROLLEE.—The term ‘at2 risk enrollee’ means an individual enrolled in a 

3 group health plan or group or individual health 

4 insurance coverage— 

5 ‘‘(i) who is 65 years of age or older; 

6 ‘‘(ii) who is at least 50 years of age 

7 but not older than 64 years of age with 

8 risk factors for atherosclerosis (such as di9 abetes mellitus, a history of smoking, 

10 hyperlipidemia, and hypertension) or a 

11 family history of peripheral artery disease; 

12 ‘‘(iii) who is younger than 50 years of 

13 age with diabetes mellitus and one addi14 tional risk factor for atherosclerosis; or 

15 ‘‘(iv) with a known atherosclerotic dis16 ease in another vascular bed such as coro17 nary, carotid, subclavian, renal, or mesen18 teric artery stenosis, or abdominal aortic 

19 aneurysm. 

20 ‘‘(B) PERIPHERAL ARTERY DISEASE

21 SCREENING TEST.—The term ‘peripheral artery 

22 disease screening test’ means— 

23 ‘‘(i) noninvasive physiologic studies of 

24 extremity arteries (commonly referred to 

25 as ankle-brachial index testing); 


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1 ‘‘(ii) arterial duplex scans of lower ex2 tremity arteries vascular; and 

3 ‘‘(iii) such other items and services as 

4 the Secretary determines, in consultation 

5 with relevant stakeholders, to be appro6 priate for screening for peripheral artery 

7 disease for at-risk enrollees. 

8 ‘‘(5) RULE OF CONSTRUCTION.—Nothing in 

9 this subsection shall be construed to prohibit a plan 

10 or issuer from providing coverage for services in ad11 dition to those recommended by the United States 

12 Preventive Services Task Force or to deny coverage 

13 for services that are not recommended by such Task 

14 Force.’’; and 

15 (B) in subsection (b)(1)— 

16 (i) by striking ‘‘subsection (a)(1) or 

17 (a)(2) or a guideline under subsection 

18 (a)(3)’’ and inserting ‘‘subparagraph (A) 

19 or (B) of subsection (a)(1) or a guideline 

20 under subparagraph (C) of such sub21 section’’; and 

22 (ii) by striking ‘‘described in sub23 section (a)’’ and inserting ‘‘described in 

24 subsection (a)(1)’’. 


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1 (2) EFFECTIVE DATE.—The amendments made 

2 by paragraph (1) shall apply with respect to plan 

3 years beginning on or after January 1, 2025. 

4 (e) DISALLOWANCE OF PAYMENT FOR NONTRAU5 MATIC AMPUTATION SERVICES FURNISHED WITHOUT

6 ANATOMICAL TESTING SERVICES.—Section 1834 of the 

7 Social Security Act (42 U.S.C. 1395m), as amended by 

8 section 4221(b)(2), is amended by adding at the end the 

9 following new subsection: 

10 ‘‘(bb) DISALLOWANCE OF PAYMENT FOR NONTRAU11 MATIC AMPUTATION SERVICES FURNISHED WITHOUT

12 ANATOMICAL TESTING SERVICES.— 

13 ‘‘(1) IN GENERAL.—In the case of nontrau14 matic amputation services furnished by a supplier on 

15 or after January 1, 2025, to an individual entitled 

16 to, or enrolled for, benefits under part A and en17 rolled for benefits under this part, for which pay18 ment is made under this part, payment may only be 

19 made under this part if— 

20 ‘‘(A) such supplier furnishes anatomical 

21 testing services to such individual during the 3- 

22 month period preceding the date on which such 

23 nontraumatic amputation services is furnished; 

24 or 


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1 ‘‘(B) such individual has a pre-existing 

2 dysfunctional or unsalvageable limb, life-threat3 ening sepsis, intractable infection, extensive 

4 gangrene or necrotic tissue loss beyond salvage, 

5 a poor functional status, severe dementia, or a 

6 short life expectancy after shared decision mak7 ing with a health care team and patient, family, 

8 or caregiver. 

9 ‘‘(2) DEFINITIONS.—In this subsection: 

10 ‘‘(A) ANATOMICAL TESTING SERVICES.— 

11 The term ‘anatomical testing services’ means 

12 arterial duplex scanning, computed tomography 

13 angiography, and magnetic resonance 

14 angiography. 

15 ‘‘(B) NONTRAUMATIC AMPUTATION SERV16 ICES.—The term ‘nontraumatic amputation 

17 services’ means amputations as a result of ath18 erosclerotic vascular disease or a related comor19 bidity of such disease (including diabetes).’’. 

20 (f) DEVELOPMENT AND IMPLEMENTATION OF QUAL21 ITY MEASURES.— 

22 (1) DEVELOPMENT.—The Secretary of Health 

23 and Human Services (referred to in this subsection 

24 as the ‘‘Secretary’’) shall, in consultation with rel25 evant stakeholders, develop quality measures for 


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1 nontraumatic, lower-limb, major amputation that 

2 utilize appropriate diagnostic screening (including 

3 peripheral artery disease screening) in order to en4 courage alternative treatments (including 

5 revascularization) in lieu of such an amputation. 

6 (2) IMPLEMENTATION.—After appropriate test7 ing and validation of the measures developed under 

8 paragraph (1), the Secretary shall incorporate such 

9 measures in quality reporting programs for appro10 priate providers of services and suppliers under the 

11 Medicare program under title XVIII of the Social 

12 Security Act (42 U.S.C. 1395 et seq.), including for 

13 purposes of— 

14 (A) the merit-based incentive payment sys15 tem under section 1848(q) of such Act (42 

16 U.S.C. 1395w–4(q)); 

17 (B) incentive payments for participation in 

18 eligible alternative payment models under sec19 tion 1833(z) of such Act (42 U.S.C. 1395l(z)); 

20 (C) the shared savings program under sec21 tion 1899 of such Act (42 U.S.C. 1395jjj); 

22 (D) models under section 1115A of such 

23 Act (42 U.S.C. 1315a); and 

24 (E) such other payment systems or models 

25 as the Secretary may specify. 


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1 SEC. 7901C–2. ELIMINATING THE COINSURANCE REQUIRE2 MENT FOR CERTAIN COLORECTAL CANCER 

3 SCREENING TESTS FURNISHED UNDER THE 

4 MEDICARE PROGRAM. 

5 Section 1833(dd) of the Social Security Act (42 

6 U.S.C. 1395l(dd)) is amended— 

7 (1) in paragraph (1), by striking ‘‘and before 

8 January 1, 2030,’’; and 

9 (2) in paragraph (2)— 

10 (A) in subparagraph (A), by adding ‘‘and’’ 

11 at the end; 

12 (B) in subparagraph (B), by striking 

13 ‘‘through 2026’’ and inserting ‘‘through 2024’’; 

14 and 

15 (C) by striking subparagraph (C) and in16 serting the following: 

17 ‘‘(C) for 2025 and each subsequent year, 

18 100 percent.’’. 

19 SEC. 7901C–3. EXPANDING THE AVAILABILITY OF MEDICAL 

20 NUTRITION THERAPY SERVICES UNDER THE 

21 MEDICARE PROGRAM. 

22 (a) IN GENERAL.—Section 1861 of the Social Secu23 rity Act (42 U.S.C. 1395x) is amended— 

24 (1) in subsection (s)(2)(V), by striking ‘‘in the 

25 case of’’ and all that follows through ‘‘organiza26 tions’’; and 


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1 (2) in subsection (vv)— 

2 (A) in paragraph (1)— 

3 (i) by striking ‘‘disease management’’ 

4 and inserting ‘‘the prevention, manage5 ment, or treatment of a disease or condi6 tion specified in paragraph (4)’’; and 

7 (ii) by striking ‘‘by a physician’’ and 

8 all that follows through the period at the 

9 end and inserting the following: ‘‘by a— 

10 ‘‘(A) physician (as defined in subsection 

11 (r)(1)); 

12 ‘‘(B) physician assistant; 

13 ‘‘(C) nurse practitioner; 

14 ‘‘(D) clinical nurse specialist (as defined in 

15 subsection (aa)(5)(B)); or 

16 ‘‘(E) in the case of such services furnished 

17 to manage such a disease or condition that is 

18 an eating disorder, a clinical psychologist (as 

19 defined by the Secretary). 

20 Such term shall not include any services furnished 

21 to an individual for the prevention, management, or 

22 treatment of a renal disease if such individual is re23 ceiving maintenance dialysis for which payment is 

24 made under section 1881.’’; and 


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1 (B) by adding at the end the following new 

2 paragraph: 

3 ‘‘(4) For purposes of paragraph (1), the diseases and 

4 conditions specified in this paragraph are the following: 

5 ‘‘(A) Diabetes and prediabetes. 

6 ‘‘(B) A renal disease. 

7 ‘‘(C) Obesity (as defined for purposes of sub8 section (yy)(2)(C) or as otherwise defined by the 

9 Secretary). 

10 ‘‘(D) Hypertension. 

11 ‘‘(E) Dyslipidemia. 

12 ‘‘(F) Malnutrition. 

13 ‘‘(G) Eating disorders. 

14 ‘‘(H) Cancer. 

15 ‘‘(I) Gastrointestinal diseases, including celiac 

16 disease. 

17 ‘‘(J) HIV. 

18 ‘‘(K) AIDS. 

19 ‘‘(L) Cardiovascular disease. 

20 ‘‘(M) Any other disease or condition— 

21 ‘‘(i) specified by the Secretary relating to 

22 unintentional weight loss; 

23 ‘‘(ii) for which the Secretary determines 

24 the services described in paragraph (1) to be 

25 medically necessary and appropriate for the 


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1 prevention, management, or treatment of such 

2 disease or condition, consistent with any appli3 cable recommendations of the United States 

4 Preventive Services Task Force; or 

5 ‘‘(iii) for which the Secretary determines 

6 the services described in paragraph (1) are 

7 medically necessary, consistent with either pro8 tocols established by registered dietitians or nu9 trition professional organizations or with ac10 cepted clinical guidelines identified by the Sec11 retary.’’. 

12 (b) EXCLUSION MODIFICATION.—Section 1862(a)(1) 

13 of the Social Security Act (42 U.S.C. 1395y(a)(1)), as 

14 amended by sections 7901C(b)(2) and 7901C–1(b)(4), is 

15 amended— 

16 (1) in subparagraph (Q), by striking ‘‘and’’ at 

17 the end; 

18 (2) in subparagraph (R), by striking the semi19 colon at the end and inserting ‘‘, and’’; and 

20 (3) by adding at the end the following new sub21 paragraph: 

22 ‘‘(S) in the case of medical nutrition therapy 

23 services (as defined in section 1861(vv)), which are 

24 not furnished for the prevention, management, or 


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1 treatment of a disease or condition specified in para2 graph (4) of such section;’’. 

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

4 this section shall apply with respect to items and services 

5 furnished on or after January 1, 2024. 

6 SEC. 7901C–4. ENCOURAGING THE DEVELOPMENT AND USE 

7 OF DISARM ANTIMICROBIAL DRUGS. 

8 (a) ADDITIONAL PAYMENT FOR DISARM ANTI9 MICROBIAL DRUGS UNDER MEDICARE.— 

10 (1) IN GENERAL.—Section 1886(d)(5) of the 

11 Social Security Act (42 U.S.C. 1395ww(d)(5)) is 

12 amended by adding at the end the following new 

13 subparagraph: 

14 ‘‘(N)(i)(I) Effective for discharges beginning on or 

15 after October 1, 2025, or such sooner date as specified 

16 by the Secretary, subject to subclause (II), the Secretary 

17 shall, after notice and opportunity for public comment (in 

18 the publications required by subsection (e)(5) for a fiscal 

19 year or otherwise), provide for an additional payment 

20 under a mechanism (separate from the mechanism estab21 lished under subparagraph (K)), with respect to such dis22 charges involving any DISARM antimicrobial drug, in an 

23 amount equal to— 


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1 ‘‘(aa) the amount payable under section 1847A 

2 for such drug during the calendar quarter in which 

3 the discharge occurred; or 

4 ‘‘(bb) if no amount for such drug is determined 

5 under section 1847A, an amount to be determined 

6 by the Secretary in a manner similar to the manner 

7 in which payment amounts are determined under 

8 section 1847A based on information submitted by 

9 the manufacturer or sponsor of such drug (as re10 quired under clause (v)). 

11 ‘‘(II) In determining the amount payable under sec12 tion 1847A for purposes of items (aa) and (bb) of sub13 clause (I), subparagraphs (A) and (B) of subsection (b)(1) 

14 of such section shall be applied by substituting ‘102 per15 cent’ for ‘106 percent’ each place it appears and para16 graph (8)(B) of such section shall be applied by sub17 stituting ‘2 percent’ for ‘6 percent’. 

18 ‘‘(ii) For purposes of this subparagraph, a DISARM 

19 antimicrobial drug is— 

20 ‘‘(I) a drug— 

21 ‘‘(aa) that— 

22 ‘‘(AA) is approved by the Food and 

23 Drug Administration; 

24 ‘‘(BB) is designated by the Food and 

25 Drug Administration as a qualified infecVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 01457 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 tious disease product under subsection (d) 

2 of section 505E of the Federal Food, 

3 Drug, and Cosmetic Act (21 U.S.C. 

4 355f(d)); and 

5 ‘‘(CC) has received an extension of its 

6 exclusivity period pursuant to subsection 

7 (a) of such section; and 

8 ‘‘(bb) that has been designated by the Sec9 retary pursuant to the process established 

10 under clause (iv)(I)(bb); or 

11 ‘‘(II) an antibacterial or antifungal biological 

12 product— 

13 ‘‘(aa) that is licensed for use, or an anti14 bacterial or antifungal biological product for 

15 which an indication is first licensed for use, by 

16 the Food and Drug Administration on or after 

17 June 5, 2014, under section 351(a) of the Pub18 lic Health Service Act for human use to treat 

19 serious or life-threatening infections, as deter20 mined by the Food and Drug Administration, 

21 including those caused by, or likely to be caused 

22 by— 

23 ‘‘(AA) an antibacterial or antifungal 

24 resistant pathogen, including novel or 

25 emerging infectious pathogens; or 


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1 ‘‘(BB) a qualifying pathogen (as de2 fined under section 505E(f) of the Federal 

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

4 355f(f))); and 

5 ‘‘(bb) has been designated by the Secretary 

6 pursuant to the process established under 

7 clause (iv)(I)(bb). 

8 ‘‘(iii) The mechanism established pursuant to clause 

9 (i) shall provide that the additional payment under clause 

10 (i) shall— 

11 ‘‘(I) with respect to a discharge, only be made 

12 to a subsection (d) hospital that, as determined by 

13 the Secretary— 

14 ‘‘(aa) is participating in the National 

15 Healthcare Safety Network Antimicrobial Use 

16 and Resistance Module of the Centers for Dis17 ease Control and Prevention; and 

18 ‘‘(bb) has an antimicrobial stewardship 

19 program that aligns with the Core Elements of 

20 Hospital Antibiotic Stewardship Programs of 

21 the Centers for Disease Control and Prevention 

22 or the Antimicrobial Stewardship Standard set 

23 by the Joint Commission; and 

24 ‘‘(II) apply to discharges occurring on or after 

25 October 1 of the year in which the drug or biological 


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1 product is designated by the Secretary as a DIS2 ARM antimicrobial drug. 

3 For purposes of this clause, in the case of a similar report4 ing program described in item (aa), a subsection (d) hos5 pital shall be treated as participating in such a program 

6 if the entity maintaining such program identifies to the 

7 Secretary such hospital as so participating. 

8 ‘‘(iv)(I) The mechanism established pursuant to 

9 clause (i) shall provide for a process for— 

10 ‘‘(aa) a manufacturer or sponsor of a drug or 

11 biological product to request the Secretary to des12 ignate the drug or biological product as a DISARM 

13 antimicrobial drug; and 

14 ‘‘(bb) the designation (and removal of such des15 ignation) by the Secretary of drugs and biological 

16 products as DISARM antimicrobial drugs. 

17 ‘‘(II) A designation of a drug or biological product 

18 as a DISARM antimicrobial drug may be revoked by the 

19 Secretary if the Secretary determines that— 

20 ‘‘(aa) the drug or biological product no longer 

21 meets the requirements for a DISARM antimicrobial 

22 drug under clause (ii); 

23 ‘‘(bb) the request for such designation con24 tained an untrue statement of material fact; or 


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1 ‘‘(cc) clinical or other information that was not 

2 available to the Secretary at the time such designa3 tion was made shows that— 

4 ‘‘(AA) such drug or biological product is 

5 unsafe for use or not shown to be safe for use 

6 for individuals who are entitled to benefits 

7 under part A; or 

8 ‘‘(BB) an alternative to such drug or bio9 logical product is an advance that substantially 

10 improves the diagnosis or treatment of such in11 dividuals. 

12 ‘‘(III) Not later than October 1, 2024, the Secretary 

13 shall publish in the Federal Register a list of the DISARM 

14 antimicrobial drugs designated under this subparagraph 

15 pursuant to the process established under subclause 

16 (I)(bb). The Secretary shall annually update such list. 

17 ‘‘(v)(I) For purposes of determining additional pay18 ment amounts under clause (i), a manufacturer or sponsor 

19 of a drug or biological product that submits a request de20 scribed in clause (iv)(I)(aa) shall submit to the Secretary 

21 information described in section 1927(b)(3)(A)(iii). 

22 ‘‘(II) The penalties for failure to provide timely infor23 mation under clause (i) of subparagraph (C) section 

24 1927(b)(3) and for providing false information under 

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1 turers and sponsors of a drug or biological product under 

2 this section with respect to information under subclause 

3 (I) in the same manner as such penalties apply to manu4 facturers under such clauses with respect to information 

5 under subparagraph (A) of such section. 

6 ‘‘(vi)(I) The mechanism established pursuant to 

7 clause (i) shall provide that— 

8 ‘‘(aa) except as provided in item (bb), no addi9 tional payment shall be made under this subpara10 graph for discharges involving a DISARM anti11 microbial drug if any additional payments have been 

12 made for discharges involving such drug as a new 

13 medical service or technology under subparagraph 

14 (K); 

15 ‘‘(bb) additional payments may be made under 

16 this subparagraph for discharges involving a DIS17 ARM antimicrobial drug if any additional payments 

18 have been made for discharges occurring prior to the 

19 date of enactment of this subparagraph involving 

20 such drug as a new medical service or technology 

21 under subparagraph (K); and 

22 ‘‘(cc) no additional payment shall be made 

23 under subparagraph (K) for discharges involving a 

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1 charges involving such drug have been made under 

2 this subparagraph.’’. 

3 (2) CONFORMING AMENDMENT.—Section 

4 1886(d)(5)(K)(ii)(III) of the Social Security Act (42 

5 U.S.C. 1395ww(d)(5)(K)(ii)(III)) is amended by 

6 striking ‘‘provide’’ and inserting ‘‘subject to sub7 paragraph (N)(vi), provide’’. 

8 (b) AUTHORIZATION OF APPROPRIATIONS FOR THE

9 CENTERS FOR DISEASE CONTROL AND PREVENTION.— 

10 There is authorized to be appropriated to the Centers for 

11 Disease Control and Prevention $500,000,000, to remain 

12 available until expended, to support the establishment and 

13 implementation of antimicrobial stewardship programs 

14 and data reporting capabilities to the Antimicrobial Use 

15 and Resistance option of the CDC National Healthcare 

16 Safety Network, especially in critical access hospitals, 

17 rural hospitals, and community hospitals, to support de18 tection, surveillance, containment, and prevention of re19 sistant pathogens in the United States and overseas. 

20 (c) STUDY AND REPORTS ON REMOVING BARRIERS

21 TO THE DEVELOPMENT OF DISARM ANTIMICROBIAL

22 DRUGS.— 

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

24 United States (in this subsection referred to as the 

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1 rector of the National Institutes of Health, the Com2 missioner of Food and Drugs, the Administrator of 

3 the Centers for Medicare & Medicaid Services, and 

4 the Director of the Centers for Disease Control and 

5 Prevention, shall conduct a study over a 5-year pe6 riod of the barriers that prevent the development of 

7 DISARM antimicrobial drugs (as defined in section 

8 1886(d)(5)(N)(ii) of the Social Security Act, as 

9 added by subsection (a)), including— 

10 (A) patient outcomes in conjunction with 

11 the use of DISARM drugs, including— 

12 (i) duration of stay in the intensive 

13 care unit; 

14 (ii) recidivism within 30 days; and 

15 (iii) measures of additional follow-up 

16 care; 

17 (B) the effectiveness of antimicrobial stew18 ardship and surveillance programs, including— 

19 (i) changes in the percentage of hos20 pitals in the United States with an anti21 microbial stewardship program in place 

22 that aligns with the Core Elements of Hos23 pital Antibiotic Stewardship Programs, as 

24 outlined by the Centers for Disease Control 

25 and Prevention; 


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1 (ii) changes in inpatient care of 

2 clostridioides difficile infection; and 

3 (iii) changes in inpatient rates of re4 sistance to key pathogens; and 

5 (C) considerations relating to Medicare 

6 payment reform, including— 

7 (i) changes in the number of qualified 

8 antimicrobial products approved; 

9 (ii) changes in wholesale acquisition 

10 cost of individual qualified antimicrobial 

11 products over time; 

12 (iii) changes in year-over-year volume 

13 of individual qualified antimicrobial prod14 ucts sold; and 

15 (iv) the overall cost of qualified anti16 microbial products to the Medicare pro17 gram as a proportion of total Medicare 

18 part A spending. 

19 (2) REPORT.—Not later than 5 years after the 

20 date of the enactment of this section, the Comp21 troller General shall submit to Congress a report 

22 containing the results of the study conducted under 

23 paragraph (1), together with recommendations for 

24 such legislation and administrative action as the 

25 Comptroller General determines appropriate. 


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1 SEC. 7901C–5. TREAT AND REDUCE OBESITY ACT. 

2 (a) AUTHORITY TO EXPAND HEALTH CARE PRO3 VIDERS QUALIFIED TO FURNISH INTENSIVE BEHAVIORAL

4 THERAPY.—Section 1861(ddd) of the Social Security Act 

5 (42 U.S.C. 1395x(ddd)) is amended by adding at the end 

6 the following new paragraph: 

7 ‘‘(4)(A) Subject to subparagraph (B), the Sec8 retary may, in addition to qualified primary care 

9 physicians and other primary care practitioners, 

10 cover intensive behavioral therapy for obesity fur11 nished by any of the following: 

12 ‘‘(i) A physician (as defined in subsection 

13 (r)(1)) who is not a qualified primary care phy14 sician. 

15 ‘‘(ii) Any other appropriate health care 

16 provider (including a physician assistant, nurse 

17 practitioner, or clinical nurse specialist (as 

18 those terms are defined in subsection (aa)(5)), 

19 a clinical psychologist, a registered dietitian or 

20 nutrition professional (as defined in subsection 

21 (vv))). 

22 ‘‘(iii) An evidence-based, community-based 

23 lifestyle counseling program approved by the 

24 Secretary. 

25 ‘‘(B) In the case of intensive behavioral therapy 

26 for obesity furnished by a provider described in 


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1 clause (ii) or (iii) of subparagraph (A), the Secretary 

2 may only cover such therapy if such therapy is fur3 nished— 

4 ‘‘(i) upon referral from, and in coordina5 tion with, a physician or primary care practi6 tioner operating in a primary care setting or 

7 any other setting specified by the Secretary; 

8 and 

9 ‘‘(ii) in an office setting, a hospital out10 patient department, a community-based site 

11 that complies with the Federal regulations con12 cerning the privacy of individually identifiable 

13 health information promulgated under section 

14 264(c) of the Health Insurance Portability and 

15 Accountability Act of 1996, or another setting 

16 specified by the Secretary. 

17 ‘‘(C) In order to ensure a collaborative effort, 

18 the coordination described in subparagraph (B)(i) 

19 shall include the health care provider or lifestyle 

20 counseling program communicating to the referring 

21 physician or primary care practitioner any rec22 ommendations or treatment plans made regarding 

23 the therapy.’’. 

24 (b) MEDICARE PART D COVERAGE OF OBESITY

25 MEDICATION.— 


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1 (1) IN GENERAL.—Section 1860D–2(e)(2)(A) 

2 of the Social Security Act (42 U.S.C. 1395w– 

3 102(e)(2)(A)) is amended, in the first sentence— 

4 (A) by striking ‘‘and other than’’ and in5 serting ‘‘other than’’; and 

6 (B) by inserting after ‘‘benzodiazepines),’’ 

7 the following: ‘‘and other than subparagraph 

8 (A) of such section if the drug is used for the 

9 treatment of obesity (as defined in section 

10 1861(yy)(2)(C)) or for weight loss management 

11 for an individual who is overweight (as defined 

12 in section 1861(yy)(2)(F)(i)) and has 1 or more 

13 related comorbidities,’’. 

14 (2) EFFECTIVE DATE.—The amendments made 

15 by paragraph (1) shall apply to plan years beginning 

16 on or after the date that is 2 years after the date 

17 of the enactment of this section. 

18 (c) REPORT TO CONGRESS.— 

19 (1) IN GENERAL.—Not later than the date that 

20 is 1 year after the date of the enactment of this sec21 tion, and every 2 years thereafter, the Secretary of 

22 Health and Human Services shall submit a report to 

23 Congress describing the steps the Secretary has 

24 taken to implement the provisions of, and amend25 ments made by, this section. 


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1 (2) RECOMMENDATIONS.—Such report shall 

2 also include recommendations for better coordination 

3 and leveraging of programs within the Department 

4 of Health and Human Services and other Federal 

5 agencies that relate in any way to supporting appro6 priate research and clinical care (such as any inter7 actions between physicians and other health care 

8 providers and their patients) to treat, reduce, and 

9 prevent obesity in the adult population. 

10 SEC. 7901C–6. INCENTIVES, IMPROVEMENTS, AND OUT11 REACH TO INCREASE DIVERSITY IN ALZ12 HEIMER’S DISEASE RESEARCH. 

13 (a) IMPROVING ACCESS FOR AND OUTREACH TO

14 UNDERREPRESENTED POPULATIONS.— 

15 (1) EXPANDING ACCESS TO ALZHEIMER’S RE16 SEARCH CENTERS.— 

17 (A) IN GENERAL.—Section 445(a)(1) of 

18 the Public Health Service Act (42 U.S.C. 285e– 

19 2(a)(1)) is amended— 

20 (i) by striking ‘‘(a)(1) The Director of 

21 the Institute may’’ and inserting the fol22 lowing: 

23 ‘‘(a)(1) The Director of the Institute— 

24 ‘‘(A) may’’; 


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1 (ii) by striking ‘‘disease.’’ and insert2 ing ‘‘disease; and’’; and 

3 (iii) by adding at the end the fol4 lowing: 

5 ‘‘(B) beginning January 1, 2024, shall enter 

6 into cooperative agreements and make grants to 

7 public or private nonprofit entities under this sub8 section for the planning, establishment, and oper9 ation of new such centers that are located in areas 

10 with a higher concentration of minority groups (as 

11 determined under section 444(d)(3)(D)), such as en12 tities that are historically Black colleges and univer13 sities, Hispanic-serving institutions, Tribal colleges 

14 and universities, or centers of excellence for other 

15 minority populations.’’. 

16 (B) USE OF FUNDING FOR CLINICS TO OP17 ERATE CLINICAL TRIALS.—Section 445(b) of 

18 the Public Health Service Act (42 U.S.C. 285e– 

19 2(b)) is amended by adding at the end the fol20 lowing: 

21 ‘‘(3) Federal payments made under a cooperative 

22 agreement or grant under subsection (a) from funds made 

23 available under section 7901C–6(g) of the Health Equity 

24 and Accountability Act of 2024 shall, with respect to AlzVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 01470 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 heimer’s disease, be used in part to establish and operate 

2 diagnostic and treatment clinics designed— 

3 ‘‘(A) to meet the special needs of minority and 

4 rural populations and other underserved populations; 

5 and 

6 ‘‘(B) to operate clinical trials.’’. 

7 (2) OUTREACH.— 

8 (A) ALZHEIMER’S DISEASE CENTERS.— 

9 Section 445(b) of the Public Health Service Act 

10 (42 U.S.C. 285e–2(b)), as amended by para11 graph (1)(B), is amended by adding at the end 

12 the following: 

13 ‘‘(4) Federal payments made under a cooperative 

14 agreement or grant under subsection (a) shall be used to 

15 establish engagement centers to carry out public outreach, 

16 education efforts, and dissemination of information for 

17 members of minority groups about clinical trial participa18 tion. Activities funded pursuant to the preceding sentence 

19 shall include— 

20 ‘‘(A) using established mechanisms to encour21 age members of minority groups to participate in 

22 clinical trials on Alzheimer’s disease; 

23 ‘‘(B) expanding education efforts to make mem24 bers of minority groups aware of ongoing clinical 

25 trials; 


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1 ‘‘(C) working with trial sponsors to increase the 

2 number of recruitment events for members of minor3 ity groups; 

4 ‘‘(D) conducting outreach to national, State, 

5 and local physician professional organizations, espe6 cially for members of such organizations who are 

7 primary care physicians or physicians who specialize 

8 in dementia, to increase awareness of clinical re9 search opportunities for members of minority 

10 groups; and 

11 ‘‘(E) using community-based participatory re12 search methodologies to engage with minority popu13 lations.’’. 

14 (B) RESOURCE CENTERS FOR MINORITY

15 AGING RESEARCH.—Section 444(c) of the Pub16 lic Health Service Act (42 U.S.C. 285e–1(c)) is 

17 amended— 

18 (i) by striking ‘‘(c) The Director’’ and 

19 inserting ‘‘(c)(1) The Director’’; and 

20 (ii) by adding at the end the following 

21 new paragraph: 

22 ‘‘(2) The Director of the Institute, acting through the 

23 Resource Centers for Minority Aging Research of the In24 stitute, shall carry out public outreach, education efforts, 

25 and dissemination of information for members of minority 


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1 groups about participation in clinical research on Alz2 heimer’s disease carried out or supported under this sub3 part.’’. 

4 (b) INCENTIVES TO INCREASE DIVERSITY IN ALZ5 HEIMER’S DISEASE RESEARCH THROUGH PRINCIPAL IN6 VESTIGATORS AND RESEARCHERS FROM UNDERREP7 RESENTED POPULATIONS.— 

8 (1) ALZHEIMER’S CLINICAL RESEARCH AND

9 TRAINING AWARDS.—Section 445I of the Public 

10 Health Service Act (42 U.S.C. 285e–10a) is amend11 ed by adding at the end the following: 

12 ‘‘(d) ENHANCING THE PARTICIPATION OF PRINCIPAL

13 INVESTIGATORS AND RESEARCHERS WHO ARE MEMBERS

14 OF UNDERREPRESENTED POPULATIONS.— 

15 ‘‘(1) IN GENERAL.—The Director of the Insti16 tute shall enhance diversity in the conduct or sup17 port of clinical research on Alzheimer’s disease 

18 under this subpart by encouraging the participation 

19 of individuals from groups that are underrepresented 

20 in the biomedical, clinical, behavioral, and social 

21 sciences as principal investigators of such clinical re22 search, as researchers for such clinical research, or 

23 both. 

24 ‘‘(2) TRAINING FOR PRINCIPAL INVESTIGA25 TORS.—The Director of the Institute shall provide 


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1 training for principal investigators who are members 

2 of a minority group with respect to skills for— 

3 ‘‘(A) the design and conduct of clinical re4 search and clinical protocols; 

5 ‘‘(B) applying for grants for clinical re6 search; and 

7 ‘‘(C) such other areas as the Director of 

8 the Institute determines to be appropriate.’’. 

9 (2) SENIOR RESEARCHER AWARDS.—Section 

10 445B(a) of the Public Health Service Act (42 

11 U.S.C. 285e–4(a)) is amended by inserting ‘‘, in12 cluding senior researchers who are members of a mi13 nority group’’ before the period at the end of the 

14 first sentence. 

15 (c) INCENTIVES TO INCREASE DIVERSITY IN ALZ16 HEIMER’S DISEASE RESEARCH THROUGH TRIAL SITES.— 

17 Section 444(d) of the Public Health Service Act (42 

18 U.S.C. 285e–1(d)) is amended— 

19 (1) by striking ‘‘(d) The Director’’ and insert20 ing ‘‘(d)(1) The Director’’; and 

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

22 ‘‘(2) In conducting or supporting clinical research on 

23 Alzheimer’s disease for purposes of this subpart, in addi24 tion to requirements otherwise imposed under this title, 

25 including under section 492B, the Director of the Institute 


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1 shall increase the participation of members of minority 

2 groups in such clinical research through one or more of 

3 the activities described in paragraph (3). 

4 ‘‘(3)(A) The Director of the Institute shall provide 

5 incentives for the support of clinical research on Alz6 heimer’s disease with clinical trial sites established in 

7 areas with a higher concentration of minority groups, in8 cluding rural areas if practicable. 

9 ‘‘(B) In determining whether to conduct or support 

10 clinical research on Alzheimer’s disease, the Director of 

11 the Institute shall encourage the conduct of clinical re12 search with clinical trial sites in areas described in sub13 paragraph (A) as a higher-level priority criterion among 

14 the criteria established to evaluate whether to conduct or 

15 support clinical research. 

16 ‘‘(C) In determining the amount of funding to be pro17 vided for the conduct or support of such clinical research, 

18 the Director of the Institute shall provide additional fund19 ing for the conduct of such clinical research with clinical 

20 trial sites in areas described in subparagraph (A). 

21 ‘‘(D) In determining whether an area is an area with 

22 a higher concentration of minority groups, the Director 

23 of the Institute— 

24 ‘‘(i) shall consider the most recent data col25 lected by the Bureau of the Census; and 


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1 ‘‘(ii) may also consider— 

2 ‘‘(I) data from the Centers for Medicare & 

3 Medicaid Services on the incidence of Alz4 heimer’s disease in the United States by region; 

5 and 

6 ‘‘(II) such other data as the Director de7 termines appropriate. 

8 ‘‘(4) In order to facilitate the participation of mem9 bers of minority groups in clinical research supported 

10 under this subpart, in addition to activities described in 

11 paragraph (3), the Director of the Institute shall— 

12 ‘‘(A) ensure that such clinical research uses 

13 community-based participatory research methodolo14 gies; and 

15 ‘‘(B) encourage the use of remote health tech16 nologies, including telehealth, remote patient moni17 toring, and mobile technologies, that reduce or elimi18 nate barriers to participation of members of minor19 ity groups in such clinical research. 

20 ‘‘(5)(A) Clinical research on Alzheimer’s disease con21 ducted or supported under this subpart shall ensure that 

22 such research includes outreach activities designed to in23 crease the participation of members of minority groups in 

24 such research. 


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1 ‘‘(B)(i) Each applicant for a grant under this subpart 

2 for clinical research on Alzheimer’s disease shall submit 

3 to the Director of the Institute in the application for such 

4 grant— 

5 ‘‘(I) a budget for outreach activities to members 

6 of minority populations with respect to participation 

7 in such clinical research; and 

8 ‘‘(II) a description of the plan to conduct such 

9 outreach. 

10 ‘‘(ii) The Director of the Institute shall encourage ap11 plicants for, and recipients of, grants under this subpart 

12 to conduct clinical research on Alzheimer’s disease to en13 gage with community-based organizations to increase par14 ticipation of minority populations in such research. 

15 ‘‘(6) For purposes of this subpart: 

16 ‘‘(A) The term ‘clinical research’ includes a 

17 clinical trial. 

18 ‘‘(B) The term ‘minority group’ has the mean19 ing given such term under section 492B(g).’’. 

20 (d) PARTICIPANT ELIGIBILITY CRITERIA.—Section 

21 445I of the Public Health Service Act (42 U.S.C. 285e– 

22 10a), as amended by subsection (b)(1), is amended by 

23 adding at the end the following: 

24 ‘‘(e) PARTICIPANT ELIGIBILITY CRITERIA.—The Di25 rector of the Institute shall take such actions as are necVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 01477 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 essary to ensure that clinical research on Alzheimer’s dis2 ease conducted or supported under this subpart is de3 signed with eligibility criteria that ensure the clinical trial 

4 population reflects the diversity of the prospective patient 

5 population. Such actions may include the following: 

6 ‘‘(1) EXAMINATION OF CRITERIA.— 

7 ‘‘(A) IN GENERAL.—An examination of 

8 each exclusion criterion to determine if the cri9 terion is necessary to ensure the safety of trial 

10 participants or to achieve the study objectives. 

11 ‘‘(B) MODIFICATION OF CRITERIA.—In the 

12 case of an exclusion criterion that is not nec13 essary to ensure the safety of trial participants 

14 or to achieve the study objectives— 

15 ‘‘(i) encouraging the modification or 

16 elimination of the criterion; or 

17 ‘‘(ii) encouraging tailoring the cri18 terion as narrowly as possible to avoid un19 necessary limits to the population of the 

20 clinical study. 

21 ‘‘(2) REQUIREMENT FOR STRONG JUSTIFICA22 TION FOR EXCLUSION.—A review of each exclusion 

23 criterion to ensure that populations are included in 

24 clinical trials, such as older adults, individuals with 

25 a mild form of disease, individuals at the extremes 


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1 of the weight range, or children, unless there is a 

2 strong clinical or scientific justification to exclude 

3 them. 

4 ‘‘(3) USE OF ADAPTIVE DESIGN.—Encouraging 

5 the use of an adaptive clinical trial design that— 

6 ‘‘(A) starts with a defined population 

7 where there are concerns about safety; and 

8 ‘‘(B) may expand to a broader population 

9 based on initial data from the trial and external 

10 data.’’. 

11 (e) RESOURCE CENTER FOR SUCCESSFUL STRATE12 GIES TO INCREASE PARTICIPATION OF UNDERREP13 RESENTED POPULATIONS IN ALZHEIMER’S DISEASE

14 CLINICAL RESEARCH.—Section 444 of the Public Health 

15 Service Act (42 U.S.C. 285e–1) is amended by adding at 

16 the end the following: 

17 ‘‘(e)(1) The Director of the Institute, acting through 

18 the Office of Special Populations and in consultation with 

19 the Division of Extramural Activities, shall support re20 source information and technical assistance to grantees 

21 under section 445 (relating to Alzheimer’s disease cen22 ters), other grantees, and prospective grantees, designed 

23 to increase the participation of minority populations in 

24 clinical research on Alzheimer’s disease conducted or sup25 ported under this subpart. 


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1 ‘‘(2) The resource information and technical assist2 ance provided under paragraph (1) shall include the main3 tenance of a central resource library in order to collect, 

4 prepare, analyze, and disseminate information relating to 

5 strategies and best practices used by recipients of grants 

6 under this subpart and other researchers in the develop7 ment of the clinical research designed to increase the par8 ticipation of minority populations in such clinical re9 search.’’. 

10 (f) ANNUAL REPORTS.—Section 444 of the Public 

11 Health Service Act (42 U.S.C. 285e–1), as amended by 

12 subsection (e), is amended by adding at the end the fol13 lowing: 

14 ‘‘(f)(1)(A) The Director of the Institute shall submit 

15 annual reports to the Congress on the impact of the 

16 amendments made to this subpart by the Health Equity 

17 and Accountability Act of 2024. 

18 ‘‘(B) The Secretary shall transmit a copy of each 

19 such report to the Advisory Council on Alzheimer’s Re20 search, Care, and Services established under section 2(e) 

21 of the National Alzheimer’s Project Act. 

22 ‘‘(2) In each report under paragraph (1), the Director 

23 of the Institute shall include information and data on the 

24 following matters with respect to clinical trials on Alz25 heimer’s disease conducted during the preceding year: 


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1 ‘‘(A) The number of participants who are mem2 bers of a minority group in such clinical trials. 

3 ‘‘(B) The number of such clinical trials for 

4 which incentives under subsection (d)(3) were made 

5 available, the nature of such incentives, the amount 

6 of increased funding (if any) made available for re7 search on Alzheimer’s disease, and the training pro8 vided to principal investigators who are members of 

9 a minority group and the amount of funding (if any) 

10 for such training. 

11 ‘‘(C) The number of such clinical trials for 

12 which the principal investigator is a member of a mi13 nority group. 

14 ‘‘(D) The number of such clinical trials for 

15 which a significant percentage of researchers are 

16 members of a minority group. 

17 ‘‘(E) Modifications to patient eligibility criteria 

18 in clinical trial designs under section 445I(e). 

19 ‘‘(F) Outreach and education efforts conducted 

20 under section 445(b)(4). 

21 ‘‘(3) The Director of the Institute shall make each 

22 report under paragraph (1) available to the public, includ23 ing through posting on the appropriate website of the De24 partment of Health and Human Services.’’. 


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1 (g) AUTHORIZATION OF APPROPRIATIONS.—For each 

2 of fiscal years 2025 through 2029, there is authorized to 

3 be appropriated to the Secretary of Health and Human 

4 Services $60,000,000 to carry out the amendments made 

5 by this section, to remain available until expended. 

6 TITLE VIII—HEALTH 

7 INFORMATION TECHNOLOGY 

8 SEC. 8001. DEFINITIONS. 

9 In this title: 

10 (1) ACCESS.—The term ‘‘access’’, with respect 

11 to health information, means access described in sec12 tion 164.524 of title 45, Code of Federal Regula13 tions (or any successor regulations). 

14 (2) CERTIFIED ELECTRONIC HEALTH RECORD

15 TECHNOLOGY.—The term ‘‘certified EHR tech16 nology’’— 

17 (A) has the meaning given such term in 

18 section 3000 of the Public Health Service Act 

19 (42 U.S.C. 300jj); 

20 (B) includes the health information infra21 structure for interoperability, access, exchange, 

22 and use of electronic health information re23 quired under title XXX of the Public Health 

24 Service Act (42 U.S.C. 300jj et seq.); and 


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1 (C) is not limited to electronic health 

2 records maintained by doctors. 

3 (3) EHR.—The term ‘‘EHR’’— 

4 (A) means an electronic health record; 

5 (B) includes the health information infra6 structure for interoperability, access, exchange, 

7 and use of electronic health information re8 quired under title XXX of the Public Health 

9 Service Act (42 U.S.C. 300jj et seq.); and 

10 (C) is not limited to electronic health 

11 records maintained by doctors. 

12 (4) INTEROPERABILITY.—The term ‘‘interoper13 ability’’ has the meaning given such term in section 

14 3000 of the Public Health Service Act (42 U.S.C. 

15 300jj). 

16 Subtitle A—Reducing Health 

17 Disparities Through Health IT 

18 SEC. 8101. HRSA ASSISTANCE TO HEALTH CENTERS FOR 

19 PROMOTION OF HEALTH IT. 

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

21 Human Services, acting through the Administrator of the 

22 Health Resources and Services Administration, shall ex23 pand and intensify the programs and activities of the Ad24 ministration (directly or through grants or contracts) to 

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1 ters (as defined in section 330(a) of the Public Health 

2 Service Act (42 U.S.C. 254b(a))) to adopt and meaning3 fully use certified EHR technology for the management 

4 of chronic diseases and health conditions and reduction 

5 of health disparities. 

6 (b) FUNDING INITIATIVES.—The activities under 

7 subsection (a) may include funding initiatives, including 

8 establishing basic connectivity such as 5G internet for 

9 telemedicine capabilities, grant funding to implement the 

10 next generation of EHR, and funding for technology hard11 ware. 

12 SEC. 8102. ASSESSMENT OF IMPACT OF HEALTH IT ON RA13 CIAL AND ETHNIC MINORITY COMMUNITIES; 

14 OUTREACH AND ADOPTION OF HEALTH IT IN 

15 SUCH COMMUNITIES. 

16 (a) NATIONAL COORDINATOR FOR HEALTH INFOR17 MATION TECHNOLOGY.— 

18 (1) IN GENERAL.—Not later than 18 months 

19 after the date of enactment of this Act, the National 

20 Coordinator for Health Information Technology (re21 ferred to in this title as the ‘‘National Coordinator’’) 

22 shall— 

23 (A) conduct an evaluation of the level of 

24 interoperability, access, use, and accessibility of 

25 electronic health records in racial and ethnic 


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1 minority communities, focusing on whether pa2 tients in such communities have providers who 

3 use electronic health records, and the degree to 

4 which patients in such communities can access, 

5 exchange, and use without special effort their 

6 health information in those electronic health 

7 records; 

8 (B) include in such evaluation an indica9 tion of whether such providers— 

10 (i) are participating in the Medicare 

11 program under title XVIII of the Social 

12 Security Act (42 U.S.C. 1395 et seq.) or 

13 a State plan under title XIX of such Act 

14 (42 U.S.C. 1396 et seq.) (or a waiver of 

15 such plan); 

16 (ii) have received incentive payments 

17 or incentive payment adjustments under 

18 Medicare and Medicaid Electronic Health 

19 Records Incentive Programs (as defined in 

20 subsection (c)(2)); 

21 (iii) are MIPS eligible professionals, 

22 as defined in paragraph (1)(C) of section 

23 1848(q) of the Social Security Act (42 

24 U.S.C. 1395w–4(q)), for purposes of the 


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1 Merit-Based Incentive Payment System 

2 under such section; or 

3 (iv) have been recruited by any of the 

4 Health Information Technology Regional 

5 Extension Centers established under sec6 tion 3012 of the Public Health Service Act 

7 (42 U.S.C. 300jj–32); and 

8 (C) publish the results of such evaluation 

9 including the indications under subparagraph 

10 (B), the race and ethnicity of such providers, 

11 and the populations served by such providers. 

12 (2) EVALUATION OF INTEROPERABILITY.—The 

13 evaluation of the level of interoperability described in 

14 paragraph (1)(A) shall consider exchange of elec15 tronic health information, usability of exchanged 

16 electronic health information, effective application 

17 and use of the exchanged electronic health informa18 tion, and impact on outcomes of interoperability. 

19 (3) CERTIFICATION CRITERION.—Not later 

20 than 1 year after the date of enactment of this Act, 

21 the National Coordinator shall— 

22 (A) promulgate a certification criterion and 

23 module of certified EHR technology that strati24 fies quality measures for purposes of the Merit25 Based Incentive Payment System by disparity 


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1 characteristics, including race, ethnicity, lan2 guage, gender, gender identity, sexual orienta3 tion, socio-economic status, and disability sta4 tus, as such characteristics are defined for pur5 poses of certified EHR technology; and 

6 (B) report to the Centers for Medicare & 

7 Medicaid Services the quality measures strati8 fied by race and at least 2 other disparity char9 acteristics. 

10 (b) NATIONAL CENTER FOR HEALTH STATISTICS.— 

11 Not later than one year after the date of enactment of 

12 this Act, the Director of the National Center for Health 

13 Statistics shall provide to Congress a report that details 

14 the adoption of certified electronic health record systems 

15 and electronic information sharing in physicians’ offices 

16 in communities of color and rural communities during fis17 cal years 2017 through 2020. 

18 (c) CENTERS FOR MEDICARE & MEDICAID SERV19 ICES.— 

20 (1) IN GENERAL.—As part of the process of 

21 collecting information, with respect to a provider, at 

22 registration and attestation for purposes of Medicare 

23 and Medicaid Electronic Health Records Incentive 

24 Programs (as defined in paragraph (2)) or the 

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1 tion 1848(q) of the Social Security Act (42 U.S.C. 

2 1395w–4(q)), the Secretary of Health and Human 

3 Services shall collect the race and ethnicity of such 

4 provider. 

5 (2) MEDICARE AND MEDICAID ELECTRONIC

6 HEALTH RECORDS INCENTIVE PROGRAMS DE7 FINED.—For purposes of paragraph (1), the term 

8 ‘‘Medicare and Medicaid Electronic Health Records 

9 Incentive Programs’’ means the incentive programs 

10 under the following: 

11 (A) Subsection (l)(3) of section 1814(l)(3) 

12 of the Social Security Act (42 U.S.C. 1395f). 

13 (B) Subsections (a)(7) and (o) of section 

14 1848 of such Act (42 U.S.C. 1395w–4). 

15 (C) Subsections (l) and (m) of section 

16 1853 of such Act (42 U.S.C. 1395w–23). 

17 (D) Subsections (b)(3)(B)(ix)(I) and (n) of 

18 section 1886 of such Act (42 U.S.C. 1395ww). 

19 (E) Subsections (a)(3)(F) and (t) of sec20 tion 1903 such Act (42 U.S.C. 1396b). 

21 (d) NATIONAL COORDINATOR’S ASSESSMENT OF IM22 PACT OF HIT.—Section 3001(c)(6)(C) of the Public 

23 Health Service Act (42 U.S.C. 300jj–11(c)(6)(C)) is 

24 amended— 


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1 (1) in the heading by inserting ‘‘, RACIAL AND

2 ETHNIC MINORITY COMMUNITIES,’’ after ‘‘HEALTH

3 DISPARITIES’’; 

4 (2) by inserting ‘‘, in communities with a high 

5 proportion of individuals from racial and ethnic mi6 nority groups (as defined in section 1707(g)), in7 cluding people with disabilities in such groups,’’ 

8 after ‘‘communities with health disparities’’; 

9 (3) by striking ‘‘The National Coordinator’’ and 

10 inserting the following: 

11 ‘‘(i) IN GENERAL.—The National Co12 ordinator’’; and 

13 (4) by adding at the end the following: 

14 ‘‘(ii) CRITERIA.—In any publication 

15 under clause (i), the National Coordinator 

16 shall include best practices for encouraging 

17 partnerships between the Federal Govern18 ment, States, private entities, national 

19 nonprofit intermediaries, and community20 based organizations to expand outreach 

21 and education for and the adoption of cer22 tified EHR technology in communities with 

23 a high proportion of individuals from racial 

24 and ethnic minority groups (as defined in 

25 section 1707(g)), while also maintaining 


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1 the accessibility requirements of section 

2 508 of the Rehabilitation Act of 1973 to 

3 encourage patient involvement in patient 

4 health care. The National Coordinator 

5 shall— 

6 ‘‘(I) not later than 6 months 

7 after the submission of the report re8 quired under section 8302(b) of the 

9 Health Equity and Accountability Act 

10 of 2024, establish criteria for evalu11 ating the impact of health information 

12 technology on communities with a 

13 high proportion of individuals from 

14 racial and ethnic minority groups (as 

15 so defined) taking into account the 

16 findings in such report; and 

17 ‘‘(II) not later than 1 year after 

18 the submission of such report, publish 

19 the results of an evaluation of such 

20 impact.’’. 

21 SEC. 8103. NONDISCRIMINATION AND HEALTH EQUITY IN 

22 HEALTH INFORMATION TECHNOLOGY. 

23 (a) IN GENERAL.—Covered entities shall ensure that 

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1 ticipation in, deny individuals the benefits of, or subject 

2 individuals to discrimination under any health program or 

3 activity on the basis of race, color, national origin, sex, 

4 age, or disability. 

5 (b) COVERED ENTITIES.—In this section, the term 

6 ‘‘covered entity’’ means— 

7 (1) an entity that operates a health program or 

8 activity, any part of which receives Federal financial 

9 assistance; 

10 (2) an entity established under title I of the Pa11 tient Protection and Affordable Care Act (Public 

12 Law 114–148) that administers a health program or 

13 activity; or 

14 (3) the Department of Health and Human 

15 Services. 

16 SEC. 8104. LANGUAGE ACCESS IN HEALTH INFORMATION 

17 TECHNOLOGY. 

18 The National Coordinator shall— 

19 (1) not later than 18 months after the date of 

20 enactment of this Act, propose a rule for providing 

21 access to patients, through certified EHR tech22 nology, to their personal health information in a 

23 computable format, including using patient portals 

24 or third-party applications (as described in section 

25 3009(e) of the Public Health Service Act (42 U.S.C. 


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1 300jj–19(e))), in the 10 most common non-English 

2 languages; 

3 (2) hold a public hearing to identify best prac4 tices for carrying out paragraph (1); and 

5 (3) not later than 6 months after the public 

6 hearing under paragraph (2), promulgate a final 

7 regulation with respect to paragraph (1). 

8 Subtitle B—Modifications To 

9 Achieve Parity in Existing Pro10 grams 

11 SEC. 8201. EXTENDING FUNDING TO STRENGTHEN THE 

12 HEALTH IT INFRASTRUCTURE IN RACIAL 

13 AND ETHNIC MINORITY COMMUNITIES. 

14 Section 3011 of the Public Health Service Act (42 

15 U.S.C. 300jj–31) is amended— 

16 (1) in subsection (a), in the matter preceding 

17 paragraph (1), by inserting ‘‘, including with respect 

18 to communities with a high proportion of individuals 

19 from racial and ethnic minority groups (as defined 

20 in section 1707(g))’’ before the colon at the end; and 

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

23 ‘‘(e) ANNUAL REPORT ON EXPENDITURES.—The 

24 National Coordinator shall report annually to Congress on 

25 activities and expenditures under this section.’’. 


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1 SEC. 8202. EXTENDING COMPETITIVE GRANTS FOR THE DE2 VELOPMENT OF LOAN PROGRAMS TO FACILI3 TATE ADOPTION OF CERTIFIED EHR TECH4 NOLOGY BY PROVIDERS SERVING RACIAL 

5 AND ETHNIC MINORITY GROUPS. 

6 Section 3014(e) of the Public Health Service Act (42 

7 U.S.C. 300jj–34(e)) is amended, in the matter preceding 

8 paragraph (1), by inserting ‘‘, including with respect to 

9 communities with a high proportion of individuals from 

10 racial and ethnic minority groups (as defined in section 

11 1707(g))’’ after ‘‘health care provider to’’. 

12 SEC. 8203. AUTHORIZATION OF APPROPRIATIONS. 

13 Section 3018 of the Public Health Service Act (42 

14 U.S.C. 300jj–38) is amended by striking ‘‘fiscal years 

15 2009 through 2013’’ and inserting ‘‘fiscal years 2025 

16 through 2030’’. 

17 Subtitle C—Additional Research 

18 and Studies 

19 SEC. 8301. DATA COLLECTION AND ASSESSMENTS CON20 DUCTED IN COORDINATION WITH MINORITY21 SERVING INSTITUTIONS. 

22 Section 3001(c)(6) of the Public Health Service Act 

23 (42 U.S.C. 300jj–11(c)(6)) is amended by adding at the 

24 end the following new subparagraph: 


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1 ‘‘(F) DATA COLLECTION AND ASSESS2 MENTS CONDUCTED IN COORDINATION WITH

3 MINORITY-SERVING INSTITUTIONS.— 

4 ‘‘(i) IN GENERAL.—In carrying out 

5 subparagraph (C) with respect to commu6 nities with a high proportion of individuals 

7 from racial and ethnic minority groups (as 

8 defined in section 1707(g)), the National 

9 Coordinator shall, to the greatest extent 

10 possible, coordinate with an entity de11 scribed in clause (ii). 

12 ‘‘(ii) MINORITY-SERVING INSTITU13 TIONS.—For purposes of clause (i), an en14 tity described in this clause is a historically 

15 Black college or university, a Hispanic16 serving institution, a Tribal College or 

17 University, or an Asian-American-, Native 

18 American-, or Pacific Islander-serving in19 stitution with an accredited public health, 

20 health policy, or health services research 

21 program.’’. 


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1 SEC. 8302. STUDY OF HEALTH INFORMATION TECHNOLOGY 

2 IN MEDICALLY UNDERSERVED COMMU3 NITIES. 

4 (a) IN GENERAL.—Not later than 2 years after the 

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

6 Human Services shall— 

7 (1) enter into an agreement with the National 

8 Academies of Sciences, Engineering, and Medicine to 

9 conduct a study on the development, implementa10 tion, and effectiveness of health information tech11 nology within medically underserved areas; and 

12 (2) submit a report to Congress describing the 

13 results of such study, including any recommenda14 tions for legislative or administrative action. 

15 (b) STUDY.—The study described in subsection 

16 (a)(1) shall— 

17 (1) identify barriers to successful implementa18 tion of health information technology in medically 

19 underserved areas; 

20 (2) survey a cross-section of individuals in 

21 medically underserved areas and report their opin22 ions about the various topics of study; 

23 (3) examine the degree of interoperability 

24 among health information technology and users of 

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1 munity services, which such examination shall con2 sider the exchange of electronic health information, 

3 usability of exchanged electronic health information, 

4 effective application and use of the exchanged elec5 tronic health information, and impact on outcomes 

6 of interoperability; 

7 (4) examine the impact of health information 

8 technology on providing quality care and reducing 

9 the cost of care to individuals in such areas, includ10 ing the impact of such technology on improved 

11 health outcomes for individuals, including which 

12 technology worked for which population and how it 

13 improved health outcomes for that population; 

14 (5) examine the impact of health information 

15 technology on improving health care-related deci16 sions by both patients and providers in such areas; 

17 (6) identify specific best practices for using 

18 health information technology to foster the con19 sistent provision of accessibility and reasonable pol20 icy accommodations in health care to individuals 

21 with disabilities in such areas; 

22 (7) assess the feasibility and costs associated 

23 with the use of health information technology in 

24 such areas; 


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1 (8) evaluate whether the adoption and use of 

2 qualified electronic health records (as defined in sec3 tion 3000 of the Public Health Service Act (42 

4 U.S.C. 300jj)) is effective in reducing health dispari5 ties, including analysis of clinical quality measures 

6 reported by providers who are participating in the 

7 Medicare program under title XVIII of the Social 

8 Security Act (42 U.S.C. 1395 et seq.) or a State 

9 plan under title XIX of such Act (42 U.S.C. 1396 

10 et seq.) (or a waiver of such plan), pursuant to pro11 grams to encourage the adoption and use of certified 

12 EHR technology; 

13 (9) identify providers in medically underserved 

14 areas that are not electing to adopt and use elec15 tronic health records and determine what barriers 

16 are preventing those providers from adopting and 

17 using such records; and 

18 (10) examine urban and rural community 

19 health systems and determine the impact that health 

20 information technology may have on the capacity of 

21 primary health providers in those systems. 

22 (c) MEDICALLY UNDERSERVED AREA.—In this sec23 tion, the term ‘‘medically underserved area’’ means— 

24 (1) a population that has been designated as a 

25 medically underserved population under section 


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1 330(b)(3) of the Public Health Service Act (42 

2 U.S.C. 254b(b)(3)); 

3 (2) an area that has been designated as a 

4 health professional shortage area under section 332 

5 of the Public Health Service Act (42 U.S.C. 254e); 

6 (3) an area or population that has been des7 ignated as a medically underserved community under 

8 section 799B of the Public Health Service Act (42 

9 U.S.C. 295p); or 

10 (4) another area or population that— 

11 (A) experiences significant barriers to ac12 cessing quality health services; and 

13 (B) has a high prevalence of diseases or 

14 conditions described in title VII, with such dis15 eases or conditions having a disproportionate 

16 impact on racial and ethnic minority groups (as 

17 defined in section 1707(g) of the Public Health 

18 Service Act (42 U.S.C. 300u–6(g))) or a sub19 group of people with disabilities who have spe20 cific functional impairments. 

21 SEC. 8303. ASSESSMENT OF USE AND MISUSE OF DE-IDEN22 TIFIED HEALTH DATA. 

23 (a) IN GENERAL.—Not later than 18 months after 

24 the date of enactment of this Act, the Secretary of Health 

25 and Human Services shall— 


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1 (1) enter into an agreement with the Office of 

2 the National Coordinator of Health Information 

3 Technology to conduct a study, in consultation with 

4 relevant stakeholders, on the impact of digital health 

5 technology on medically underserved areas (as de6 fined in section 8302(c)); and 

7 (2) submit a report to Congress describing the 

8 results of such study, including any recommenda9 tions for legislative or administrative action. 

10 (b) STUDY.—The study described in subsection 

11 (a)(1) shall— 

12 (1) examine the overall prevalence, and histor13 ical and existing practices and their respective preva14 lence, of use and misuse of de-identified protected 

15 health information to discriminate against or benefit 

16 medically underserved areas; 

17 (2) identify best practices and tools to leverage 

18 the benefits and prevent misuse of de-identified pro19 tected health information to discriminate against 

20 medically underserved areas; 

21 (3) examine the overall prevalence, and histor22 ical and existing practices and their respective preva23 lence, of use and misuse of de-identified personal 

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1 mation to discriminate against or benefit medically 

2 underserved areas; and 

3 (4) identify best practices and tools to leverage 

4 the benefits and prevent misuse of de-identified per5 sonal health information other than protected health 

6 information to discriminate against medically under7 served areas. 

8 (c) DEFINITION OF PROTECTED HEALTH INFORMA9 TION.—In this section, the term ‘‘protected health infor10 mation’’ has the meaning given such term in section 

11 160.103, title 45, Code of Federal Regulations (or any 

12 successor regulations). 

13 Subtitle D—Closing Gaps in 

14 Funding To Adopt Certified EHRs 

15 SEC. 8401. EXTENDING MEDICAID EHR INCENTIVE PAY16 MENTS TO REHABILITATION FACILITIES, 

17 LONG-TERM CARE FACILITIES, AND HOME 

18 HEALTH AGENCIES. 

19 (a) IN GENERAL.—Section 1903(t)(2)(B) of the So20 cial Security Act (42 U.S.C. 1396b(t)(2)(B)) is amend21 ed— 

22 (1) in clause (i), by striking ‘‘, or’’ and insert23 ing a semicolon; 

24 (2) in clause (ii), by striking the period at the 

25 end and inserting a semicolon; and 


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1 (3) by inserting after clause (ii) the following 

2 new clauses: 

3 ‘‘(iii) a rehabilitation facility (as defined in sec4 tion 1886(j)(1)) that furnishes acute or subacute re5 habilitation services; 

6 ‘‘(iv) a long-term care hospital described in sec7 tion 1886(d)(1)(B)(iv); or 

8 ‘‘(v) a home health agency (as defined in sec9 tion 1861(o)).’’. 

10 (b) EFFECTIVE DATE.—The amendments 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. 

15 SEC. 8402. EXTENDING PHYSICIAN ASSISTANT ELIGIBILITY 

16 FOR MEDICAID ELECTRONIC HEALTH 

17 RECORD INCENTIVE PAYMENTS. 

18 (a) IN GENERAL.—Section 1903(t)(3)(B)(v) of the 

19 Social Security Act (42 U.S.C. 1396b(t)(3)(B)(v)) is 

20 amended to read as follows: 

21 ‘‘(v) physician assistant.’’. 

22 (b) EFFECTIVE DATE.—The amendment made by 

23 subsection (a) shall apply with respect to amounts ex24 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 Subtitle E—Expanding Access to 

4 Telehealth Services 

5 SEC. 8501. REMOVING GEOGRAPHIC REQUIREMENTS FOR 

6 TELEHEALTH SERVICES. 

7 Section 1834(m)(4)(C) of the Social Security Act (42 

8 U.S.C. 1395m(m)(4)(C)) is amended— 

9 (1) in clause (i), in the matter preceding sub10 clause (I), by striking ‘‘clause (iii)’’ and inserting 

11 ‘‘clauses (iii) and (iv)’’; and 

12 (2) by adding at the end the following new 

13 clause: 

14 ‘‘(iv) REMOVAL OF GEOGRAPHIC RE15 QUIREMENTS.—The geographic require16 ments described in clause (i) shall not 

17 apply with respect to telehealth services 

18 furnished on or after the first day after the 

19 end of the period for which clause (iii) ap20 plies.’’. 

21 SEC. 8502. EXPANDING ORIGINATING SITES. 

22 (a) EXPANDING THE HOME AS AN ORIGINATING

23 SITE.—Section 1834(m)(4)(C)(ii)(X) of the Social Secu24 rity Act (42 U.S.C. 1395m(m)(4)(C)(ii)(X)) is amended 

25 to read as follows: 


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1 ‘‘(X)(aa) Prior to the date de2 scribed in item (bb), the home of an 

3 individual but only for purposes of 

4 section 1881(b)(3)(B) or telehealth 

5 services described in paragraph (7) or 

6 clause (iii). 

7 ‘‘(bb) On or after the first day 

8 after the end of the period for which 

9 clause (iii) applies, the home of an in10 dividual.’’. 

11 (b) ALLOWING ADDITIONAL ORIGINATING SITES.— 

12 Section 1834(m)(4)(C)(ii) of the Social Security Act (42 

13 U.S.C. 1395m(m)(4)(C)(ii)) is amended by adding at the 

14 end the following new subclause: 

15 ‘‘(XII) Any other site determined 

16 appropriate by the Secretary at which 

17 an eligible telehealth individual is lo18 cated at the time a telehealth service 

19 is furnished via a telecommunications 

20 system.’’. 

21 (c) PARAMETERS FOR NEW ORIGINATING SITES.— 

22 Section 1834(m)(4)(C) of the Social Security Act (42 

23 U.S.C. 1395m(m)(4)(C)), as amended by section 8501, is 

24 amended by adding at the end the following new clause: 


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1 ‘‘(v) REQUIREMENTS FOR NEW

2 SITES.— 

3 ‘‘(I) IN GENERAL.—The Sec4 retary may establish requirements for 

5 the furnishing of telehealth services at 

6 sites described in clause (ii)(XII) to 

7 provide for beneficiary and program 

8 integrity protections. 

9 ‘‘(II) CLARIFICATION.—Nothing 

10 in this clause shall be construed to 

11 preclude the Secretary from estab12 lishing requirements for other origi13 nating sites described in clause (ii).’’. 

14 (d) NO ORIGINATING SITE FACILITY FEE FOR NEW

15 SITES.—Section 1834(m)(2)(B)(ii) of the Social Security 

16 Act (42 U.S.C. 1395m(m)(2)(B)(ii)) is amended— 

17 (1) in the heading, by striking ‘‘IF ORIGINATING

18 SITE IS THE HOME’’ and inserting ‘‘FOR CERTAIN

19 SITES’’; and 

20 (2) by striking ‘‘paragraph (4)(C)(ii)(X)’’ and 

21 inserting ‘‘subclause (X) or (XII) of paragraph 

22 (4)(C)’’. 


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1 TITLE IX—ACCOUNTABILITY 

2 AND EVALUATION 

3 SEC. 9001. PROHIBITION ON DISCRIMINATION IN FEDERAL 

4 ASSISTED HEALTH CARE SERVICES AND RE5 SEARCH ON THE BASIS OF SEX (INCLUDING 

6 SEXUAL ORIENTATION, GENDER IDENTITY, 

7 AND PREGNANCY, INCLUDING TERMINATION 

8 OF PREGNANCY), RACE, COLOR, NATIONAL 

9 ORIGIN, MARITAL STATUS, FAMILIAL STATUS, 

10 OR DISABILITY STATUS. 

11 (a) IN GENERAL.—No person in the United States 

12 shall, on the basis of sex (including sexual orientation, 

13 gender identity, and pregnancy, including termination of 

14 pregnancy), race, color, national origin, marital status, fa15 milial status, sexual orientation, gender identity, or dis16 ability status, be excluded from participation in, be denied 

17 the benefits of, or be subjected to discrimination under— 

18 (1) any health program or activity, including 

19 any health research program or activity, receiving 

20 Federal financial assistance, including credits, sub21 sidies, or contracts of insurance; or 

22 (2) any health program or activity that is ad23 ministered by an 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. 9002. TREATMENT OF MEDICARE PAYMENTS UNDER 

8 TITLE VI OF THE CIVIL RIGHTS ACT OF 1964. 

9 For the purposes of title VI of the Civil Rights Act 

10 of 1964 (42 U.S.C. 2000d et seq.), a payment made under 

11 part A, B, C, or D of title XVIII of the Social Security 

12 Act (42 U.S.C. 1395 et seq.) to a provider of services, 

13 physician, or other supplier (including a payment made 

14 to a subcontractor of the provider of services, physician, 

15 or other supplier) shall be deemed a grant, not a contract 

16 of insurance or guaranty. 

17 SEC. 9003. ACCOUNTABILITY AND TRANSPARENCY WITHIN 

18 THE DEPARTMENT OF HEALTH AND HUMAN 

19 SERVICES. 

20 Title XXXIV of the Public Health Service Act, as 

21 amended by titles I, II, III, and IV of this Act, is further 

22 amended by inserting after subtitle D the following: 


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1 ‘‘Subtitle E—Strengthening 

2 Accountability 

3 ‘‘SEC. 3451. ELEVATION OF THE OFFICE FOR CIVIL RIGHTS 

4 AND HEALTH EQUITY. 

5 ‘‘(a) IN GENERAL.— 

6 ‘‘(1) NAME OF OFFICE.—Beginning on the date 

7 of enactment of this subtitle, the Office for Civil 

8 Rights of the Department of Health and Human 

9 Services shall be known as the ‘Office for Civil 

10 Rights and Health Equity’ of the Department of 

11 Health and Human Services. Any reference to the 

12 Office for Civil Rights of the Department of Health 

13 and Human Services in any law, regulation, map, 

14 document, record, or other paper of the United 

15 States shall be deemed to be a reference to the Of16 fice for Civil Rights and Health Equity. 

17 ‘‘(2) HEAD OF OFFICE.—The head of the Office 

18 for Civil Rights and Health Equity shall be the Di19 rector for Civil Rights and Health Equity, to be ap20 pointed by the President. Any reference to the Di21 rector of the Office for Civil Rights of the Depart22 ment of Health and Human Services in any law, 

23 regulation, map, document, record, or other paper of 

24 the United States shall be deemed to be a reference 

25 to the Director for Civil Rights and Health Equity. 


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1 ‘‘(b) PURPOSE.—The Director for Civil Rights and 

2 Health Equity shall ensure that the health programs, ac3 tivities, policies, projects, procedures, and operations of 

4 health entities that receive Federal financial assistance are 

5 in compliance with title VI of the Civil Rights Act of 1964 

6 (42 U.S.C. 2000d et seq.), including through the following 

7 activities: 

8 ‘‘(1) The development and implementation of 

9 an action plan to address racial and ethnic health 

10 care disparities. Such plan shall— 

11 ‘‘(A) address concerns relating to the Of12 fice for Civil Rights and Health Equity as re13 leased by the United States Commission on 

14 Civil Rights in the report entitled ‘Health Care 

15 Challenge: Acknowledging Disparity, Con16 fronting Discrimination, and Ensuring Equity’ 

17 (September 1999), in conjunction with existing 

18 and future reports of the National Academy of 

19 Medicine (formerly known as the Institute of 

20 Medicine) including the reports titled ‘Unequal 

21 Treatment: Confronting Racial and Ethnic Dis22 parities in Health Care’, ‘Crossing the Quality 

23 Chasm: A New Health System for the 21st 

24 Century’, ‘In the Nation’s Compelling Interest: 

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1 force’, ‘The National Partnership for Action to 

2 End Health Disparities’, and ‘The Health of 

3 Lesbian, Gay, Bisexual, and Transgender Peo4 ple’, and other related reports of the National 

5 Academies of Sciences, Engineering, and Medi6 cine; 

7 ‘‘(B) be issued in proposed form for public 

8 review and comment; and 

9 ‘‘(C) be finalized taking into consideration 

10 any comments or concerns that are received by 

11 the Office. 

12 ‘‘(2) Investigative and enforcement actions 

13 against intentional or in effect discrimination and 

14 policies and practices that have a disparate impact 

15 on racial and ethnic minority groups and commu16 nities of color pursuant to section 9007 of the 

17 Health Equity and Accountability Act of 2024. 

18 ‘‘(3) The review of racial, ethnic, gender iden19 tity, sexual orientation, sex, disability status, socio20 economic status, and primary language health data 

21 collected by Federal health agencies to assess health 

22 care disparities related to intentional discrimination 

23 and policies and practices that have a disparate im24 pact on minorities. Such review shall include an asVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 01509 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 sessment of health disparities in communities with a 

2 combination of these classes. 

3 ‘‘(4) Outreach and education activities relating 

4 to compliance with title VI of the Civil Rights Act 

5 of 1964, including the process of filing a complaint 

6 in accordance with section 9007 of the Health Eq7 uity and Accountability Act of 2024. 

8 ‘‘(5) The provision of technical assistance for 

9 health entities to facilitate compliance with title VI 

10 of the Civil Rights Act of 1964. 

11 ‘‘(6) Coordination and oversight of activities of 

12 the civil rights compliance offices established under 

13 section 3452. 

14 ‘‘(7) Ensuring— 

15 ‘‘(A) at a minimum, compliance with the 

16 most recent version of the Office of Manage17 ment and Budget statistical policy directive en18 titled ‘Standards for Maintaining, Collecting, 

19 and Presenting Federal Data on Race and Eth20 nicity’; and 

21 ‘‘(B) consideration of available data and 

22 language standards such as— 

23 ‘‘(i) the standards for collecting, mon24 itoring, and reporting data under section 

25 3101; and 


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1 ‘‘(ii) the National Standards on Cul2 turally and Linguistically Appropriate 

3 Services of the Office of Minority Health. 

4 ‘‘(c) FUNDING AND STAFF.—The Secretary shall en5 sure the effectiveness of the Office for Civil Rights and 

6 Health Equity by ensuring that the Office is provided 

7 with— 

8 ‘‘(1) adequate funding to enable the Office to 

9 carry out its duties under this section; and 

10 ‘‘(2) staff with expertise in— 

11 ‘‘(A) epidemiology; 

12 ‘‘(B) statistics; 

13 ‘‘(C) health quality assurance; 

14 ‘‘(D) minority health and health dispari15 ties; 

16 ‘‘(E) health equity; 

17 ‘‘(F) cultural and linguistic competency; 

18 ‘‘(G) civil rights; and 

19 ‘‘(H) social, political, mental, behavioral, 

20 economic, and related determinants of health, 

21 including education access and quality, health 

22 care access and quality, neighborhood and built 

23 environment, and social and community context. 

24 ‘‘(d) ADVISORY BOARD.— 


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1 ‘‘(1) ESTABLISHMENT.—The Secretary, in col2 laboration with the Director Civil Rights and Health 

3 Equity and the Deputy Assistant Secretary for Mi4 nority Health, shall establish an advisory board (in 

5 this subsection referred to as the ‘advisory board’) 

6 to report in accordance with paragraph (2). 

7 ‘‘(2) REPORTS TO CONGRESS.—Not later than 

8 December 31, 2025, and annually thereafter, the ad9 visory board shall publish and submit to the Office, 

10 other Federal agencies, and the Congress a report 

11 that includes— 

12 ‘‘(A) the number of complaints filed in ac13 cordance with section 9007 of the Health Eq14 uity and Accountability Act of 2024 during the 

15 reporting period under title VI of the Civil 

16 Rights Act of 1964, broken down by category; 

17 ‘‘(B) the number of such complaints inves18 tigated and closed by the Office; 

19 ‘‘(C) the outcomes of such complaints in20 vestigated; 

21 ‘‘(D) the staffing levels of the Office, in22 cluding staff credentials; 

23 ‘‘(E) the number of such complaints that 

24 are pending (including backlogged complaints) 

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1 onstrated and an explanation of why such com2 plaints remain pending; and 

3 ‘‘(F) trends among filed complaints and 

4 other systemic patterns or themes, including an 

5 analysis from the Department of Justice about 

6 litigation concerning such complaints. 

7 ‘‘(3) COMPOSITION.—The members of the advi8 sory board shall include— 

9 ‘‘(A) representatives of stakeholders; and 

10 ‘‘(B) subject matter- and disciplinary-ap11 propriate experts. 

12 ‘‘(e) 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 2025 through 2029. 

16 ‘‘SEC. 3452. ESTABLISHMENT OF HEALTH PROGRAM OF17 FICES FOR CIVIL RIGHTS WITHIN AGENCIES 

18 OF DEPARTMENT OF HEALTH AND HUMAN 

19 SERVICES. 

20 ‘‘(a) IN GENERAL.—The Secretary shall establish 

21 civil rights compliance offices in each agency within the 

22 Department of Health and Human Services that admin23 isters health programs. 

24 ‘‘(b) PURPOSE OF OFFICES.—Each office established 

25 under subsection (a) shall ensure that recipients of FedVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 01513 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 eral financial assistance under Federal health programs 

2 administer programs, and determine and implement poli3 cies, services, and activities, in a manner that— 

4 ‘‘(1) does not discriminate, either intentionally 

5 or in effect, on the basis of race, color, national ori6 gin, language, ethnicity, sex, age, disability status, 

7 sexual orientation, or gender identity; and 

8 ‘‘(2) promotes the reduction and elimination of 

9 disparities in health and health care based on race, 

10 color, national origin, language, ethnicity, sex, age, 

11 disability status, sexual orientation, or gender iden12 tity. 

13 ‘‘(c) POWERS AND DUTIES.—The offices established 

14 in subsection (a) shall, with respect to the applicable agen15 cy, have the following powers and duties: 

16 ‘‘(1) The establishment of compliance and pro17 gram participation standards for recipients of Fed18 eral financial assistance under each program admin19 istered by the agency, including the establishment of 

20 disparity reduction standards to encompass dispari21 ties in health and health care related to race, color, 

22 national origin, language, ethnicity, sex, age, dis23 ability, sexual orientation, or gender identity. 

24 ‘‘(2) The development and implementation of 

25 policies, procedures, and program-specific guidelines 


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1 that interpret and apply Department of Health and 

2 Human Services guidance under title VI of the Civil 

3 Rights Act of 1964 and section 1557 of the Patient 

4 Protection and Affordable Care Act to each Federal 

5 health program administered by the agency. 

6 ‘‘(3) The development of a disparity-reduction 

7 impact analysis methodology that shall— 

8 ‘‘(A) be applied to every rule issued by the 

9 agency and published as part of the formal 

10 rulemaking process under sections 555, 556, 

11 and 557 of title 5, United States Code; and 

12 ‘‘(B) include an analysis of the intersecting 

13 forms of discrimination. 

14 ‘‘(4) Oversight of data collection, reporting, 

15 analysis, and publication requirements for all recipi16 ents of Federal financial assistance under each Fed17 eral health program administered by the agency, 

18 compliance with, at a minimum, the most recent 

19 version of the Office of Management and Budget 

20 statistical policy directive entitled ‘Standards for 

21 Maintaining, Collecting, and Presenting Federal 

22 Data on Race and Ethnicity’, and consideration of 

23 available data and language standards such as— 

24 ‘‘(A) the standards for collecting and re25 porting data under section 3101; 


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1 ‘‘(B) the National Standards on Culturally 

2 and Linguistically Appropriate Services of the 

3 Office of Minority Health; and 

4 ‘‘(C) the disaggregation of all health and 

5 health care data by racial and ethnic minority 

6 group. 

7 ‘‘(5) The conduct of publicly available studies 

8 regarding discrimination within Federal health pro9 grams administered by the agency as well as dis10 parity reduction initiatives by recipients of Federal 

11 financial assistance under Federal health programs. 

12 ‘‘(6) Annual reports to the Committee on 

13 Health, Education, Labor, and Pensions and the 

14 Committee on Finance of the Senate and the Com15 mittee on Energy and Commerce and the Committee 

16 on Ways and Means of the House of Representatives 

17 on the progress in reducing disparities in health and 

18 health care through the Federal programs adminis19 tered by the agency. 

20 ‘‘(d) RELATIONSHIP TO OFFICE FOR CIVIL RIGHTS

21 IN THE DEPARTMENT OF JUSTICE.— 

22 ‘‘(1) DEPARTMENT OF HEALTH AND HUMAN

23 SERVICES.—The Office for Civil Rights of the De24 partment of Health and Human Services shall pro25 vide standard-setting and compliance review invesVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 01516 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 tigation support services to each civil rights compli2 ance office established under subsection (a), subject 

3 to paragraph (2). 

4 ‘‘(2) DEPARTMENT OF JUSTICE.—The Office 

5 for Civil Rights of the Department of Justice may, 

6 as appropriate, institute formal proceedings when a 

7 civil rights compliance office established under sub8 section (a) determines that a recipient of Federal fi9 nancial assistance is not in compliance with the dis10 parity reduction standards of the applicable agency. 

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

12 health programs’ mean programs— 

13 ‘‘(1) under the Social Security Act (42 U.S.C. 

14 301 et seq.) that pay for health care and services; 

15 and 

16 ‘‘(2) under this Act that— 

17 ‘‘(A) provide Federal financial assistance 

18 for health care, biomedical research, or health 

19 services research; or 

20 ‘‘(B) are designed to improve the public’s 

21 health, including health service programs.’’. 

22 SEC. 9004. UNITED STATES COMMISSION ON CIVIL RIGHTS. 

23 (a) COORDINATION WITHIN DEPARTMENT OF JUS24 TICE OF ACTIVITIES REGARDING HEALTH DISPARIVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 01517 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 TIES.—Section 3(a) of the Civil Rights Commission Act 

2 of 1983 (42 U.S.C. 1975a(a)) is amended— 

3 (1) in paragraph (1), by striking ‘‘and’’ at the 

4 end; 

5 (2) in paragraph (2), by striking the period at 

6 the end and inserting ‘‘; and’’; and 

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

8 ‘‘(3) shall, with respect to activities carried out 

9 in health care and correctional facilities, toward the 

10 goal of eliminating health disparities between the 

11 general population and members of minority groups 

12 based on race or color, promote coordination of such 

13 activities of— 

14 ‘‘(A) the Office of Justice Programs of the 

15 Department of Justice, including the Office for 

16 Civil Rights within that Office; 

17 ‘‘(B) the Office for Civil Rights within the 

18 Department of Health and Human Services; 

19 and 

20 ‘‘(C) the Office of Minority Health within 

21 the Department of Health and Human Serv22 ices.’’. 

23 (b) AUTHORIZATION OF APPROPRIATIONS.—Section 

24 5 of the Civil Rights Commission Act of 1983 (42 U.S.C. 

25 1975c) is amended by striking the first sentence and inVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 01518 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 serting the following: ‘‘For the purpose of carrying out 

2 this Act, there are authorized to be appropriated 

3 $30,000,000 for fiscal year 2025, and such sums as may 

4 be necessary for each of the fiscal years 2026 through 

5 2030.’’. 

6 SEC. 9005. SENSE OF CONGRESS CONCERNING FULL FUND7 ING OF ACTIVITIES TO ELIMINATE RACIAL 

8 AND ETHNIC HEALTH DISPARITIES. 

9 It is the sense of the Congress that— 

10 (1) health disparities negatively impact out11 comes for health and human security of the Nation; 

12 (2) reducing racial, ethnic, age, sexual, and 

13 gender disparities in prevention and treatment are 

14 unique civil and human rights challenges and, as 

15 such, Federal agencies and health care entities and 

16 systems receiving Federal funds should be account17 able for their role in causing disparities and in18 equity; 

19 (3) funding for the National Institute on Mi20 nority Health and Health Disparities, the Office of 

21 Civil Rights in the Department of Health and 

22 Human Services, the National Institute of Nursing 

23 Research, and the Office of Minority Health should 

24 be doubled by fiscal year 2025, to effectively address 

25 racial and ethnic disparities elimination in health 


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1 and health care as a matter of health and national 

2 security; 

3 (4) adequate funding by fiscal year 2025, and 

4 subsequent funding increases, should be provided for 

5 health and human service professions training pro6 grams, the Racial and Ethnic Approaches to Com7 munity Health Initiative at the Centers for Disease 

8 Control and Prevention, the Minority HIV/AIDS 

9 Initiative, the Excellence Centers to Eliminate Eth10 nic/Racial Disparities Program at the Agency for 

11 Healthcare Research and Quality, and the National 

12 Health Service Corps Scholarship Program initia13 tives, programs, policies, projects, and activities that 

14 are the backbone of the Nation’s agenda to eliminate 

15 racial and ethnic health disparities and inequities; 

16 (5) adequate funding for fiscal year 2025 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 (6) current and newly created health disparity 

25 elimination incentives, programs, agencies, and deVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 01520 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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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 2025; and 

4 (7) stewardship and accountability should be 

5 provided to the Congress and the President for 

6 measurable and sustainable progress toward health 

7 disparity elimination under programs under this Act, 

8 including increased data collection and reporting, ca9 pacity building for impacted communities, technical 

10 assistance, training programs, and avenues to dis11 seminate program details and successes to the public 

12 and to policymakers. 

13 SEC. 9006. GAO AND NIH REPORTS. 

14 (a) GAO REPORT ON NIH GRANT RACIAL AND ETH15 NIC DIVERSITY.— 

16 (1) IN GENERAL.—The Comptroller General of 

17 the United States shall conduct a study on the racial 

18 and ethnic diversity among the following groups: 

19 (A) All applicants for grants, contracts, 

20 and cooperative agreements awarded by the Na21 tional Institutes of Health during the period be22 ginning on January 1, 2025, and ending De23 cember 31, 2034. 


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1 (B) All recipients of such grants, con2 tracts, and cooperative agreements during such 

3 period. 

4 (C) All members of the peer review panels 

5 of such applicants and recipients, respectively. 

6 (2) REPORT.—Not later than 6 months after 

7 the date of enactment of this Act, the Comptroller 

8 General shall complete the study under paragraph 

9 (1) and submit to Congress a report containing the 

10 results of such study. 

11 (b) NIH REPORT ON CERTAIN AUTHORITY OF NA12 TIONAL INSTITUTE ON MINORITY HEALTH AND HEALTH

13 DISPARITIES.—Not later than 6 months after the date of 

14 enactment of this Act, and biennially thereafter, the Direc15 tor of the National Institutes of Health, in collaboration 

16 with the Director of the National Institute on Minority 

17 Health and Health Disparities, shall submit to Congress 

18 a report that details and evaluates— 

19 (1) the steps taken during the applicable report 

20 period by the Director of the National Institutes of 

21 Health to plan, coordinate, review, and evaluate all 

22 minority health and health disparity research that is 

23 conducted or supported by the institutes and centers 

24 at the National Institutes of Health; and 

25 (2) the outcomes of such steps. 


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1 (c) GAO REPORT RELATED TO RECIPIENTS OF

2 PPACA FUNDING.—Not later than one year after the 

3 date of enactment of this Act and biennially thereafter, 

4 the Comptroller General of the United States shall submit 

5 to Congress a report that identifies— 

6 (1) the racial and ethnic diversity of commu7 nity-based organizations that applied for Federal en8 rollment funding provided pursuant to the Patient 

9 Protection and Affordable Care Act (Public Law 

10 111–148) (including the amendments made by such 

11 Act); 

12 (2) the percentage of such organizations that 

13 were awarded such funding; and 

14 (3) the impact of such community-based organi15 zations’ enrollment efforts on the insurance status of 

16 their communities. 

17 (d) ANNUAL REPORT ON ACTIVITIES OF NATIONAL

18 INSTITUTE ON MINORITY HEALTH AND HEALTH DIS19 PARITIES.—The Director of the National Institute on Mi20 nority Health and Health Disparities shall prepare an an21 nual report on the activities carried out or to be carried 

22 out by such institute, and shall submit each such report 

23 to the Committee on Health, Education, Labor, and Pen24 sions of the Senate, the Committee on Energy and Com25 merce of the House of Representatives, the Secretary of 


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1 Health and Human Services, and the Director of the Na2 tional Institutes of Health. With respect to the fiscal year 

3 involved, the report shall— 

4 (1) describe and evaluate the progress made in 

5 health disparities research conducted or supported 

6 by institutes and centers of the National Institutes 

7 of Health; 

8 (2) summarize and analyze expenditures made 

9 for activities with respect to health disparities re10 search conducted or supported by the National Insti11 tutes of Health; 

12 (3) include a separate statement applying the 

13 requirements of paragraphs (1) and (2) specifically 

14 to minority health disparities research; and 

15 (4) contain such recommendations as the Direc16 tor of the Institute considers appropriate. 

17 SEC. 9007. INVESTIGATIVE AND ENFORCEMENT ACTIONS. 

18 (a) IN GENERAL.—In carrying out the investigative 

19 and enforcement actions of section 3451(b)(2) of the Pub20 lic Health Service Act, as added by section 9003 of this 

21 Act, the Director for Civil Rights and Health Equity (re22 ferred to in this section as the ‘‘Director’’) shall pursue 

23 such investigative and enforcement actions pursuant to 

24 this section. 


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1 (b) ADMINISTRATIVE COMPLAINT AND CONCILIATION

2 PROCESS.— 

3 (1) COMPLAINTS AND ANSWERS.— 

4 (A) IN GENERAL.—An aggrieved person 

5 may, not later than 1 year after an alleged vio6 lation of subsection (a) has occurred or con7 cluded, file a complaint with the Director alleg8 ing inequitable provision of health care by a 

9 provider described in subsection (a). 

10 (B) COMPLAINT.—A complaint submitted 

11 pursuant to subparagraph (A) shall be in writ12 ing and shall contain such information and be 

13 in such form as the Director requires. 

14 (C) OATH OR AFFIRMATION.—The com15 plaint and any answer made under this sub16 section shall be made under oath or affirmation, 

17 and may be reasonably and fairly modified at 

18 any time. 

19 (2) RESPONSE TO COMPLAINTS.— 

20 (A) IN GENERAL.—Upon the filing of a 

21 complaint under this subsection, the following 

22 procedures shall apply: 

23 (i) COMPLAINANT NOTICE.—The Di24 rector shall serve notice upon the com25 plainant acknowledging receipt of such filVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 01525 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 ing and advising the complainant of the 

2 time limits and procedures provided under 

3 this section. 

4 (ii) RESPONDENT NOTICE.—The Di5 rector shall, not later than 30 days after 

6 receipt of such filing— 

7 (I) serve on the respondent a no8 tice of the complaint, together with a 

9 copy of the original complaint; and 

10 (II) advise the respondent of the 

11 procedural rights and obligations of 

12 respondents under this section. 

13 (iii) ANSWER.—The respondent may 

14 file, not later than 60 days after receipt of 

15 the notice from the Director, an answer to 

16 such complaint. 

17 (iv) INVESTIGATIVE DUTIES.—The Di18 rector shall— 

19 (I) make an investigation of the 

20 alleged inequitable provision of health 

21 care; and 

22 (II) complete such investigation 

23 within 180 days (unless it is impracti24 cable to complete such investigation 


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1 within 180 days) after the filing of 

2 the complaint. 

3 (B) INVESTIGATIONS.— 

4 (i) PATTERN OR PRACTICE.—In the 

5 course of investigating the complaint, the 

6 Director may seek records of care provided 

7 to patients other than the complainant if 

8 necessary to demonstrate or disprove an 

9 allegation of inequitable provision of health 

10 care or to determine whether there is a 

11 pattern or practice of such care. 

12 (ii) ACCOUNTING FOR SOCIAL DETER13 MINANTS OF HEALTH.—In investigating 

14 the complaint and reaching a determina15 tion on the validity of the complaint, the 

16 Director shall account for social deter17 minants of health and the effect of such 

18 social determinants on health care out19 comes. 

20 (iii) INABILITY TO COMPLETE INVES21 TIGATION.—If the Director is unable to 

22 complete (or finds it is impracticable to 

23 complete) the investigation within 180 

24 days after the filing of the complaint (or, 

25 if the Secretary takes further action under 


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1 paragraph (6)(B) with respect to a com2 plaint, within 180 days after the com3 mencement of such further action), the Di4 rector shall notify the complainant and re5 spondent in writing of the reasons in6 volved. 

7 (C) REPORT.— 

8 (i) FINAL REPORT.—On completing 

9 each investigation under this paragraph, 

10 the Director shall prepare a final investiga11 tive report. 

12 (ii) MODIFICATION OF REPORT.—A 

13 final report under this subparagraph may 

14 be modified if additional evidence is later 

15 discovered. 

16 (3) CONCILIATION.— 

17 (A) IN GENERAL.—During the period be18 ginning on the date on which a complaint is 

19 filed under this subsection and ending on the 

20 date of final disposition of such complaint (in21 cluding during an investigation under para22 graph (2)(B)), the Director shall, to the extent 

23 feasible, engage in conciliation with respect to 

24 such complaint. 


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1 (B) CONCILIATION AGREEMENT.—A con2 ciliation agreement arising out of such concilia3 tion shall be an agreement between the re4 spondent and the complainant, and shall be 

5 subject to approval by the Director. 

6 (C) RIGHTS PROTECTED.—The Director 

7 shall approve a conciliation agreement only if 

8 the agreement protects the rights of the com9 plainant and other persons similarly situated. 

10 (D) PUBLICLY AVAILABLE AGREEMENT.— 

11 (i) IN GENERAL.—Subject to clause 

12 (ii), the Secretary shall make available to 

13 the public a copy of a conciliation agree14 ment entered into pursuant to this sub15 section unless the complainant and re16 spondent otherwise agree, and the Sec17 retary determines, that disclosure is not re18 quired to further the purposes of this sub19 section. 

20 (ii) LIMITATION.—A conciliation 

21 agreement that is made available to the 

22 public pursuant to clause (i) may not dis23 close individually identifiable health infor24 mation. 


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1 (4) FAILURE TO COMPLY WITH CONCILIATION

2 AGREEMENT.—Whenever the Director has reason3 able cause to believe that a respondent has breached 

4 a conciliation agreement, the Director shall refer the 

5 matter to the Attorney General to consider filing a 

6 civil action to enforce such agreement. 

7 (5) WRITTEN CONSENT FOR DISCLOSURE OF

8 INFORMATION.—Nothing said or done in the course 

9 of conciliation under this subsection may be made 

10 public, or used as evidence in a subsequent pro11 ceeding under this subsection, without the written 

12 consent of the parties to the conciliation. 

13 (6) PROMPT JUDICIAL ACTION.— 

14 (A) IN GENERAL.—If the Director deter15 mines at any time following the filing of a com16 plaint under this subsection that prompt judi17 cial action is necessary to carry out the pur18 poses of this subsection, the Director may rec19 ommend that the Attorney General promptly 

20 commence a civil action under subsection (d). 

21 (B) IMMEDIATE SUIT.—If the Director de22 termines at any time following the filing of a 

23 complaint under this subsection that the public 

24 interest would be served by allowing the com25 plainant to bring a civil action under subsection 


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1 (c) in a State or Federal court immediately, the 

2 Director shall certify that the administrative 

3 process has concluded and that the complainant 

4 may file such a suit immediately. 

5 (7) ANNUAL REPORT.—Not later than 1 year 

6 after the date of enactment of this Act, and annually 

7 thereafter, the Director shall make publicly available 

8 a report detailing the activities of the Office for Civil 

9 Rights and Health Equity under this subsection, in10 cluding— 

11 (A) the number of complaints filed and the 

12 basis on which the complaints were filed; 

13 (B) the number of investigations under14 taken as a result of such complaints; and 

15 (C) the disposition of all such investiga16 tions. 

17 (c) ENFORCEMENT BY PRIVATE PERSONS.— 

18 (1) IN GENERAL.— 

19 (A) CIVIL ACTION.— 

20 (i) IN SUIT.—A complainant under 

21 subsection (b) may commence a civil action 

22 to obtain appropriate relief with respect to 

23 an alleged violation of subsection (a), or 

24 for breach of a conciliation agreement 

25 under subsection (b), in an appropriate 


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1 district court of the United States or State 

2 court— 

3 (I) not sooner than the earliest 

4 of— 

5 (aa) the date a conciliation 

6 agreement is reached under sub7 section (b); 

8 (bb) the date of a final dis9 position of a complaint under 

10 subsection (b); or 

11 (cc) 180 days after the first 

12 day of the alleged violation; and 

13 (II) not later than 2 years after 

14 the final day of the alleged violation. 

15 (ii) STATUTE OF LIMITATIONS.—The 

16 computation of such 2-year period shall 

17 not include any time during which an ad18 ministrative proceeding (including inves19 tigation or conciliation) under subsection 

20 (b) was pending with respect to a com21 plaint under such subsection. 

22 (B) BARRING SUIT.—If the Director has 

23 obtained a conciliation agreement under sub24 section (b) regarding an alleged violation of 

25 subsection (a), no action may be filed under 


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1 this paragraph by the complainant involved 

2 with respect to the alleged violation except for 

3 the purpose of enforcing the terms of such an 

4 agreement. 

5 (2) RELIEF WHICH MAY BE GRANTED.— 

6 (A) IN GENERAL.—In a civil action under 

7 paragraph (1), if the court finds that a viola8 tion of subsection (a) or breach of a conciliation 

9 agreement has occurred, the court may award 

10 to the plaintiff actual and punitive damages, 

11 and may grant as relief, as the court deter12 mines to be appropriate, any permanent or tem13 porary injunction, temporary restraining order, 

14 or other order (including an order enjoining the 

15 defendant from engaging in a practice violating 

16 subsection (a) or ordering such affirmative ac17 tion as may be appropriate). 

18 (B) FEES AND COSTS.—In a civil action 

19 under paragraph (1), the court, in its discre20 tion, may allow the prevailing party, other than 

21 the United States, a reasonable attorney’s fee 

22 and costs. The United States shall be liable for 

23 such fees and costs to the same extent as a pri24 vate person. 


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1 (3) INTERVENTION BY ATTORNEY GENERAL.— 

2 Upon timely application, the Attorney General may 

3 intervene in a civil action under paragraph (1), if 

4 the Attorney General certifies that the case is of 

5 general public importance. 

6 (d) ENFORCEMENT BY THE ATTORNEY GENERAL.— 

7 (1) COMMENCEMENT OF ACTIONS.— 

8 (A) PATTERN OR PRACTICE CASES.—The 

9 Attorney General may commence a civil action 

10 in any appropriate district court of the United 

11 States if the Attorney General has reasonable 

12 cause to believe that any health care provider 

13 covered by subsection (a)— 

14 (i) is engaged in a pattern or practice 

15 that violates such subsection; or 

16 (ii) is engaged in a violation of such 

17 subsection that raises an issue of signifi18 cant public importance. 

19 (B) CASES BY REFERRAL.—The Director 

20 may determine, based on a pattern of com21 plaints, a pattern of violations, a review of data 

22 reported by a health care provider covered by 

23 subsection (a), or any other means, that there 

24 is reasonable cause to believe a health care pro25 vider is engaged in a pattern or practice that 


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1 violates subsection (a). If the Director makes 

2 such a determination, the Director shall refer 

3 the related findings to the Attorney General. If 

4 the Attorney General finds that such reasonable 

5 cause exists, the Attorney General may com6 mence a civil action in any appropriate district 

7 court of the United States. 

8 (2) ENFORCEMENT OF SUBPOENAS.—The At9 torney General, on behalf of the Director, or another 

10 party at whose request a subpoena is issued under 

11 this subsection, may enforce such subpoena in ap12 propriate proceedings in the district court of the 

13 United States for the district in which the person to 

14 whom the subpoena was addressed resides, was 

15 served, or transacts business. 

16 (3) RELIEF WHICH MAY BE GRANTED IN CIVIL

17 ACTIONS.— 

18 (A) IN GENERAL.—In a civil action under 

19 paragraph (1), the court— 

20 (i) may award such preventive relief, 

21 including a permanent or temporary in22 junction, temporary restraining order, or 

23 other order against the person responsible 

24 for a violation of subsection (a) as is necVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 01535 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 essary to assure the full enjoyment of the 

2 rights granted by this subsection; 

3 (ii) may award such other relief as the 

4 court determines to be appropriate, includ5 ing monetary damages, to aggrieved per6 sons; and 

7 (iii) may, to vindicate the public inter8 est, assess punitive damages against the 

9 respondent— 

10 (I) in an amount not exceeding 

11 $500,000, for a first violation; and 

12 (II) in an amount not exceeding 

13 $1,000,000, for any subsequent viola14 tion. 

15 (B) FEES AND COSTS.—In a civil action 

16 under this subsection, the court, in its discre17 tion, may allow the prevailing party, other than 

18 the United States, a reasonable attorney’s fee 

19 and costs. The United States shall be liable for 

20 such fees and costs to the extent provided by 

21 section 2412 of title 28, United States Code. 

22 (4) INTERVENTION IN CIVIL ACTIONS.—Upon 

23 timely application, any person may intervene in a 

24 civil action commenced by the Attorney General 

25 under paragraphs (1) and (2) if the action involves 


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1 an alleged violation of subsection (a) with respect to 

2 which such person is an aggrieved person (including 

3 a person who is a complainant under subsection (b)) 

4 or a conciliation agreement to which such person is 

5 a party. 

6 SEC. 9008. FEDERAL HEALTH EQUITY COMMISSION. 

7 (a) ESTABLISHMENT OF COMMISSION.— 

8 (1) IN GENERAL.—There is established the 

9 Federal Health Equity Commission (hereinafter in 

10 this section referred to as the ‘‘Commission’’). 

11 (2) MEMBERSHIP.— 

12 (A) IN GENERAL.—The Commission shall 

13 be composed of— 

14 (i) 8 voting members appointed under 

15 subparagraph (B); and 

16 (ii) the nonvoting, ex officio members 

17 listed in subparagraph (C). 

18 (B) VOTING MEMBERS.—Not more than 4 

19 of the members described in subparagraph 

20 (A)(i) shall at any one time be of the same po21 litical party. Such members shall have recog22 nized expertise in and personal experience with 

23 racial and ethnic health inequities, health care 

24 needs of vulnerable and marginalized popu25 lations, and health equity as a vehicle for imVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 01537 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 proving health status and health outcomes. 

2 Such members shall be appointed to the Com3 mission as follows: 

4 (i) Four members of the Commission 

5 shall be appointed by the President. 

6 (ii) Two members of the Commission 

7 shall be appointed by the President pro 

8 tempore of the Senate, upon the rec9 ommendations of the majority leader and 

10 the minority leader of the Senate. Each 

11 member appointed to the Commission 

12 under this clause shall be appointed from 

13 a different political party. 

14 (iii) Two members of the Commission 

15 shall be appointed by the Speaker of the 

16 House of Representatives upon the rec17 ommendations of the majority leader and 

18 the minority leader of the House of Rep19 resentatives. Each member appointed to 

20 the Commission under this clause shall be 

21 appointed from a different political party. 

22 (C) EX OFFICIO MEMBER.—The Commis23 sion shall have the following nonvoting, ex offi24 cio members: 


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1 (i) The Director for Civil Rights and 

2 Health Equity of the Department of 

3 Health and Human Services. 

4 (ii) The Deputy Assistant Secretary 

5 for Minority Health of the Department of 

6 Health and Human Services. 

7 (iii) The Director of the National In8 stitute on Minority Health and Health Dis9 parities. 

10 (iv) The Chairperson of the Advisory 

11 Committee on Minority Health established 

12 under section 1707(c) of the Public Health 

13 Service Act (42 U.S.C. 300u–6(c)). 

14 (3) TERMS.—The term of office of each mem15 ber appointed under paragraph (2)(B) of the Com16 mission shall be 6 years. 

17 (4) CHAIRPERSON; VICE CHAIRPERSON.— 

18 (A) CHAIRPERSON.—The President shall, 

19 with the concurrence of a majority of the mem20 bers of the Commission appointed under para21 graph (2)(B), designate a Chairperson from 

22 among the members of the Commission ap23 pointed under such paragraph. 

24 (B) VICE CHAIRPERSON.— 


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1 (i) DESIGNATION.—The Speaker of 

2 the House of Representatives shall, in con3 sultation with the majority leaders and the 

4 minority leaders of the Senate and the 

5 House of Representatives and with the 

6 concurrence of a majority of the members 

7 of the Commission appointed under para8 graph (2)(B), designate a Vice Chairperson 

9 from among the members of the Commis10 sion appointed under such paragraph. The 

11 Vice Chairperson may not be a member of 

12 the same political party as the Chair13 person. 

14 (ii) DUTY.—The Vice Chairperson 

15 shall act in place of the Chairperson in the 

16 absence of the Chairperson. 

17 (5) REMOVAL OF MEMBERS.—The President 

18 may remove a member of the Commission only for 

19 neglect of duty or malfeasance in office. 

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

21 Commission appointed under paragraph (2)(B) shall 

22 constitute a quorum of the Commission, but a lesser 

23 number of members may hold hearings. 

24 (b) DUTIES OF THE COMMISSION.— 

25 (1) IN GENERAL.—The Commission shall— 


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1 (A) monitor and report on the implementa2 tion of this Act; and 

3 (B) investigate, monitor, and report on 

4 progress towards health equity and the elimi5 nation of health disparities. 

6 (2) ANNUAL REPORT.—The Commission 

7 shall— 

8 (A) submit to the President and Congress 

9 at least one report annually on health equity 

10 and health disparities; and 

11 (B) include in such report— 

12 (i) a description of actions taken by 

13 the Department of Health and Human 

14 Services and any other Federal agency re15 lated to health equity or health disparities; 

16 and 

17 (ii) recommendations on ensuring eq18 uitable health care and eliminating health 

19 disparities. 

20 (c) POWERS.— 

21 (1) HEARINGS.— 

22 (A) IN GENERAL.—The Commission or, at 

23 the direction of the Commission, any sub24 committee or member of the Commission, may, 

25 for the purpose of carrying out this section, as 


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1 the Commission or the subcommittee or mem2 ber considers advisable— 

3 (i) hold such hearings, meet and act 

4 at such times and places, take such testi5 mony, receive such evidence, and admin6 ister such oaths; and 

7 (ii) require, by subpoena or otherwise, 

8 the attendance and testimony of such wit9 nesses and the production of such books, 

10 records, correspondence, memoranda, pa11 pers, documents, tapes, and materials. 

12 (B) LIMITATION ON HEARINGS.—The 

13 Commission may hold a hearing under subpara14 graph (A)(i) only if the hearing is approved— 

15 (i) by a majority of the members of 

16 the Commission appointed under sub17 section (a)(2)(B); or 

18 (ii) by a majority of such members 

19 present at a meeting when a quorum is 

20 present. 

21 (2) ISSUANCE AND ENFORCEMENT OF SUB22 POENAS.— 

23 (A) ISSUANCE.—A subpoena issued under 

24 paragraph (1) shall— 


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1 (i) bear the signature of the Chair2 person of the Commission; and 

3 (ii) be served by any person or class 

4 of persons designated by the Chairperson 

5 for that purpose. 

6 (B) ENFORCEMENT.—In the case of contu7 macy or failure to obey a subpoena issued 

8 under paragraph (1), the United States district 

9 court for the district in which the subpoenaed 

10 person resides, is served, or may be found may 

11 issue an order requiring the person to appear at 

12 any designated place to testify or to produce 

13 documentary or other evidence. 

14 (C) NONCOMPLIANCE.—Any failure to 

15 obey the order of the court may be punished by 

16 the court as a contempt of court. 

17 (3) WITNESS ALLOWANCES AND FEES.— 

18 (A) IN GENERAL.—Section 1821 of title 

19 28, United States Code, shall apply to a witness 

20 requested or subpoenaed to appear at a hearing 

21 of the Commission. 

22 (B) EXPENSES.—The per diem and mile23 age allowances for a witness shall be paid from 

24 funds available to pay the expenses of the Com25 mission. 


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1 (4) POSTAL SERVICES.—The Commission may 

2 use the United States mails in the same manner and 

3 under the same conditions as other agencies of the 

4 Federal Government. 

5 (5) GIFTS.—The Commission may accept, use, 

6 and dispose of gifts or donations of services or prop7 erty. 

8 (d) ADMINISTRATIVE PROVISIONS.— 

9 (1) STAFF.— 

10 (A) DIRECTOR.—There shall be a full-time 

11 staff director for the Commission who shall— 

12 (i) serve as the administrative head of 

13 the Commission; and 

14 (ii) be appointed by the Chairperson 

15 with the concurrence of the Vice Chair16 person. 

17 (B) OTHER PERSONNEL.—The Commis18 sion may— 

19 (i) appoint such other personnel as it 

20 considers advisable, subject to the provi21 sions of title 5, United States Code, gov22 erning appointments in the competitive 

23 service, and the provisions of chapter 51 

24 and subchapter III of chapter 53 of that 


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1 title relating to classification and General 

2 Schedule pay rates; and 

3 (ii) may procure temporary and inter4 mittent services under section 3109(b) of 

5 title 5, United States Code, at rates for in6 dividuals not in excess of the daily equiva7 lent paid for positions at the maximum 

8 rate for GS–15 of the General Schedule 

9 under section 5332 of title 5, United 

10 States Code. 

11 (2) COMPENSATION OF MEMBERS.— 

12 (A) NON-FEDERAL EMPLOYEES.—Each 

13 member of the Commission who is not an offi14 cer or employee of the Federal Government 

15 shall be compensated at a rate equal to the 

16 daily equivalent of the annual rate of basic pay 

17 prescribed for level IV of the Executive Sched18 ule under section 5315 of title 5, United States 

19 Code, for each day (including travel time) dur20 ing which the member is engaged in the per21 formance of the duties of the Commission. 

22 (B) FEDERAL EMPLOYEES.—Each member 

23 of the Commission who is an officer or em24 ployee of the Federal Government shall serve 

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1 pensation received for the services of the mem2 ber as an office or employee of the Federal 

3 Government. 

4 (C) TRAVEL EXPENSES.—A member of the 

5 Commission shall be allowed travel expenses, in6 cluding per diem in lieu of subsistence, at rates 

7 authorized for an employee of an agency under 

8 subchapter I of chapter 57 of title 5, United 

9 States Code, while away from the home or reg10 ular place of business of the member in the per11 formance of the duties of the Commission. 

12 (3) COOPERATION.—The Commission may se13 cure directly from any Federal department or agency 

14 such information as the Commission considers nec15 essary to carry out this Act. Upon request of the 

16 Chairman of the Commission, the head of such de17 partment or agency shall furnish such information to 

18 the Commission. 

19 (e) PERMANENT COMMISSION.—Section 14 of the 

20 Federal Advisory Committee Act (5 U.S.C. App.) shall not 

21 apply to the Commission. 

22 (f) AUTHORIZATION OF APPROPRIATIONS.—There 

23 are authorized to be appropriated for fiscal year 2025 and 

24 each fiscal year thereafter such sums as may be necessary 

25 to carry out the duties of the Commission. 


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1 TITLE X—ADDRESSING SOCIAL 

2 DETERMINANTS AND IM3 PROVING ENVIRONMENTAL 

4 JUSTICE 

5 Subtitle A—In General 

6 SEC. 10001. DEFINITIONS. 

7 In this title: 

8 (1) ADMINISTRATOR.—The term ‘‘Adminis9 trator’’ means the Administrator of the Environ10 mental Protection Agency. 

11 (2) AGENCY.—The term ‘‘Agency’’ means the 

12 Environmental Protection Agency. 

13 (3) BUILT ENVIRONMENT.—The term ‘‘built 

14 environment’’ means the components of the environ15 ment, and the location of those 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) DETERMINANTS OF HEALTH.—The term 

8 ‘‘determinants of health’’— 

9 (A) means the range of nonclinical factors 

10 inclusive of personal, social, economic, and envi11 ronmental factors that directly influence health 

12 status; and 

13 (B) includes social determinants of health. 

14 (5) ECONOMIC DETERMINANTS OF HEALTH.— 

15 The term ‘‘economic determinants of health’’ means 

16 income and social status. 

17 (6) ENVIRONMENTAL DETERMINANTS OF

18 HEALTH.—The term ‘‘environmental determinants 

19 of health’’ means the broad physical (including man20 made and natural), psychological, social, spiritual, 

21 cultural, and aesthetic environment. 

22 (7) PERSONAL DETERMINANTS OF HEALTH.— 

23 The term ‘‘personal determinants of health’’ means 

24 an individual’s behavior, biology, and genetics. 


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1 (8) SECRETARY.—The term ‘‘Secretary’’ means 

2 the Secretary of Health and Human Services. 

3 (9) SOCIAL DETERMINANTS OF HEALTH.—The 

4 term ‘‘social determinants of health’’— 

5 (A) means a subset of determinants of the 

6 health of individuals and environments (such as 

7 communities, neighborhoods, and societies) that 

8 describe an individual’s or group of people’s so9 cial identity, describe the social and economic 

10 resources to which such individual or group has 

11 access, and describe the conditions in which an 

12 individual or group of people works, lives, and 

13 plays; and 

14 (B) are sometimes referred to as ‘‘social 

15 and economic determinants of health’’, ‘‘socio16 economic determinants of health’’, ‘‘environ17 mental determinants of health’’, ‘‘social drivers 

18 of inequality’’, or ‘‘personal determinants of 

19 health’’. 

20 SEC. 10002. HEALTH IMPACT ASSESSMENTS. 

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

22 (42 U.S.C. 280g et seq.), as amended by section 7901C– 

23 1(a), is further amended by adding at the end the fol24 lowing: 


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1 ‘‘SEC. 399V–15. HEALTH IMPACT ASSESSMENTS. 

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

3 ‘‘(1) ADMINISTRATOR.—The term ‘Adminis4 trator’ means the Administrator of the Environ5 mental Protection Agency. 

6 ‘‘(2) DIRECTOR.—The term ‘Director’ means 

7 the Director of the Centers for Disease Control and 

8 Prevention. 

9 ‘‘(3) HEALTH IMPACT ASSESSMENT.—The term 

10 ‘health impact assessment’ means a systematic proc11 ess that uses an array of data sources and analytic 

12 methods and considers input from stakeholders to 

13 determine the potential effects of a proposed policy, 

14 plan, program, or project on the health of a popu15 lation and the distribution of those effects within the 

16 population. Such term includes identifying and rec17 ommending appropriate actions on monitoring and 

18 maximizing potential benefits and minimizing poten19 tial harms. 

20 ‘‘(4) HEALTH INEQUITY.—The term ‘health in21 equity’ means a particular type of health difference 

22 that is closely linked with social, economic, or envi23 ronmental disadvantage and that adversely affects 

24 groups of people who have systematically experi25 enced greater obstacles to health based on their— 

26 ‘‘(A) racial or ethnic group; 


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1 ‘‘(B) religion; 

2 ‘‘(C) socioeconomic status; 

3 ‘‘(D) gender; 

4 ‘‘(E) age; 

5 ‘‘(F) mental health; 

6 ‘‘(G) cognitive, sensory, or physical dis7 ability; 

8 ‘‘(H) sexual orientation or gender identity; 

9 ‘‘(I) geographic location; 

10 ‘‘(J) citizenship status; or 

11 ‘‘(K) other characteristics historically 

12 linked to discrimination or exclusion. 

13 ‘‘(b) ESTABLISHMENT.—The Secretary, acting 

14 through the Director and in collaboration with the Admin15 istrator, shall— 

16 ‘‘(1) in consultation with the Director of the 

17 National Center for Chronic Disease Prevention and 

18 Health Promotion and the heads of relevant offices 

19 within the Department of Housing and Urban De20 velopment, the Department of Transportation, and 

21 the Department of Agriculture, establish a program 

22 at the National Center for Environmental Health of 

23 the Centers for Disease Control and Prevention fo24 cused on advancing the field of health impact assess25 ment that includes— 


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1 ‘‘(A) collecting and disseminating best 

2 practices; 

3 ‘‘(B) administering capacity building 

4 grants to States, Indian Tribes, and Tribal or5 ganizations to support subgrantees in initiating 

6 health impact assessments, in accordance with 

7 subsection (d); 

8 ‘‘(C) providing technical assistance; 

9 ‘‘(D) developing training tools and pro10 viding training on conducting a health impact 

11 assessment and the implementation of built en12 vironment and health indicators; 

13 ‘‘(E) making information available, as ap14 propriate, regarding the existence of other com15 munity healthy living tools, checklists, and indi16 ces that help connect public health to other sec17 tors, and tools to help examine the effect of the 

18 indoor built environment and building codes on 

19 population health; 

20 ‘‘(F) conducting research and evaluations 

21 of health impact assessments; and 

22 ‘‘(G) awarding competitive extramural re23 search grants; 


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1 ‘‘(2) develop guidance and guidelines to conduct 

2 health impact assessments in accordance with sub3 section (c); and 

4 ‘‘(3) establish a grant program to allow States, 

5 Indian Tribes, and Tribal organizations to award 

6 subgrants to eligible entities to conduct health im7 pact assessments. 

8 ‘‘(c) GUIDANCE.— 

9 ‘‘(1) IN GENERAL.—Not later than 1 year after 

10 the date of enactment of the Health Equity and Ac11 countability Act of 2024, the Secretary, acting 

12 through the Director, shall issue final guidance for 

13 conducting health impact assessments. In developing 

14 such guidance, the Secretary shall— 

15 ‘‘(A) consult with the Director of the Na16 tional Center for Environmental Health, the Di17 rector of the National Center for Chronic Dis18 ease Prevention and Health Promotion, and the 

19 heads of relevant offices within the Department 

20 of Housing and Urban Development, the De21 partment of Transportation, and the Depart22 ment of Agriculture; and 

23 ‘‘(B) consider available international health 

24 impact assessment guidance, North American 

25 health impact assessment practice standards, 


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1 and recommendations from the National Acad2 emy of Sciences. 

3 ‘‘(2) CONTENT.—The guidance under this sub4 section shall include— 

5 ‘‘(A) background on national and inter6 national efforts to bridge urban planning, cli7 mate forecasting, and public health institutions 

8 and disciplines, including a review of health im9 pact assessment best practices internationally; 

10 ‘‘(B) evidence-based direct and indirect 

11 pathways that link land-use planning, transpor12 tation, and housing policy and objectives to 

13 human health outcomes; 

14 ‘‘(C) data resources and quantitative and 

15 qualitative forecasting methods to evaluate both 

16 the status of health determinants and health ef17 fects, including identification of existing pro18 grams that can disseminate these resources; 

19 ‘‘(D) best practices for inclusive public in20 volvement in conducting health impact assess21 ments; and 

22 ‘‘(E) technical assistance for other agen23 cies seeking to develop their own guidelines and 

24 procedures for health impact assessment. 

25 ‘‘(d) GRANT PROGRAM.— 


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

2 through the Director and in collaboration with the 

3 Administrator, shall— 

4 ‘‘(A) award grants to States, Indian 

5 Tribes, and Tribal organizations to award sub6 grants to eligible entities for capacity building 

7 or to prepare health impact assessments; and 

8 ‘‘(B) ensure that States, Indian Tribes, 

9 and Tribal organizations receiving a grant 

10 under this subsection further support training 

11 and technical assistance for subgrantees under 

12 subparagraph (A) by funding and overseeing 

13 appropriate experts on health impact assess14 ments from local, State, and Tribal govern15 ments, the Federal Government, institutions of 

16 higher education, and nonprofit organizations 

17 to provide such training and technical assist18 ance. 

19 ‘‘(2) APPLICATIONS FOR SUBGRANTS.— 

20 ‘‘(A) IN GENERAL.—To be eligible to re21 ceive a subgrant under this subsection, an eligi22 ble entity shall— 

23 ‘‘(i) be a community-based organiza24 tion serving individuals or populations, the 


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1 health of which are, or will be, affected by 

2 an activity or a proposed activity; and 

3 ‘‘(ii) submit to the grantee an applica4 tion in accordance with this subsection, at 

5 such time, in such manner, and containing 

6 such additional information as the Sec7 retary (acting through the Director and in 

8 collaboration with the Administrator) and 

9 the grantee may require. 

10 ‘‘(B) INCLUSION.—An application for a 

11 subgrant under this subsection shall include— 

12 ‘‘(i) a list of proposed activities that 

13 require or would benefit from conducting a 

14 health impact assessment by not later than 

15 180 days after receiving the subgrant; 

16 ‘‘(ii) supporting documentation, in17 cluding letters of support, from potential 

18 conductors of health impact assessments 

19 for the listed proposed activities; 

20 ‘‘(iii) an assessment by the applicant 

21 of the health of the population to be served 

22 through the subgrant; and 

23 ‘‘(iv) a description of potential adverse 

24 or positive effects on health that the pro25 posed activities may create. 


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1 ‘‘(C) PREFERENCE.—In awarding sub2 grants under this subsection, a State may give 

3 preference to eligible entities that demonstrate 

4 the potential to significantly improve population 

5 health or lower health care costs as a result of 

6 potential health impact assessment work. 

7 ‘‘(3) USE OF FUNDS.— 

8 ‘‘(A) IN GENERAL.—A State, Indian Tribe, 

9 or Tribal organization receiving a grant under 

10 this subsection shall use such grant to conduct 

11 health impact assessment capacity building in 

12 support of a subgrantee conducting a health im13 pact assessment for a proposed activity in ac14 cordance with this subsection. 

15 ‘‘(B) PURPOSES.—The purposes of a 

16 health impact assessment under this subsection 

17 are— 

18 ‘‘(i) to facilitate the involvement of 

19 Tribal, State, and local public health offi20 cials in community planning, transpor21 tation, housing, and land use decisions and 

22 other decisions affecting the built environ23 ment to identify any potential health con24 cern or health benefit relating to an activ25 ity or proposed activity; 


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1 ‘‘(ii) to provide for an investigation of 

2 any health-related issue of concern raised 

3 in a planning process, an environmental 

4 impact assessment process, or policy ap5 praisal relating to a proposed activity; 

6 ‘‘(iii) to describe and compare alter7 natives (including no-action alternatives) to 

8 a proposed activity to provide clarification 

9 with respect to the potential health out10 comes associated with the proposed activity 

11 and, where appropriate, to the related ben12 efit-cost or cost-effectiveness of the pro13 posed activity and alternatives; 

14 ‘‘(iv) to contribute, when applicable, 

15 to the findings of a planning process, pol16 icy appraisal, or an environmental impact 

17 statement with respect to the terms and 

18 conditions of implementing a proposed ac19 tivity or related mitigation recommenda20 tions, as necessary; 

21 ‘‘(v) to ensure that the dispropor22 tionate distribution of negative impacts 

23 among vulnerable populations is minimized 

24 as much as possible; 


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1 ‘‘(vi) to engage affected community 

2 members and ensure adequate opportunity 

3 for public comment on all stages of the 

4 health impact assessment; 

5 ‘‘(vii) where appropriate, to consult 

6 with local and county health departments 

7 and appropriate organizations, including 

8 planning, transportation, and housing or9 ganizations, and provide them information 

10 and tools regarding how to conduct and in11 tegrate health impact assessment into their 

12 work; and 

13 ‘‘(viii) to inspect homes, water sys14 tems, and other elements that pose risks to 

15 lead exposure, with an emphasis on areas 

16 that pose a higher risk to children. 

17 ‘‘(4) ASSESSMENTS.—Health impact assess18 ments carried out using funds under this section 

19 shall— 

20 ‘‘(A) take appropriate health factors into 

21 consideration as early as practicable during the 

22 planning, review, or decision-making processes; 

23 ‘‘(B) assess the effect on the health of in24 dividuals and populations of proposed policies, 


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1 projects, or plans that result in modifications to 

2 the built environment; and 

3 ‘‘(C) assess the distribution of health ef4 fects across various factors, such as race, in5 come, ethnicity, age, disability status, gender, 

6 and geography. 

7 ‘‘(5) ELIGIBLE ACTIVITIES.— 

8 ‘‘(A) IN GENERAL.—A State, Indian Tribe, 

9 or Tribal organization receiving a grant under 

10 this section shall conduct an evaluation of any 

11 activity proposed to be funded through the 

12 grant, including through a subgrant, to deter13 mine whether such activity will have a signifi14 cant adverse or positive effect on the health of 

15 the affected population to be served, based on 

16 the criteria described in subparagraph (B). 

17 ‘‘(B) CRITERIA.—The criteria described in 

18 this subparagraph include, as applicable to the 

19 proposed activity, the following: 

20 ‘‘(i) Any substantial adverse effect or 

21 significant health benefit on health out22 comes or factors known to influence health, 

23 including the following: 

24 ‘‘(I) Physical activity. 

25 ‘‘(II) Injury. 


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1 ‘‘(III) Mental health. 

2 ‘‘(IV) Accessibility to health-pro3 moting goods and services. 

4 ‘‘(V) Respiratory health. 

5 ‘‘(VI) Chronic disease. 

6 ‘‘(VII) Nutrition. 

7 ‘‘(VIII) Land use changes that 

8 promote local, sustainable food 

9 sources. 

10 ‘‘(IX) Infectious disease. 

11 ‘‘(X) Health inequities. 

12 ‘‘(XI) Existing air quality, 

13 ground or surface water quality or 

14 quantity, or noise levels. 

15 ‘‘(XII) Lead exposure. 

16 ‘‘(XIII) Drinking water quality 

17 and accessibility. 

18 ‘‘(ii) Other factors that may be con19 sidered, including— 

20 ‘‘(I) the potential for a proposed 

21 activity to result in systems failure 

22 that leads to a public health emer23 gency; 

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1 cant increase in tourism, economic de2 velopment, or employment in the pop3 ulation to be served; 

4 ‘‘(III) any other significant po5 tential hazard or enhancement to 

6 human health, as determined by the 

7 grantee; or 

8 ‘‘(IV) whether the evaluation of a 

9 proposed activity would duplicate an10 other analysis or study being under11 taken in conjunction with the pro12 posed activity. 

13 ‘‘(C) FACTORS FOR CONSIDERATION.—In 

14 evaluating a proposed activity under subpara15 graph (A), a grantee may take into consider16 ation any reasonable, direct, indirect, or cumu17 lative effect that can be clearly related to poten18 tial health effects and that is related to the pro19 posed activity, including the effect of any action 

20 that is— 

21 ‘‘(i) included in the long-range plan 

22 relating to the proposed activity; 

23 ‘‘(ii) likely to be carried out in coordi24 nation with the proposed activity; 


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1 ‘‘(iii) dependent on the occurrence of 

2 the proposed activity; or 

3 ‘‘(iv) likely to have a disproportionate 

4 impact on high-risk or vulnerable popu5 lations. 

6 ‘‘(6) REQUIREMENTS.—A health impact assess7 ment prepared with funds awarded under this sub8 section shall incorporate the following, after con9 ducting the screening phase (identifying projects or 

10 policies for which a health impact assessment would 

11 be valuable and feasible) through the application 

12 process: 

13 ‘‘(A) SCOPING.—Identifying which health 

14 effects to consider and the research methods to 

15 be utilized. 

16 ‘‘(B) ASSESSING RISKS AND BENEFITS.— 

17 Assessing the baseline health status and factors 

18 known to influence the health status in the af19 fected community, which may include aggre20 gating and synthesizing existing health assess21 ment evidence and data from the community. 

22 ‘‘(C) DEVELOPING RECOMMENDATIONS.— 

23 Suggesting changes to proposals to promote 

24 positive or mitigate adverse health effects. 


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1 ‘‘(D) REPORTING.—Synthesizing the as2 sessment and recommendations and commu3 nicating the results to decision makers. 

4 ‘‘(E) MONITORING AND EVALUATING.— 

5 Tracking the decision and implementation effect 

6 on health determinants and health status. 

7 ‘‘(7) PLAN.—A subgrantee under this sub8 section shall develop and implement a plan, to be ap9 proved by the Secretary (acting through the Director 

10 and in collaboration with the Administrator) and the 

11 grantee, for meaningful and inclusive stakeholder in12 volvement in all phases of the health impact assess13 ment. Stakeholders may include community leaders, 

14 community-based organizations, youth-serving orga15 nizations, planners, public health experts, State and 

16 local public health departments and officials, health 

17 care experts or officials, housing experts or officials, 

18 and transportation experts or officials. 

19 ‘‘(8) SUBMISSION OF FINDINGS.—A grantee 

20 under this subsection shall submit the findings of 

21 any funded health impact assessment activities to 

22 the Secretary and make these findings publicly avail23 able. 

24 ‘‘(9) ASSESSMENT OF IMPACTS.—A subgrantee 

25 under this subsection shall ensure the assessment of 


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1 the distribution of health impacts (related to the 

2 proposed activity) across race, ethnicity, income, 

3 age, gender, disability status, and geography. 

4 ‘‘(10) CONDUCT OF ASSESSMENT.—To the 

5 greatest extent feasible, a health impact assessment 

6 shall be conducted under this section in a manner 

7 that respects the needs and timing of the decision8 making process such assessment evaluates. 

9 ‘‘(11) METHODOLOGY.—In preparing a health 

10 impact assessment funded under this subsection, a 

11 subgrantee under this subsection shall follow the 

12 guidance published under subsection (c). 

13 ‘‘(e) HEALTH IMPACT ASSESSMENT DATABASE.— 

14 The Secretary, acting through the Director and in collabo15 ration with the Administrator, shall establish, maintain, 

16 and make publicly available a health impact assessment 

17 database, including— 

18 ‘‘(1) a catalog of health impact assessments re19 ceived under this section; 

20 ‘‘(2) an inventory of tools used by subgrantees 

21 to conduct health impact assessments; and 

22 ‘‘(3) guidance for subgrantees with respect to 

23 the selection of appropriate tools described in para24 graph (2). 


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1 ‘‘(f) EVALUATION OF GRANTEE ACTIVITIES.—The 

2 Secretary shall award competitive grants to Prevention 

3 Research Centers, or nonprofit organizations or academic 

4 institutions with expertise in health impact assessments, 

5 to— 

6 ‘‘(1) assist grantees and subgrantees with the 

7 provision of training and technical assistance in the 

8 conducting of health impact assessments; 

9 ‘‘(2) evaluate the activities carried out with 

10 grants and subgrants under subsection (d); and 

11 ‘‘(3) assist the Secretary in disseminating evi12 dence, best practices, and lessons learned from 

13 grantees and subgrantees. 

14 ‘‘(g) REPORT TO CONGRESS.—Not later than 1 year 

15 after the date of enactment of the Health Equity and Ac16 countability Act of 2024, the Secretary shall submit to 

17 Congress a report concerning the evaluation of the pro18 grams under this section, including recommendations as 

19 to how lessons learned from such programs can be incor20 porated into future guidance documents developed and 

21 provided by the Secretary and other Federal agencies, as 

22 appropriate. 

23 ‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—There 

24 are authorized to be appropriated to carry out this section 

25 such sums as may be necessary. 


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1 ‘‘SEC. 399V–16. IMPLEMENTATION OF RESEARCH FINDINGS 

2 TO IMPROVE HEALTH OUTCOMES THROUGH 

3 THE BUILT ENVIRONMENT. 

4 ‘‘(a) RESEARCH GRANT PROGRAM.—The Secretary, 

5 in collaboration with the Administrator of the Environ6 mental Protection Agency (referred to in this section as 

7 the ‘Administrator’), shall award grants to public agencies 

8 or private nonprofit institutions to implement evidence9 based programming to improve human health through im10 provements to the built environment and subsequently 

11 human health, by addressing— 

12 ‘‘(1) levels of physical activity; 

13 ‘‘(2) consumption of nutritional foods; 

14 ‘‘(3) rates of crime; 

15 ‘‘(4) air, water, and soil quality; 

16 ‘‘(5) risk or rate of injury; 

17 ‘‘(6) accessibility to health-promoting goods and 

18 services; 

19 ‘‘(7) chronic disease rates; 

20 ‘‘(8) community design; 

21 ‘‘(9) housing; 

22 ‘‘(10) transportation options; and 

23 ‘‘(11) other factors as the Secretary determines 

24 appropriate. 

25 ‘‘(b) APPLICATIONS.—A public agency or private 

26 nonprofit institution desiring a grant under this section 


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1 shall submit to the Secretary an application at such time, 

2 in such manner, and containing such agreements, assur3 ances, and information as the Secretary, in consultation 

4 with the Administrator, may require. 

5 ‘‘(c) RESEARCH.—The Secretary, in consultation 

6 with the Administrator, shall support, through grants 

7 awarded under this section, research that— 

8 ‘‘(1) uses evidence-based research to improve 

9 the built environment and human health; 

10 ‘‘(2) examines— 

11 ‘‘(A) the scope and intensity of the impacts 

12 that the built environment (including the var13 ious characteristics of the built environment) 

14 has on human health; or 

15 ‘‘(B) the distribution of such impacts by— 

16 ‘‘(i) location; and 

17 ‘‘(ii) population subgroup; 

18 ‘‘(3) is used to develop— 

19 ‘‘(A) measures and indicators to address 

20 health impacts and the connection of health to 

21 the built environment; 

22 ‘‘(B) efforts to link the measures to trans23 portation, land use, and health databases; and 

24 ‘‘(C) efforts to enhance the collection of 

25 built environment surveillance data; 


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1 ‘‘(4) distinguishes carefully between personal 

2 attitudes and choices and external influences on be3 havior to determine how much the association be4 tween the built environment and the health of resi5 dents, versus the lifestyle preferences of the people 

6 that choose to live in the neighborhood, reflects the 

7 physical characteristics of the neighborhood; and 

8 ‘‘(5)(A) identifies or develops effective interven9 tion strategies focusing on enhancements to the built 

10 environment that promote increased use, physical ac11 tivity, access to nutritious foods, or other health-pro12 moting activities by residents; and 

13 ‘‘(B) in developing the intervention strategies 

14 under subparagraph (A), ensures that the interven15 tion strategies will reach out to high-risk or vulner16 able populations, including low-income urban and 

17 rural communities and aging populations, in addi18 tion to the general population. 

19 ‘‘(d) SURVEYS.—The Secretary may allow recipients 

20 of grants under this section to use such grant funds to 

21 support the expansion of national surveys and data track22 ing systems to provide more detailed information about 

23 the connection between the built environment and health. 


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1 ‘‘(e) PRIORITY.—In awarding grants under this sec2 tion, the Secretary and the Administrator shall give pri3 ority to entities with programming that incorporates— 

4 ‘‘(1) interdisciplinary approaches; or 

5 ‘‘(2) the expertise of the public health, physical 

6 activity, urban planning, land use, and transpor7 tation research communities in the United States 

8 and abroad. 

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

10 are authorized to be appropriated such sums as may be 

11 necessary to carry out this section. The Secretary may al12 locate not more than 20 percent of the amount so appro13 priated for a fiscal year for purposes of conducting re14 search under subsection (c).’’. 

15 SEC. 10003. GRANT PROGRAM TO CONDUCT ENVIRON16 MENTAL HEALTH IMPROVEMENT ACTIVITIES 

17 AND TO IMPROVE SOCIAL DETERMINANTS OF 

18 HEALTH. 

19 (a) DEFINITIONS.—In this section: 

20 (1) DIRECTOR.—The term ‘‘Director’’ means 

21 the Director of the Centers for Disease Control and 

22 Prevention, acting in collaboration with the Adminis23 trator and the Director of the National Institute of 

24 Environmental Health Sciences. 


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1 (2) ELIGIBLE ENTITY.—The term ‘‘eligible enti2 ty’’ means a State, Indian Tribe, Tribal organiza3 tion, or local community that— 

4 (A) bears a disproportionate burden of ex5 posure to environmental health hazards; 

6 (B) bears a disproportionate burden of ex7 posure to unhealthy living conditions, low 

8 standard housing conditions, low socioeconomic 

9 status, poor nutrition, less opportunity for edu10 cational attainment, disproportionately high un11 employment rates, or lower literacy levels and 

12 access to information; 

13 (C) has established a coalition— 

14 (i) with not less than 1 community15 based organization or demonstration pro16 gram; and 

17 (ii) with not less than 1— 

18 (I) public health entity; 

19 (II) health care provider organi20 zation; 

21 (III) academic institution, includ22 ing any minority-serving institution 

23 described in section 371(a) of the 

24 Higher Education Act of 1965 (20 

25 U.S.C. 1067q(a)); 


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1 (IV) child-serving institution; or 

2 (V) landlord or housing provider 

3 working on lead remediation; 

4 (D) ensures planned activities and funding 

5 streams are coordinated to improve community 

6 health; and 

7 (E) submits an application in accordance 

8 with subsection (c). 

9 (b) ESTABLISHMENT.—The Director shall establish a 

10 grant program under which eligible entities shall receive 

11 grants to conduct environmental health improvement ac12 tivities and to improve social determinants of health. 

13 (c) APPLICATION.—To receive a grant under this sec14 tion, an eligible entity shall submit an application to the 

15 Director at such time, in such manner, and accompanied 

16 by such information as the Director may require. 

17 (d) USE OF GRANT FUNDS.—An eligible entity may 

18 use a grant under this section— 

19 (1) to promote environmental health; 

20 (2) to address environmental health inequities 

21 among all populations, including children; and 

22 (3) to address racial and ethnic inequities in so23 cial determinants of health. 

24 (e) AMOUNT OF GRANTS.—The Director shall award 

25 grants to eligible entities at the following 3 funding levels: 


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1 (1) LEVEL 1 GRANTS.— 

2 (A) IN GENERAL.—An eligible entity 

3 awarded a grant under this paragraph shall use 

4 the funds to identify environmental health prob5 lems and solutions by— 

6 (i) establishing a planning and 

7 prioritizing council in accordance with sub8 paragraph (B); and 

9 (ii) conducting an environmental 

10 health assessment in accordance with sub11 paragraph (C). 

12 (B) PLANNING AND PRIORITIZING COUN13 CIL.— 

14 (i) IN GENERAL.—A planning and 

15 prioritizing council established under sub16 paragraph (A)(i) (referred to in this para17 graph as a ‘‘PPC’’) shall assist the envi18 ronmental health assessment process and 

19 environmental health promotion activities 

20 of the eligible entity. 

21 (ii) MEMBERSHIP.—Membership of a 

22 PPC shall consist of representatives from 

23 various organizations within public health, 

24 planning, development, and environmental 

25 services and shall include stakeholders 


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1 from vulnerable groups such as children, 

2 the elderly, disabled, and minority ethnic 

3 groups that are often not actively involved 

4 in democratic or decision-making proc5 esses. 

6 (iii) DUTIES.—A PPC shall— 

7 (I) identify key stakeholders and 

8 engage and coordinate potential part9 ners in the planning process; 

10 (II) establish a formal advisory 

11 group to plan for the establishment of 

12 services; 

13 (III) conduct an in-depth review 

14 of the nature and extent of the need 

15 for an environmental health assess16 ment, including a local epidemiological 

17 profile, an evaluation of the service 

18 provider capacity of the community, 

19 and a profile of any target popu20 lations; and 

21 (IV) define the components of 

22 care and form essential programmatic 

23 linkages with related providers in the 

24 community. 


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1 (C) ENVIRONMENTAL HEALTH ASSESS2 MENT.— 

3 (i) IN GENERAL.—A PPC shall carry 

4 out an environmental health assessment to 

5 identify environmental health concerns. 

6 (ii) ASSESSMENT PROCESS.—The 

7 PPC shall— 

8 (I) define the goals of the assess9 ment; 

10 (II) generate the environmental 

11 health issue list; 

12 (III) analyze issues with a sys13 tems framework; 

14 (IV) develop appropriate commu15 nity environmental health indicators; 

16 (V) rank the environmental 

17 health issues; 

18 (VI) set priorities for action; 

19 (VII) develop an action plan; 

20 (VIII) implement the plan; and 

21 (IX) evaluate progress and plan22 ning for the future. 

23 (D) EVALUATION.—Each eligible entity 

24 that receives a grant under this paragraph shall 


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1 evaluate, report, and disseminate program find2 ings and outcomes. 

3 (E) TECHNICAL ASSISTANCE.—The Direc4 tor may provide such technical and other non5 financial assistance to eligible entities as the 

6 Director determines to be necessary. 

7 (2) LEVEL 2 GRANTS.— 

8 (A) ELIGIBILITY.— 

9 (i) IN GENERAL.—The Director shall 

10 award grants under this paragraph to eli11 gible entities that have already— 

12 (I) established broad-based col13 laborative partnerships; and 

14 (II) completed environmental as15 sessments. 

16 (ii) NO LEVEL 1 REQUIREMENT.—To 

17 be eligible to receive a grant under this 

18 paragraph, an eligible entity is not re19 quired to have successfully completed a 

20 Level 1 grant (as described in paragraph 

21 (1)). 

22 (B) USE OF GRANT FUNDS.—An eligible 

23 entity awarded a grant under this paragraph 

24 shall use the funds to further activities to carry 


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1 out environmental health improvement activi2 ties, including— 

3 (i) addressing community environ4 mental health priorities in accordance with 

5 paragraph (1)(C)(ii), including— 

6 (I) geography; 

7 (II) the built environment; 

8 (III) air quality; 

9 (IV) water quality; 

10 (V) land use; 

11 (VI) solid waste; 

12 (VII) housing; 

13 (VIII) violence; 

14 (IX) socioeconomic status; 

15 (X) ethnicity, social construct, 

16 and language preference; 

17 (XI) educational attainment; 

18 (XII) employment; 

19 (XIII) food safety, accessibility, 

20 and affordability; 

21 (XIV) nutrition; 

22 (XV) health care services; and 

23 (XVI) injuries; 

24 (ii) building partnerships between 

25 planning, public health, and other sectors, 


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1 including child-serving institutions, to ad2 dress how the built environment impacts 

3 food availability and access and physical 

4 activity to promote healthy behaviors and 

5 lifestyles and reduce overweight and obe6 sity, musculoskeletal diseases, respiratory 

7 conditions, infectious diseases, dental, oral, 

8 and mental health conditions, poverty, and 

9 related co-morbidities; 

10 (iii) establishing programs to ad11 dress— 

12 (I) how environmental and social 

13 conditions of work and living choices 

14 influence physical activity and dietary 

15 intake; or 

16 (II) how the conditions described 

17 in subclause (I) influence the concerns 

18 and needs of people who have im19 paired mobility and use assistance de20 vices, including wheelchairs, lower 

21 limb prostheses, and hip, knee, and 

22 other joint replacements; and 

23 (iv) convening intervention and dem24 onstration programs that examine the role 

25 of the social environment in connection 


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1 with the physical and chemical environ2 ment in— 

3 (I) determining access to nutri4 tional food; 

5 (II) improving physical activity to 

6 reduce overweight, obesity, and co7 morbidities and increase quality of 

8 life; and 

9 (III) location and access to med10 ical facilities. 

11 (3) LEVEL 3 GRANTS.— 

12 (A) IN GENERAL.—An eligible entity 

13 awarded a grant under this paragraph shall use 

14 the funds to identify and address racial and 

15 ethnic inequities in social determinants of 

16 health by creating demonstration programs that 

17 assess the feasibility of establishing a federally 

18 funded comprehensive program and describe 

19 key outcomes that address racial and ethnic in20 equities in social determinants of health. 

21 (B) PROGRAM DESIGN.— 

22 (i) EVALUATION.—Not later than 1 

23 year after the date of enactment of this 

24 Act, the Director shall evaluate the best 

25 practices of existing programs from the 


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1 private, public, community-based, and aca2 demically supported initiatives focused on 

3 reducing inequities in the social deter4 minants of health for racial and ethnic 

5 populations. 

6 (ii) DEMONSTRATION PROJECTS.— 

7 Not later than 2 years after the date of en8 actment of this Act, the Director shall im9 plement at least 12 demonstration 

10 projects, including at least one project for 

11 each major racial and ethnic minority 

12 group, each of which is unique to the cul13 tural and linguistic needs of each of the 

14 following groups: 

15 (I) Native Americans and Alaska 

16 Natives. 

17 (II) Asian Americans. 

18 (III) African Americans/Blacks. 

19 (IV) Hispanic/Latino-Americans. 

20 (V) Native Hawaiians and Pacific 

21 Islanders. 

22 (VI) Middle Eastern and North23 ern African communities. 

24 (iii) REPORT TO CONGRESS.—No later 

25 than 2 years after the implementation of 


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1 the initial demonstration projects under 

2 this paragraph, the Director shall submit 

3 to Congress a report that includes— 

4 (I) a description of each dem5 onstration project and design; 

6 (II) an evaluation of the cost-ef7 fectiveness of each project’s preven8 tion and treatment efforts; 

9 (III) an evaluation of the cultural 

10 and linguistic appropriateness of each 

11 project by racial and ethnic group; 

12 and 

13 (IV) an evaluation of the bene14 ficiary’s health status improvement 

15 under the demonstration project. 

16 (iv) ANY OTHER INFORMATION DE17 TERMINED APPROPRIATE BY THE DIREC18 TOR.—The Director shall require eligible 

19 entities awarded a grant under this para20 graph to report any other information the 

21 Director determines appropriate to be 

22 shared by or developed by such entity, in23 cluding the following: 

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1 tural and linguistically appropriate 

2 services provided through the Centers 

3 for Disease Control and Prevention to 

4 target individuals impacted by health 

5 inequities based on their race, eth6 nicity, gender, or sexual orientation. 

7 (II) Promoting the collaboration 

8 between primary and specialty care 

9 health care providers and patients, to 

10 ensure patients impacted by health in11 equities based on race, ethnicity, gen12 der, or sexual orientation are receiving 

13 comprehensive and organized treat14 ment and care. 

15 (III) Educating health care pro16 fessionals on the causes and effects of 

17 inequities in the social determinants 

18 of health in relation to minority and 

19 racial and ethnic communities and the 

20 need for culturally and linguistically 

21 appropriate care in the prevention and 

22 treatment of high-impact diseases. 

23 (IV) Encouraging collaboration 

24 among community- and patient-based 

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1 equities in the social determinants of 

2 health in relation to high-impact dis3 eases in minority and racial and eth4 nic populations. 

5 (f) AUTHORIZATION OF APPROPRIATIONS.—There 

6 are authorized to be appropriated to carry out this sec7 tion— 

8 (1) $25,000,000 for fiscal year 2025; and 

9 (2) such sums as may be necessary for fiscal 

10 years 2026 through 2028. 

11 SEC. 10004. ADDITIONAL RESEARCH ON THE RELATION12 SHIP BETWEEN THE BUILT ENVIRONMENT 

13 AND THE HEALTH OF COMMUNITY RESI14 DENTS. 

15 (a) DEFINITION OF ELIGIBLE INSTITUTION.—In this 

16 section, the term ‘‘eligible institution’’ means a public or 

17 private nonprofit institution that submits to the Secretary 

18 and the Administrator an application for a grant under 

19 the grant program authorized under subsection (b)(2) at 

20 such time, in such manner, and containing such agree21 ments, assurances, and information as the Secretary and 

22 Administrator may require. 

23 (b) RESEARCH GRANT PROGRAM.— 

24 (1) DEFINITION OF HEALTH.—In this section, 

25 the term ‘‘health’’ includes— 


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1 (A) levels of physical activity; 

2 (B) degree of mobility due to factors such 

3 as musculoskeletal diseases, arthritis, and obe4 sity; 

5 (C) consumption of nutritional foods; 

6 (D) rates of crime; 

7 (E) air, water, and soil quality; 

8 (F) risk of injury; 

9 (G) accessibility to health care services; 

10 (H) levels of educational attainment; and 

11 (I) other indicators as determined appro12 priate by the Secretary. 

13 (2) GRANTS.—The Secretary, in collaboration 

14 with the Administrator, shall provide grants to eligi15 ble institutions to conduct and coordinate research 

16 on the built environment and its influence on indi17 vidual and population-based health. 

18 (3) RESEARCH.—The Secretary shall support 

19 research that— 

20 (A) investigates and defines the causal 

21 links between all aspects of the built environ22 ment and the health of residents; 

23 (B) examines— 

24 (i) the extent of the impact of the 

25 built environment (including the various 


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1 characteristics of the built environment) on 

2 the health of residents; 

3 (ii) the variation in the health of resi4 dents by— 

5 (I) location (such as inner cities, 

6 inner suburbs, outer suburbs, reserva7 tions, and rural areas); and 

8 (II) population subgroup (includ9 ing children, young adults, the elderly, 

10 the disadvantaged); or 

11 (iii) the importance of the built envi12 ronment to the total health of residents, 

13 which is the primary variable of interest 

14 from a public health perspective; 

15 (C) is used to develop— 

16 (i) measures to address health and the 

17 connection of health to the built environ18 ment; and 

19 (ii) efforts to link the measures to 

20 travel and health databases; 

21 (D) distinguishes carefully between per22 sonal attitudes and choices and external influ23 ences on observed behavior to determine how 

24 much an observed association between the built 

25 environment and the health of residents, versus 


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1 the lifestyle preferences of the people that 

2 choose to live in the neighborhood, reflects the 

3 physical characteristics of the neighborhood; 

4 and 

5 (E)(i) identifies or develops effective inter6 vention strategies to promote better health 

7 among residents with a focus on behavioral 

8 interventions and enhancements of the built en9 vironment that promote increased use by resi10 dents; and 

11 (ii) in developing the intervention strate12 gies under clause (i), ensures that the interven13 tion strategies will reach out to high-risk popu14 lations, including racial and ethnic minorities, 

15 low-income urban and rural communities, and 

16 children. 

17 (4) PRIORITY.—In providing assistance under 

18 the grant program authorized under paragraph (2), 

19 the Secretary and the Administrator shall give pri20 ority to research that incorporates— 

21 (A) minority-serving institutions as grant22 ees; 

23 (B) interdisciplinary approaches; or 

24 (C) the expertise of the public health, 

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1 cluding child health), urban planning, and 

2 transportation research communities in the 

3 United States and abroad. 

4 SEC. 10005. ENVIRONMENT AND PUBLIC HEALTH RESTORA5 TION. 

6 (a) STATEMENT OF POLICY.—It is the policy of the 

7 Federal Government to work in conjunction with States, 

8 territories, Tribal governments, international organiza9 tions, and foreign governments as a steward of the envi10 ronment for the benefit of public health, to maintain air 

11 quality and water quality, to sustain the diversity of plant 

12 and animal species, to combat global climate change, and 

13 to protect the environment for future generations. 

14 (b) STUDY AND REPORT ON PUBLIC HEALTH OR EN15 VIRONMENTAL IMPACT OF REVISED RULES, REGULA16 TIONS, LAWS, OR OTHER AGENCY DECISIONS.— 

17 (1) STUDY.—Not later than 30 days after the 

18 date of enactment of this Act, the President shall 

19 seek to enter into an arrangement under which the 

20 National Academy of Sciences shall conduct a study 

21 to determine the effects on public health, air quality, 

22 water quality, wildlife, and the environment of the 

23 following regulations, laws, and other agency deci24 sions: 

25 (A) CLEAN WATER.— 


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1 (i) The final rule of the Environ2 mental Protection Agency and the Corps of 

3 Engineers entitled ‘‘Final Revisions to the 

4 Clean Water Act Regulatory Definitions of 

5 ‘Fill Material’ and ‘Discharge of Fill Mate6 rial’ ’’ and published in the Federal Reg7 ister on May 9, 2002 (67 Fed. Reg. 

8 31129). 

9 (ii) The final rule of the Environ10 mental Protection Agency entitled ‘‘Na11 tional Pollutant Discharge Elimination 

12 System Permit Regulation for Con13 centrated Animal Feeding Operations: Re14 moval of Vacated Elements in Response to 

15 2011 Court Decision’’ and published in the 

16 Federal Register on July 30, 2012 (77 

17 Fed. Reg. 44494). 

18 (iii) The final rule of the Environ19 mental Protection Agency entitled ‘‘With20 drawal of Revisions to the Water Quality 

21 Planning and Management Regulation and 

22 Revisions to the National Pollutant Dis23 charge Elimination System Program in 

24 Support of Revisions to the Water Quality 

25 Planning and Management Regulation’’ 


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1 and published in the Federal Register on 

2 March 19, 2003 (68 Fed. Reg. 13608). 

3 (iv) The final rule of the Environ4 mental Protection Agency entitled ‘‘Con5 solidated Permit Regulations: RCRA Haz6 ardous Waste; SDWA Underground Injec7 tion Control; CWA National Pollutant Dis8 charge Elimination System; CWA Section 

9 404 Dredge or Fill Programs; and CAA 

10 Prevention of Significant Deterioration’’ 

11 and published in the Federal Register on 

12 May 19, 1980 (45 Fed. Reg. 33290), with 

13 respect to the definition of the ‘‘waters of 

14 the United States’’. 

15 (v) The final rule of the Corps of En16 gineers and the Environmental Protection 

17 Agency entitled ‘‘Definition of ‘Waters of 

18 the United States’—Recodification of Pre19 Existing Rules’’ and published in the Fed20 eral Register on October 22, 2019 (84 

21 Fed. Reg. 56626). 

22 (vi) The final rule of the Corps of En23 gineers and the Environmental Protection 

24 Agency entitled ‘‘The Navigable Waters 

25 Protection Rule: Definition of ‘Waters of 


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1 the United States’ ’’ and published in the 

2 Federal Register on April 21, 2020 (85 

3 Fed. Reg. 22250). 

4 (B) FORESTS AND LAND MANAGEMENT.— 

5 (i) The Healthy Forests Restoration 

6 Act of 2003 (16 U.S.C. 6501 et seq.). 

7 (ii) The application of section 553(e) 

8 of title 5, United States Code, such that a 

9 State may petition for a special rule for 

10 the inventoried roadless areas within Na11 tional Forest System land within the State. 

12 (iii) The final rules of the Forest 

13 Service entitled ‘‘National Forest System 

14 Land Management Planning’’ (77 Fed. 

15 Reg. 21162), ‘‘National Forest System 

16 Land Management Planning; Correction’’ 

17 (78 Fed. Reg. 23491), and ‘‘National For18 est System Land Management Planning’’ 

19 (81 Fed. Reg. 90723), published on April 

20 9, 2012, April 19, 2013, and December 15, 

21 2016, respectively. 

22 (iv) The final rule of the Bureau of 

23 Land Management entitled ‘‘Oil Shale 

24 Management—General’’ and published on 

25 November 18, 2008 (73 Fed. Reg. 69414). 


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1 (v) The record of decision described in 

2 the notice of availability of the Bureau of 

3 Land Management entitled ‘‘Notice of 

4 Availability of Approved Land Use Plan 

5 Amendments/Record of Decision for Allo6 cation of Oil Shale and Tar Sands Re7 sources on Lands Administered by the Bu8 reau of Land Management in Colorado, 

9 Utah, and Wyoming and Final Pro10 grammatic Environmental Impact State11 ment’’ and published on April 1, 2013 (78 

12 Fed. Reg. 19518). 

13 (C) SCIENTIFIC REVIEW.—The final rule 

14 of the United States Fish and Wildlife Service 

15 and the National Oceanic and Atmospheric Ad16 ministration entitled ‘‘Interagency Cooperation 

17 Under the Endangered Species Act’’ and pub18 lished on December 16, 2008 (73 Fed. Reg. 

19 76272), as amended by the final rule of the 

20 United States Fish and Wildlife Service and the 

21 National Oceanic and Atmospheric Administra22 tion entitled ‘‘Endangered and Threatened 

23 Wildlife and Plants; Regulations for Inter24 agency Cooperation’’ and published on August 

25 27, 2019 (84 Fed. Reg. 44976). 


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1 (2) METHOD.—In conducting the study under 

2 paragraph (1), the National Academy of Sciences 

3 may use and compare existing scientific studies re4 garding the regulations, laws, and other agency deci5 sions described in paragraph (1). 

6 (3) REPORT.—Not later than 270 days after 

7 the date on which the President enters into the ar8 rangement under paragraph (1), the National Acad9 emy of Sciences shall make publicly available and 

10 shall submit to Congress and to the head of each de11 partment and agency of the Federal Government 

12 that issued, implements, or would implement a regu13 lation, law, or other agency decision described in 

14 paragraph (1), a report that includes— 

15 (A) a description of the effects of each reg16 ulation, law, or other agency decision described 

17 in paragraph (1) on public health, air quality, 

18 water quality, wildlife, and the environment, 

19 compared to the impact of preexisting regula20 tions, laws, or other agency decisions in effect, 

21 as applicable, including— 

22 (i) any negative impacts to air quality 

23 or water quality; 

24 (ii) any negative impacts to wildlife; 


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1 (iii) any delays in hazardous waste 

2 cleanup that are projected to be hazardous 

3 to public health; and 

4 (iv) any other negative impact on pub5 lic health or the environment; and 

6 (B) any recommendations that the Na7 tional Academy of Sciences considers appro8 priate to maintain, restore, or improve in whole 

9 or in part protections for public health, air 

10 quality, water quality, wildlife, and the environ11 ment for each of the regulations, laws, and 

12 other agency decisions described in paragraph 

13 (1), which may include recommendations for 

14 the adoption of any regulation or law in place 

15 or proposed prior to January 1, 2001. 

16 (c) DEPARTMENT AND AGENCY REVISION OF EXIST17 ING RULES, REGULATIONS, OR LAWS.—Not later than 

18 180 days after the date on which the report is submitted 

19 pursuant to subsection (b)(3), the head of each depart20 ment or agency that has issued or implemented a regula21 tion, law, or other agency decision described in subsection 

22 (b)(1) shall submit to Congress a plan describing the steps 

23 the department or agency will take, or has taken, to re24 store or improve protections for public health and the envi25 ronment in whole or in part that were in existence prior 


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1 to the issuance of the applicable regulation, law, or other 

2 agency decision. 

3 SEC. 10006. GAO REPORT ON HEALTH EFFECTS OF DEEP4 WATER HORIZON OIL RIG EXPLOSION IN THE 

5 GULF COAST. 

6 (a) STUDY.—The Comptroller General of the United 

7 States shall conduct a study on the type and scope of 

8 health care services administered through the Department 

9 of Health and Human Services addressing the provision 

10 of health care to racial and ethnic minorities, including 

11 residents, cleanup workers, and volunteers, affected by the 

12 blowout and explosion of the mobile offshore drilling unit 

13 Deepwater Horizon that occurred on April 20, 2010, and 

14 resulting hydrocarbon releases into the environment. 

15 (b) SPECIFIC COMPONENTS.—In carrying out sub16 section (a), the Comptroller General of the United States 

17 shall— 

18 (1) assess the type, size, and scope of programs 

19 administered by the Secretary that focus on the pro20 vision of health care to communities on the Gulf 

21 Coast; 

22 (2) identify the merits and disadvantages asso23 ciated with each of the programs; 

24 (3) perform an analysis of the costs and bene25 fits of the programs; and 


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1 (4) determine whether there is any duplication 

2 of programs. 

3 (c) REPORT.—Not later than 180 days after the date 

4 of enactment of this Act, the Comptroller General of the 

5 United States shall submit to Congress a report that in6 cludes— 

7 (1) the findings of the study conducted under 

8 subsection (a); and 

9 (2) recommendations for improving access to 

10 health care for racial and ethnic minorities. 

11 SEC. 10007. ESTABLISH AN INTERAGENCY COUNCIL AND 

12 GRANT PROGRAMS ON SOCIAL DETER13 MINANTS OF HEALTH. 

14 (a) PURPOSES.—The purposes of this section are as 

15 follows: 

16 (1) To establish effective, coordinated Federal 

17 technical assistance to help State and local govern18 ments to improve outcomes and cost-effectiveness of, 

19 and return on investment from, health and social 

20 services programs. 

21 (2) To build a pipeline of State and locally de22 signed, cross-sector interventions and strategies that 

23 generate rigorous evidence about how to improve 

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1 eral, State, local, and Tribal health and social serv2 ices programs. 

3 (3) To enlist State and local governments and 

4 the service providers of such governments as part5 ners in identifying Federal statutory, regulatory, and 

6 administrative challenges in improving the health 

7 and social outcomes of, cost-effectiveness of, and re8 turn on investment from, Federal spending on indi9 viduals enrolled in Medicaid. 

10 (4) To develop strategies to improve health and 

11 social outcomes without denying services to, or re12 stricting the eligibility of, vulnerable populations. 

13 (b) SOCIAL DETERMINANTS ACCELERATOR COUN14 CIL.— 

15 (1) ESTABLISHMENT.—The Secretary, in co16 ordination with the Administrator of the Centers for 

17 Medicare & Medicaid Services (referred to in this 

18 section as the ‘‘Administrator’’), shall establish an 

19 interagency council, to be known as the Social De20 terminants Accelerator Interagency Council (referred 

21 to in this section as the ‘‘Council’’) to achieve the 

22 purposes listed in subsection (a). 

23 (2) MEMBERSHIP.— 


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1 (A) FEDERAL COMPOSITION.—The Council 

2 shall be composed of at least one designee from 

3 each of the following Federal agencies: 

4 (i) The Office of Management and 

5 Budget. 

6 (ii) The Department of Agriculture. 

7 (iii) The Department of Education. 

8 (iv) The Indian Health Service. 

9 (v) The Department of Housing and 

10 Urban Development. 

11 (vi) The Department of Labor. 

12 (vii) The Department of Transpor13 tation. 

14 (viii) Any other Federal agency the 

15 Chair of the Council determines necessary. 

16 (B) DESIGNATION.— 

17 (i) IN GENERAL.—The head of each 

18 agency specified in subparagraph (A) shall 

19 designate at least one employee described 

20 in clause (ii) to serve as a member of the 

21 Council. 

22 (ii) RESPONSIBILITIES.—An employee 

23 described in this clause shall be a senior 

24 employee of the agency— 


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1 (I) whose responsibilities relate 

2 to authorities, policies, and procedures 

3 with respect to the health and well4 being of individuals receiving medical 

5 assistance under a State plan (or a 

6 waiver of such plan) under title XIX 

7 of the Social Security Act (42 U.S.C. 

8 1396 et seq.); or 

9 (II) who has authority to imple10 ment and evaluate transformative ini11 tiatives that harness data or conduct 

12 rigorous evaluation to improve the im13 pact and cost-effectiveness of federally 

14 funded services and benefits. 

15 (C) HHS REPRESENTATION.—In addition 

16 to the designees under subparagraph (A), the 

17 Council shall include designees from at least 3 

18 agencies within the Department of Health and 

19 Human Services, including the Centers for 

20 Medicare & Medicaid Services, at least one of 

21 whom shall meet the criteria under subpara22 graph (B)(ii). 

23 (D) OMB ROLE.—The Director of the Of24 fice of Management and Budget shall facilitate 

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1 wide and multiagency issues to help the Council 

2 achieve consensus recommendations described 

3 under this section. 

4 (E) NON-FEDERAL COMPOSITION.—The 

5 Comptroller General of the United States may 

6 designate up to 6 Council designees— 

7 (i) who have relevant subject matter 

8 expertise, including expertise implementing 

9 and evaluating transformative initiatives 

10 that harness data and conduct evaluations 

11 to improve the impact and cost-effective12 ness of Federal Government services; and 

13 (ii) that each represent— 

14 (I) State, local, and Tribal health 

15 and human services agencies; 

16 (II) public housing authorities or 

17 State housing finance agencies; 

18 (III) State and local government 

19 budget offices; 

20 (IV) State Medicaid agencies; or 

21 (V) national consumer advocacy 

22 organizations. 

23 (F) CHAIR.— 


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1 (i) IN GENERAL.—The Secretary shall 

2 select the Chair of the Council from among 

3 the members of the Council. 

4 (ii) INITIATING GUIDANCE.—The 

5 Chair, on behalf of the Council, shall iden6 tify and invite individuals from diverse en7 tities to provide the Council with advice 

8 and information pertaining to addressing 

9 social determinants of health, including— 

10 (I) individuals from State and 

11 local government health and human 

12 services agencies; 

13 (II) individuals from State Med14 icaid agencies; 

15 (III) individuals from State and 

16 local government budget offices; 

17 (IV) individuals from public 

18 housing authorities or State housing 

19 finance agencies; 

20 (V) individuals from nonprofit or21 ganizations, small businesses, and 

22 philanthropic organizations; 

23 (VI) advocates; 

24 (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 and cost-effectiveness 

4 of, and return on investment from, Federal, 

5 State, local, and Tribal governments, and to fa6 cilitate technical assistance, where needed, to 

7 help to improve State and local evaluation de8 signs and 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 subsection (c); 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 enactment of this Act, the Council shall 

25 convene to develop a schedule and plan for carrying 


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1 out the duties described in this section, including so2 licitation of applications for the grants under this 

3 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 and cost-effectiveness of, and return on in21 vestment from, Federal, State, local, and 

22 Tribal governments with respect to such 

23 purposes; 

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 (c), and the actions that 

9 Federal agencies are taking to address such 

10 challenges. 

11 (6) FACA INAPPLICABILITY.—Chapter 10 of 

12 title 5, United States Code, shall not apply to the 

13 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 (c) 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 enactment of this Act, the Administrator, in 

14 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, and Tribal govern7 ments, academic institutions, nonprofit organi8 zations, community-based organizations, and 

9 other public and private sector partners that 

10 would participate in the development of the pro11 posed plan and subsequent implementation of 

12 programs or initiatives included in such pro13 posed plan. 

14 (F) Such other information as the Admin15 istrator, in consultation with the Secretary and 

16 the Council, determines necessary to achieve the 

17 purposes of this section. 

18 (5) USE OF FUNDS.—A recipient of a grant 

19 under this subsection may use funds received 

20 through the grant for the following purposes: 

21 (A) To convene and coordinate with rel22 evant government entities and other stake23 holders across sectors to assist in the develop24 ment of a social determinant accelerator plan. 


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1 (B) To identify populations of individuals 

2 receiving medical assistance under a State plan 

3 (or a waiver of such plan) under title XIX of 

4 the Social Security Act (42 U.S.C. 1396 et 

5 seq.) who may benefit from the proposed ap6 proaches to improving the health and well-being 

7 of such individuals through the implementation 

8 of the proposed social determinants accelerator 

9 plan. 

10 (C) To engage qualified research experts to 

11 advise on relevant research and to design a pro12 posed evaluation plan, in accordance with the 

13 standards and guidelines issued by the Admin14 istrator. 

15 (D) To collaborate with the Council to sup16 port the development of social determinants ac17 celerator plans. 

18 (E) To prepare and submit a final social 

19 determinants accelerator plan to the Council. 

20 (6) CONTENTS OF PLANS.—A social deter21 minant accelerator plan developed under this sub22 section shall include the following: 

23 (A) A description of the target population 

24 (or populations) that would benefit from imple25 mentation of the social determinants accelerator 


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1 plan, including an analysis describing the pro2 jected impact on the well-being of individuals 

3 described in paragraph (5)(B). 

4 (B) A description of the interventions or 

5 approaches designed under the social deter6 minants accelerator plan and the evidence for 

7 selecting such interventions or approaches. 

8 (C) The objectives and outcome goals of 

9 such interventions or approaches, including at 

10 least one health outcome and at least one other 

11 important social outcome. 

12 (D) A plan for accessing and linking rel13 evant data to enable coordinated benefits and 

14 services for the jurisdictions described in this 

15 section and an evaluation of the proposed inter16 ventions and approaches. 

17 (E) A description of the State, local, and 

18 Tribal governments, academic institutions, non19 profit organizations, or any other public or pri20 vate sector organizations that would participate 

21 in implementing the proposed interventions or 

22 approaches, and the role each would play to 

23 contribute to the success of the proposed inter24 ventions or approaches. 


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1 (F) The identification of the funding 

2 sources that would be used to finance the pro3 posed interventions or approaches. 

4 (G) A description of any financial incen5 tives that may be provided, including outcome6 focused contracting approaches to encourage 

7 service providers and other partners to improve 

8 outcomes of, cost-effectiveness of, and return on 

9 investment from, Federal, State, local, or Tribal 

10 government spending. 

11 (H) The identification of the applicable 

12 Federal, State, local, or Tribal statutory and 

13 regulatory authorities, including waiver authori14 ties, to be leveraged to implement the proposed 

15 interventions or approaches. 

16 (I) A description of potential consider17 ations that would enhance the impact, 

18 scalability, or sustainability of the proposed 

19 interventions or approaches and the actions the 

20 grant awardee would take to address such con21 siderations. 

22 (J) A proposed evaluation plan, to be car23 ried out by an independent evaluator, to meas24 ure the impact of the proposed interventions or 

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1 ness of, and return on investment from, Fed2 eral, State, local, and Tribal governments. 

3 (K) Precautions for ensuring that vulner4 able populations will not be denied access to 

5 Medicaid or other essential services as a result 

6 of implementing the proposed plan. 

7 (d) FUNDING.— 

8 (1) IN GENERAL.—Out of any money in the 

9 Treasury not otherwise appropriated, there is appro10 priated to carry out this section $25,000,000, to re11 main available for obligation until the date that is 

12 5 years after the date of enactment of this section. 

13 (2) RESERVATION OF FUNDS.— 

14 (A) IN GENERAL.—Of the funds made 

15 available under paragraph (1), the Secretary 

16 shall reserve not less than 20 percent to award 

17 grants to eligible applicants for the development 

18 of social determinants accelerator plans under 

19 this section intended to serve rural populations. 

20 (B) EXCEPTION.—In the case of a fiscal 

21 year for which the Secretary determines that 

22 there are not sufficient eligible applicants to 

23 award up to 25 grants under subsection (c) 

24 that are intended to serve rural populations and 

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1 quirement, the Secretary may reserve an 

2 amount that is less than 20 percent of amounts 

3 made available under paragraph (1) to award 

4 grants for such purpose. 

5 (3) RULE OF CONSTRUCTION.—Nothing in this 

6 section shall prevent Federal agencies represented 

7 on the Council from contributing additional funding 

8 from other sources to support activities to improve 

9 the effectiveness of the Council. 

10 SEC. 10008. CORRECTING HURTFUL AND ALIENATING 

11 NAMES IN GOVERNMENT EXPRESSION 

12 (CHANGE). 

13 (a) SHORT TITLE.—This section may be cited as the 

14 ‘‘Correcting Hurtful and Alienating Names in Government 

15 Expression Act’’ or the ‘‘CHANGE Act’’. 

16 (b) DEFINITIONS.—In this section: 

17 (1) EMPLOYEE.—The term ‘‘employee’’ has the 

18 meaning given the term in section 2105 of title 5, 

19 United States Code. 

20 (2) EXECUTIVE AGENCY.—The term ‘‘Executive 

21 agency’’ has the meaning given the term in section 

22 105 of title 5, United States Code. 

23 (3) OFFICER.—The term ‘‘officer’’ has the 

24 meaning given the term in section 2104 of title 5, 

25 United States Code. 


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1 (4) PROHIBITED TERM.—The term ‘‘prohibited 

2 term’’ means— 

3 (A) the term ‘‘alien’’, when used to refer to 

4 an individual who is not a citizen or national of 

5 the United States; and 

6 (B) the term ‘‘illegal alien’’, when used to 

7 refer to an individual who— 

8 (i) is unlawfully present in the United 

9 States; or 

10 (ii) lacks a lawful immigration status 

11 in the United States. 

12 (c) MODERNIZATION OF LANGUAGE REFERRING TO

13 INDIVIDUALS WHO ARE NOT CITIZENS OR NATIONALS OF

14 THE UNITED STATES.— 

15 (1) IN GENERAL.—Except as provided in para16 graph (2), on and after the date of enactment of this 

17 Act, an Executive agency may not use a prohibited 

18 term in any proposed or final rule, regulation, inter19 pretation, publication, other document, display, or 

20 sign issued by the Executive agency. 

21 (2) EXCEPTION.—An Executive agency may use 

22 a prohibited term under paragraph (1) if the Execu23 tive agency uses the prohibited term while quoting 

24 or reproducing text written by a source that is not 

25 an officer or employee of the Executive agency. 


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1 (d) UNIFORM DEFINITION.— 

2 (1) IN GENERAL.—Chapter 1 of title 1, United 

3 States Code, is amended by adding at the end the 

4 following: 

5 ‘‘§ 9. Definition of ‘foreign national’ 

6 ‘‘In determining the meaning of any Act of Congress 

7 or any ruling, regulation, or interpretation of an adminis8 trative bureau or agency of the United States, the term 

9 ‘foreign national’ means any individual who is not an indi10 vidual who— 

11 ‘‘(1) is a citizen of the United States; or 

12 ‘‘(2) though not a citizen of the United States, 

13 owes permanent allegiance to the United States.’’. 

14 (2) TECHNICAL AMENDMENT.—The table of 

15 sections for chapter 1 of title 1, United States Code, 

16 is amended by adding at the end the following: 

‘‘9. Definition of ‘foreign national’.’’. 

17 (e) REFERENCES.—Any reference in any Federal 

18 statute, rule, regulation, Executive order, publication, or 

19 other document of the United States— 

20 (1) to the term ‘‘alien’’, when used to refer to 

21 an individual who is not a citizen or national of the 

22 United States, is deemed to refer to the term ‘‘for23 eign national’’; and 


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1 (2) to the term ‘‘illegal alien’’ is deemed to 

2 refer to the term ‘‘undocumented foreign national’’, 

3 when used to refer to an individual who— 

4 (A) is unlawfully present in the United 

5 States; or 

6 (B) lacks a lawful immigration status in 

7 the United States. 

8 SEC. 10009. ANDREW KEARSE ACCOUNTABILITY FOR DE9 NIAL OF MEDICAL CARE. 

10 (a) IN GENERAL.—Chapter 13 of title 18, United 

11 States Code, is amended by adding at the end the fol12 lowing: 

13 ‘‘§ 251. Medical attention for individuals in Federal 

14 custody displaying medical distress 

15 ‘‘(a) DEFINITIONS.—In this section— 

16 ‘‘(1) the term ‘appropriate Inspector General’, 

17 with respect to a covered official, means— 

18 ‘‘(A) the Inspector General of the Federal 

19 agency that employs the covered official; or 

20 ‘‘(B) in the case of a covered official em21 ployed by a Federal agency that does not have 

22 an Inspector General, the Inspector General of 

23 the Department of Justice; 

24 ‘‘(2) the term ‘covered official’ means— 


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1 ‘‘(A) a Federal law enforcement officer (as 

2 defined in section 115); 

3 ‘‘(B) an officer or employee of the Bureau 

4 of Prisons; or 

5 ‘‘(C) an officer or employee of the United 

6 States Marshals Service; and 

7 ‘‘(3) the term ‘medical distress’ includes breath8 ing difficulties. 

9 ‘‘(b) REQUIREMENT.— 

10 ‘‘(1) OFFENSE.—It shall be unlawful for a cov11 ered official to negligently fail to obtain or provide 

12 immediate medical attention to an individual in Fed13 eral custody who displays medical distress in the 

14 presence of the covered official if the individual suf15 fers unnecessary pain, injury, or death as a result of 

16 that failure. 

17 ‘‘(2) PENALTY.—A covered official who violates 

18 paragraph (1) shall be fined under this title, impris19 oned for not more than 1 year, or both. 

20 ‘‘(3) STATE CIVIL ENFORCEMENT.—Whenever 

21 an attorney general of a State has reasonable cause 

22 to believe that a resident of the State has been ag23 grieved by a violation of paragraph (1) by a covered 

24 official, the attorney general, or another official, 

25 agency, or entity designated by the State, may bring 


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1 a civil action in any appropriate district court of the 

2 United States to obtain appropriate equitable and 

3 declaratory relief. 

4 ‘‘(c) INSPECTOR GENERAL INVESTIGATION.— 

5 ‘‘(1) IN GENERAL.—The appropriate Inspector 

6 General shall investigate any instance in which— 

7 ‘‘(A) a covered official fails to obtain or 

8 provide immediate medical attention to an indi9 vidual in Federal custody who displays medical 

10 distress in the presence of the covered official; 

11 and 

12 ‘‘(B) the individual suffers unnecessary 

13 pain, injury, or death as a result of the failure 

14 to obtain or provide immediate medical atten15 tion. 

16 ‘‘(2) REFERRAL FOR PROSECUTION.—If an ap17 propriate Inspector General, in conducting an inves18 tigation under paragraph (1), concludes that the 

19 covered official acted negligently in failing to obtain 

20 or provide immediate medical attention to the indi21 vidual in Federal custody, the appropriate Inspector 

22 General shall refer the case to the Attorney General 

23 for prosecution under this section. 

24 ‘‘(3) CONFIDENTIAL COMPLAINT PROCESS.— 

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1 ploys covered officials shall establish a process under 

2 which an individual may confidentially submit a 

3 complaint to the Inspector General regarding an in4 cident described in paragraph (1) involving a covered 

5 official employed by the Federal agency (or, in the 

6 case of the Inspector General of the Department of 

7 Justice, involving a covered official employed by a 

8 Federal agency that does not have an Inspector Gen9 eral). 

10 ‘‘(d) TRAINING.—The head of an agency that em11 ploys covered officials shall provide training to each such 

12 covered official on obtaining or providing medical assist13 ance to individuals in medical distress.’’. 

14 (b) TECHNICAL AND CONFORMING AMENDMENT.— 

15 The table of sections for chapter 13 of title 18, United 

16 States Code, is amended by adding at the end the fol17 lowing: 

‘‘251. Medical attention for individuals in Federal custody displaying medical 

distress.’’. 

18 SEC. 10010. INVESTING IN COMMUNITY HEALING. 

19 (a) SENSE OF CONGRESS.—It is the sense of Con20 gress that it is imperative that a comprehensive public 

21 health approach to addressing trauma and mental health 

22 care be focused on care delivery that is culturally sensitive 

23 and competent. 


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1 (b) RESEARCH ON ADVERSE HEALTH EFFECTS AS2 SOCIATED WITH INTERACTIONS WITH LAW ENFORCE3 MENT.— 

4 (1) IN GENERAL.—The Secretary, acting 

5 through the Director of the Office of Minority 

6 Health of the Centers for Disease Control and Pre7 vention (established pursuant to section 1707A of 

8 the Public Health Service Act (42 U.S.C. 300u– 

9 6a)), shall conduct research on the adverse health 

10 effects associated with interactions with law enforce11 ment. 

12 (2) EFFECTS AMONG RACIAL AND ETHNIC MI13 NORITIES.—The research under paragraph (1) shall 

14 include research on— 

15 (A) the health consequences, both indi16 vidual and community-wide, of trauma related 

17 to violence committed by law enforcement 

18 among racial and ethnic minorities; and 

19 (B) the disproportionate burden of mor20 bidity and mortality associated with such trau21 ma. 

22 (3) REPORT.—Not later than 1 year after the 

23 date of enactment of this Act, the Secretary shall— 

24 (A) complete the research under this sub25 section; and 


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1 (B) submit to Congress a report on the 

2 findings, conclusions, and recommendations re3 sulting from such research. 

4 (c) GRANTS FOR INCREASING RACIAL AND ETHNIC

5 MINORITY ACCESS TO HIGH-QUALITY TRAUMA SUPPORT

6 SERVICES AND MENTAL HEALTH CARE.— 

7 (1) IN GENERAL.—The Secretary, acting 

8 through the Assistant Secretary for Mental Health 

9 and Substance Use, shall award grants to eligible 

10 entities to establish or expand programs for the pur11 pose of increasing racial and ethnic minority access 

12 to high-quality trauma support services and mental 

13 health care. 

14 (2) ELIGIBLE ENTITIES.—To seek a grant 

15 under this subsection, an entity shall be a commu16 nity-based program or organization that— 

17 (A) provides culturally competent pro18 grams and resources that are aligned with evi19 dence-based practices for trauma-informed care; 

20 and 

21 (B) has demonstrated expertise in serving 

22 communities of color or can partner with a pro23 gram that has such demonstrated expertise. 

24 (3) USE OF FUNDS.—As a condition on receipt 

25 of a grant under this subsection, a grantee shall 


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1 agree to use the grant to increase racial and ethnic 

2 minority access to high-quality trauma support serv3 ices and mental health care, such as by— 

4 (A) establishing and maintaining commu5 nity-based programs providing evidence-based 

6 services in trauma-informed care and culturally 

7 specific services and other resources; 

8 (B) developing innovative culturally spe9 cific strategies and projects to enhance access 

10 to trauma-informed care and resources for ra11 cial and ethnic minorities who face obstacles to 

12 using more traditional services and resources 

13 (such as obstacles in geographic access to pro14 viders, insurance coverage, and access to audio 

15 and video technologies); 

16 (C) working with State and local govern17 ments and social service agencies to develop and 

18 enhance effective strategies to provide culturally 

19 specific services to racial and ethnic minorities; 

20 (D) increasing communities’ capacity to 

21 provide culturally specific resources and support 

22 for communities of color; 

23 (E) working in cooperation with the com24 munity to develop education and prevention 

25 strategies highlighting culturally specific issues 


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1 and resources regarding racial and ethnic mi2 norities; 

3 (F) providing culturally specific programs 

4 for racial and ethnic minorities exposed to law 

5 enforcement violence; and 

6 (G) examining the dynamics of culture and 

7 its impact on victimization and healing. 

8 (4) PRIORITY.—In awarding grants under this 

9 subsection, the Secretary shall give priority to eligi10 ble entities proposing to serve communities that have 

11 faced high rates of community trauma, including 

12 from exposure to law enforcement violence, intergen13 erational poverty, civil unrest, discrimination, or op14 pression. 

15 (5) GRANT PERIOD.—The period of a grant 

16 under this subsection shall be 4 years. 

17 (6) EVALUATION.—Not later than 6 months 

18 after the end of the period of all grants under this 

19 subsection, the Secretary shall— 

20 (A) conduct an evaluation of the programs 

21 funded by a grant under this subsection; 

22 (B) include in such evaluation an assess23 ment of the outcomes of each such program; 

24 and 


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1 (C) submit a report on the results of such 

2 evaluation to Congress. 

3 (7) AUTHORIZATION OF APPROPRIATIONS.—To 

4 carry out this subsection, there is authorized to be 

5 appropriated $20,000,000 for each of fiscal years 

6 2025 through 2029. 

7 (d) BEHAVIORAL AND MENTAL HEALTH OUTREACH

8 EDUCATION STRATEGY.— 

9 (1) IN GENERAL.—The Secretary, in coordina10 tion with advocacy and behavioral and mental health 

11 organizations serving racial and ethnic minority 

12 groups, shall develop and implement an outreach 

13 and education strategy to promote behavioral and 

14 mental health, and reduce stigma associated with 

15 mental health conditions, among racial and ethnic 

16 minorities. 

17 (2) DESIGN.—The strategy under this sub18 section shall be designed to— 

19 (A) meet the diverse cultural and language 

20 needs of racial and ethnic minority groups; 

21 (B) provide information on evidence-based, 

22 culturally and linguistically appropriate and 

23 adapted interventions and treatments; 


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1 (C) increase awareness of symptoms of 

2 mental illness among racial and ethnic minority 

3 groups; and 

4 (D) ensure full participation of, and en5 gage, both consumers and community members 

6 in the development and implementation of ma7 terials. 

8 (3) REPORT.—Not later than 1 year after the 

9 date of enactment of this Act, the Secretary shall 

10 submit to Congress, and make publicly available, a 

11 report detailing the outreach and education strategy 

12 that is developed and implemented under this sub13 section and the results of such implementation. 

14 SEC. 10011. ENVIRONMENTAL JUSTICE MAPPING AND DATA 

15 COLLECTION. 

16 (a) DEFINITIONS.—In this section: 

17 (1) ADVISORY COUNCIL.—The term ‘‘advisory 

18 council’’ means the advisory council established 

19 under subsection (b)(4)(B)(i). 

20 (2) COMMITTEE.—The term ‘‘Committee’’ 

21 means the Environmental Justice Mapping Com22 mittee established by subsection (b)(1). 

23 (3) ENVIRONMENTAL JUSTICE.—The term ‘‘en24 vironmental justice’’ means the fair treatment and 

25 meaningful involvement of all people regardless of 


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1 race, color, culture, national origin, or income, with 

2 respect to the development, implementation, and en3 forcement of environmental laws, regulations, and 

4 policies to ensure that each person enjoys— 

5 (A) the same degree of protection from en6 vironmental and health hazards; and 

7 (B) equal access to any Federal agency ac8 tion relating to the development, implementa9 tion, and enforcement of environmental laws, 

10 regulations, and policies for the purpose of hav11 ing a healthy environment in which to live, 

12 learn, work, and recreate. 

13 (4) ENVIRONMENTAL JUSTICE COMMUNITY.— 

14 The term ‘‘environmental justice community’’ means 

15 a community with significant representation of com16 munities of color, low-income communities, or Tribal 

17 and indigenous communities, that experiences, or is 

18 at risk of experiencing, higher or more adverse 

19 human health or environmental effects, as compared 

20 to other communities. 

21 (5) GROUND-TRUTHING.—The term ‘‘ground22 truthing’’ means a community fact-finding process 

23 by which residents of a community supplement tech24 nical information with local knowledge for the pur25 pose of better informing policy and project decisions. 


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1 (6) RELEVANT STAKEHOLDER.—The term ‘‘rel2 evant stakeholder’’ means— 

3 (A) a representative of a regional, State, 

4 Tribal, or local government agency; 

5 (B) a representative of a nongovernmental 

6 organization with experience in areas that may 

7 include Tribal relations, environmental con8 servation, city and regional planning, and public 

9 health; 

10 (C) a representative of a labor union; 

11 (D) a representative or member of— 

12 (i) an environmental justice commu13 nity; or 

14 (ii) a community-based organization 

15 for an environmental justice community; 

16 (E) an individual with expertise in cumu17 lative impacts, geospatial data, and environ18 mental justice, particularly such an individual 

19 from an academic or research institution; and 

20 (F) an advocate with experience in envi21 ronmental justice who represents an environ22 mental justice community. 

23 (b) ESTABLISHMENT OF COMMITTEE.— 


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1 (1) IN GENERAL.—There is established a com2 mittee, to be known as the ‘‘Environmental Justice 

3 Mapping Committee’’. 

4 (2) MEMBERSHIP.— 

5 (A) IN GENERAL.—The Committee shall be 

6 composed of not fewer than 1 representative of 

7 each of the following: 

8 (i) Of the Environmental Protection 

9 Agency— 

10 (I) the Office of Air and Radi11 ation; 

12 (II) the Office of Chemical Safety 

13 and Pollution Prevention; 

14 (III) the Office of International 

15 and Tribal Affairs; 

16 (IV) the Office of Land and 

17 Emergency Management; 

18 (V) the Office of Water; 

19 (VI) the Office of Environmental 

20 Justice and External Civil Rights; 

21 (VII) the Office of Research and 

22 Development; and 

23 (VIII) the Office of Public En24 gagement and Environmental Edu25 cation. 


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1 (ii) The Council on Environmental 

2 Quality. 

3 (iii) Of the Department of Com4 merce— 

5 (I) the Office of Oceanic and At6 mospheric Research of the National 

7 Oceanic and Atmospheric Administra8 tion, including not fewer than 1 rep9 resentative of the Climate Program 

10 Office; 

11 (II) the Bureau of Economic 

12 Analysis; and 

13 (III) the National Institute of 

14 Standards and Technology. 

15 (iv) Of the Department of Health and 

16 Human Services— 

17 (I) the Centers for Disease Con18 trol and Prevention, not including the 

19 Agency for Toxic Substances and Dis20 ease Registry; 

21 (II) the Agency for Toxic Sub22 stances and Disease Registry; 

23 (III) the Administration for Chil24 dren and Families; 


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1 (IV) of the National Institutes of 

2 Health— 

3 (aa) the National Institute 

4 of Environmental Health 

5 Sciences; 

6 (bb) the National Institute 

7 of Mental Health; and 

8 (cc) the National Institute 

9 on Minority Health and Health 

10 Disparities; and 

11 (V) the Office for Civil Rights. 

12 (v) Of the Department of the Inte13 rior— 

14 (I) the Bureau of Indian Affairs; 

15 (II) the Office of Diversity, In16 clusion, and Civil Rights; and 

17 (III) the United States Geologi18 cal Survey. 

19 (vi) The Forest Service. 

20 (vii) The Department of Housing and 

21 Urban Development. 

22 (viii) The Department of Energy. 

23 (ix) The Department of Transpor24 tation. 

25 (x) The Department of Justice. 


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1 (xi) The Federal Energy Regulatory 

2 Commission. 

3 (xii) The Department of the Treasury. 

4 (xiii) Such other Federal departments, 

5 agencies, and offices as the Administrator 

6 determines to be appropriate, particularly 

7 offices relating to public engagement. 

8 (B) SELECTION OF REPRESENTATIVES.— 

9 The head of a department or agency described 

10 in subparagraph (A) shall, in appointing to the 

11 Committee a representative of the department 

12 or agency, select a representative— 

13 (i) of a component of the department 

14 or agency that is among the components 

15 that are the most relevant to the respon16 sibilities of the Committee; or 

17 (ii) who has expertise in areas rel18 evant to those responsibilities, such as de19 mographic indicators relating to socio20 economic hardship, environmental justice, 

21 public engagement, public health, exposure 

22 to pollution, future climate and extreme 

23 weather mapping, affordable energy, sus24 tainable transportation, and access to 

25 water, food, and green space. 


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1 (C) CO-CHAIRS.— 

2 (i) IN GENERAL.—The members of 

3 the Committee shall select 3 members to 

4 serve as co-chairs of the Committee— 

5 (I) 1 of whom shall be a rep6 resentative of the Environmental Pro7 tection Agency; 

8 (II) 1 of whom shall be a rep9 resentative of the Council on Environ10 mental Quality; and 

11 (III) 1 of whom shall have sub12 stantial experience in public engage13 ment. 

14 (ii) TERMS.—Each co-chair shall 

15 serve for a term of not more than 3 years. 

16 (iii) RESPONSIBILITIES OF CO17 CHAIRS.—The co-chairs of the Committee 

18 shall— 

19 (I) determine the agenda of the 

20 Committee, in consultation with other 

21 members of the Committee; 

22 (II) direct the work of the Com23 mittee, including the oversight of a 

24 meaningful public engagement proc25 ess; and 


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1 (III) convene meetings of the 

2 Committee not less frequently than 

3 once each fiscal quarter. 

4 (3) ADMINISTRATIVE SUPPORT.— 

5 (A) IN GENERAL.—The Administrator 

6 shall provide technical and administrative sup7 port to the Committee. 

8 (B) FUNDING.—The Administrator may 

9 carry out subparagraph (A) using, in addition 

10 to any amounts made available under sub11 section (e), amounts authorized to be appro12 priated to the Administrator before the date of 

13 enactment of this Act and available for obliga14 tion as of that date of enactment. 

15 (4) CONSULTATION.— 

16 (A) IN GENERAL.—In carrying out the du17 ties of the Committee, the Committee shall con18 sult with relevant stakeholders. 

19 (B) ADVISORY COUNCIL.— 

20 (i) IN GENERAL.—The Committee 

21 shall establish an advisory council com22 posed of a balanced proportion of relevant 

stakeholders, at least 1 23 ⁄2 of whom shall 

24 represent environmental justice commu25 nities. 


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1 (ii) CHAIR.—The advisory council 

2 shall be chaired by an environmental jus3 tice advocate or other relevant stakeholder 

4 with substantial experience in environ5 mental justice. 

6 (iii) REQUIREMENTS.—Consultation 

7 described in subparagraph (A) shall in8 clude— 

9 (I) early and regular engagement 

10 with the advisory council, including in 

11 carrying out public engagement under 

12 subparagraph (C); and 

13 (II) consideration of the rec14 ommendations of the advisory council. 

15 (iv) RECOMMENDATIONS NOT USED.— 

16 If the Committee does not use a rec17 ommendation of the advisory council, not 

18 later than 60 days after the date on which 

19 the Committee receives notice of the rec20 ommendation, the Committee shall— 

21 (I) make available to the public 

22 on an internet website of the Environ23 mental Protection Agency a written 

24 report describing the rationale of the 


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1 Committee for not using the rec2 ommendation; and 

3 (II) submit the report described 

4 in subclause (I) to the Committee on 

5 Environment and Public Works of the 

6 Senate and the Committee on Energy 

7 and Commerce of the House of Rep8 resentatives. 

9 (v) OUTREACH.—The advisory council 

10 may carry out public outreach activities 

11 using amounts made available under sub12 section (e) to supplement public engage13 ment carried out by the Committee under 

14 subparagraph (C). 

15 (C) PUBLIC ENGAGEMENT.— 

16 (i) IN GENERAL.—The Committee 

17 shall, throughout the process of carrying 

18 out the duties of the Committee described 

19 in subsection (c)— 

20 (I) meaningfully engage with rel21 evant stakeholders, particularly— 

22 (aa) members and represent23 atives of environmental justice 

24 communities; 


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1 (bb) environmental justice 

2 advocates; and 

3 (cc) individuals with exper4 tise in cumulative impacts and 

5 geospatial data; and 

6 (II) ensure that the input of the 

7 stakeholders described in subclause (I) 

8 is central to the activities of the Com9 mittee. 

10 (ii) PLAN.— 

11 (I) IN GENERAL.—In carrying 

12 out clause (i), the Committee shall de13 velop a plan, in consultation with the 

14 advisory council, for comprehensive 

15 public engagement with, and incorpo16 ration of feedback from, environ17 mental justice advocates and members 

18 of environmental justice communities. 

19 (II) STRATEGIES TO OVERCOME

20 BARRIERS TO PUBLIC ENGAGE21 MENT.—The plan developed under 

22 subclause (I) shall include strategies 

23 to overcome barriers to public engage24 ment, including— 

25 (aa) language barriers; 


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1 (bb) transportation barriers; 

2 (cc) economic barriers; and 

3 (dd) lack of internet access. 

4 (III) CONSIDERATION.—In devel5 oping the plan under subclause (I), 

6 the Committee shall consider the di7 verse and varied experiences of envi8 ronmental justice communities relat9 ing to the scope and types of environ10 mental hazards and socioeconomic in11 justices. 

12 (iii) CONSULTATION AND SOLICITA13 TION OF PUBLIC COMMENT.— 

14 (I) IN GENERAL.—In carrying 

15 out clause (i), not less frequently than 

16 once each fiscal quarter, the Com17 mittee shall consult with the advisory 

18 council and solicit meaningful public 

19 comment, particularly from relevant 

20 stakeholders, on the activities of the 

21 Committee. 

22 (II) REQUIREMENTS.—The Com23 mittee shall carry out subclause (I) 

24 through means including— 


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1 (aa) public notice of a meet2 ing of the Committee occurring 

3 during the applicable fiscal quar4 ter, which shall include— 

5 (AA) notice in publica6 tions relevant to environ7 mental justice communities; 

8 (BB) notification to en9 vironmental justice commu10 nities through direct means, 

11 such as community centers 

12 and schools; and 

13 (CC) direct outreach to 

14 known environmental justice 

15 groups; 

16 (bb) public broadcast of that 

17 meeting, including soliciting and 

18 receiving comments by virtual 

19 means; and 

20 (cc) public availability of a 

21 transcript of that meeting 

22 through publication on an acces23 sible website. 

24 (III) LANGUAGES.—The Com25 mittee shall provide each notice, notiVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 01637 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 fication, direct outreach, broadcast, 

2 and transcript described in subclause 

3 (II) in each language commonly used 

4 in the applicable environmental justice 

5 community, including through oral in6 terpretation, if applicable. 

7 (iv) FUNDING.—Of amounts made 

8 available under subsection (e), the Admin9 istrator shall make available to the Com10 mittee such sums as are necessary for par11 ticipation by relevant stakeholders in pub12 lic engagement under this paragraph, as 

13 determined by the Administrator, in con14 sultation with the advisory council. 

15 (c) DUTIES OF COMMITTEE.— 

16 (1) IN GENERAL.—The Committee shall— 

17 (A) establish a tool described in paragraph 

18 (2) to identify environmental justice commu19 nities, including the identification of— 

20 (i) criteria to be used in the tool; and 

21 (ii) a methodology to determine the 

22 cumulative impacts of those criteria; 

23 (B) assess and address data gaps in ac24 cordance with paragraph (4); and 


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1 (C) collect data for the environmental jus2 tice data repository established under sub3 section (d). 

4 (2) ESTABLISHMENT OF TOOL.— 

5 (A) IN GENERAL.—The Committee, in con6 sultation with relevant stakeholders and the ad7 visory council, shall establish an interactive, 

8 transparent, integrated, and Federal Govern9 ment-wide tool for assessing and mapping envi10 ronmental justice communities based on the cu11 mulative impacts of all indicators selected by 

12 the Committee to be integrated into the tool. 

13 (B) REQUIREMENTS.—In establishing the 

14 tool under subparagraph (A), the Committee 

15 shall— 

16 (i) integrate into the tool multiple 

17 data layers of indicators that fall into cat18 egories including— 

19 (I) demographics, particularly re20 lating to socioeconomic hardship and 

21 social stressors, such as— 

22 (aa) race and ethnicity; 

23 (bb) low income; 

24 (cc) high unemployment; 


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1 (dd) low levels of home own2 ership; 

3 (ee) high rent burden; 

4 (ff) high transportation bur5 den; 

6 (gg) low levels of educational 

7 attainment; 

8 (hh) linguistic isolation; 

9 (ii) energy insecurity or high 

10 utility rate burden; 

11 (jj) food insecurity; 

12 (kk) health insurance status 

13 and access to health care; and 

14 (ll) membership in an Indian 

15 Tribe; 

16 (II) public health, particularly 

17 data that are indicative of sensitive 

18 populations, such as— 

19 (aa) rates of asthma; 

20 (bb) rates of cardiovascular 

21 disease; 

22 (cc) childhood leukemia or 

23 other cancers that correlate with 

24 environmental hazards; 

25 (dd) low birth weight; 


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1 (ee) maternal mortality; 

2 (ff) rates of lead poisoning; 

3 and 

4 (gg) rates of diabetes; 

5 (III) pollution burdens, such as 

6 pollution burdens created by— 

7 (aa) toxic chemicals; 

8 (bb) air pollutants; 

9 (cc) water pollutants; 

10 (dd) soil contaminants; and 

11 (ee) perfluoroalkyl and 

12 polyfluoroalkyl substances; and 

13 (IV) environmental effects, such 

14 as effects created by proximity to— 

15 (aa) risk management plan 

16 sites; 

17 (bb) hazardous waste facili18 ties; 

19 (cc) sites on the National 

20 Priorities List developed by the 

21 President in accordance with sec22 tion 105(a)(8)(B) of the Com23 prehensive Environmental Re24 sponse, Compensation, and LiVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 01641 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 ability Act of 1980 (42 U.S.C. 

2 9605(a)(8)(B)); and 

3 (dd) fossil fuel infrastruc4 ture; 

5 (ii) investigate how further indicators 

6 of vulnerability to the impacts of climate 

7 change (including proximity and exposure 

8 to sea level rise, wildfire smoke, flooding, 

9 drought, rising average temperatures, ex10 treme storms, and extreme heat, and fi11 nancial burdens from flood and fire insur12 ance) should be incorporated into the tool 

13 as an additional set of layers; 

14 (iii) identify and consider the effects 

15 of other indicators relating to environ16 mental justice for integration into the tool 

17 as layers, including— 

18 (I) safe, sufficient, and affordable 

19 drinking water, sanitation, and 

20 stormwater services; 

21 (II) access to and the quality 

22 of— 

23 (aa) green space and tree 

24 canopy cover; 

25 (bb) healthy food; 


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1 (cc) affordable energy and 

2 water; 

3 (dd) transportation; 

4 (ee) reliable communication 

5 systems, such as broadband 

6 internet; 

7 (ff) child care; 

8 (gg) high-quality public 

9 schools, early childhood edu10 cation, and child care; and 

11 (hh) health care facilities; 

12 (III) length of commute; 

13 (IV) indoor air quality in multi14 unit dwellings; 

15 (V) mental health; 

16 (VI) labor market categories, 

17 particularly relating to essential work18 ers; and 

19 (VII) each type of utility expense; 

20 (iv) consider the implementation of 

21 specific regional indicators, with the poten22 tial— 

23 (I) to create regionally and lo24 cally downscaled maps in addition to a 

25 national map; 


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1 (II) to provide incentives for 

2 States to collect data and conduct ad3 ditional analyses to capture conditions 

4 specific to their localities; 

5 (III) to provide resources for and 

6 engage in ground-truthing to identify 

7 and verify important data with com8 munity members; and 

9 (IV) to develop companion re10 sources for, and provide technical sup11 port to, regional, State, local, or Trib12 al governments to create their own 

13 maps and environmental justice scores 

14 with relevant regional, State, local, 

15 and Tribal data; 

16 (v) identify a methodology to account 

17 for the cumulative impacts of all indicators 

18 selected by the Committee under clause (i), 

19 in addition to other indicators as the Com20 mittee determines to be necessary, to pro21 vide relative environmental justice scores 

22 for regions that are— 

23 (I) as small as practicable to 

24 identify communities; and 


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1 (II) not larger than a census 

2 tract; 

3 (vi) ensure that the tool is capable of 

4 providing maps of environmental justice 

5 communities based on environmental jus6 tice scores described in clause (v); 

7 (vii) ensure that users of the tool are 

8 able to map available layers together or 

9 independently as desired; 

10 (viii) implement a method for users of 

11 the tool to generate a map and environ12 mental justice score based on a subset of 

13 indicators, particularly for the purpose of 

14 using the tool in addressing various policy 

15 needs, permitting processes, and invest16 ment goals; 

17 (ix) make the tool customizable to ad18 dress specific policy needs, permitting 

19 processes, and investment goals; 

20 (x) account for conditions that are not 

21 captured by the quantitative data used to 

22 develop the 1 or more maps and environ23 mental justice scores comprising the tool, 

24 by— 


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1 (I) developing and executing a 

2 plan to perform outreach to relevant 

3 communities; and 

4 (II) establishing a mechanism by 

5 which communities can self-identify as 

6 environmental justice communities to 

7 be included in the tool, which may in8 clude citing qualitative data on condi9 tions for which quantitative data are 

10 lacking, such as cultural loss in Tribal 

11 communities; 

12 (xi) consider that the tool— 

13 (I) will be used across the Fed14 eral Government in screening Federal 

15 policies, permitting processes, and in16 vestments for environmental and cli17 mate justice impacts; and 

18 (II) may be used to assess com19 munities for pollution reduction pro20 grams; and 

21 (xii) carry out such other activities as 

22 the Committee determines to be appro23 priate. 

24 (3) TRANSPARENCY AND UPDATES.— 

25 (A) IN GENERAL.— 


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1 (i) NOTICE AND COMMENT.—The 

2 Committee shall establish the tool de3 scribed in paragraph (2) after providing 

4 notice and an opportunity for public com5 ment. 

6 (ii) HEARINGS.—In carrying out 

7 clause (i), the Committee shall hold hear8 ings, which shall be time and language ap9 propriate, in communities affected by envi10 ronmental justice issues in geographically 

11 disparate States and Tribal areas. 

12 (B) UPDATES.— 

13 (i) ANNUAL UPDATES.—The Com14 mittee shall update the tool described in 

15 paragraph (2) not less frequently than an16 nually to account for data sets that are up17 dated annually. 

18 (ii) OTHER UPDATES.—Not less fre19 quently than once every 3 years, the Com20 mittee shall— 

21 (I) update the indicators, meth22 odology, or both for the tool described 

23 in paragraph (2); and 


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1 (II) reevaluate data submitted by 

2 Federal departments and agencies 

3 that is used for the tool. 

4 (iii) REPORTS.—After the initial es5 tablishment of the tool described in para6 graph (2) and each update under clause (i) 

7 or (ii), the Committee shall publish a re8 port describing— 

9 (I) the process for identifying in10 dicators relating to environmental jus11 tice in the development of the tool; 

12 (II) the methodology described in 

13 paragraph (2)(B)(v); and 

14 (III) the use of public input and 

15 community engagement in that proc16 ess. 

17 (C) TRAINING TUTORIALS AND SES18 SIONS.— 

19 (i) IN GENERAL.—The Committee 

20 shall— 

21 (I) develop virtual training tuto22 rials and sessions for environmental 

23 justice communities for the use of the 

24 tool described in paragraph (2); and 


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1 (II) where practicable, provide in2 person training sessions for environ3 mental justice communities for the 

4 use of that tool. 

5 (ii) LANGUAGES.—The tutorials and 

6 sessions under clause (i) shall be made 

7 available in each language commonly used 

8 in the applicable environmental justice 

9 community. 

10 (D) PUBLIC AVAILABILITY.— 

11 (i) IN GENERAL.—The Committee 

12 shall make available to the public on an 

13 internet website of the Environmental Pro14 tection Agency— 

15 (I) the tool described in para16 graph (2); 

17 (II) each update under clauses (i) 

18 and (ii) of subparagraph (B); 

19 (III) each report under subpara20 graph (B)(iii); and 

21 (IV) the training tutorials and 

22 sessions developed under subpara23 graph (C)(i)(I). 

24 (ii) ACCESSIBILITY.—The Committee 

25 shall make the tool, updates, and reports 


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1 described in clause (i) accessible to the 

2 public by publication in relevant languages 

3 and with accessibility functions, as appro4 priate. 

5 (iii) REQUIREMENT.—In carrying out 

6 clause (i)(I), the Committee shall take 

7 measures to prevent the tool from being 

8 misused to discriminate against environ9 mental justice communities, such as by 

10 providing safeguards against the use of 

11 downscaled data that may enable the iden12 tification of individuals. 

13 (4) DATA GAP AUDIT.— 

14 (A) IN GENERAL.—In establishing the tool 

15 described in paragraph (2), the Committee shall 

16 direct relevant Federal departments and agen17 cies to conduct an audit of data collected by the 

18 department or agency to identify any data that 

19 are relevant to environmental justice concerns, 

20 including data relating to— 

21 (i) public health metrics; 

22 (ii) toxic chemicals; 

23 (iii) socioeconomic demographics; 

24 (iv) air quality; 

25 (v) water quality; and 


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1 (vi) killings of individuals by law en2 forcement officers. 

3 (B) REQUIREMENTS.—An audit described 

4 in subparagraph (A) shall— 

5 (i) examine the granularity and acces6 sibility of the data; 

7 (ii) address the need for improved air 

8 quality monitoring; and 

9 (iii) include recommendations to other 

10 Federal departments and agencies on 

11 means to improve the quality, granularity, 

12 and transparency of, and public involve13 ment in, data collection and dissemination. 

14 (C) IMPROVEMENTS.—The Committee 

15 shall direct a Federal department or agency, in 

16 conducting an audit under subparagraph (A), to 

17 address gaps in existing data collection that will 

18 assist the Committee in establishing and oper19 ating the tool described in paragraph (2), in20 cluding by providing to the department or agen21 cy— 

22 (i) benchmarks to meet in addressing 

23 the gaps; 

24 (ii) instructions for consistency in 

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1 sion of data in the environmental justice 

2 data repository described in subsection (d); 

3 and 

4 (iii) best practices for collecting data 

5 in collaboration with local organizations 

6 and partners, such as engaging in ground7 truthing. 

8 (D) REPORTS.—Not later than 180 days 

9 after a Federal department or agency has con10 ducted an audit under subparagraph (A), the 

11 Committee shall— 

12 (i) make available to the public on an 

13 internet website of the Environmental Pro14 tection Agency a report describing the 

15 findings and conclusions of the audit, in16 cluding the progress made by the Federal 

17 department or agency in addressing envi18 ronmental justice data gaps; and 

19 (ii) submit the report described in 

20 clause (i) to— 

21 (I) the Committee on Environ22 ment and Public Works of the Senate; 

23 (II) the Committee on Health, 

24 Education, Labor, and Pensions of 

25 the Senate; 


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1 (III) the Committee on Energy 

2 and Commerce of the House of Rep3 resentatives; and 

4 (IV) the Committee on Education 

5 and the Workforce of the House of 

6 Representatives. 

7 (d) ENVIRONMENTAL JUSTICE DATA REPOSITORY.— 

8 (1) IN GENERAL.—The Administrator shall es9 tablish an environmental justice data repository to 

10 maintain— 

11 (A) the data collected by the Committee 

12 through the establishment of the tool described 

13 in subsection (c)(2) and the audits conducted 

14 under subsection (c)(4)(A); and 

15 (B) any subnational data collected under 

16 paragraph (3)(B). 

17 (2) UPDATES.—The Administrator shall update 

18 the data in the data repository described in para19 graph (1) as frequently as practicable, including 

20 every year if practicable, but not less frequently than 

21 once every 3 years. 

22 (3) AVAILABILITY; INCLUSION OF SUBNATIONAL

23 DATA.—The Administrator— 


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1 (A) shall make the data repository de2 scribed in paragraph (1) available to regional, 

3 State, local, and Tribal governments; and 

4 (B) may collaborate with the governments 

5 described in subparagraph (A) to include within 

6 that data repository subnational data in exist7 ence before the establishment of the tool de8 scribed in subsection (c)(2) and the completion 

9 of the audits under subsection (c)(4)(A). 

10 (4) REQUIREMENT.—The Administrator shall 

11 take measures to prevent the data in the data repos12 itory described in paragraph (1) from being misused 

13 to discriminate against environmental justice com14 munities, such as by providing safeguards against 

15 the use of downscaled data that may enable the 

16 identification of individuals. 

17 (e) AUTHORIZATION OF APPROPRIATIONS.—There 

18 are authorized to be appropriated to the Administrator to 

19 carry out this section, including any necessary administra20 tive costs of the Committee— 

21 (1) $20,000,000 for each of fiscal years 2025 

22 and 2026; and 

23 (2) $18,000,000 for each of fiscal years 2027 

24 through 2029. 


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1 (f) EFFECT.—Nothing in any provision of this section 

2 relating to the tool described in subsection (c)(2) prohibits 

3 a State from developing a map relating to environmental 

4 justice or pollution burden that relies on different data, 

5 or analyzes data differently, than that tool. 

6 SEC. 10012. ANTIRACISM IN PUBLIC HEALTH. 

7 (a) PUBLIC HEALTH RESEARCH AND INVESTMENT

8 IN DISMANTLING STRUCTURAL RACISM.—Part B of title 

9 III of the Public Health Service Act (42 U.S.C. 243 et 

10 seq.), as amended by section 5201(e), is further amended 

11 by adding at the end the following: 

12 ‘‘SEC. 320D. NATIONAL CENTER ON ANTIRACISM AND 

13 HEALTH. 

14 ‘‘(a) IN GENERAL.— 

15 ‘‘(1) NATIONAL CENTER.—There is established 

16 within the Centers for Disease Control and Preven17 tion a center to be known as the ‘National Center 

18 on Antiracism and Health’ (referred to in this sec19 tion as the ‘Center’). The Director of the Centers for 

20 Disease Control and Prevention shall appoint a di21 rector to head the Center who has experience living 

22 in and working with racial and ethnic minority com23 munities. The Center shall promote public health 

24 by— 


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1 ‘‘(A) declaring racism a public health crisis 

2 and naming racism as an historical and present 

3 threat to the physical and mental health and 

4 well-being of the United States and world; 

5 ‘‘(B) aiming to develop new knowledge in 

6 the science and practice of antiracism, including 

7 by identifying the mechanisms by which racism 

8 operates in the provision of health care and in 

9 systems that impact health and well-being; 

10 ‘‘(C) transferring that knowledge into 

11 practice, including by developing interventions 

12 that dismantle the mechanisms of racism and 

13 replace such mechanisms with equitable struc14 tures, policies, practices, norms, and values so 

15 that a healthy society can be realized; and 

16 ‘‘(D) contributing to a national and global 

17 conversation regarding the impacts of racism on 

18 the health and well-being of the United States 

19 and world. 

20 ‘‘(2) GENERAL DUTIES.—The Secretary, acting 

21 through the Center, shall undertake activities to 

22 carry out the mission of the Center as described in 

23 paragraph (1), such as the following: 

24 ‘‘(A) Conduct research into, collect, ana25 lyze and make publicly available data on, and 


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1 provide leadership and coordination for the 

2 science and practice of antiracism, the public 

3 health impacts of structural racism, and the ef4 fectiveness of intervention strategies to address 

5 these impacts. Topics of research and data col6 lection under this subparagraph may include 

7 identifying and understanding— 

8 ‘‘(i) policies and practices that have a 

9 disparate impact on the health and well10 being of communities of color; 

11 ‘‘(ii) the public health impacts of im12 plicit racial bias, White supremacy, weath13 ering, xenophobia, discrimination, and 

14 prejudice; 

15 ‘‘(iii) the social determinants of health 

16 resulting from structural racism, including 

17 poverty, housing, employment, political 

18 participation, and environmental factors; 

19 and 

20 ‘‘(iv) the intersection of racism and 

21 other systems of oppression, including as 

22 related to age, sexual orientation, gender 

23 identity, and disability status. 

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1 profit private entities, including State, local, 

2 territorial, and Tribal health agencies and orga3 nizations, for the research and collection, anal4 ysis, and reporting of data on the topics de5 scribed in subparagraph (A). 

6 ‘‘(C) Establish, through grants or coopera7 tive agreements, at least 3 regional centers of 

8 excellence, located in racial and ethnic minority 

9 communities, in antiracism for the purpose of 

10 developing new knowledge in the science and 

11 practice of antiracism in health by researching, 

12 understanding, and identifying the mechanisms 

13 by which racism operates in the health space, 

14 racial and ethnic inequities in health care ac15 cess and outcomes, the history of successful 

16 antiracist movements in health, and other 

17 antiracist public health work. 

18 ‘‘(D) Establish a clearinghouse within the 

19 Centers for Disease Control and Prevention for 

20 the collection and storage of data generated 

21 under the programs implemented under this 

22 section for which there is not an otherwise ex23 isting surveillance system at the Centers for 

24 Disease Control and Prevention. Such data 

25 shall— 


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1 ‘‘(i) be comprehensive and 

2 disaggregated, to the extent practicable, by 

3 including racial, ethnic, primary language, 

4 sex, gender identity, sexual orientation, 

5 age, socioeconomic status, and disability 

6 disparities; 

7 ‘‘(ii) be made publicly available; 

8 ‘‘(iii) protect the privacy of individuals 

9 whose information is included in such data; 

10 and 

11 ‘‘(iv) comply with privacy protections 

12 under the regulations promulgated under 

13 section 264(c) of the Health Insurance 

14 Portability and Accountability Act of 1996. 

15 ‘‘(E) Provide information and education to 

16 the public on the public health impacts of struc17 tural racism and on antiracist public health 

18 interventions. 

19 ‘‘(F) Consult with other Centers and Na20 tional Institutes within the Centers for Disease 

21 Control and Prevention, including the Office of 

22 Health Equity, the Office of Tribal Affairs and 

23 Strategic Alliances, the Office of Rural Health, 

24 and the Office of Island Affairs, to ensure that 

25 scientific and programmatic activities initiated 


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1 by the agency consider structural racism in 

2 their designs, conceptualizations, and execu3 tions, which shall include— 

4 ‘‘(i) putting measures of racism in 

5 population-based surveys; 

6 ‘‘(ii) establishing a Federal Advisory 

7 Committee on racism and health for the 

8 Centers for Disease Control and Preven9 tion; 

10 ‘‘(iii) developing training programs, 

11 curricula, and seminars for the purposes of 

12 training public health professionals and re13 searchers around issues of race, racism, 

14 and antiracism; 

15 ‘‘(iv) providing standards and best 

16 practices for programming and grant re17 cipient compliance with Federal data col18 lection standards, including section 3101 

19 of the Public Health Service Act; and 

20 ‘‘(v) establishing leadership and stake21 holder councils with experts and leaders in 

22 racism and public health disparities. 

23 ‘‘(G) Coordinate with the Indian Health 

24 Service and with the Tribal Advisory Committee 

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1 tion to ensure meaningful Tribal consultation, 

2 the gathering of information from Tribal au3 thorities, and respect for Tribal data sov4 ereignty. 

5 ‘‘(H) Engage in government to government 

6 consultation with Indian Tribes and Tribal or7 ganizations. 

8 ‘‘(I) At least every 2 years, produce and 

9 publicly post on the Centers for Disease Control 

10 and Prevention’s website a report on antiracist 

11 activities completed by the Center, which may 

12 include newly identified antiracist public health 

13 practices. 

14 ‘‘(b) DEFINITIONS.—In this section: 

15 ‘‘(1) ANTIRACISM.—The term ‘antiracism’ is a 

16 collection of antiracist policies that lead to racial eq17 uity, and are substantiated by antiracist ideas. 

18 ‘‘(2) ANTIRACIST.—The term ‘antiracist’ is any 

19 measure that produces or sustains racial equity be20 tween racial groups. 

21 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 

22 is authorized to be appropriated such sums as may be nec23 essary to carry out this section.’’. 

24 (b) PUBLIC HEALTH RESEARCH AND INVESTMENT

25 IN POLICE VIOLENCE.— 


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1 (1) IN GENERAL.—The Secretary shall establish 

2 within the National Center for Injury Prevention 

3 and Control of the Centers for Disease Control and 

4 Prevention (referred to in this subsection as the 

5 ‘‘Center’’) a law enforcement violence prevention 

6 program. 

7 (2) GENERAL DUTIES.—In implementing the 

8 program under paragraph (1), the Center shall con9 duct research into, and provide leadership and co10 ordination for— 

11 (A) the understanding and promotion of 

12 knowledge about the public health impacts of 

13 uses of force by law enforcement, including po14 lice brutality and violence; 

15 (B) developing public health interventions 

16 and perspectives for eliminating deaths, injury, 

17 trauma, and negative mental health effects 

18 from police presence and interactions, including 

19 police brutality and violence; and 

20 (C) ensuring comprehensive data collection, 

21 analysis, and reporting regarding police violence 

22 and misconduct, in consultation with the De23 partment of Justice and independent research24 ers. 


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1 (3) FUNCTIONS.—Under the program under 

2 paragraph (1), the Center shall— 

3 (A) summarize and enhance the knowledge 

4 of the distribution, status, and characteristics 

5 of law enforcement-related death, trauma, and 

6 injury; 

7 (B) conduct research and prepare, with the 

8 assistance of State public health departments— 

9 (i) statistics on law enforcement-re10 lated death, injury, and brutality; 

11 (ii) studies of the factors, including 

12 legal, socioeconomic, discrimination, and 

13 other factors that correlate with or influ14 ence police brutality; 

15 (iii) public information about uses of 

16 force by law enforcement, including police 

17 brutality and violence, for the practical use 

18 of the public health community, including 

19 publications that synthesize information 

20 relevant to the national goal of under21 standing police violence and methods for 

22 its control; 

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1 tegic plan for research necessary to com2 prehend the extent and nature of police 

3 uses of force by law enforcement, including 

4 police brutality and violence, and deter5 mine what options exist to reduce or eradi6 cate death and injury that result; and 

7 (v) best practices in police violence 

8 prevention in other countries; 

9 (C) award grants, contracts, and coopera10 tive agreements to provide for the conduct of 

11 epidemiologic research on uses of force by law 

12 enforcement, including police brutality and vio13 lence, by Federal, State, local, and private 

14 agencies, institutions, organizations, and indi15 viduals; 

16 (D) award grants, contracts, and coopera17 tive agreements to community groups, inde18 pendent research organizations, academic insti19 tutions, and other entities to support, execute, 

20 or conduct research on interventions to reduce 

21 or eliminate uses of force by law enforcement, 

22 including police brutality and violence; 

23 (E) coordinate with the Department of 

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1 tion, storage, and retrieval necessary to collect, 

2 evaluate, analyze, and disseminate information 

3 about the extent and nature of uses of force by 

4 law enforcement, including police brutality and 

5 violence, as well as options for the eradication 

6 of such practices; 

7 (F) submit an annual report to Congress 

8 on research findings with recommendations to 

9 improve data collection and standardization and 

10 to disrupt processes in policing that preserve 

11 and reinforce racism and racial disparities in 

12 public health; 

13 (G) conduct primary research and explore 

14 uses of force by law enforcement, including po15 lice brutality and violence, and options for its 

16 control; and 

17 (H) study alternatives to law enforcement 

18 response as a method of reducing police vio19 lence. 

20 (4) AUTHORIZATION OF APPROPRIATIONS.— 

21 There is authorized to be appropriated such sums as 

22 may be necessary to carry out this subsection. 

23 SEC. 10013. LGBTQ ESSENTIAL DATA. 

24 (a) IMPROVING DATA COLLECTION ON THE SEXUAL

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1 DIVIDUALS THROUGH THE NATIONAL VIOLENT DEATH

2 REPORTING SYSTEM.— 

3 (1) COLLECTION OF SEXUAL ORIENTATION AND

4 GENDER IDENTITY DATA.— 

5 (A) IN GENERAL.—Not later than 120 

6 days after the date of enactment of this Act, 

7 the Director of the Centers for Disease Control 

8 and Prevention shall take measures to improve 

9 the incidence of the collection of information on 

10 the sexual orientation and gender identity of de11 ceased individuals through the National Violent 

12 Death Reporting System or any successor pro13 grams. 

14 (B) CONFIDENTIALITY.—Any information 

15 collected relating to the sexual orientation or 

16 gender identity of a decedent shall be main17 tained in accordance with the confidentiality 

18 and privacy standards and policies for the pro19 tection of individuals applicable to all other 

20 data collected for purposes of the National Vio21 lent Death Reporting System. 

22 (2) DEFINITIONS.—In this subsection: 

23 (A) GENDER IDENTITY.—The term ‘‘gen24 der identity’’ means an individual’s sense of 

25 being male, female, transgender, or another 


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1 gender, as distinct from the individual’s sex as2 signed at birth. 

3 (B) SEXUAL ORIENTATION.—The term 

4 ‘‘sexual orientation’’ means how a person iden5 tifies in terms of their emotional, romantic, or 

6 sexual attractions, and includes identification as 

7 straight, heterosexual, gay, lesbian, or bisexual, 

8 among other terms. 

9 (3) AUTHORIZATION.—There is authorized to 

10 be appropriated $25,000,000 for fiscal year 2025 to 

11 carry out this subsection. 

12 (b) SENSE OF CONGRESS.—It is the sense of Con13 gress that— 

14 (1) the Centers for Disease Control and Preven15 tion has made significant efforts to encourage States 

16 and other jurisdictions to collect data on sexual ori17 entation and gender identity through the National 

18 Violent Death Reporting System; and 

19 (2) jurisdictions that participate in the collec20 tion of such data through the National Violent 

21 Death Reporting System should be commended for 

22 their participation. 

23 SEC. 10014. SOCIAL DETERMINANTS ACCELERATOR. 

24 (a) PURPOSES.—The purposes of this section are as 

25 follows: 


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1 (1) To establish effective, coordinated Federal 

2 technical assistance to help State and local govern3 ments to improve outcomes and cost-effectiveness of, 

4 and return on investment from, health and social 

5 services programs. 

6 (2) To build a pipeline of State and locally de7 signed, cross-sector interventions and strategies that 

8 generate rigorous evidence about how to improve 

9 health and social outcomes, and increase the cost-ef10 fectiveness of, and return on investment from, Fed11 eral, State, local, and Tribal health and social serv12 ices programs. 

13 (3) To enlist State and local governments and 

14 the service providers of such governments as part15 ners in identifying Federal statutory, regulatory, and 

16 administrative challenges in improving the health 

17 and social outcomes of, cost-effectiveness of, and re18 turn on investment from, Federal spending on indi19 viduals enrolled in the Medicaid program under title 

20 XIX of the Social Security Act (42 U.S.C. 1396 et 

21 seq.). 

22 (4) To develop strategies to improve health and 

23 social outcomes without denying services to, or re24 stricting the eligibility of, vulnerable populations. 


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1 (b) SOCIAL DETERMINANTS ACCELERATOR COUN2 CIL.— 

3 (1) ESTABLISHMENT.—The Secretary, in co4 ordination with the Administrator of the Centers for 

5 Medicare & Medicaid Services (referred to in this 

6 section as the ‘‘Administrator’’), shall establish an 

7 interagency council, to be known as the Social De8 terminants Accelerator Interagency Council (referred 

9 to in this section as the ‘‘Council’’), to achieve the 

10 purposes listed in subsection (a). 

11 (2) MEMBERSHIP.— 

12 (A) FEDERAL COMPOSITION.—The Council 

13 shall be composed of at least one designee from 

14 each of the following Federal agencies: 

15 (i) The Office of Management and 

16 Budget. 

17 (ii) The Department of Agriculture. 

18 (iii) The Department of Education. 

19 (iv) The Indian Health Service. 

20 (v) The Department of Housing and 

21 Urban Development. 

22 (vi) The Department of Labor. 

23 (vii) The Department of Transpor24 tation. 


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1 (viii) Any other Federal agency the 

2 Chair of the Council determines necessary. 

3 (B) DESIGNATION.— 

4 (i) IN GENERAL.—The head of each 

5 agency specified in subparagraph (A) shall 

6 designate at least one employee described 

7 in clause (ii) to serve as a member of the 

8 Council. 

9 (ii) RESPONSIBILITIES.—An employee 

10 described in this clause shall be a senior 

11 employee of the agency— 

12 (I) whose responsibilities relate 

13 to authorities, policies, and procedures 

14 with respect to the health and well15 being of individuals receiving medical 

16 assistance under a State plan (or a 

17 waiver of such plan) under title XIX 

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

19 1396 et seq.); or 

20 (II) who has authority to imple21 ment and evaluate transformative ini22 tiatives that harness data or conducts 

23 rigorous evaluation to improve the im24 pact and cost-effectiveness of federally 

25 funded services and benefits. 


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1 (C) HHS REPRESENTATION.—In addition 

2 to the designees under subparagraph (A), the 

3 Council shall include designees from at least 

4 three agencies within the Department of Health 

5 and Human Services, including the Centers for 

6 Medicare & Medicaid Services, at least one of 

7 whom shall meet the criteria under subpara8 graph (B)(ii). 

9 (D) OMB ROLE.—The Director of the Of10 fice of Management and Budget shall facilitate 

11 the timely resolution of Government-wide and 

12 multiagency issues to help the Council achieve 

13 consensus recommendations described under 

14 paragraph (3)(A). 

15 (E) NON-FEDERAL COMPOSITION.—The 

16 Comptroller General of the United States may 

17 designate up to 6 Council designees— 

18 (i) who have relevant subject matter 

19 expertise, including expertise implementing 

20 and evaluating transformative initiatives 

21 that harness data and conduct evaluations 

22 to improve the impact and cost-effective23 ness of Federal Government services; and 

24 (ii) that each represent— 


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1 (I) State, local, and Tribal health 

2 and human services agencies; 

3 (II) public housing authorities or 

4 State housing finance agencies; 

5 (III) State and local government 

6 budget offices; 

7 (IV) State Medicaid agencies; or 

8 (V) national consumer advocacy 

9 organizations. 

10 (F) CHAIR.— 

11 (i) IN GENERAL.—The Secretary shall 

12 select the Chair of the Council from among 

13 the members of the Council. 

14 (ii) INITIATING GUIDANCE.—The 

15 Chair, on behalf of the Council, shall iden16 tify and invite individuals from diverse en17 tities to provide the Council with advice 

18 and information pertaining to addressing 

19 social determinants of health, including— 

20 (I) individuals from State and 

21 local government health and human 

22 services agencies; 

23 (II) individuals from State Med24 icaid agencies; 


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1 (III) individuals from State and 

2 local government budget offices; 

3 (IV) individuals from public 

4 housing authorities or State housing 

5 finance agencies; 

6 (V) individuals from nonprofit or7 ganizations, small businesses, and 

8 philanthropic organizations; 

9 (VI) advocates; 

10 (VII) researchers; and 

11 (VIII) any other individuals the 

12 Chair determines to be appropriate. 

13 (3) DUTIES.—The duties of the Council are— 

14 (A) to make recommendations to the Sec15 retary and the Administrator regarding the cri16 teria for making awards under subsection (b); 

17 (B) to identify Federal authorities and op18 portunities for use by States or local govern19 ments to improve coordination of funding and 

20 administration of Federal programs, the bene21 ficiaries of whom include individuals described 

22 in subsection (a), and which may be unknown 

23 or underutilized and to make information on 

24 such authorities and opportunities publicly 

25 available; 


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1 (C) to provide targeted technical assistance 

2 to States developing a social determinants ac3 celerator plan under subsection (c), including 

4 identifying potential statutory or regulatory 

5 pathways for implementation of the plan and 

6 assisting in identifying potential sources of 

7 funding to implement the plan; 

8 (D) to report to Congress annually on the 

9 subjects set forth in paragraph (5); 

10 (E) to develop and disseminate evaluation 

11 guidelines and standards that can be used to 

12 reliably assess the impact of an intervention or 

13 approach that may be implemented pursuant to 

14 this section on outcomes, cost-effectiveness of, 

15 and return on investment from Federal, State, 

16 local, and Tribal governments, and to facilitate 

17 technical assistance, where needed, to help to 

18 improve State and local evaluation designs and 

19 implementation; 

20 (F) to seek feedback from State, local, and 

21 Tribal governments, including through an an22 nual survey by an independent third party, on 

23 how to improve the technical assistance the 

24 Council provides to better equip State, local, 


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1 and Tribal governments to coordinate health 

2 and social service programs; 

3 (G) to solicit applications for grants under 

4 subsection (c); and 

5 (H) to coordinate with other cross-agency 

6 initiatives focused on improving the health and 

7 well-being of low-income and at-risk populations 

8 in order to prevent unnecessary duplication be9 tween agency initiatives. 

10 (4) SCHEDULE.—Not later than 60 days after 

11 the date of enactment of this Act, the Council shall 

12 convene to develop a schedule and plan for carrying 

13 out the duties described in paragraph (3), including 

14 solicitation of applications for the grants under sub15 section (c). 

16 (5) REPORT TO CONGRESS.—The Council shall 

17 submit an annual report to Congress, which shall in18 clude— 

19 (A) a list of the Council members; 

20 (B) a description of the activities and ex21 penditures of the Council; 

22 (C) summaries of the interventions and ap23 proaches that will be supported by State, local, 

24 and Tribal governments that received a grant 

25 under subsection (c), including— 


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1 (i) the best practices and evidence2 based approaches such governments plan 

3 to employ to achieve the purposes listed in 

4 subsection (a); and 

5 (ii) a description of how the practices 

6 and approaches will impact the outcomes, 

7 cost-effectiveness of, and return on invest8 ment from, Federal, State, local, and Trib9 al governments with respect to such pur10 poses; 

11 (D) the feedback received from State and 

12 local governments on ways to improve the tech13 nical assistance of the Council, including find14 ings from a third-party survey and actions the 

15 Council plans to take in response to such feed16 back; and 

17 (E) the major statutory, regulatory, and 

18 administrative challenges identified by State, 

19 local, and Tribal governments that received a 

20 grant under subsection (c), and the actions that 

21 Federal agencies are taking to address such 

22 challenges. 

23 (6) FACA APPLICABILITY.—Chapter 10 of title 

24 5, United States Code, shall not apply to the Coun25 cil. 


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1 (7) COUNCIL PROCEDURES.—The Secretary, in 

2 consultation with the Comptroller General of the 

3 United States and the Director of the Office of Man4 agement and Budget, shall establish procedures for 

5 the Council to— 

6 (A) ensure that adequate resources are 

7 available to effectively execute the responsibil8 ities of the Council; 

9 (B) effectively coordinate with other rel10 evant advisory bodies and working groups to 

11 avoid unnecessary duplication; 

12 (C) create transparency to the public and 

13 Congress with regard to Council membership, 

14 costs, and activities, including through use of 

15 modern technology and social media to dissemi16 nate information; and 

17 (D) avoid conflicts of interest that would 

18 jeopardize the ability of the Council to make de19 cisions and provide recommendations. 

20 (c) SOCIAL DETERMINANTS ACCELERATOR GRANTS

21 TO STATES OR LOCAL GOVERNMENTS.— 

22 (1) GRANTS TO STATES, LOCAL GOVERNMENTS, 

23 AND TRIBES.—Not later than 180 days after the 

24 date of enactment of this Act, the Administrator, in 

25 consultation with the Secretary and the Council, 


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1 shall award on a competitive basis not more than 25 

2 grants to eligible applicants described in paragraph 

3 (2), for the development of social determinants ac4 celerator plans, as described in paragraph (6). 

5 (2) ELIGIBLE APPLICANT.—An eligible appli6 cant described in this subsection is a State, local, or 

7 Tribal health or human services agency that— 

8 (A) demonstrates the support of relevant 

9 parties across relevant State, local, or Tribal ju10 risdictions; and 

11 (B) in the case of an applicant that is a 

12 local government agency, provides to the Sec13 retary a letter of support from the lead State 

14 health or human services agency for the State 

15 in which the local government is located. 

16 (3) AMOUNT OF GRANT.—The Administrator, 

17 in coordination with the Council, shall determine the 

18 total amount that the Administrator will make avail19 able to each grantee under this subsection. 

20 (4) APPLICATION.—An eligible applicant seek21 ing a grant under this subsection shall include in the 

22 application the following information: 

23 (A) The target population (or populations) 

24 that would benefit from implementation of the 


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1 social determinants accelerator plan proposed to 

2 be developed by the applicant. 

3 (B) A description of the objective or objec4 tives and outcome goals of such proposed plan, 

5 which shall include at least one health outcome 

6 and at least one other important social out7 come. 

8 (C) The sources and scope of inefficiencies 

9 that, if addressed by the plan, could result in 

10 improved cost-effectiveness of or return on in11 vestment from Federal, State, local, and Tribal 

12 governments. 

13 (D) A description of potential interventions 

14 that could be designed or enabled using such 

15 proposed plan. 

16 (E) The State, local, Tribal, academic, 

17 nonprofit, community-based organizations, and 

18 other private sector partners that would partici19 pate in the development of the proposed plan 

20 and subsequent implementation of programs or 

21 initiatives included in such proposed plan. 

22 (F) Such other information as the Admin23 istrator, in consultation with the Secretary and 

24 the Council, determines necessary to achieve the 

25 purposes of this section. 


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1 (5) USE OF FUNDS.—A recipient of a grant 

2 under this subsection may use funds received 

3 through the grant for the following purposes: 

4 (A) To convene and coordinate with rel5 evant government entities and other stake6 holders across sectors to assist in the develop7 ment of a social determinants accelerator plan. 

8 (B) To identify populations of individuals 

9 receiving medical assistance under a State plan 

10 (or a waiver of such plan) under title XIX of 

11 the Social Security Act (42 U.S.C. 1396 et 

12 seq.) who may benefit from the proposed ap13 proaches to improving the health and well-being 

14 of such individuals through the implementation 

15 of the proposed social determinants accelerator 

16 plan. 

17 (C) To engage qualified research experts to 

18 advise on relevant research and to design a pro19 posed evaluation plan, in accordance with the 

20 standards and guidelines issued by the Admin21 istrator. 

22 (D) To collaborate with the Council to sup23 port the development of social determinants ac24 celerator plans. 


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1 (E) To prepare and submit a final social 

2 determinants accelerator plan to the Council. 

3 (6) CONTENTS OF PLANS.—A social deter4 minants accelerator plan developed under this sub5 section shall include the following: 

6 (A) A description of the target population 

7 (or populations) that would benefit from imple8 mentation of the social determinants accelerator 

9 plan, including an analysis describing the pro10 jected impact on the well-being of individuals 

11 described in paragraph (5)(B). 

12 (B) A description of the interventions or 

13 approaches designed under the social deter14 minants accelerator plan and the evidence for 

15 selecting such interventions or approaches. 

16 (C) The objectives and outcome goals of 

17 such interventions or approaches, including at 

18 least one health outcome and at least one other 

19 important social outcome. 

20 (D) A plan for accessing and linking rel21 evant data to enable coordinated benefits and 

22 services for the jurisdictions described in para23 graph (2)(A) and an evaluation of the proposed 

24 interventions and approaches. 


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1 (E) A description of the State, local, Trib2 al, academic, nonprofit, or community-based or3 ganizations, or any other private sector organi4 zations that would participate in implementing 

5 the proposed interventions or approaches, and 

6 the role each would play to contribute to the 

7 success of the proposed interventions or ap8 proaches. 

9 (F) The identification of the funding 

10 sources that would be used to finance the pro11 posed interventions or approaches. 

12 (G) A description of any financial incen13 tives that may be provided, including outcome14 focused contracting approaches to encourage 

15 service providers and other partners to improve 

16 outcomes of, cost-effectiveness of, and return on 

17 investment from, Federal, State, local, or Tribal 

18 government spending. 

19 (H) The identification of the applicable 

20 Federal, State, local, or Tribal statutory and 

21 regulatory authorities, including waiver authori22 ties, to be leveraged to implement the proposed 

23 interventions or approaches. 

24 (I) A description of potential consider25 ations that would enhance the impact, 


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1 scalability, or sustainability of the proposed 

2 interventions or approaches and the actions the 

3 grant awardee would take to address such con4 siderations. 

5 (J) A proposed evaluation plan, to be car6 ried out by an independent evaluator, to meas7 ure the impact of the proposed interventions or 

8 approaches on the outcomes of, cost-effective9 ness of, and return on investment from, Fed10 eral, State, local, and Tribal governments. 

11 (K) Precautions for ensuring that vulner12 able populations will not be denied access to 

13 Medicaid or other essential services as a result 

14 of implementing the proposed plan. 

15 (d) FUNDING.— 

16 (1) IN GENERAL.—Out of any money in the 

17 Treasury not otherwise appropriated, there is appro18 priated to carry out this section $25,000,000 for the 

19 period of fiscal years 2025 through 2029, of which 

20 up to $5,000,000 may be used to carry out this sec21 tion, to remain available for obligation until the date 

22 that is 5 years after the date of enactment of this 

23 Act. 

24 (2) RESERVATION OF FUNDS.— 


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1 (A) IN GENERAL.—Of the funds made 

2 available under paragraph (1), the Secretary 

3 shall reserve not less than 20 percent to award 

4 grants to eligible applicants for the development 

5 of social determinants accelerator plans under 

6 subsection (c) intended to serve rural popu7 lations. 

8 (B) EXCEPTION.—In the case of a fiscal 

9 year for which the Secretary determines that 

10 there are not sufficient eligible applicants for 

11 grants under subsection (c) that are intended to 

12 serve rural populations and the Secretary can13 not satisfy the 20-percent requirement, the Sec14 retary may reserve an amount that is less than 

15 20 percent of amounts made available under 

16 paragraph (1) to award grants for such pur17 pose. 

18 (3) RULE OF CONSTRUCTION.—Nothing in this 

19 section shall prevent Federal agencies represented 

20 on the Council from contributing additional funding 

21 from other sources to support activities to improve 

22 the effectiveness of the Council. 


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1 SEC. 10015. IMPROVING SOCIAL DETERMINANTS OF 

2 HEALTH. 

3 (a) SOCIAL DETERMINANTS OF HEALTH PRO4 GRAM.— 

5 (1) PROGRAM.—To the extent and in the 

6 amounts made available in advance in appropriations 

7 Acts, the Director of the Centers for Disease Control 

8 and Prevention (in this section referred to as the 

9 ‘‘Director’’) shall carry out a program, to be known 

10 as the Social Determinants of Health Program (in 

11 this section referred to as the ‘‘Program’’), to 

12 achieve the following goals: 

13 (A) Improve health outcomes and reduce 

14 health inequities by coordinating social deter15 minants of health activities across the Centers 

16 for Disease Control and Prevention. 

17 (B) Improve the capacity of public health 

18 agencies and community organizations to ad19 dress social determinants of health in commu20 nities. 

21 (2) ACTIVITIES.—To achieve the goals listed in 

22 paragraph (1), the Director shall carry out activities 

23 including the following: 

24 (A) Coordinating across the Centers for 

25 Disease Control and Prevention to ensure that 

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1 cial determinants of health in grant awards and 

2 other activities. 

3 (B) Awarding grants under subsection (b) 

4 to State, local, territorial, and Tribal health 

5 agencies and organizations, and to other eligible 

6 entities, to address social determinants of 

7 health in target communities. 

8 (C) Awarding grants under subsection (c) 

9 to nonprofit organizations and public or other 

10 nonprofit institutions of higher education— 

11 (i) to conduct research on best prac12 tices to improve social determinants of 

13 health; 

14 (ii) to provide technical assistance, 

15 training, and evaluation assistance to 

16 grantees under subsection (b); and 

17 (iii) to disseminate best practices to 

18 grantees under subsection (b). 

19 (D) Coordinating, supporting, and aligning 

20 activities of the Centers for Disease Control and 

21 Prevention related to social determinants of 

22 health with activities of other Federal agencies 

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1 ment of Health and Human Services such as 

2 the Centers for Medicare & Medicaid Services. 

3 (E) Collecting and analyzing data related 

4 to the social determinants of health. 

5 (b) GRANTS TO ADDRESS SOCIAL DETERMINANTS

6 OF HEALTH.— 

7 (1) IN GENERAL.—The Director, as part of the 

8 Program, shall award grants to eligible entities to 

9 address social determinants of health in their com10 munities. 

11 (2) ELIGIBILITY.—To be eligible to apply for a 

12 grant under this subsection, an entity shall be— 

13 (A) a State, local, territorial, or Tribal 

14 health agency or organization; 

15 (B) a qualified nongovernmental entity, as 

16 defined by the Director; or 

17 (C) a consortium of entities that includes 

18 a State, local, territorial, or Tribal health agen19 cy or organization. 

20 (3) USE OF FUNDS.— 

21 (A) IN GENERAL.—A grant under this sub22 section shall be used to address social deter23 minants of health in a target community by de24 signing and implementing innovative, evidence25 based, cross-sector strategies. 


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1 (B) TARGET COMMUNITY.—For purposes 

2 of this subsection, a target community shall be 

3 a State, county, city, or other municipality. 

4 (4) PRIORITY.—In awarding grants under this 

5 subsection, the Director shall prioritize applicants 

6 proposing to serve target communities with signifi7 cant unmet health and social needs, as defined by 

8 the Director. 

9 (5) APPLICATION.—To seek a grant under this 

10 subsection, an eligible entity shall— 

11 (A) submit an application at such time, in 

12 such manner, and containing such information 

13 as the Director may require; 

14 (B) propose a set of activities to address 

15 social determinants of health through evidence16 based, cross-sector strategies, which activities 

17 may include— 

18 (i) collecting quantifiable data from 

19 health care, social services, and other enti20 ties regarding the most significant gaps in 

21 health-promoting social, economic, and en22 vironmental needs; 

23 (ii) identifying evidence-based ap24 proaches to meeting the nonmedical, social 

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1 lection described in clause (i), such as un2 stable housing or food insecurity; 

3 (iii) developing scalable methods to 

4 meet patients’ social needs identified in 

5 clinical settings or other sites; 

6 (iv) convening entities such as local 

7 and State governmental and nongovern8 mental organizations, health systems, 

9 payors, and community-based organiza10 tions to review, plan, and implement com11 munity-wide interventions and strategies to 

12 advance health-promoting social conditions; 

13 (v) monitoring and evaluating the im14 pact of activities funded through the grant 

15 on the health and well-being of the resi16 dents of the target community and on the 

17 cost of health care; and 

18 (vi) such other activities as may be 

19 specified by the Director; 

20 (C) demonstrate how the eligible entity will 

21 collaborate with— 

22 (i) health systems; 

23 (ii) payors, including, as appropriate, 

24 Medicaid managed care organizations (as 

25 defined in section 1903(m)(1)(A) of the 


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1 Social Security Act (42 U.S.C. 

2 1396b(m)(1)(A))), Medicare Advantage 

3 plans under part C of title XVIII of such 

4 Act (42 U.S.C. 1395w–21 et seq.), and 

5 health insurance issuers and group health 

6 plans (as such terms are defined in section 

7 2791 of the Public Health Service Act (42 

8 U.S.C. 300gg–91)); 

9 (iii) other relevant stakeholders and 

10 initiatives in areas of need, such as the Ac11 countable Health Communities Model of 

12 the Centers for Medicare & Medicaid Serv13 ices, health homes under the Medicaid pro14 gram under title XIX of the Social Secu15 rity Act (42 U.S.C. 1396 et seq.), commu16 nity-based organizations, and human serv17 ices organizations; 

18 (iv) other non-health care sector orga19 nizations, including organizations focusing 

20 on transportation, housing, or food access; 

21 and 

22 (v) local employers; and 

23 (D) identify key health inequities in the 

24 target community and demonstrate how the 


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1 proposed efforts of the eligible entity would ad2 dress such inequities. 

3 (6) MONITORING AND EVALUATION.—As a con4 dition of receipt of a grant under this subsection, a 

5 grantee shall agree to submit an annual report to 

6 the Director describing the activities carried out 

7 through the grant and the outcomes of such activi8 ties. 

9 (7) INDEPENDENT NATIONAL EVALUATION.— 

10 (A) IN GENERAL.—Not later than 5 years 

11 after the first grants are awarded under this 

12 subsection, the Director shall provide for the 

13 commencement of an independent national eval14 uation of the program under this subsection. 

15 (B) REPORT TO CONGRESS.—Not later 

16 than 60 days after receiving the results of such 

17 independent national evaluation, the Director 

18 shall report such results to Congress. 

19 (c) RESEARCH AND TRAINING.—The Director, as 

20 part of the Program— 

21 (1) shall award grants to nonprofit organiza22 tions and public or other nonprofit institutions of 

23 higher education— 

24 (A) to conduct research on best practices 

25 to improve social determinants of health; 


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1 (B) to provide technical assistance, train2 ing, and evaluation assistance to grantees under 

3 subsection (b); and 

4 (C) to disseminate best practices to grant5 ees under subsection (b); and 

6 (2) may require a grantee under paragraph (1) 

7 to provide technical assistance and capacity building 

8 to entities that are eligible entities under subsection 

9 (b) but not receiving funds through such subsection. 

10 (d) FUNDING.— 

11 (1) IN GENERAL.—There is authorized to be 

12 appropriated to carry out this section, $50,000,000 

13 for each of fiscal years 2025 through 2030. 

14 (2) ALLOCATION.—Of the amount made avail15 able to carry out this section for a fiscal year, not 

16 less than 75 percent shall be used for grants under 

17 subsections (b) and (c). 

18 SEC. 10016. NOTIFICATION REGARDING SNAP FOR STU19 DENTS RECEIVING FEDERAL WORK-STUDY 

20 ASSISTANCE. 

21 Section 443 of the Higher Education Act of 1965 (20 

22 U.S.C. 1087–53) is amended by adding at the end the fol23 lowing: 

24 ‘‘(f) NOTIFICATION REGARDING SNAP.— 


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1 ‘‘(1) IN GENERAL.—An institution receiving a 

2 grant under this part shall send a notification (by 

3 email or other electronic means) to each eligible stu4 dent informing the student of their potential eligi5 bility for participation in SNAP and the process for 

6 obtaining more information, confirming eligibility, 

7 and accessing benefits under that program. The no8 tification shall be developed by the Secretary of Edu9 cation in consultation with the Secretary of Agri10 culture, and shall include details on eligibility re11 quirements for participation in SNAP that a student 

12 must satisfy. The notification shall be, to the extent 

13 practicable, specific to the student’s State of resi14 dence and shall provide contact information for the 

15 local office where an application for SNAP may be 

16 made. 

17 ‘‘(2) EVIDENCE OF PARTICIPATION IN FEDER18 ALLY FINANCED WORK-STUDY PROGRAM.—The noti19 fication under paragraph (1) shall include an official 

20 document confirming that the recipient is an eligible 

21 student sufficient for purposes of demonstrating that 

22 the exclusion from ineligibility for participation in 

23 SNAP under section 6(e)(4) of the Food and Nutri24 tion Act of 2008 (7 U.S.C. 2015(e)(4)) applies to 

25 the student. 


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1 ‘‘(3) GUIDANCE.—The Secretary of Education, 

2 in consultation with the Secretary of Agriculture, 

3 shall provide guidance to States and institutions of 

4 higher education on how to identify and commu5 nicate with students who are likely to be eligible for 

6 SNAP, including those eligible for a State or feder7 ally financed work-study program. 

8 ‘‘(4) DEFINITIONS.—For purposes of this sub9 section: 

10 ‘‘(A) The term ‘eligible student’ means a 

11 student receiving work-study assistance under 

12 this part. 

13 ‘‘(B) The term ‘SNAP’ means the supple14 mental nutrition assistance program (as defined 

15 in section 3(t) of the Food and Nutrition Act 

16 of 2008 (7 U.S.C. 2012(t))).’’. 

17 Subtitle B—Gun Violence 

18 SEC. 10101. REAFFIRMING RESEARCH AUTHORITY OF THE 

19 CENTERS FOR DISEASE CONTROL AND PRE20 VENTION. 

21 (a) IN GENERAL.—Section 391 of the Public Health 

22 Service Act (42 U.S.C. 280b) is amended— 

23 (1) in subsection (a)(1), by striking ‘‘research 

24 relating to the causes, mechanisms, prevention, diag25 nosis, treatment of injuries, and rehabilitation from 


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1 injuries;’’ and inserting the following: ‘‘research, in2 cluding data collection, relating to— 

3 ‘‘(A) the causes, mechanisms, prevention, 

4 diagnosis, and treatment of injuries, including 

5 with respect to gun violence; and 

6 ‘‘(B) rehabilitation from such injuries;’’; 

7 and 

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

9 ‘‘(c) NO ADVOCACY OR PROMOTION OF GUN CON10 TROL.—Nothing in this section shall be construed to— 

11 ‘‘(1) authorize the Secretary to give assistance, 

12 make grants, or enter into cooperative agreements or 

13 contracts for the purpose of advocating or promoting 

14 gun control; or 

15 ‘‘(2) permit a recipient of any assistance, grant, 

16 cooperative agreement, or contract under this section 

17 to use such assistance, grant, agreement, or contract 

18 for the purpose of advocating or promoting gun con19 trol.’’. 

20 SEC. 10102. NATIONAL VIOLENT DEATH REPORTING SYS21 TEM. 

22 The Secretary, acting through the Director of the 

23 Centers for Disease Control and Prevention, shall improve 

24 the National Violent Death Reporting System (as author25 ized by sections 301(a) and 391(a) of the Public Service 


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1 Health Act (42 U.S.C. 241(a), 280b(a)), particularly 

2 through the inclusion of additional States and activities 

3 to increase the quality, type, and timeliness of reported 

4 data. Participation in the System by the States shall be 

5 voluntary. 

6 SEC. 10103. REPORT ON EFFECTS OF GUN VIOLENCE ON 

7 PUBLIC HEALTH. 

8 Not later than one year after the date of enactment 

9 of this Act, and annually thereafter, the Surgeon General 

10 shall submit to Congress a report on the effects on public 

11 health, including mental health, of gun violence in the 

12 United States during the preceding year, and the status 

13 of actions taken to address such effects. 

14 SEC. 10104. REPORT ON EFFECTS OF GUN VIOLENCE ON 

15 MENTAL HEALTH IN MINORITY COMMU16 NITIES. 

17 Not later than one year after the date of enactment 

18 of this Act, the Deputy Assistant Secretary for Minority 

19 Health shall submit to Congress a report on the effects 

20 of gun violence on public health, including mental health, 

21 in minority communities in the United States, and the sta22 tus of actions taken to address such effects. 


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1 Subtitle C—Nutrition for Women, 

2 Children, Families 

3 CHAPTER 1—SENIOR HUNGER 

4 PREVENTION 

5 SEC. 10201. SHORT TITLE. 

6 This chapter may be cited as the ‘‘Senior Hunger 

7 Prevention Act of 2024’’. 

8 SEC. 10202. IMPROVING SNAP EFFICACY. 

9 (a) CERTIFICATION PERIOD.—Section 3(f) of the 

10 Food and Nutrition Act of 2008 (7 U.S.C. 2012(f)) is 

11 amended, in the second sentence, by striking ‘‘24’’ and 

12 inserting ‘‘36’’. 

13 (b) STANDARD MEDICAL EXPENSE DEDUCTION.— 

14 Section 5(e)(5) of the Food and Nutrition Act of 2008 

15 (7 U.S.C. 2014(e)(5)) is amended— 

16 (1) in the paragraph heading, by striking ‘‘EX17 CESS MEDICAL’’ and inserting ‘‘MEDICAL’’; 

18 (2) in subparagraph (A), by striking ‘‘an excess 

19 medical’’ and all that follows through the period at 

20 the end and inserting ‘‘a standard medical deduction 

21 or a medical expense deduction of actual costs for 

22 the allowable medical expenses incurred by the elder23 ly or disabled member, exclusive of special diets.’’; 

24 (3) in subparagraph (B)(i), by striking ‘‘ex25 cess’’; and 


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1 (4) by adding at the end the following: 

2 ‘‘(D) STANDARD MEDICAL EXPENSE DE3 DUCTION AMOUNT.— 

4 ‘‘(i) IN GENERAL.—Except as pro5 vided in clause (ii), the standard medical 

6 expense deduction shall be equal to— 

7 ‘‘(I) for fiscal year 2024, $155; 

8 and 

9 ‘‘(II) for each subsequent fiscal 

10 year, the applicable amount for the 

11 immediately preceding fiscal year, as 

12 adjusted to reflect changes for the 12- 

13 month period ending the preceding 

14 June 30 in the Consumer Price Index 

15 for All Urban Consumers: Medical 

16 Care published by the Bureau of 

17 Labor Statistics of the Department of 

18 Labor. 

19 ‘‘(ii) EXCEPTION.—For any fiscal 

20 year, a State agency may establish a great21 er standard medical expense deduction 

22 than the deduction described in clause (i) 

23 if the greater deduction satisfies the appli24 cable cost-neutrality standards established 

25 by the Secretary for that fiscal year.’’. 


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1 (c) VALUE OF ALLOTMENT.—Section 8(a) of the 

2 Food and Nutrition Act of 2008 (7 U.S.C. 2017(a)) is 

3 amended, in the proviso, by striking ‘‘8 percent’’ and inserting ‘‘1 4 ⁄3’’. 

5 SEC. 10203. STREAMLINING NUTRITION ACCESS FOR 

6 OLDER ADULTS AND ADULTS WITH DISABIL7 ITIES. 

8 (a) DEFINITION OF ELDERLY AND DISABLED.—Sec9 tion 3(j) of the Food and Nutrition Act of 2008 (7 U.S.C. 

10 2012(j)) is amended— 

11 (1) in the matter preceding paragraph (1), by 

12 striking the subsection designation and all that fol13 lows through ‘‘who’’ and inserting the following: 

14 ‘‘(j) ELDERLY OR DISABLED.—The term ‘elderly or 

15 disabled’, with respect to an individual or member of a 

16 household, means that the individual or member of the 

17 household’’; and 

18 (2) in paragraph (2)(B), by inserting ‘‘(which 

19 includes medical assistance provided to an individual 

20 described in section 1902(e)(14)(D)(i)(III) of that 

21 Act (42 U.S.C. 1396a(e)(14)(D)(i)(III)))’’ after 

22 ‘‘(42 U.S.C. 1396 et seq.)’’. 

23 (b) ELDERLY SIMPLIFIED APPLICATION PRO24 GRAM.—The Food and Nutrition Act of 2008 (7 U.S.C. 


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1 2011 et seq.) is amended by adding at the end the fol2 lowing: 

3 ‘‘SEC. 31. ELDERLY SIMPLIFIED APPLICATION PROGRAM. 

4 ‘‘(a) IN GENERAL.—Not later than 180 days after 

5 the date of enactment of this section, the Secretary shall 

6 establish a program, to be known as the ‘elderly simplified 

7 application program’ (referred to in this section as 

8 ‘ESAP’), under which a State, in carrying out the supple9 mental nutrition assistance program, may elect to imple10 ment a streamlined application and certification process 

11 for households in which all adult members— 

12 ‘‘(1) are elderly or disabled members; and 

13 ‘‘(2) have no earned income. 

14 ‘‘(b) CERTIFICATION PERIOD.—The certification pe15 riod for participants in ESAP shall be 36 months. 

16 ‘‘(c) INCOME AND OTHER DATA VERIFICATION.— 

17 ‘‘(1) IN GENERAL.—A State agency deter18 mining the eligibility for an applicant household 

19 under ESAP shall, notwithstanding section 

20 11(e)(3)— 

21 ‘‘(A) to the maximum extent practicable, 

22 use data matching for income verification and 

23 household size; and 

24 ‘‘(B)(i) allow self-declaration by the appli25 cant of the information required under section 


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1 273.2(f) of title 7, Code of Federal Regulations 

2 (or a successor regulation); but 

3 ‘‘(ii) verify, prior to certification of the 

4 household, factors of eligibility provided by the 

5 applicant that the State agency determines are 

6 questionable. 

7 ‘‘(2) ACCOUNTABILITY AND FRAUD PREVEN8 TION.—In carrying out paragraph (1), a State agen9 cy shall establish accountability and fraud protection 

10 measures to deter fraud and ensure the integrity of 

11 ESAP and the supplemental nutrition assistance 

12 program. 

13 ‘‘(d) INTERVIEWS.— 

14 ‘‘(1) IN GENERAL.—Notwithstanding section 

15 11(e)(6)(A), for recertification of a household under 

16 ESAP, a State agency shall not require an interview 

17 unless requested by the household. 

18 ‘‘(2) VIRTUAL INTERVIEWS.—An interview 

19 under paragraph (1) may be conducted virtually. 

20 ‘‘(e) GUIDANCE.—Prior to the establishment of 

21 ESAP under subsection (a), the Administrator of the 

22 Food and Nutrition Service shall develop guidance for 

23 States, including by consulting with States, to carry out 

24 ESAP, which shall include— 

25 ‘‘(1) general implementation guidelines; 


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1 ‘‘(2) reporting requirements; 

2 ‘‘(3) quality control requirements; and 

3 ‘‘(4) best practices.’’. 

4 (c) COMBINED APPLICATION PROGRAM.—The Food 

5 and Nutrition Act of 2008 (7 U.S.C. 2011 et seq.) (as 

6 amended by subsection (b)) is amended by adding at the 

7 end the following: 

8 ‘‘SEC. 32. COMBINED APPLICATION PROGRAM. 

9 ‘‘(a) IN GENERAL.—Not later than 180 days after 

10 the date of enactment of this section, the Secretary, in 

11 coordination with the Commissioner of Social Security, 

12 shall establish a program, to be known as the ‘combined 

13 application program’ (referred to in this section as ‘CAP’), 

14 under which a State, in carrying out the supplemental nu15 trition assistance program, may elect to implement a 

16 streamlined application process for households in which all 

17 adult members are applicants for or recipients of benefits 

18 under title II of the Social Security Act (42 U.S.C. 401 

19 et seq.) on the basis of a disability or supplemental secu20 rity income under title XVI of that Act (42 U.S.C. 1381 

21 et seq.). 

22 ‘‘(b) PURPOSES.—The purposes of CAP are— 

23 ‘‘(1) to reduce the need for households de24 scribed in subsection (a) to have in-person interviews 


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1 with State offices administering the supplemental 

2 nutrition assistance program; and 

3 ‘‘(2) to increase participation in the supple4 mental nutrition assistance program by simplifying 

5 the application process for the supplemental nutri6 tion assistance program through increased automa7 tion and simplified calculation of benefits. 

8 ‘‘(c) CAP MODELS.—The Secretary, in coordination 

9 with the Commissioner of the Social Security Administra10 tion, shall offer, at a minimum, each of the following mod11 els for States to implement CAP: 

12 ‘‘(1) STANDARD MODEL.— 

13 ‘‘(A) IN GENERAL.—Under the standard 

14 model, the Commissioner of the Social Security 

15 Administration and the State agency admin16 istering the supplemental nutrition assistance 

17 program shall coordinate— 

18 ‘‘(i) to develop a simplified joint appli19 cation process for the supplemental nutri20 tion assistance program that uses stand21 ardized benefit amounts or standardized 

22 shelter expenses, in accordance with this 

23 paragraph; and 

24 ‘‘(ii) to conduct outreach to adult 

25 members receiving supplemental security 


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1 income under title XVI of the Social Secu2 rity Act (42 U.S.C. 1381 et seq.) that are 

3 not receiving benefits under the supple4 mental nutrition assistance program. 

5 ‘‘(B) STANDARDIZED BENEFIT

6 AMOUNTS.— 

7 ‘‘(i) IN GENERAL.—Under the stand8 ardized model described in subparagraph 

9 (A), applicants shall receive a standardized 

10 or automated benefit level under the sup11 plemental nutrition assistance program 

12 based on the shelter expenses and other in13 come of the applicants. 

14 ‘‘(ii) MINIMUM STANDARDIZED BEN15 EFIT LEVELS.—At a minimum, there shall 

16 be in effect 2 standardized benefit levels 

17 under clause (i), including, as determined 

18 by the State— 

19 ‘‘(I) a level for participants with 

20 low shelter expenses; and 

21 ‘‘(II) a level for participants with 

22 high shelter expenses. 

23 ‘‘(iii) COMPARABLE AMOUNT.—A 

24 State shall ensure that the amount pro25 vided under a standardized benefit level 


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1 under clause (i) is comparable to an 

2 amount that a participant would otherwise 

3 receive under the supplemental nutrition 

4 assistance program. 

5 ‘‘(iv) REFERRAL.—A State shall refer 

6 a household described in subsection (a) to 

7 the supplemental nutrition assistance pro8 gram instead of enrolling that household in 

9 CAP if the standardized amount that the 

10 household would receive under CAP would 

11 be significantly less than the amount of 

12 benefits that the household would receive 

13 under the supplemental nutrition assist14 ance program. 

15 ‘‘(C) STANDARDIZED SHELTER EX16 PENSES.—In computing an excess shelter ex17 pense deduction under section 5(e)(6), a State 

18 agency may use a standard utility allowance in 

19 accordance with regulations promulgated by the 

20 Secretary. 

21 ‘‘(2) MODIFIED MODEL.—Under the modified 

22 model, a State agency administering the supple23 mental nutrition assistance program shall— 

24 ‘‘(A) conduct outreach to prospective par25 ticipants in the supplemental nutrition assistVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 01705 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 ance program using information from the Social 

2 Security Administration to identify households 

3 described in subsection (a) that are not partici4 pants in the supplemental nutrition assistance 

5 program; and 

6 ‘‘(B) send to those households simplified 

7 application forms for the supplemental nutrition 

8 assistance program.’’. 

9 SEC. 10204. ENROLLMENT AND OUTREACH PILOT PRO10 GRAM FOR OLDER ADULTS, KINSHIP FAMI11 LIES, AND ADULTS WITH DISABILITIES. 

12 The Food and Nutrition Act of 2008 (7 U.S.C. 2011 

13 et seq.) (as amended by section 10203(c)) is amended by 

14 adding at the end the following: 

15 ‘‘SEC. 33. ENROLLMENT AND OUTREACH PILOT PROGRAM 

16 FOR OLDER ADULTS, KINSHIP FAMILIES, AND 

17 ADULTS WITH DISABILITIES. 

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

19 ‘‘(1) DISABILITY.—The term ‘disability’ has the 

20 meaning given the term in section 3 of the Ameri21 cans with Disabilities Act of 1990 (42 U.S.C. 

22 12102). 

23 ‘‘(2) ELIGIBLE ENTITY.—The term ‘eligible en24 tity’ means— 

25 ‘‘(A) a State or local government agency; 


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1 ‘‘(B) an Indian tribe or Tribal organiza2 tion; 

3 ‘‘(C) a nonprofit organization, including a 

4 public or nonprofit provider of services; 

5 ‘‘(D) a community-based organization; and 

6 ‘‘(E) an educational provider. 

7 ‘‘(3) KINSHIP FAMILY.—The term ‘kinship fam8 ily’ means a family in which a child resides with, 

9 and is being raised by, a grandparent, another ex10 tended family member, or an adult with whom the 

11 child has a close family-like relationship, such as a 

12 godparent or a close family friend. 

13 ‘‘(4) OLDER ADULT.—The term ‘older adult’ 

14 has the meaning given the term ‘older individual’ in 

15 section 102 of the Older Americans Act of 1965 (42 

16 U.S.C. 3002). 

17 ‘‘(5) PILOT PROGRAM.—The term ‘pilot pro18 gram’ means the Enrollment and Outreach Pilot 

19 Program for Older Adults, Kinship Families, and 

20 Adults with Disabilities established under subsection 

21 (b). 

22 ‘‘(b) ESTABLISHMENT.—Not later than 180 days 

23 after the date of enactment of this section, the Secretary 

24 shall establish a pilot program, to be known as the ‘Enroll25 ment and Outreach Pilot Program for Older Adults, KinVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 01707 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 ship Families, and Adults with Disabilities’, under which 

2 the Secretary shall award grants to eligible entities— 

3 ‘‘(1) to raise awareness among older adults, 

4 kinship families, and adults with disabilities of the 

5 availability, eligibility requirements, application pro6 cedures, and benefits of the supplemental nutrition 

7 assistance program; and 

8 ‘‘(2) to support older adults, kinship families, 

9 and adults with disabilities in enrolling in the sup10 plemental nutrition assistance program. 

11 ‘‘(c) PRIORITY.—In awarding grants under the pilot 

12 program, the Secretary shall give priority to— 

13 ‘‘(1) eligible entities that— 

14 ‘‘(A) provide services to older adults or 

15 adults with disabilities; 

16 ‘‘(B) provide services to kinship families, 

17 including kinship navigator programs; 

18 ‘‘(C) have experience implementing pro19 grams that receive funding under the Older 

20 Americans Act of 1965 (42 U.S.C. 3001 et 

21 seq.); 

22 ‘‘(D) have experience implementing pro23 grams administered by the Food and Nutrition 

24 Service; or 


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1 ‘‘(E) receive, plan to receive, or dem2 onstrate an ability to partner with a program 

3 that receives, funding under— 

4 ‘‘(i) the Older Americans Act of 1965 

5 (42 U.S.C. 3001 et seq.); 

6 ‘‘(ii) the Americans with Disabilities 

7 Act of 1990 (42 U.S.C. 12101 et seq.); or 

8 ‘‘(iii) 1 or more nutrition programs 

9 administered by the Secretary; and 

10 ‘‘(2) projects that will— 

11 ‘‘(A) serve communities with— 

12 ‘‘(i) high rates of food insecurity or 

13 malnutrition; or 

14 ‘‘(ii) low food access; 

15 ‘‘(B) serve rural communities, indigenous 

16 communities, or communities of color; 

17 ‘‘(C) serve members of the lesbian, gay, bi18 sexual, transgender, and queer community; 

19 ‘‘(D) serve adults with limited English pro20 ficiency; 

21 ‘‘(E) serve veterans; 

22 ‘‘(F) serve residents in federally subsidized 

23 housing, including federally subsidized housing 

24 units for older adults and adults with disabil25 ities; 


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1 ‘‘(G) serve residents living in housing serv2 ing kinship families; and 

3 ‘‘(H) incorporate nutrition education ac4 tivities that promote healthy eating and active 

5 lifestyles. 

6 ‘‘(d) ELIGIBLE ACTIVITIES.—An eligible entity re7 ceiving a grant under the pilot program shall use the grant 

8 to carry out 1 or more of the following activities: 

9 ‘‘(1) Application assistance, including— 

10 ‘‘(A) eligibility prescreening; 

11 ‘‘(B) assistance in completing an applica12 tion for the supplemental nutrition assistance 

13 program; 

14 ‘‘(C) assistance in obtaining application 

15 verification documents; 

16 ‘‘(D) medical expense deduction coun17 seling; and 

18 ‘‘(E) translation of materials and bilingual 

19 accommodation. 

20 ‘‘(2) Tailored dissemination of information re21 lating to the supplemental nutrition assistance pro22 gram, including through— 

23 ‘‘(A) community-based outreach workshops 

24 and events; 


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1 ‘‘(B) a toll-free hotline to provide informa2 tion relating to Federal, State, and local food 

3 resources; 

4 ‘‘(C) informational websites and other so5 cial media sites; and 

6 ‘‘(D) printed or digital informational con7 tent. 

8 ‘‘(3) Transportation, including— 

9 ‘‘(A) transportation to or from a local of10 fice of the supplemental nutrition assistance 

11 program; and 

12 ‘‘(B) administration of vouchers or similar 

13 items for the transportation described in sub14 paragraph (A). 

15 ‘‘(4) Identification, implementation, analysis, 

16 and dissemination of replicable and scalable models 

17 for increasing enrollment in the supplemental nutri18 tion assistance program among older adults, kinship 

19 families, and adults with disabilities. 

20 ‘‘(e) GRANTS.— 

21 ‘‘(1) MAXIMUM AMOUNT.—A grant awarded 

22 under the pilot program to an eligible entity for a 

23 fiscal year shall be— 

24 ‘‘(A) not less than $50,000; and 

25 ‘‘(B) not more than $250,000. 


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1 ‘‘(2) DURATION.—An eligible entity may be 

2 awarded a grant under the pilot program for not 

3 more than 5 years. 

4 ‘‘(f) EVALUATION.—Not later than 2 years after the 

5 date of establishment of the pilot program, the Secretary 

6 shall conduct an evaluation of the pilot program. 

7 ‘‘(g) FUNDING.— 

8 ‘‘(1) IN GENERAL.—In addition to amounts 

9 otherwise available, there is appropriated, out of any 

10 funds in the Treasury not otherwise appropriated, 

11 $12,250,000, to remain available until expended, to 

12 carry out the pilot program, of which not more than 

13 $250,000 shall be used to carry out the evaluation 

14 under subsection (f). 

15 ‘‘(2) ADMINISTRATIVE COSTS.—Of the amounts 

16 made available under paragraph (1) (excluding the 

17 amount made available to carry out subsection (f)), 

18 not more than 3 percent may be used by the Sec19 retary for administrative costs.’’. 

20 SEC. 10205. FOOD DELIVERY UNDER SUPPLEMENTAL NU21 TRITION ASSISTANCE PROGRAM. 

22 The Food and Nutrition Act of 2008 (7 U.S.C. 2011 

23 et seq.) (as amended by section 10204) is amended by 

24 adding at the end the following: 


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1 ‘‘SEC. 34. FOOD DELIVERY. 

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

3 ‘‘(1) COVERED RETAIL FOOD STORE.—The 

4 term ‘covered retail food store’ means a retail food 

5 store, a public or private nonprofit meal delivery 

6 service, or a public or nonprofit meal delivery pro7 vider participating in the supplemental nutrition as8 sistance program that is unable to cover the cost of 

9 food delivery for participants of the supplemental 

10 nutrition assistance program. 

11 ‘‘(2) EMPLOYEE.—The term ‘employee’ has the 

12 meaning given the term in section 3 of the Fair 

13 Labor Standards Act of 1938 (29 U.S.C. 203). 

14 ‘‘(b) PROGRAM MODIFICATIONS.— 

15 ‘‘(1) IN GENERAL.—In carrying out the supple16 mental nutrition assistance program, the Secretary 

17 shall— 

18 ‘‘(A) notify retail food stores participating 

19 in the supplemental nutrition assistance pro20 gram of existing opportunities through which 

21 the retail food stores can deliver food to pro22 gram participants, including by— 

23 ‘‘(i) allowing an EBT card to be 

24 swiped with a mobile device on delivery of 

25 food to the home; and 

26 ‘‘(ii) preparing food for pickup; 


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1 ‘‘(B) authorize public-private partnerships 

2 between the Department of Agriculture, retail 

3 food stores participating in the supplemental 

4 nutrition assistance program, and community5 based organizations to provide free or low-cost 

6 food delivery, including through the use of pri7 vate funds; 

8 ‘‘(C) in the case of a covered retail food 

9 store, use funds made available under subpara10 graph (E) of paragraph (3) to provide, in ac11 cordance with that paragraph, free grocery de12 livery for participants in the supplemental nu13 trition assistance program who are older adults 

14 or adults with disabilities (as those terms are 

15 defined in section 33(a)) who are unable to 

16 shop for food or lack safe and accessible trans17 portation options to the covered retail food 

18 store; and 

19 ‘‘(D) require each State to submit to the 

20 Secretary a plan that describes the methods by 

21 which the State will— 

22 ‘‘(i) work with retail food stores par23 ticipating in the supplemental nutrition as24 sistance program and other communityVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 01714 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 based partners to establish a process for 

2 food delivery for program participants; 

3 ‘‘(ii) administer the reimbursements 

4 described in paragraph (3), including tim5 ing, eligibility, and distribution processes; 

6 and 

7 ‘‘(iii) ensure that retail food stores 

8 participating in the supplemental nutrition 

9 assistance program that are reimbursed for 

10 delivery costs under paragraph (3) adhere 

11 to the requirements described in subpara12 graph (B) of that paragraph. 

13 ‘‘(2) STATE PLANS.—Not later than 10 days 

14 after the date on which the Secretary receives a 

15 State plan under paragraph (1)(D), the Secretary 

16 shall— 

17 ‘‘(A) determine whether to approve or dis18 approve the State plan; and 

19 ‘‘(B) make publicly available on the 

20 website of the Department of Agriculture— 

21 ‘‘(i) the State plan; 

22 ‘‘(ii) the determination made under 

23 subparagraph (A) with respect to that 

24 plan; and 


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1 ‘‘(iii) any guidance issued to the State 

2 with respect to that plan. 

3 ‘‘(3) REIMBURSEMENT OF COVERED RETAIL

4 FOOD STORES.— 

5 ‘‘(A) IN GENERAL.—Notwithstanding any 

6 other provision of law (including sections 

7 274.7(f) and 278.2(b) of title 7, Code of Fed8 eral Regulations (or successor regulations), and 

9 any other regulations), subject to the avail10 ability of funds, a State agency shall reimburse 

11 a covered retail food store for the cost of food 

12 delivery to participants described in paragraph 

13 (1)(C) if— 

14 ‘‘(i) the covered retail food store 

15 meets the requirements under subpara16 graph (B); and 

17 ‘‘(ii) the majority of the number of 

18 food items delivered by the covered retail 

19 food store are eligible for redemption using 

20 benefits under the supplemental nutrition 

21 assistance program, regardless of whether 

22 the delivery includes nonfood items, subject 

23 to the condition that those nonfood items 

24 shall be of de minimis value. 


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1 ‘‘(B) REQUIREMENTS.—A covered retail 

2 food store may receive reimbursement for the 

3 cost of food delivery to participants described in 

4 paragraph (1)(C) if the following requirements 

5 are met: 

6 ‘‘(i) Food delivery is performed by 

7 employees of the covered retail food store 

8 or employees of an entity contracted by the 

9 covered retail food store to perform deliv10 eries. 

11 ‘‘(ii) Before any employee described in 

12 clause (i) begins making food deliveries, 

13 that employee receives employer-provided 

14 health and safety training that reflects the 

15 most recent guidelines of the Centers for 

16 Disease Control and Prevention. 

17 ‘‘(iii) All employees described in 

18 clause (i) performing deliveries are paid at 

19 a rate that is not less than the greater 

20 of— 

21 ‘‘(I) the minimum wage rate es22 tablished under section 6(a)(1) of the 

23 Fair Labor Standards Act of 1938 

24 (29 U.S.C. 206(a)(1)); and 


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1 ‘‘(II) the minimum wage rate es2 tablished by the applicable State or lo3 cality in which the employee works. 

4 ‘‘(iv) The covered retail food store 

5 meets the size standard determined by the 

6 Small Business Administration for a super7 market or other grocery retailer or a con8 venience retailer under section 121.201 of 

9 title 13, Code of Federal Regulations (or a 

10 successor regulation). 

11 ‘‘(v) The covered retail food store does 

12 not— 

13 ‘‘(I) charge the supplemental nu14 trition assistance program participant 

15 for delivery costs for which the cov16 ered retail food store will be reim17 bursed; 

18 ‘‘(II) require minimum purchase 

19 thresholds in order to provide free de20 livery; 

21 ‘‘(III) restrict delivery times to 

22 least-favorable windows for those par23 ticipants; or 

24 ‘‘(IV) charge surge pricing. 


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1 ‘‘(C) REIMBURSABLE COSTS.—Reimburs2 able costs under subparagraph (A) include costs 

3 associated with purchasing point-of-sale devices 

4 or receiving technical assistance relating to 

5 point-of-sale devices. 

6 ‘‘(D) MAXIMUM REIMBURSEMENT PER DE7 LIVERY.—The maximum amount of reimburse8 ment under subparagraph (A) for a food deliv9 ery fee shall be $10 per delivery, which may be 

10 adjusted by the Secretary for inflation. 

11 ‘‘(E) AUTHORIZATION OF APPROPRIA12 TIONS.—There is authorized to be appropriated 

13 to the Secretary $500,000,000 for fiscal year 

14 2025, and each fiscal year thereafter, to remain 

15 available until expended, to cover the cost of 

16 food delivery described in paragraph (1)(C), to 

17 be distributed among States to fund reimburse18 ments by States under subparagraph (A). 

19 ‘‘(4) REPORT.—Not later than April 30, 2026, 

20 and April 30 of each year thereafter, the Secretary 

21 shall submit to the Committee on Agriculture, Nutri22 tion, and Forestry of the Senate and the Committee 

23 on Agriculture of the House of Representatives a re24 port that describes, for the period covered by the re25 port, as applicable— 


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1 ‘‘(A) the number of supplemental nutrition 

2 assistance program participants using food de3 livery services, including the percentage of those 

4 participants that are older adults and adults 

5 with disabilities (as those terms are defined in 

6 section 33(a)); 

7 ‘‘(B) the covered retail food stores that 

8 were reimbursed under paragraph (3), including 

9 the amount of each reimbursement; 

10 ‘‘(C) any complications or difficulties expe11 rienced by States in administering reimburse12 ments under paragraph (3); and 

13 ‘‘(D) recommendations or best practices to 

14 assist States in implementing food delivery pro15 grams similar to the program under this sec16 tion.’’. 

17 SEC. 10206. COMMODITY SUPPLEMENTAL FOOD PROGRAM. 

18 (a) FUNDS.—Section 4 of the Agriculture and Con19 sumer Protection Act of 1973 (7 U.S.C. 612c note; Public 

20 Law 93–86) is amended— 

21 (1) in subsection (a), in the first sentence, by 

22 striking ‘‘2023’’ and inserting ‘‘2028’’; and 

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

24 ‘‘(d) FUNDS.—In addition to amounts otherwise 

25 available, there is appropriated, out of any funds in the 


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1 Treasury not otherwise appropriated, to carry out the pro2 gram under this section $10,000,000 for each of fiscal 

3 years 2024 through 2028.’’. 

4 (b) ADULTS WITH DISABILITIES.—Section 5 of the 

5 Agriculture and Consumer Protection Act of 1973 (7 

6 U.S.C. 612c note; Public Law 93–86) is amended— 

7 (1) by striking ‘‘2023’’ each place it appears 

8 and inserting ‘‘2028’’; 

9 (2) in subsection (g)— 

10 (A) in paragraph (1), by striking ‘‘to low11 income persons aged 60 and older.’’ and insert12 ing the following: ‘‘to— 

13 ‘‘(A) low-income persons aged 60 and 

14 older; and 

15 ‘‘(B) low-income adults with disabilities (as 

16 defined in section 3 of the Americans with Dis17 abilities Act of 1990 (42 U.S.C. 12102)).’’; 

18 (B) by redesignating paragraph (2) as 

19 paragraph (3); 

20 (C) by inserting after paragraph (1) the 

21 following: 

22 ‘‘(2) INCOME ELIGIBILITY.—For purposes of 

23 paragraph (1), a low-income individual described in 

24 subparagraph (A) or (B) of that paragraph shall 


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1 have a gross income level that is less than 185 per2 cent of the Federal poverty line.’’; and 

3 (D) in subparagraph (B) of paragraph (3) 

4 (as so redesignated), in the matter preceding 

5 clause (i), by striking ‘‘of—’’ and all that fol6 lows through the period at the end of clause (ii) 

7 and inserting ‘‘of 36 months.’’; and 

8 (3) in subsection (i), in the matter preceding 

9 paragraph (1)— 

10 (A) by inserting ‘‘or low-income adults 

11 with disabilities described in subsection 

12 (g)(1)(B)’’ after ‘‘elderly persons’’; and 

13 (B) by striking ‘‘to each elderly participant 

14 in, or applicant for, the commodity supple15 mental food program for the elderly’’ and in16 serting ‘‘to each participant in, or applicant for, 

17 such a program’’. 

18 SEC. 10207. SENIORS FARMERS’ MARKET NUTRITION PRO19 GRAM. 

20 (a) IN GENERAL.—Section 4402 of the Farm Secu21 rity and Rural Investment Act of 2002 (7 U.S.C. 3007) 

22 is amended— 

23 (1) in subsection (a)— 

24 (A) by striking ‘‘Of the funds’’ and insert25 ing the following: 


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1 ‘‘(1) MANDATORY FUNDING.—Of the funds’’; 

2 (B) in paragraph (1) (as so designated), by 

3 inserting ‘‘(referred to in this section as the 

4 ‘Secretary’)’’ after ‘‘Agriculture’’; and 

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

6 ‘‘(2) AUTHORIZATION OF APPROPRIATIONS.— 

7 There are authorized to be appropriated to the Sec8 retary to carry out and expand the seniors farmers’ 

9 market nutrition program— 

10 ‘‘(A) not less than $60,000,000 for fiscal 

11 year 2024; 

12 ‘‘(B) not less than $70,000,000 for fiscal 

13 year 2025; and 

14 ‘‘(C) not less than $100,000,000 for each 

15 of fiscal years 2026 through 2028.’’; 

16 (2) in subsection (b)(1), by inserting ‘‘and 

17 adults with disabilities (as defined in section 3 of the 

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

19 12102))’’ before the semicolon at the end; 

20 (3) by redesignating subsections (c) through (f) 

21 as subsections (f) through (i), respectively; and 

22 (4) by inserting after subsection (b) the fol23 lowing: 

24 ‘‘(c) BENEFIT AMOUNTS.—Under the seniors farm25 ers’ market nutrition program— 


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1 ‘‘(1) the minimum individual benefit shall be 

2 $35; and 

3 ‘‘(2) the maximum individual benefit shall be 

4 $80. 

5 ‘‘(d) CERTIFICATION PERIOD.—The certification pe6 riod for participants in the seniors farmers’ market nutri7 tion program shall be 36 months. 

8 ‘‘(e) MODERNIZATION GRANTS.— 

9 ‘‘(1) IN GENERAL.—Not later than 180 days 

10 after the date of enactment of the Senior Hunger 

11 Prevention Act of 2024, the Secretary shall establish 

12 a grant program under which the Secretary shall 

13 award grants to State agencies, including Tribal or14 ganizations (as defined in section 3 of the Food and 

15 Nutrition Act of 2008 (7 U.S.C. 2012)) and terri16 tories, that administer the senior farmers’ market 

17 nutrition program to modernize program operations, 

18 including— 

19 ‘‘(A) by transitioning from paper-based 

20 coupons to an electronic transaction technology, 

21 such as a web-based service or installable soft22 ware; and 

23 ‘‘(B) by increasing benefit use at farmers’ 

24 markets. 

25 ‘‘(2) GRANT AMOUNT.— 


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1 ‘‘(A) IN GENERAL.—The amount of a 

2 grant awarded under paragraph (1) shall not 

3 exceed $350,000. 

4 ‘‘(B) SUPPLIES.—Not more than $25,000 

5 may be used to carry out subparagraph (F) of 

6 paragraph (3). 

7 ‘‘(3) ELIGIBLE EXPENSES.—An entity receiving 

8 a grant under paragraph (1) may use the grant 

9 for— 

10 ‘‘(A) costs associated with the procurement 

11 of electronic transaction technology; 

12 ‘‘(B) planning costs, including personnel 

13 costs, relating to electronic transaction tech14 nology procurement and implementation; 

15 ‘‘(C) costs associated with evaluating the 

16 impact of transitioning from coupon-based oper17 ations to an electronic transaction technology; 

18 ‘‘(D) training, outreach, and promotional 

19 material costs, including the costs associated 

20 with translating materials; 

21 ‘‘(E) maintenance and operation of elec22 tronic transaction technology procured using 

23 the grant during the period of performance of 

24 the grant; 


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1 ‘‘(F) subject to paragraph (2)(B), the pur2 chase of supplies needed to perform electronic 

3 transactions onsite; and 

4 ‘‘(G) additional costs associated with mod5 ernizing program operations, as determined ap6 propriate by the Secretary. 

7 ‘‘(4) REPORTS.—Each entity that receives a 

8 grant under paragraph (1) shall submit to the Sec9 retary and the Administrator of the Food and Nutri10 tion Service quarterly performance progress reports 

11 on the use of the grant. 

12 ‘‘(5) AUTHORIZATION OF APPROPRIATIONS.— 

13 There is authorized to be appropriated to the Sec14 retary to carry out this subsection $15,000,000 for 

15 fiscal year 2024 and each fiscal year thereafter.’’. 

16 (b) INCOME GUIDELINES.—The Secretary of Agri17 culture shall revise section 249.6(a)(3) of title 7, Code of 

18 Federal Regulations, to ensure that income eligibility 

19 under that section is at or below 200 percent of the pov20 erty income guidelines. 


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1 SEC. 10208. INFRASTRUCTURE FUNDING FOR FARMERS’ 

2 MARKETS; LOCAL PROCUREMENT PILOT 

3 PROGRAM. 

4 The Farm Security and Rural Investment Act of 

5 2002 is amended by inserting after section 4402 (7 U.S.C. 

6 3007) the following: 

7 ‘‘SEC. 4403. INFRASTRUCTURE FUNDING FOR FARMERS’ 

8 MARKETS; LOCAL PROCUREMENT PILOT 

9 PROGRAM. 

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

11 ‘‘(1) DISABILITY.—The term ‘disability’ has the 

12 meaning given the term in section 3 of the Ameri13 cans with Disabilities Act of 1990 (42 U.S.C. 

14 12102). 

15 ‘‘(2) OLDER ADULT.—The term ‘older adult’ 

16 has the meaning given the term ‘older individual’ in 

17 section 102 of the Older Americans Act of 1965 (42 

18 U.S.C. 3002). 

19 ‘‘(3) SECRETARY.—The term ‘Secretary’ means 

20 the Secretary of Agriculture. 

21 ‘‘(b) INFRASTRUCTURE FUNDING FOR FARMERS’ 

22 MARKETS.— 

23 ‘‘(1) DEFINITION OF ELIGIBLE ENTITY.—In 

24 this subsection, the term ‘eligible entity’ means an 

25 entity that— 

26 ‘‘(A) is— 


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1 ‘‘(i) an agricultural cooperative or 

2 other agricultural business entity or a pro3 ducer network or association, including a 

4 community-supported agriculture network 

5 or association; 

6 ‘‘(ii) a local or Tribal government; 

7 ‘‘(iii) a nonprofit corporation; 

8 ‘‘(iv) a public benefit corporation; 

9 ‘‘(v) an economic development cor10 poration; 

11 ‘‘(vi) a regional farmers’ market au12 thority; 

13 ‘‘(vii) a food council; or 

14 ‘‘(viii) any other entity as determined 

15 by the Secretary; and 

16 ‘‘(B) can demonstrate financial need, as 

17 determined by the Secretary. 

18 ‘‘(2) ESTABLISHMENT.—Not later than 180 

19 days after the date of enactment of the Senior Hun20 ger Prevention Act of 2024, the Secretary shall es21 tablish a program under which the Secretary shall 

22 provide financial assistance, in the form of loans, 

23 loan guarantees, and grants, to eligible entities for— 

24 ‘‘(A) the establishment of new farmers’ 

25 markets; 


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1 ‘‘(B) the improvement or rehabilitation of 

2 existing farmers’ markets, including by adding 

3 or improving payment technologies used in 

4 those farmers’ markets; and 

5 ‘‘(C) the expansion of community sup6 ported agriculture to serve older adults and 

7 adults with disabilities. 

8 ‘‘(3) REQUIREMENTS.—An eligible entity that 

9 receives financial assistance under paragraph (2) 

10 shall be required— 

11 ‘‘(A) to host farmers’ markets or related 

12 activities at locations accessible— 

13 ‘‘(i) by public transportation; 

14 ‘‘(ii) by paratransit; or 

15 ‘‘(iii) through transportation services 

16 provided under the Older Americans Act of 

17 1965 (42 U.S.C. 3001 et seq.); and 

18 ‘‘(B) to reserve not less than 50 percent of 

19 the floor area of an applicable farmers’ market 

20 for the sale of products that are produced lo21 cally, as determined by the Secretary, by— 

22 ‘‘(i) farmers, ranchers, or aquaculture, 

23 mariculture, or fisheries operators; or 


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1 ‘‘(ii) associations of farmers, ranchers, 

2 or aquaculture, mariculture, or fisheries 

3 operators. 

4 ‘‘(4) COST SHARING.—The non-Federal share 

5 of a grant provided under this subsection shall be 20 

6 percent of the amount of the grant, which may com7 prise transportation costs, volunteer contributions, 

8 and in-kind staffing. 

9 ‘‘(5) FUNDING.—Of the funds of the Com10 modity Credit Corporation, the Secretary shall use 

11 to carry out this subsection $50,000,000 for each of 

12 fiscal years 2024 through 2028. 

13 ‘‘(c) LOCAL PROCUREMENT PILOT PROGRAM.— 

14 ‘‘(1) DEFINITIONS.—In this subsection: 

15 ‘‘(A) AGRICULTURAL PRODUCER.—The 

16 term ‘agricultural producer’ includes— 

17 ‘‘(i) an agricultural cooperative; 

18 ‘‘(ii) a person engaged in farming, 

19 ranching, or aquaculture; 

20 ‘‘(iii) a person engaged in the packing 

21 of a food product; and 

22 ‘‘(iv) a person engaged in the minimal 

23 processing of a food product, as deter24 mined by the Secretary. 


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1 ‘‘(B) ELIGIBLE ENTITY.—The term ‘eligi2 ble entity’ means an entity that— 

3 ‘‘(i)(I) coordinates enrollment in, and 

4 distribution of, benefits under the seniors 

5 farmers’ market nutrition program; or 

6 ‘‘(II) demonstrates an ability to part7 ner with an entity that coordinates enroll8 ment in and distribution of benefits under 

9 the seniors farmers’ market nutrition pro10 gram; and 

11 ‘‘(ii) is— 

12 ‘‘(I) a public or nonprofit pro13 vider of nutrition services or support 

14 to older adults or adults with disabil15 ities, including— 

16 ‘‘(aa) an Aging and Dis17 ability Resource Center (as de18 fined in section 102 of the Older 

19 Americans Act of 1965 (42 

20 U.S.C. 3002)); 

21 ‘‘(bb) an area agency on 

22 aging (as defined in that section); 

23 ‘‘(cc) a State health insur24 ance program; 

25 ‘‘(dd) a State unit on aging; 


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1 ‘‘(ee) a center for inde2 pendent living; 

3 ‘‘(ff) a community health 

4 center; 

5 ‘‘(gg) a multipurpose senior 

6 center; and 

7 ‘‘(hh) federally subsidized 

8 housing, including federally sub9 sidized housing units for older 

10 adults and adults with disabil11 ities; or 

12 ‘‘(II) a local, State, or national 

13 parks and recreation department. 

14 ‘‘(2) ESTABLISHMENT.—Not later than 180 

15 days after the date of enactment of the Senior Hun16 ger Prevention Act of 2024, the Secretary shall es17 tablish a pilot program under which the Secretary 

18 shall award grants to eligible entities to contract 

19 with agricultural producers that will grow produce to 

20 support the local procurement and contracting of 

21 produce for eligible entities. 

22 ‘‘(3) PRIORITY.—In awarding grants under 

23 paragraph (2), the Secretary shall give priority to an 

24 eligible entity that will use grant funds to benefit 

25 underserved communities, including communities 


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1 that are located in areas of concentrated poverty 

2 with limited access to fresh locally or regionally 

3 grown food. 

4 ‘‘(4) METHODS.—Under a contract described in 

5 paragraph (2), an agricultural producer may grow 

6 produce through traditional or controlled environ7 mental agriculture. 

8 ‘‘(5) EVALUATION.—Not later than 2 years 

9 after the date of establishment of the pilot program 

10 under paragraph (2), the Secretary shall conduct an 

11 evaluation of the pilot program. 

12 ‘‘(6) FUNDING.— 

13 ‘‘(A) IN GENERAL.—Of the funds of the 

14 Commodity Credit Corporation, the Secretary 

15 shall use to carry out this subsection $350,000 

16 for each of fiscal years 2024 through 2028. 

17 ‘‘(B) ADMINISTRATIVE COSTS.—Of the 

18 amounts made available under subparagraph 

19 (A) for a fiscal year, not more than 5 percent 

20 may be used for administrative costs. 

21 ‘‘(C) EVALUATION.—In addition to 

22 amounts made available under subparagraph 

23 (A), there is appropriated to the Secretary, out 

24 of any funds in the Treasury not otherwise apVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 01733 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 propriated, $25,000 to carry out paragraph 

2 (5).’’. 

3 CHAPTER 2—CLOSING THE MEAL GAP 

4 SEC. 10211. ELIMINATION OF TIME LIMIT. 

5 (a) IN GENERAL.—Section 6 of the Food and Nutri6 tion Act of 2008 (7 U.S.C. 2015) is amended— 

7 (1) by striking subsection (o); and 

8 (2) by redesignating subsections (p) through (s) 

9 as subsections (o) through (r), respectively. 

10 (b) CONFORMING AMENDMENTS.— 

11 (1) Section 5(a) of the Food and Nutrition Act 

12 of 2008 (7 U.S.C. 2014(a)) is amended, in the sec13 ond sentence, by striking ‘‘(r)’’ and inserting ‘‘(q)’’. 

14 (2) Section 6(d)(4) of the Food and Nutrition 

15 Act of 2008 (7 U.S.C. 2015(d)(4)) is amended— 

16 (A) in subparagraph (B)(ii)(I)(bb)(DD), 

17 by striking ‘‘or subsection (o)’’; and 

18 (B) in subparagraph (N), by striking ‘‘or 

19 subsection (o)’’ each place it appears. 

20 (3) Section 7(i)(1) of the Food and Nutrition 

21 Act of 2008 (7 U.S.C. 2016(i)(1)) is amended by 

22 striking ‘‘section 6(o)(2) of this Act or’’. 

23 (4) Section 16(h) of the Food and Nutrition 

24 Act of 2008 (7 U.S.C. 2025(h)) is amended— 

25 (A) in paragraph (1)— 


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1 (i) in subparagraph (B), in the matter 

2 preceding clause (i), by striking ‘‘that—’’ 

3 and all that follows through the period at 

4 the end of clause (ii) and inserting ‘‘that 

5 is determined and adjusted by the Sec6 retary.’’; 

7 (ii) by striking subparagraph (E); 

8 (iii) by redesignating subparagraph 

9 (F) as subparagraph (E); and 

10 (iv) in clause (ii)(III)(ee)(AA) of sub11 paragraph (E) (as so redesignated), by 

12 striking ‘‘, individuals subject to the re13 quirements under section 6(o),’’; and 

14 (B) in paragraph (5)(C)— 

15 (i) in clause (ii), by adding ‘‘and’’ at 

16 the end; 

17 (ii) in clause (iii), by striking ‘‘; and’’ 

18 and inserting a period; and 

19 (iii) by striking clause (iv). 

20 (5) Section 51(d)(8)(A)(ii) of the Internal Rev21 enue Code of 1986 is amended— 

22 (A) in subclause (I), by striking ‘‘, or’’ at 

23 the end and inserting a period; 

24 (B) in the matter preceding subclause (I), 

25 by striking ‘‘family—’’ and all that follows 


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1 through ‘‘receiving’’ in subclause (I) and insert2 ing ‘‘family receiving’’; and 

3 (C) by striking subclause (II). 

4 (6) Section 103(a)(2) of the Workforce Innova5 tion and Opportunity Act (29 U.S.C. 3113) is 

6 amended— 

7 (A) by striking subparagraph (D); and 

8 (B) by redesignating subparagraphs (E) 

9 through (K) as subparagraphs (D) through (J), 

10 respectively. 

11 (7) Section 121(b)(2)(B) of the Workforce In12 novation and Opportunity Act (29 U.S.C. 3151) is 

13 amended— 

14 (A) by striking clause (iv); and 

15 (B) by redesignating clauses (v) through 

16 (vii) as clauses (iv) through (vi), respectively. 

17 SEC. 10212. INCLUSION OF PUERTO RICO IN SUPPLE18 MENTAL NUTRITIONAL ASSISTANCE PRO19 GRAM. 

20 (a) DEFINITIONS.—Section 3 of the Food and Nutri21 tion Act of 2008 (7 U.S.C. 2012) is amended— 

22 (1) in subsection (r), by inserting ‘‘the Com23 monwealth of Puerto Rico,’’ after ‘‘Guam,’’; and 

24 (2) in subsection (u)(3), by inserting ‘‘the Com25 monwealth of Puerto Rico,’’ after ‘‘Guam,’’. 


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1 (b) ELIGIBLE HOUSEHOLDS.—Section 5 of the Food 

2 and Nutrition Act of 2008 (7 U.S.C. 2014) is amended— 

3 (1) in subsection (b), in the first sentence, by 

4 inserting ‘‘the Commonwealth of Puerto Rico,’’ after 

5 ‘‘Guam,’’; 

6 (2) in subsection (c)— 

7 (A) in paragraph (1), by striking ‘‘and 

8 Guam,’’ and inserting ‘‘Guam, and the Com9 monwealth of Puerto Rico,’’; and 

10 (B) in the undesignated matter at the end, 

11 by striking ‘‘States or Guam’’ and inserting 

12 ‘‘States, Guam, or the Commonwealth of Puer13 to Rico’’; and 

14 (3) in subsection (e)— 

15 (A) in paragraph (1)(A), by inserting ‘‘the 

16 Commonwealth of Puerto Rico,’’ after ‘‘Ha17 waii,’’ each place it appears; and 

18 (B) in paragraph (6)(B), in the matter 

19 preceding clause (i), by inserting ‘‘the Common20 wealth of Puerto Rico,’’ after ‘‘Guam,’’. 

21 (c) EFFECTIVE DATE.— 

22 (1) IN GENERAL.—The amendments made by 

23 subsections (a) and (b) shall be effective with re24 spect to the Commonwealth of Puerto Rico on the 

25 date described in paragraph (2) if the Secretary of 


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1 Agriculture submits to Congress a certification 

2 under subsection (f)(2)(C) of section 19 of the Food 

3 and Nutrition Act of 2008 (7 U.S.C. 2028) (as 

4 added by subsection (d)). 

5 (2) DATE DESCRIBED.—The date referred to in 

6 paragraph (1) is the date established by the Com7 monwealth of Puerto Rico in the applicable plan of 

8 operation submitted to the Secretary of Agriculture 

9 under subsection (f)(1) of section 19 of the Food 

10 and Nutrition Act of 2008 (7 U.S.C. 2028) (as 

11 added by subsection (d)). 

12 (d) TRANSITION OF PUERTO RICO TO SUPPLE13 MENTAL NUTRITION ASSISTANCE PROGRAM.—Section 19 

14 of the Food and Nutrition Act of 2008 (7 U.S.C. 2028) 

15 is amended by adding at the end the following: 

16 ‘‘(f) TRANSITION OF PUERTO RICO TO SUPPLE17 MENTAL NUTRITION ASSISTANCE PROGRAM.— 

18 ‘‘(1) REQUEST FOR PARTICIPATION.—The Com19 monwealth of Puerto Rico may submit to the Sec20 retary a request to participate in the supplemental 

21 nutrition assistance program, which shall include a 

22 plan of operation described in section 11(d), includ23 ing a description of the date on which the Common24 wealth of Puerto Rico intends to begin participation 

25 in the supplemental nutrition assistance program. 


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1 ‘‘(2) CERTIFICATION BY SECRETARY.— 

2 ‘‘(A) IN GENERAL.—On submission of a 

3 request by the Commonwealth of Puerto Rico 

4 under paragraph (1), the Secretary shall certify 

5 the Commonwealth of Puerto Rico as qualified 

6 to participate in the supplemental nutrition as7 sistance program if the Secretary— 

8 ‘‘(i) approves the plan of operation 

9 submitted with the request, in accordance 

10 with this subsection; and 

11 ‘‘(ii) approves the applications de12 scribed in paragraph (4) in accordance 

13 with that paragraph. 

14 ‘‘(B) DEADLINE.—The Secretary shall cer15 tify or deny the request of the Commonwealth 

16 of Puerto Rico under paragraph (1) not later 

17 than 90 days after the date on which the Sec18 retary receives the request. 

19 ‘‘(C) SUBMISSION TO CONGRESS.—The 

20 Secretary shall submit a certification under 

21 subparagraph (A) to Congress. 

22 ‘‘(3) DETERMINATION OF PLAN OF OPER23 ATION.— 

24 ‘‘(A) APPROVAL.—The Secretary shall ap25 prove a plan of operation submitted with a reVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 01739 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 quest under paragraph (1) if the plan satisfies 

2 the requirements under this Act. 

3 ‘‘(B) DISAPPROVAL.—If the Secretary does 

4 not approve a plan of operation submitted with 

5 a request under paragraph (1), the Secretary 

6 shall provide a statement that describes each 

7 requirement under this Act that is not satisfied 

8 by the plan. 

9 ‘‘(4) APPROVAL OF RETAIL FOOD STORES.—If 

10 the Secretary approves a plan of operation under 

11 paragraph (3)(A) for the Commonwealth of Puerto 

12 Rico, the Secretary shall accept applications from re13 tail food stores located in the Commonwealth of 

14 Puerto Rico to be authorized under section 9 to par15 ticipate in the supplemental nutrition assistance pro16 gram. 

17 ‘‘(5) FAMILY MARKET PROGRAM.—Notwith18 standing subsection (g), the Secretary shall allow the 

19 Commonwealth of Puerto Rico to continue to carry 

20 out under the supplemental nutrition assistance pro21 gram the Family Market Program established pur22 suant to this section. 

23 ‘‘(6) TEMPORARY FUNDING.—If the Common24 wealth of Puerto Rico has a request under para25 graph (1) pending before the Secretary (including a 


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1 plan of operation pending under paragraph (3)), the 

2 Commonwealth of Puerto Rico shall receive block 

3 grants under this section, in amounts determined by 

4 the Secretary, until the date on which the Secretary 

5 certifies the Commonwealth of Puerto Rico under 

6 paragraph (2)(B). 

7 ‘‘(7) AUTHORIZATION OF APPROPRIATIONS.— 

8 There are authorized to be appropriated to the Sec9 retary such sums as are necessary to carry out this 

10 subsection for fiscal year 2024, to remain available 

11 until expended. 

12 ‘‘(g) TECHNICAL INFRASTRUCTURE IMPLEMENTA13 TION.— 

14 ‘‘(1) IN GENERAL.—The Commonwealth of 

15 Puerto Rico may request from the Secretary a 1- 

16 time grant to pay for the cost of the technology in17 frastructure necessary to implement the supple18 mental nutrition assistance program, including the 

19 cost of information technology, information tech20 nology personnel, and training relating to program 

21 implementation. 

22 ‘‘(2) APPLICATION.—In making a request under 

23 paragraph (1), the Commonwealth of Puerto Rico 

24 shall submit to the Secretary an application at such 


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1 time, in such manner, and containing such informa2 tion as the Secretary may require, including— 

3 ‘‘(A) a description of the costs to be paid 

4 for by the grant; and 

5 ‘‘(B) a plan for implementing the tech6 nology infrastructure described in paragraph 

7 (1)— 

8 ‘‘(i) within 1 year of receiving the 

9 grant; and 

10 ‘‘(ii) that is reasonably cost efficient, 

11 as determined by the Secretary. 

12 ‘‘(3) DETERMINATION.— 

13 ‘‘(A) TIME LIMIT.—The Secretary shall 

14 approve or deny an application submitted under 

15 paragraph (2) not later than 90 days after the 

16 date on which the application is submitted. 

17 ‘‘(B) DENIAL.—If the Secretary denies an 

18 application submitted under paragraph (2), the 

19 Commonwealth of Puerto Rico may amend the 

20 plan described in subparagraph (B) of that 

21 paragraph, in coordination with the Secretary, 

22 to resubmit to the Secretary for approval. 

23 ‘‘(4) FUNDING.— 

24 ‘‘(A) IN GENERAL.—There is appropriated 

25 to the Secretary, out of funds in the Treasury 


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1 not otherwise appropriated, $112,500,000 to 

2 carry out this subsection, to remain available 

3 until 3 years after the date of enactment of this 

4 subsection. 

5 ‘‘(B) REVERSION OF FUNDS.—Any funds 

6 appropriated to the Secretary under subpara7 graph (A) that remain available by the date de8 scribed in that subparagraph shall revert to the 

9 Treasury. 

10 ‘‘(h) TERMINATION OF EFFECTIVENESS.— 

11 ‘‘(1) IN GENERAL.—Subsections (a) through (e) 

12 shall cease to be effective with respect to the Com13 monwealth of Puerto Rico on the date described in 

14 paragraph (2) if the Secretary submits to Congress 

15 a certification under subsection (f)(2)(C) for the 

16 Commonwealth of Puerto Rico. 

17 ‘‘(2) DATE DESCRIBED.—The date referred to 

18 in paragraph (1) is the date established by the Com19 monwealth of Puerto Rico in the applicable plan of 

20 operation submitted to the Secretary under sub21 section (f)(1).’’. 

22 Subtitle D—Universal School Meals 

23 SEC. 10301. SHORT TITLE. 

24 This subtitle may be cited as the ‘‘Universal School 

25 Meals Program Act of 2024’’. 


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1 SEC. 10302. EFFECTIVE DATE. 

2 Except as otherwise provided, this subtitle, and the 

3 amendments made by this subtitle, take effect on the date 

4 that is 1 year after the date of enactment of this Act. 

5 CHAPTER 1—SCHOOL BREAKFAST 

6 PROGRAM 

7 SEC. 10311. FREE SCHOOL BREAKFAST PROGRAM. 

8 (a) IN GENERAL.—Section 4(a) of the Child Nutri9 tion Act of 1966 (42 U.S.C. 1773(a)) is amended, in the 

10 first sentence— 

11 (1) by striking ‘‘is hereby’’ and inserting ‘‘are’’; 

12 and 

13 (2) by inserting ‘‘to provide free breakfast to all 

14 children enrolled at those schools’’ before ‘‘in accord15 ance’’. 

16 (b) APPORTIONMENT TO STATES.—Section 4(b) of 

17 the Child Nutrition Act of 1966 (42 U.S.C. 1773(b)) is 

18 amended— 

19 (1) in paragraph (1)— 

20 (A) in subparagraph (A)(i), by striking 

21 subclause (II) and inserting the following: 

22 ‘‘(II) the national average pay23 ment for free breakfasts, as specified 

24 in subparagraph (B).’’; 

25 (B) by striking subparagraph (B) and in26 serting the following: 


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1 ‘‘(B) PAYMENT AMOUNTS.— 

2 ‘‘(i) IN GENERAL.—The national aver3 age payment for each free breakfast shall 

4 be $2.80, adjusted annually for inflation in 

5 accordance with clause (ii) and rounded in 

6 accordance with clause (iii). 

7 ‘‘(ii) INFLATION ADJUSTMENT.— 

8 ‘‘(I) IN GENERAL.—The annual 

9 inflation adjustment under clause (i) 

10 shall reflect changes in the cost of op11 erating the free breakfast program 

12 under this section, as indicated by the 

13 change in the Consumer Price Index 

14 for food away from home for all urban 

15 consumers. 

16 ‘‘(II) BASIS.—Each inflation an17 nual adjustment under clause (i) shall 

18 reflect the changes in the Consumer 

19 Price Index for food away from home 

20 for the most recent 12-month period 

21 for which those data are available. 

22 ‘‘(iii) ROUNDING.—On July 1, 2024, 

23 and annually thereafter, the national aver24 age payment rate for free breakfast shall 

25 be— 


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1 ‘‘(I) adjusted to the nearest 

2 lower-cent increment; and 

3 ‘‘(II) based on the unrounded 

4 amounts for the preceding 12-month 

5 period.’’; 

6 (C) by striking subparagraphs (C) and 

7 (E); and 

8 (D) by redesignating subparagraph (D) as 

9 subparagraph (C); 

10 (2) by striking paragraphs (2) and (3); 

11 (3) by redesignating paragraphs (4) and (5) as 

12 paragraphs (2) and (3), respectively; and 

13 (4) in paragraph (3) (as so redesignated), by 

14 striking ‘‘paragraph (3) or (4)’’ and inserting ‘‘para15 graph (2)’’. 

16 (c) STATE DISBURSEMENT TO SCHOOLS.—Section 4 

17 of the Child Nutrition Act of 1966 (42 U.S.C. 1773) is 

18 amended by striking subsection (c) and inserting the fol19 lowing: 

20 ‘‘(c) STATE DISBURSEMENT TO SCHOOLS.—Funds 

21 apportioned and paid to any State for the purpose of this 

22 section shall be disbursed by the State educational agency 

23 to schools selected by the State educational agency to as24 sist those schools in operating a breakfast program.’’. 

25 (d) NO COLLECTION OF DEBT.— 


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1 (1) IN GENERAL.—Notwithstanding any other 

2 provision of the Child Nutrition Act of 1966 (42 

3 U.S.C. 1771 et seq.) or any other provision of law, 

4 effective beginning on the date of enactment of this 

5 Act, as a condition of participation in the breakfast 

6 program under section 4 of that Act (42 U.S.C. 

7 1773), a school— 

8 (A) shall not collect any debt owed to the 

9 school for unpaid meal charges; and 

10 (B) shall continue to accrue debt for un11 paid meal charges— 

12 (i) for the purpose of receiving reim13 bursement under section 10332; and 

14 (ii) until the effective date specified in 

15 section 10302. 

16 (2) CHILD NUTRITION ACT OF 1966.— 

17 (A) IN GENERAL.—Section 4 of the Child 

18 Nutrition Act of 1966 (42 U.S.C. 1773) is 

19 amended by striking subsection (d) and insert20 ing the following: 

21 ‘‘(d) NO COLLECTION OF DEBT.—A school partici22 pating in the free breakfast program under this section 

23 shall not collect any debt owed to the school for unpaid 

24 meal charges.’’. 


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1 (B) CONFORMING AMENDMENT.—Section 

2 23(a) of the Child Nutrition Act of 1966 (42 

3 U.S.C. 1793(a)) is amended by striking ‘‘a 

4 school in severe need, as described in section 

5 4(d)(1)’’ and inserting the following: ‘‘a 

6 school— 

7 ‘‘(1) participating in the free breakfast program 

8 under section 4, or seeking to initiate a free break9 fast program under that section; and 

10 ‘‘(2) not less than 40 percent of the students of 

11 which are economically disadvantaged students (as 

12 identified under a measure described in section 

13 1113(a)(5) of the Elementary and Secondary Edu14 cation Act of 1965 (20 U.S.C. 6313(a)(5)))’’. 

15 (e) NUTRITIONAL AND OTHER PROGRAM REQUIRE16 MENTS.—Section 4(e) of the Child Nutrition Act of 1966 

17 (42 U.S.C. 1773(e)) is amended— 

18 (1) in paragraph (1)(A), in the second sentence, 

19 by striking ‘‘free or’’ and all that follows through 

20 the period at the end and inserting ‘‘free to all chil21 dren enrolled at a school participating in the school 

22 breakfast program.’’; and 

23 (2) in paragraph (2), in the second sentence, by 

24 striking ‘‘the full charge to the student for a break25 fast meeting the requirements of this section or’’. 


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1 (f) PROHIBITION ON BREAKFAST SHAMING, MEAL

2 DENIAL.— 

3 (1) IN GENERAL.—Effective beginning on the 

4 date of enactment of this Act, a school or school 

5 food authority— 

6 (A) shall not— 

7 (i) physically segregate for the pur8 pose of debt shaming or otherwise dis9 criminate against any child participating in 

10 the breakfast program under section 4 of 

11 the Child Nutrition Act of 1966 (42 

12 U.S.C. 1773); or 

13 (ii) overtly identify a child described 

14 in clause (i) by a special token or ticket, 

15 an announced or published list of names, 

16 or any other means; and 

17 (B) shall provide the program meal to each 

18 child eligible under the program described in 

19 subparagraph (A)(i). 

20 (2) CHILD NUTRITION ACT OF 1966.—Section 4 

21 of the Child Nutrition Act of 1966 (42 U.S.C. 1773) 

22 is amended by adding at the end the following: 

23 ‘‘(f) PROHIBITION ON BREAKFAST SHAMING.—A 

24 school or school food authority shall not— 


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1 ‘‘(1) physically segregate for the purpose of 

2 debt shaming or otherwise discriminate against any 

3 child participating in the free breakfast program 

4 under this section; or 

5 ‘‘(2) overtly identify a child described in para6 graph (1) by a special token or ticket, an announced 

7 or published list of names, or any other means.’’. 

8 (g) DEPARTMENT OF DEFENSE OVERSEAS DEPEND9 ENTS’ SCHOOLS.—Section 20(b) of the Child Nutrition 

10 Act of 1966 (42 U.S.C. 1789(b)) is amended by striking 

11 ‘‘by this section’’ and all that follows through the period 

12 at the end and inserting ‘‘by this section.’’. 

13 (h) CONFORMING AMENDMENTS.—The Child Nutri14 tion Act of 1966 (42 U.S.C. 1771 et seq.) is amended— 

15 (1) by striking ‘‘or reduced price’’ each place it 

16 appears; 

17 (2) by striking ‘‘and reduced price’’ each place 

18 it appears; and 

19 (3) by striking ‘‘a reduced price’’ each place it 

20 appears. 

21 CHAPTER 2—SCHOOL LUNCH PROGRAM 

22 SEC. 10321. APPORTIONMENT TO STATES. 

23 Section 4(b) of the Richard B. Russell National 

24 School Lunch Act (42 U.S.C. 1753(b)) is amended— 

25 (1) in paragraph (1)— 


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1 (A) in subparagraph (A), by striking ‘‘of 

2 this Act’’; and 

3 (B) in subparagraph (B), by striking ‘‘of 

4 this subsection’’; and 

5 (2) by striking paragraphs (2) and (3) and in6 serting the following: 

7 ‘‘(2) PAYMENT AMOUNTS.— 

8 ‘‘(A) IN GENERAL.—The national average 

9 payment for each free lunch shall be $4.63, ad10 justed annually for inflation in accordance with 

11 subparagraph (C) and rounded in accordance 

12 with subparagraph (D). 

13 ‘‘(B) ADDITIONAL PAYMENT FOR LOCAL

14 FOOD.— 

15 ‘‘(i) IN GENERAL.—During a school 

16 year, a school food authority shall receive 

17 an additional payment described in clause 

18 (ii) if the State certifies that the school 

19 food authority served meals (including 

20 breakfasts, lunches, suppers, and supple21 ments) during the preceding school year 

22 not less than 25 percent of which were 

23 made with farm products that were— 

24 ‘‘(I) produced and distributed— 


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1 ‘‘(aa) in the State in which 

2 the school food authority is lo3 cated; or 

4 ‘‘(bb) not more than 250 

5 miles from the location of the 

6 school food authority; and 

7 ‘‘(II) marketed to consumers— 

8 ‘‘(aa) directly; or 

9 ‘‘(bb) through an intermedi10 ated channel (such as a food hub 

11 or cooperative). 

12 ‘‘(ii) PAYMENT AMOUNT.— 

13 ‘‘(I) IN GENERAL.—The addi14 tional payment amount under this 

15 subparagraph shall be— 

16 ‘‘(aa) $0.30 for each free 

17 lunch and supper; 

18 ‘‘(bb) $0.21 for each free 

19 breakfast; and 

20 ‘‘(cc) $0.08 for each free 

21 supplement. 

22 ‘‘(II) ADJUSTMENTS.—Each ad23 ditional payment amount under sub24 clause (I) shall be adjusted annually 

25 in accordance with subparagraph (C) 


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1 and rounded in accordance with sub2 paragraph (D). 

3 ‘‘(iii) DISBURSEMENT.—The State 

4 agency shall disburse funds made available 

5 under this subparagraph to school food au6 thorities eligible to receive additional reim7 bursement. 

8 ‘‘(C) INFLATION ADJUSTMENT.— 

9 ‘‘(i) IN GENERAL.—The annual infla10 tion adjustment under subparagraphs (A) 

11 and (B)(ii) shall reflect changes in the cost 

12 of operating the free lunch program under 

13 this Act, as indicated by the change in the 

14 Consumer Price Index for food away from 

15 home for all urban consumers. 

16 ‘‘(ii) BASIS.—Each annual inflation 

17 adjustment under subparagraphs (A) and 

18 (B)(ii) shall reflect the changes in the Con19 sumer Price Index for food away from 

20 home for the most recent 12-month period 

21 for which those data are available. 

22 ‘‘(D) ROUNDING.—On July 1, 2024, and 

23 annually thereafter, the national average pay24 ment rate for free lunch and the additional pay25 ment amount for free breakfast, lunch, supper, 


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1 and supplement under subparagraph (B) shall 

2 be— 

3 ‘‘(i) adjusted to the nearest lower-cent 

4 increment; and 

5 ‘‘(ii) based on the unrounded amounts 

6 for the preceding 12-month period.’’. 

7 SEC. 10322. NUTRITIONAL AND OTHER PROGRAM REQUIRE8 MENTS. 

9 (a) ELIMINATION OF FREE LUNCH ELIGIBILITY RE10 QUIREMENTS.— 

11 (1) IN GENERAL.—Section 9 of the Richard B. 

12 Russell National School Lunch Act (42 U.S.C. 

13 1758) is amended by striking subsection (b) and in14 serting the following: 

15 ‘‘(b) ELIGIBILITY.—All children enrolled in a school 

16 that participates in the school lunch program under this 

17 Act shall be eligible to receive free lunch under this Act.’’. 

18 (2) CONFORMING AMENDMENTS.— 

19 (A) Section 9 of the Richard B. Russell 

20 National School Lunch Act (42 U.S.C. 1758) is 

21 amended— 

22 (i) in subsection (c), in the third sen23 tence, by striking ‘‘or at a reduced cost’’; 

24 and 


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1 (ii) in subsection (e), by striking ‘‘, re2 duced price,’’. 

3 (B)(i) Section 18 of the Richard B. Russell 

4 National School Lunch Act (42 U.S.C. 1769) is 

5 amended— 

6 (I) in subsection (b), by striking 

7 ‘‘(b)(1) Upon’’ and inserting the following: 

8 ‘‘(a) EXTENSION OF ELIGIBILITY OF CERTAIN

9 SCHOOL DISTRICTS TO RECEIVE CASH OR COMMODITY

10 LETTERS OF CREDIT ASSISTANCE FOR SCHOOL LUNCH

11 PROGRAMS.— 

12 ‘‘(1) IN GENERAL.—On’’; 

13 (II) in subsection (c), by striking 

14 ‘‘(c)(1) The’’ and inserting the following: 

15 ‘‘(b) ALTERNATIVE COUNTING AND CLAIMING PRO16 CEDURES.— 

17 ‘‘(1) IN GENERAL.—The’’; 

18 (III) in subsection (g), by striking the 

19 subsection designation and heading and in20 serting the following: 

21 ‘‘(c) ACCESS TO LOCAL FOODS: PATRICK LEAHY

22 FARM TO SCHOOL PROGRAM.—’’; 

23 (IV) by striking subsection (j); and 


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1 (V) by redesignating subsections (h), 

2 (i), and (k) as subsections (d), (e), and (f), 

3 respectively. 

4 (ii) Section 17(r)(5) of the Richard B. 

5 Russell National School Lunch Act (42 U.S.C. 

6 1766(r)(5)) is amended by striking ‘‘18(h)’’ and 

7 inserting ‘‘18(d)’’. 

8 (iii) Section 19(i)(2) of the Richard B. 

9 Russell National School Lunch Act (42 U.S.C. 

10 1769a(i)(2)) is amended by striking ‘‘State that 

11 received funding under section 18(f) on the day 

12 before the date of enactment of the Food, Con13 servation, and Energy Act of 2008’’ and insert14 ing ‘‘State that, on the day before the date of 

15 enactment of the Food, Conservation, and En16 ergy Act of 2008 (Public Law 110–246; 122 

17 Stat. 1651), received funding under section 

18 18(f) (as in effect on the day before that date 

19 of enactment)’’. 

20 (iv) Section 413(b)(2) of the Agricultural 

21 Research, Extension, and Education Reform 

22 Act of 1998 (7 U.S.C. 7633(b)(2)) is amended 

23 by striking ‘‘section 18(g) of the Richard B. 

24 Russell National School Lunch Act (42 U.S.C. 

25 1769(g))’’ and inserting ‘‘subsection (c) of secVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 01756 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 tion 18 of the Richard B. Russell National 

2 School Lunch Act (42 U.S.C. 1769)’’. 

3 (C) Section 28 of the Richard B. Russell 

4 National School Lunch Act (42 U.S.C. 1769i) 

5 is amended— 

6 (i) by striking subsection (b); and 

7 (ii) by redesignating subsection (c) as 

8 subsection (b). 

9 (D) Section 1154(a)(2)(A)(i) of title 10, 

10 United States Code, is amended by striking ‘‘in 

11 accordance with section 9(b)(1) of the Richard 

12 B. Russell National School Lunch Act (42 

13 U.S.C. 1758(b)(1)’’. 

14 (E) Section 1902(a) of the Social Security 

15 Act (42 U.S.C. 1396a(a)) is amended by strik16 ing paragraph (7) and inserting the following: 

17 ‘‘(7) provide safeguards that restrict the use or 

18 disclosure of information concerning applicants and 

19 recipients to purposes directly connected with the 

20 administration of the plan;’’. 

21 (F) Section 4301 of the Food, Conserva22 tion, and Energy Act of 2008 (42 U.S.C. 

23 1758a) is repealed. 

24 (G) Section 17 of the Child Nutrition Act 

25 of 1966 (42 U.S.C. 1786) is amended— 


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1 (i) in subsection (d)— 

2 (I) in paragraph (2)(A)— 

3 (aa) by striking clause (i); 

4 and 

5 (bb) by redesignating 

6 clauses (ii) and (iii) as clauses (i) 

7 and (ii), respectively; and 

8 (II) in paragraph (3)— 

9 (aa) by striking subpara10 graph (D); 

11 (bb) by redesignating sub12 paragraphs (E) and (F) as sub13 paragraphs (D) and (E), respec14 tively; and 

15 (cc) in subparagraph (D) (as 

16 so redesignated), by striking 

17 ‘‘clause (ii) or (iii)’’ and inserting 

18 ‘‘clause (i) or (ii)’’; and 

19 (ii) in subsection (f)(17), by striking 

20 ‘‘Notwithstanding subsection (d)(2)(A)(i), 

21 not later’’ and inserting ‘‘Not later’’. 

22 (b) NO COLLECTION OF DEBT.— 

23 (1) IN GENERAL.—Notwithstanding any other 

24 provision of the Richard B. Russell National School 

25 Lunch Act (42 U.S.C. 1751 et seq.) or any other 


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1 provision of law, effective beginning on the date of 

2 enactment of this Act, as a condition of participation 

3 in the school lunch program under that Act, a 

4 school— 

5 (A) shall not collect any debt owed to the 

6 school for unpaid meal charges; and 

7 (B) shall continue to accrue debt for un8 paid meal charges— 

9 (i) for the purpose of receiving reim10 bursement under section 10332; and 

11 (ii) until the effective date specified in 

12 section 10302. 

13 (2) NATIONAL SCHOOL LUNCH ACT.—Section 9 

14 of the Richard B. Russell National School Lunch 

15 Act (42 U.S.C. 1758) is amended by striking sub16 section (d) and inserting the following: 

17 ‘‘(d) NO COLLECTION OF DEBT.—A school partici18 pating in the school lunch program under this Act shall 

19 not collect any debt owed to the school for unpaid meal 

20 charges.’’. 

21 SEC. 10323. SPECIAL ASSISTANCE PROGRAM. 

22 (a) IN GENERAL.—Section 11 of the Richard B. Rus23 sell National School Lunch Act (42 U.S.C. 1759a) is re24 pealed. 

25 (b) CONFORMING AMENDMENTS.— 


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1 (1) Section 6 of the Richard B. Russell Na2 tional School Lunch Act (42 U.S.C. 1755) is amend3 ed— 

4 (A) in subsection (a)(2), by striking ‘‘sec5 tions 11 and 13’’ and inserting ‘‘section 13’’; 

6 and 

7 (B) in subsection (e)(1), in the matter pre8 ceding subparagraph (A), by striking ‘‘section 

9 4, this section, and section 11’’ and inserting 

10 ‘‘this section and section 4’’. 

11 (2) Section 7(d) of the Richard B. Russell Na12 tional School Lunch Act (42 U.S.C. 1756(d)) is 

13 amended by striking ‘‘or 11’’. 

14 (3) Section 8(g) of the Richard B. Russell Na15 tional School Lunch Act (42 U.S.C. 1757(g)) is 

16 amended by striking ‘‘and under section 11 of this 

17 Act’’. 

18 (4) Section 12(f) of the Richard B. Russell Na19 tional School Lunch Act (42 U.S.C. 1760(f)) is 

20 amended by striking ‘‘11,’’. 

21 (5) Section 7(a) of the Child Nutrition Act of 

22 1966 (42 U.S.C. 1766(a)) is amended— 

23 (A) in paragraph (1)(A), by striking ‘‘4, 

24 11, and 17’’ and inserting ‘‘4 and 17’’; and 


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1 (B) in paragraph (2)(A), by striking ‘‘sec2 tions 4 and 11’’ and inserting ‘‘section 4’’. 

3 (6) Section 1101(j)(3) of the Families First 

4 Coronavirus Response Act (7 U.S.C. 2011 note; 

5 Public Law 116–127) is amended— 

6 (A) by striking ‘‘or served under section 

7 11(a)(1) of the Richard B. Russell National 

8 School Lunch Act (42 U.S.C. 1760(d), 

9 1759(a)(1))’’ and inserting ‘‘of the Richard B. 

10 Russell National School Lunch Act (42 U.S.C. 

11 1760(d))’’; and 

12 (B) by striking ‘‘or reduced price’’. 

13 SEC. 10324. PRICE FOR PAID LUNCH. 

14 Section 12 of the Richard B. Russell National School 

15 Lunch Act (42 U.S.C. 1760) is amended— 

16 (1) in subsection (l)(4)— 

17 (A) by striking subparagraph (D); and 

18 (B) by redesignating subparagraphs (E) 

19 through (M) as subparagraphs (D) through 

20 (L), respectively; 

21 (2) by striking subsection (p); and 

22 (3) by redesignating subsections (q) and (r) as 

23 subsections (p) and (q), respectively. 


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1 SEC. 10325. SUMMER FOOD SERVICE PROGRAM FOR CHIL2 DREN. 

3 Section 13 of the Richard B. Russell National School 

4 Lunch Act (42 U.S.C. 1761) is amended— 

5 (1) in subsection (a)— 

6 (A) in paragraph (1)(A)(i)— 

7 (i) in subclause (I), by striking ‘‘have 

8 been determined eligible for free or re9 duced price school meals under this Act 

10 and the Child Nutrition Act of 1966 (42 

11 U.S.C. 1771 et seq.)’’ and inserting ‘‘are 

12 economically disadvantaged students (as 

13 identified under a measure described in 

14 section 1113(a)(5) of the Elementary and 

15 Secondary Education Act of 1965 (20 

16 U.S.C. 6313(a)(5)))’’; 

17 (ii) in subclause (II), by striking ‘‘are 

18 eligible for free or reduced price school 

19 meals under this Act and the Child Nutri20 tion Act of 1966 (42 U.S.C. 1771 et seq.)’’ 

21 and inserting ‘‘are economically disadvan22 taged students (as identified under a meas23 ure described in section 1113(a)(5) of the 

24 Elementary and Secondary Education Act 

25 of 1965 (20 U.S.C. 6313(a)(5)))’’; 


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1 (iii) in subclause (III)(bb), by striking 

2 ‘‘meet the income standards for free or re3 duced price school meals under this Act 

4 and the Child Nutrition Act of 1966 (42 

5 U.S.C. 1771 et seq.)’’ and inserting ‘‘are 

6 economically disadvantaged students (as 

7 identified under a measure described in 

8 section 1113(a)(5) of the Elementary and 

9 Secondary Education Act of 1965 (20 

10 U.S.C. 6313(a)(5)))’’; 

11 (iv) in subclause (IV), by striking 

12 ‘‘are eligible for free or reduced price 

13 school meals under this Act and the Child 

14 Nutrition Act of 1966 (42 U.S.C. 1771 et 

15 seq.)’’ and inserting ‘‘are economically dis16 advantaged students (as identified under a 

17 measure described in section 1113(a)(5) of 

18 the Elementary and Secondary Education 

19 Act of 1965 (20 U.S.C. 6313(a)(5)))’’; and 

20 (v) in subclause (V), by striking ‘‘are 

21 eligible for free or reduced price school 

22 meals under this Act and the Child Nutri23 tion Act of 1966 (42 U.S.C. 1771 et seq.)’’ 

24 and inserting ‘‘are economically disadvan25 taged students (as identified under a measVerDate Sep 11 2014 19:51 Sep 11, 2024 Jkt 049200 PO 00000 Frm 01763 Fmt 6652 Sfmt 6201 E:\BILLS\S4773.IS S4773

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1 ure described in section 1113(a)(5) of the 

2 Elementary and Secondary Education Act 

3 of 1965 (20 U.S.C. 6313(a)(5)))’’; 

4 (B) in paragraph (2), by adding at the end 

5 the following: 

6 ‘‘(C) WAIVER.—If the Secretary deter7 mines that a program requirement under this 

8 section limits the access of children to meals 

9 served under this section, the Secretary may 

10 waive that program requirement. 

11 ‘‘(D) ELIGIBILITY.—All children shall be 

12 eligible to participate in the program under this 

13 section.’’; 

14 (C) in paragraph (5), by striking ‘‘only 

15 for’’ and all that follows through the period at 

16 the end and inserting ‘‘for meals served to all 

17 children.’’; and 

18 (D) in paragraph (13)— 

19 (i) in subparagraph (C)(ii), by strik20 ing ‘‘eligible for a free or reduced price 

21 lunch under this Act or a free or reduced 

22 price breakfast under section 4 of the 

23 Child Nutrition Act of 1966 (42 U.S.C. 

24 1773)’’ and inserting ‘‘an economically dis25 advantaged student (as identified under a 


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1 measure described in section 1113(a)(5) of 

2 the Elementary and Secondary Education 

3 Act of 1965 (20 U.S.C. 6313(a)(5)))’’; and 

4 (ii) in subparagraph (D)(ii), by strik5 ing ‘‘eligible for free or reduced price lunch 

6 under this Act or free or reduced price 

7 breakfast under section 4 of the Child Nu8 trition Act of 1966 (42 U.S.C. 1773)’’ and 

9 inserting ‘‘economically disadvantaged stu10 dents (as identified under a measure de11 scribed in section 1113(a)(5) of the Ele12 mentary and Secondary Education Act of 

13 1965 (20 U.S.C. 6313(a)(5)))’’; 

14 (2) in subsection (b)(2), by striking ‘‘may only 

15 serve’’ and all that follows through ‘‘migrant chil16 dren’’; 

17 (3) by striking subsection (c) and inserting the 

18 following: 

19 ‘‘(c) PAYMENTS.— 

20 ‘‘(1) IN GENERAL.—Payments shall be made to 

21 service institutions for meals served— 

22 ‘‘(A) during the months of May through 

23 September; 

24 ‘‘(B) during school vacation at any time 

25 during an academic school year; 


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1 ‘‘(C) during a teacher in-service day; and 

2 ‘‘(D) on days that school is closed due to 

3 a natural disaster, building repair, court order, 

4 or similar cause, as determined by the Sec5 retary. 

6 ‘‘(2) LIMITATION ON PAYMENTS.—A service in7 stitution shall receive payments under this section 

8 for not more than 3 meals and 1 supplement per 

9 child per day.’’; and 

10 (4) in subsection (f)(3), by striking ‘‘, except 

11 that’’ and all that follows through ‘‘of this section’’. 

12 SEC. 10326. SUMMER ELECTRONIC BENEFIT TRANSFER FOR 

13 CHILDREN PROGRAM. 

14 Section 13A of the Richard B. Russell National 

15 School Lunch Act (42 U.S.C. 1762) is amended— 

16 (1) in subsection (b)(2)(A)(i), by striking 

17 ‘‘$40’’ and inserting ‘‘$60’’; 

18 (2) in subsection (c)(1)— 

19 (A) in subparagraph (A), by striking ‘‘di20 rectly certified’’ and all that follows through 

21 ‘‘this section’’ and inserting ‘‘an economically 

22 disadvantaged student (as identified under a 

23 measure described in section 1113(a)(5) of the 

24 Elementary and Secondary Education Act of 

25 1965 (20 U.S.C. 6313(a)(5)))’’; 


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1 (B) by striking subparagraph (B); and 

2 (C) by redesignating subparagraphs (C) 

3 through (E) as subparagraphs (B) through (D), 

4 respectively; 

5 (3) in subsection (f)— 

6 (A) in paragraph (3), in the matter pre7 ceding subparagraph (A), by striking ‘‘proc8 esses—’’ and all that follows through ‘‘to reli9 ably’’ in subparagraph (B) and inserting ‘‘proc10 esses to reliably’’; and 

11 (B) in paragraph (4), in the matter pre12 ceding subparagraph (A), by striking ‘‘by—’’ 

13 and all that follows through ‘‘establishing’’ in 

14 subparagraph (B) and inserting ‘‘by estab15 lishing’’; and 

16 (4) in subsection (h), by striking paragraph (2) 

17 and inserting the following: 

18 ‘‘(2) ELIGIBLE CHILD.—The term ‘eligible 

19 child’ means any child residing in a State or on land 

20 under the jurisdiction of a covered Indian Tribal or21 ganization that participates in the program estab22 lished under this section.’’. 

23 SEC. 10327. CHILD AND ADULT CARE FOOD PROGRAM. 

24 Section 17 of the Richard B. Russell National School 

25 Lunch Act (42 U.S.C. 1766) is amended— 


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1 (1) in subsection (a)(2), by striking subpara2 graph (B) and inserting the following: 

3 ‘‘(B) any other private organization pro4 viding nonresidential child care or day care out5 side school hours for school children;’’; 

6 (2) by striking subsection (c) and inserting the 

7 following: 

8 ‘‘(c) FREE MEALS.—Notwithstanding any other pro9 vision of law— 

10 ‘‘(1) all meals and supplements served under 

11 the program authorized under this section shall be 

12 provided for free to participants of the program; and 

13 ‘‘(2) an institution that serves those meals and 

14 supplements shall be reimbursed— 

15 ‘‘(A) in the case of breakfast, at the rate 

16 established for free breakfast under section 

17 4(b)(1)(B)(i) of the Child Nutrition Act of 

18 1966 (42 U.S.C. 1773(b)(1)(B)(i)); 

19 ‘‘(B) in the case of lunch, at the rate es20 tablished for free lunch under section 

21 4(b)(2)(A); and 

22 ‘‘(C) in the case of a supplemental meal, 

23 $1.20, adjusted for inflation in accordance with 

24 section 4(b)(2)(C).’’; 

25 (3) in subsection (f)— 


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1 (A) in paragraph (2), by striking subpara2 graph (B) and inserting the following: 

3 ‘‘(B) LIMITATION TO REIMBURSEMENTS.— 

4 An institution may claim reimbursement under 

5 this paragraph for not more than 3 meals and 

6 1 supplement per day per child.’’; 

7 (B) by striking paragraph (3); and 

8 (C) by redesignating paragraph (4) as 

9 paragraph (3); 

10 (4) in subsection (o)— 

11 (A) by striking paragraph (4); and 

12 (B) by redesignating paragraphs (5) and 

13 (6) as paragraphs (4) and (5), respectively; and 

14 (5) in subsection (r)— 

15 (A) in the subsection heading, by striking 

16 ‘‘PROGRAM FOR AT-RISK SCHOOL CHILDREN’’ 

17 and inserting ‘‘AFTERSCHOOL MEAL AND

18 SNACK PROGRAM’’; 

19 (B) by striking ‘‘at-risk school’’ each place 

20 it appears and inserting ‘‘eligible’’; 

21 (C) in paragraph (1)— 

22 (i) in the paragraph heading, by strik23 ing ‘‘AT-RISK SCHOOL’’ and inserting ‘‘ELI24 GIBLE’’; and 


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1 (ii) in subparagraph (B), by striking 

2 ‘‘operated’’ and all that follows through 

3 the period at the end and inserting a pe4 riod; and 

5 (D) in paragraph (4)(A), by striking ‘‘only 

6 for’’ and all that follows through the period at 

7 the end and inserting the following: ‘‘for— 

8 ‘‘(i) not more than 1 meal and 1 sup9 plement per child per day served on a reg10 ular school day; and 

11 ‘‘(ii) not more than 3 meals and 1 

12 supplement per child per day served on 

13 any day other than a regular school day.’’. 

14 SEC. 10328. MEALS AND SUPPLEMENTS FOR CHILDREN IN 

15 AFTERSCHOOL CARE. 

16 Section 17A of the Richard B. Russell National 

17 School Lunch Act (42 U.S.C. 1766a) is amended— 

18 (1) in the section heading, by striking ‘‘MEAL

19 SUPPLEMENTS’’ and inserting ‘‘MEALS AND SUP20 PLEMENTS’’; 

21 (2) in subsection (a)(1), by striking ‘‘meal sup22 plements’’ and inserting ‘‘free meals and supple23 ments’’; 

24 (3) in subsection (b), by inserting ‘‘meals and’’ 

25 before ‘‘supplements’’; and 


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1 (4) by striking subsection (c) and inserting the 

2 following: 

3 ‘‘(c) REIMBURSEMENT.— 

4 ‘‘(1) IN GENERAL.— 

5 ‘‘(A) MEALS.—A free meal provided under 

6 this section to a child shall be reimbursed at a 

7 rate of $4.63, adjusted annually for inflation in 

8 accordance with paragraph (3)(A) and rounded 

9 in accordance with paragraph (3)(B). 

10 ‘‘(B) SUPPLEMENTS.—A free supplement 

11 provided under this section to a child shall be 

12 reimbursed at the rate at which free supple13 ments are reimbursed under section 

14 17(c)(2)(C). 

15 ‘‘(2) LIMITATION TO REIMBURSEMENTS.—An 

16 institution may claim reimbursement under this sec17 tion for not more than 1 meal and 1 supplement per 

18 day per child served on a regular school day. 

19 ‘‘(3) INFLATION; ROUNDING.— 

20 ‘‘(A) INFLATION ADJUSTMENT.— 

21 ‘‘(i) IN GENERAL.—The annual infla22 tion adjustment under paragraph (1)(A) 

23 shall reflect changes in the cost of oper24 ating the program under this section, as 

25 indicated by the change in the Consumer 


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1 Price Index for food away from home for 

2 all urban consumers. 

3 ‘‘(ii) BASIS.—Each inflation annual 

4 adjustment under paragraph (1)(A) shall 

5 reflect the changes in the Consumer Price 

6 Index for food away from home for the 

7 most recent 12-month period for which 

8 those data are available. 

9 ‘‘(B) ROUNDING.—On July 1, 2024, and 

10 annually thereafter, the reimbursement rate for 

11 a free meal under this section shall be— 

12 ‘‘(i) adjusted to the nearest lower-cent 

13 increment; and 

14 ‘‘(ii) based on the unrounded amounts 

15 for the preceding 12-month period.’’. 

16 SEC. 10329. PILOT PROJECTS. 

17 Section 18 of the Richard B. Russell National School 

18 Lunch Act (42 U.S.C. 1769) is amended— 

19 (1) in paragraph (5) of subsection (c) (as redes20 ignated by section 10322(a)(2)(B)(i)(III)), by strik21 ing subparagraph (B) and inserting the following: 

22 ‘‘(B) serve a high proportion of economi23 cally disadvantaged students (as identified 

24 under a measure described in section 

25 1113(a)(5) of the Elementary and Secondary 


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1 Education Act of 1965 (20 U.S.C. 

2 6313(a)(5)));’’; and 

3 (2) in paragraph (1)(A)(ii) of subsection (d) (as 

4 redesignated by section 10322(a)(2)(B)(i)(V)), by 

5 striking ‘‘eligible for free or reduced price meals 

6 under this Act’’ and inserting ‘‘economically dis7 advantaged students (as identified under a measure 

8 described in section 1113(a)(5) of the Elementary 

9 and Secondary Education Act of 1965 (20 U.S.C. 

10 6313(a)(5)))’’. 

11 SEC. 10330. FRESH FRUIT AND VEGETABLE PROGRAM. 

12 Section 19(d) of the Richard B. Russell National 

13 School Lunch Act (42 U.S.C. 1769a(d)) is amended— 

14 (1) in paragraph (1)— 

15 (A) in the matter preceding subparagraph 

16 (A), by striking ‘‘paragraph (2) of this sub17 section and’’; 

18 (B) in subparagraph (A), in the matter 

19 preceding clause (i), by striking ‘‘school—’’ and 

20 all that follows through ‘‘submits’’ in clause (ii) 

21 and inserting ‘‘school that submits’’; 

22 (C) in subparagraph (B), by striking 

23 ‘‘schools’’ and all that follows through ‘‘Act’’ 

24 and inserting ‘‘high-need schools (as defined in 

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1 ondary Education Act of 1965 (20 U.S.C. 

2 6631(b)))’’; and 

3 (D) in subparagraph (D)— 

4 (i) by striking clause (i); and 

5 (ii) by redesignating clauses (ii) 

6 through (iv) as clauses (i) through (iii), re7 spectively; and 

8 (2) by striking paragraphs (2) and (3) and in9 serting the following: 

10 ‘‘(2) OUTREACH TO HIGH-NEED SCHOOLS.— 

11 Prior to making decisions regarding school participa12 tion in the program, a State agency shall inform 

13 high-need schools (as defined in section 2211(b) of 

14 the Elementary and Secondary Education Act of 

15 1965 (20 U.S.C. 6631(b))), including Tribal schools, 

16 of the eligibility of the schools for the program.’’. 

17 SEC. 10331. TRAINING, TECHNICAL ASSISTANCE, AND FOOD 

18 SERVICE MANAGEMENT INSTITUTE. 

19 Section 21(a)(1)(B) of the Richard B. Russell Na20 tional School Lunch Act (42 U.S.C. 1769b–1(a)(1)(B)) is 

21 amended, in the matter preceding clause (i), by striking 

22 ‘‘certified to receive free or reduced price meals’’ and in23 serting ‘‘who are economically disadvantaged students (as 

24 identified under a measure described in section 1113(a)(5) 


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1 of the Elementary and Secondary Education Act of 1965 

2 (20 U.S.C. 6313(a)(5)))’’. 

3 SEC. 10332. REIMBURSEMENT OF SCHOOL MEAL DELIN4 QUENT DEBT PROGRAM. 

5 (a) DEFINITIONS.—In this section: 

6 (1) DELINQUENT DEBT.—The term ‘‘delinquent 

7 debt’’ means the debt owed by a parent or guardian 

8 of a child to a school— 

9 (A) as of the effective date specified in sec10 tion 10302; and 

11 (B) for meals served by the school under— 

12 (i) the school breakfast program 

13 under section 4 of the Child Nutrition Act 

14 of 1966 (42 U.S.C. 1773); 

15 (ii) the school lunch program estab16 lished under the Richard B. Russell Na17 tional School Lunch Act (42 U.S.C. 1751 

18 et seq.); or 

19 (iii) both of the programs described in 

20 clauses (i) and (ii). 

21 (2) PROGRAM.—The term ‘‘program’’ means 

22 the program established under subsection (b)(1). 

23 (3) SECRETARY.—The term ‘‘Secretary’’ means 

24 the Secretary of Agriculture. 

25 (b) REIMBURSEMENT PROGRAM.— 


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1 (1) ESTABLISHMENT.—Not later than 60 days 

2 after the effective date specified in section 10302, 

3 the Secretary shall establish a program under which 

4 the Secretary shall reimburse each school partici5 pating in a program described in clause (i) or (ii) of 

6 subsection (a)(1)(B) for all delinquent debt. 

7 (2) FORM FOR REIMBURSEMENT.—To carry out 

8 the program, the Secretary shall design and dis9 tribute to State agencies a form to collect data relat10 ing to all delinquent debt in applicable schools in the 

11 State, organized by school food authority. 

12 (3) COMPLETION DATE.—The Secretary shall 

13 provide all reimbursements under the program not 

14 later than 180 days after the effective date specified 

15 in section 10302. 

16 (c) REPORT.—Not later than 2 years after the effec17 tive date specified in section 10302, the Comptroller Gen18 eral of the United States shall submit to Congress and 

19 make publicly available a report that describes the suc20 cesses and challenges of the program. 

21 SEC. 10333. CONFORMING AMENDMENTS. 

22 The Richard B. Russell National School Lunch Act 

23 (42 U.S.C. 1751 et seq.) is amended— 

24 (1) by striking ‘‘or reduced price’’ each place it 

25 appears; 


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1 (2) by striking ‘‘or a reduced price’’ each place 

2 it appears; 

3 (3) by striking ‘‘and reduced price’’ each place 

4 it appears; and 

5 (4) by striking ‘‘a reduced price’’ each place it 

6 appears. 

7 CHAPTER 3—ELEMENTARY AND 

8 SECONDARY EDUCATION DATA 

9 SEC. 10341. MEASURE OF POVERTY. 

10 Section 1113(a)(5) of the Elementary and Secondary 

11 Education Act of 1965 (20 U.S.C. 6313(a)(5)) is amend12 ed— 

13 (1) in subparagraph (A), by striking ‘‘the num14 ber of children eligible for a free or reduced price 

15 lunch under the Richard B. Russell National School 

16 Lunch Act (42 U.S.C. 1751 et seq.)’’ and inserting 

17 ‘‘the number of children from low-income back18 grounds, identified under subparagraph (D)’’; and 

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

20 ‘‘(D) IDENTIFICATION OF CHILDREN FROM

21 LOW-INCOME BACKGROUNDS.— 

22 ‘‘(i) IN GENERAL.—A local edu23 cational agency or State agency, for the 

24 purpose of identifying children from low-in25 come backgrounds enrolled in a school 


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1 served by a local educational agency, 

2 may— 

3 ‘‘(I) maintain a record, with re4 spect to each student for whom the 

5 local educational agency provides a 

6 free public education that contains the 

7 information collected from the survey 

8 described in clause (iii); 

9 ‘‘(II) distribute and collect a stu10 dent survey based on the template de11 veloped under clause (iii) to identify 

12 children from low-income back13 grounds; and 

14 ‘‘(III) utilize direct certification 

15 data described in clause (iv)(I) to 

16 identify children from low-income 

17 backgrounds. 

18 ‘‘(ii) PRIVACY.— 

19 ‘‘(I) IN GENERAL.—All individual 

20 data collected under this subpara21 graph shall be protected by the local 

22 educational agency or State agency in 

23 a manner consistent with all applica24 ble local, State, and Federal privacy 

25 laws. 


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1 ‘‘(II) REPORTING DATA.—Only 

2 aggregated data, which may include 

3 data disaggregated at the school, local 

4 educational agency, or State level, 

5 shall be reported to the Secretary at 

6 such time and in such manner as the 

7 Secretary may reasonably require. 

8 ‘‘(iii) SURVEY.—Not later than 180 

9 days after the date of enactment of the 

10 Universal School Meals Program Act of 

11 2024, the Secretary, in consultation with 

12 the Secretary of Agriculture, shall develop 

13 a template survey— 

14 ‘‘(I) to identify children from 

15 low-income backgrounds that contains 

16 only the information necessary to 

17 identify a child as a child from a low18 income background by using the cri19 teria of eligibility for a free or reduced 

20 priced lunch under the Richard B. 

21 Russell National School Lunch Act, as 

22 such criteria were in effect on Sep23 tember 30, 2022; and 


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1 ‘‘(II) that shall be designed to be 

2 easily accessible and in a user-friendly 

3 manner. 

4 ‘‘(iv) TRANSITION AUTHORITY FROM

5 FRPL TO ESEA MEASURES.—The Sec6 retary, in coordination with the Secretary 

7 of Agriculture, shall have the authority to 

8 take such steps as are necessary to provide 

9 for the orderly transition to, and imple10 mentation of— 

11 ‘‘(I) activities that are necessary 

12 for the continuity of direct certifi13 cation carried out by local educational 

14 agencies and State agencies specified 

15 in paragraphs (4), (5), and (15) sec16 tion 9(b) of the Richard B. Russell 

17 National School Lunch Act, as in ef18 fect on September 30, 2022, for the 

19 purposes of identifying any child eligi20 ble for free or reduced priced lunch 

21 under such Act, as in effect on such 

22 date, as a child from a low-income 

23 background; 

24 ‘‘(II) procedures for verification 

25 of information collected under this 


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1 subparagraph, which may include pro2 cedures modeled on the requirement 

3 specified in section 9(b)(3) of the 

4 Richard B. Russell National School 

5 Lunch Act, as in effect on September 

6 30, 2022; and 

7 ‘‘(III) data privacy provisions for 

8 information collected under this sub9 paragraph, in accordance with the re10 quirements specified in section 9(b)(6) 

11 of the Richard B. Russell National 

12 School Lunch Act, as in effect on Sep13 tember 30, 2022. 

14 ‘‘(v) SPECIAL RULE.—For the pur15 poses of subparagraph (A), a local edu16 cational agency may determine the number 

17 of children from low-income backgrounds 

18 enrolled in a school served by such agency 

19 using one or more of the following meth20 ods: 

21 ‘‘(I) Results from surveys speci22 fied in clause (i)(II). 

23 ‘‘(II) Direct certification data 

24 specified in clause (i)(III). 


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1 ‘‘(III) Utilization of both meth2 ods described in subclauses (I) and 

3 (II).’’. 

4 CHAPTER 4—AMENDMENTS TO OTHER 

5 PROGRAMS AND LAWS 

6 SEC. 10351. SUPPLEMENTAL NUTRITION ASSISTANCE PRO7 GRAM. 

8 (a) AGREEMENT FOR DIRECT CERTIFICATION.— 

9 (1) IN GENERAL.—Section 11 of the Food and 

10 Nutrition Act of 2008 (7 U.S.C. 2020) is amend11 ed— 

12 (A) by striking subsection (u); and 

13 (B) by redesignating subsections (v) 

14 through (x) as subsections (u) through (w), re15 spectively. 

16 (2) CONFORMING AMENDMENTS.—Section 11(e) 

17 of the Food and Nutrition Act of 2008 (7 U.S.C. 

18 2020(e)) is amended— 

19 (A) in paragraph (8)(F), by striking ‘‘or 

20 subsection (u)’’; and 

21 (B) in paragraph (26)(B), by striking 

22 ‘‘(x)’’ and inserting ‘‘(w)’’. 

23 (b) NUTRITION EDUCATION AND OBESITY PREVEN24 TION GRANT PROGRAM.—Section 28(a) of the Food and 


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1 Nutrition Act of 2008 (7 U.S.C. 2036a(a)) is amended 

2 by striking paragraph (1) and inserting the following: 

3 ‘‘(1) an individual eligible for benefits under 

4 this Act;’’. 

5 SEC. 10352. HIGHER EDUCATION ACT OF 1965. 

6 (a) TEACHER QUALITY ENHANCEMENT.—Section 

7 200(11) of the Higher Education Act of 1965 (20 U.S.C. 

8 1021(11)) is amended by striking subparagraph (A) and 

9 inserting the following: 

10 ‘‘(A) IN GENERAL.—The term ‘high-need 

11 school’ means a school that is in the highest 

12 quartile of schools in a ranking of all schools 

13 served by a local educational agency, ranked in 

14 descending order by percentage of students 

15 from low-income families enrolled in such 

16 schools, as determined by the local educational 

17 agency based on one of the following measures 

18 of poverty: 

19 ‘‘(i) The percentage of students aged 

20 5 through 17 in poverty counted in the 

21 most recent census data approved by the 

22 Secretary. 

23 ‘‘(ii) The percentage of students in 

24 families receiving assistance under the 

25 State program funded under the program 


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1 of block grants to States for temporary as2 sistance for needy families established 

3 under part A of title IV of the Social Secu4 rity Act (42 U.S.C. 601 et seq.). 

5 ‘‘(iii) The percentage of students eligi6 ble to receive medical assistance under the 

7 program of medical assistance established 

8 under title XIX of the Social Security Act 

9 (42 U.S.C. 1396 et seq.). 

10 ‘‘(iv) A composite of 2 or more of the 

11 measures described in clauses (i) through 

12 (iii).’’. 

13 (b) GEAR UP.—Section 404B(d)(1) of the Higher 

14 Education Act of 1965 (20 U.S.C. 1070a–22(d)(1)) is 

15 amended by striking subparagraph (A) and inserting the 

16 following: 

17 ‘‘(A) provide services under this chapter to 

18 at least one grade level of students, beginning 

19 not later than 7th grade, in a participating 

20 school— 

21 ‘‘(i) that has a 7th grade; and 

22 ‘‘(ii) in which— 

23 ‘‘(I) at least 50 percent of the 

24 students enrolled are economically dis25 advantaged students (as identified 


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1 under a measure described in section 

2 1113(a)(5) of the Elementary and 

3 Secondary Education Act of 1965); or 

4 ‘‘(II) if an eligible entity deter5 mines that it would promote the effec6 tiveness of a program, an entire grade 

7 level of students, beginning not later 

8 than the 7th grade, reside in public 

9 housing, as defined in section 3(b)(1) 

10 of the United States Housing Act of 

11 1937 (42 U.S.C. 1437a(b)(1)).’’. 

12 (c) SIMPLIFIED APPLICATION FOR FEDERAL STU13 DENT FINANCIAL AID.— 

14 (1) IN GENERAL.—Section 

15 483(a)(2)(B)(ii)(XVII) of the Higher Education Act 

16 of 1965 (20 U.S.C. 1090(a)(2)(B)(ii)(XVII)) is 

17 amended— 

18 (A) by striking item (cc); and 

19 (B) by redesignating items (dd) through 

20 (jj) as items (cc) through (ii), respectively. 

21 (2) EFFECTIVE DATE.—The amendments made 

22 by this section shall take effect as if included in sec23 tion 702 of division FF of the Consolidated Appro24 priations Act, 2021 (Public Law 116–260) and sub25 ject to the effective date of section 701(b) of such 


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1 FAFSA Simplification Act, as amended by section 

2 102(a) of the FAFSA Simplification Act Technical 

3 Corrections Act (division R of Public Law 117–103) 

4 (including the authorization provided under section 

5 102(c)(1)(A) of such Act). 

6 (d) EARLY FEDERAL PELL GRANT COMMITMENT

7 DEMONSTRATION PROGRAM.—Section 894(b) of the 

8 Higher Education Act of 1965 (20 U.S.C. 1161y(b)) is 

9 amended— 

10 (1) in paragraph (1)(B), by striking ‘‘qualify 

11 for a free or reduced price school lunch under the 

12 Richard B. Russell National School Lunch Act (42 

13 U.S.C. 1751 et seq.) or the Child Nutrition Act of 

14 1966 (42 U.S.C. 1771 et seq.)’’ and inserting ‘‘are 

15 economically disadvantaged students (as identified 

16 under a measure described in section 1113(a)(5) of 

17 the Elementary and Secondary Education Act of 

18 1965)’’; and 

19 (2) in paragraph (5), by striking ‘‘eligible for a 

20 free or reduced price school lunch under the Richard 

21 B. Russell National School Lunch Act (42 U.S.C. 

22 1751 et seq.) or the Child Nutrition Act of 1966 (42 

23 U.S.C. 1771 et seq.)’’ and inserting ‘‘economically 

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1 ure described in section 1113(a)(5) of the Elemen2 tary and Secondary Education Act of 1965)’’. 

3 SEC. 10353. ELEMENTARY AND SECONDARY EDUCATION 

4 ACT OF 1965. 

5 (a) LITERACY EDUCATION FOR ALL.—Section 

6 2221(b)(3)(B) of the Elementary and Secondary Edu7 cation Act of 1965 (20 U.S.C. 6641(b)(3)(B)) is amend8 ed— 

9 (1) by striking clause (i); and 

10 (2) by redesignating clauses (ii) and (iii) as 

11 clauses (i) and (ii), respectively. 

12 (b) GRANTS FOR EDUCATION INNOVATION AND RE13 SEARCH.—Section 4611(d)(2) of the Elementary and Sec14 ondary Education Act of 1965 (20 U.S.C. 7261(d)(2)) is 

15 amended— 

16 (1) by striking subparagraph (B); and 

17 (2) by redesignating subparagraphs (C) and 

18 (D) as subparagraphs (B) and (C), respectively. 

19 (c) ELIGIBILITY FOR HEAVILY IMPACTED LOCAL

20 EDUCATIONAL AGENCIES.—Section 7003(b)(2)(B)(i)(III) 

21 of the Elementary and Secondary Education Act of 1965 

22 (20 U.S.C. 7703(b)(2)(B)(i)(III)) is amended by striking 

23 item (bb) and inserting the following: 

24 ‘‘(bb) has an enrollment of 

25 children described in subsection 


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1 (a)(1) that constitutes a percent2 age of the total student enroll3 ment of the agency that is not 

4 less than 30 percent; and’’. 

5 SEC. 10354. AMERICA COMPETES ACT. 

6 Section 6122(3) of the America COMPETES Act (20 

7 U.S.C. 9832(3)) is amended by striking ‘‘data on children 

8 eligible for free or reduced-price lunches under the Rich9 ard B. Russell National School Lunch Act,’’. 

10 SEC. 10355. WORKFORCE INNOVATION AND OPPORTUNITY 

11 ACT. 

12 Section 3(36)(A) of the Workforce Innovation and 

13 Opportunity Act (29 U.S.C. 3102(36)(A)) is amended— 

14 (1) by striking clause (iv); and 

15 (2) by redesignating clauses (v) and (vi) as 

16 clauses (iv) and (v), respectively. 

17 SEC. 10356. NATIONAL SCIENCE FOUNDATION AUTHORIZA18 TION ACT OF 2002. 

19 Section 4(8) of the National Science Foundation Au20 thorization Act of 2002 (42 U.S.C. 1862n note; Public 

21 Law 107–368) is amended— 

22 (1) by striking subparagraph (A); and 

23 (2) by redesignating subparagraphs (B) and 

24 (C) as subparagraphs (A) and (B), respectively. 


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1 SEC. 10357. CHILD CARE AND DEVELOPMENT BLOCK 

2 GRANT. 

3 Section 658O(b) of the Child Care and Development 

4 Block Grant Act of 1990 (42 U.S.C. 9858m(b)) is amend5 ed— 

6 (1) in paragraph (1)(B), by striking ‘‘school 

7 lunch factor’’ and inserting ‘‘economically disadvan8 taged students factor’’; and 

9 (2) by striking paragraph (3) and inserting the 

10 following: 

11 ‘‘(3) ECONOMICALLY DISADVANTAGED STU12 DENTS FACTOR.—In this subsection, the term ‘eco13 nomically disadvantaged students factor’ means the 

14 ratio of the number of children in the State who are 

15 economically disadvantaged students (as identified 

16 under a measure described in section 1113(a)(5) of 

17 the Elementary and Secondary Education Act of 

18 1965 (20 U.S.C. 6313(a)(5))) to the number of such 

19 children in all the States as determined annually by 

20 the Secretary of Education.’’. 

21 SEC. 10358. CHILDREN’S HEALTH ACT OF 2000. 

22 Section 1404(b) of the Children’s Health Act of 2000 

23 (42 U.S.C. 9859c(b)) is amended— 

24 (1) in paragraph (1)(B), by striking ‘‘school 

25 lunch factor’’ and inserting ‘‘economically disadvan26 taged students factor’’; and 


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1 (2) by striking paragraph (3) and inserting the 

2 following: 

3 ‘‘(3) ECONOMICALLY DISADVANTAGED STU4 DENTS FACTOR.—In this subsection, the term ‘eco5 nomically disadvantaged students factor’ means the 

6 ratio of the number of children in the State who are 

7 economically disadvantaged students (as identified 

8 under a measure described in section 1113(a)(5) of 

9 the Elementary and Secondary Education Act of 

10 1965 (20 U.S.C. 6313(a)(5))) to the number of such 

11 children in all the States as determined annually by 

12 the Secretary of Education.’’. 

13 SEC. 10359. JUVENILE JUSTICE AND DELINQUENCY PRE14 VENTION. 

15 Section 252 of the Juvenile Justice and Delinquency 

16 Prevention Act of 1974 (34 U.S.C. 11162) is amended 

17 by striking subsection (i) and inserting the following: 

18 ‘‘(i) FREE SCHOOL LUNCHES FOR INCARCERATED

19 JUVENILES.— 

20 ‘‘(1) DEFINITION OF ELIGIBLE JUVENILE DE21 TENTION CENTER.—In this subsection, the term ‘eli22 gible juvenile detention center’ does not include any 

23 private, for-profit detention center. 

24 ‘‘(2) FREE LUNCH.—A juvenile who is incarcer25 ated in an eligible juvenile detention center is eligible 


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1 to receive free lunch under the Richard B. Russell 

2 National School Lunch Act (42 U.S.C. 1751 et 

3 seq.). 

4 ‘‘(3) GUIDANCE.—Not later than 1 year after 

5 the date of enactment of the Universal School Meals 

6 Program Act of 2024, the Attorney General, in con7 sultation with the Secretary of Agriculture, shall 

8 provide guidance to States relating to the options for 

9 school food authorities in the States to apply for re10 imbursement for free lunches under the Richard B. 

11 Russell National School Lunch Act (42 U.S.C. 1751 

12 et seq.) for juveniles who are incarcerated.’’. 

Æ 


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