PUBLIC LAW 106–525—NOV. 22, 2000 114 STAT. 2495

Public Law 106–525

106th Congress

An Act

To amend the Public Health Service Act to improve the health of minority individuals.

Be it enacted by the Senate and House of Representatives of

the United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

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

Health and Health Disparities Research and Education Act of 2000’’.

(b) TABLE OF CONTENTS.—The table of contents of this Act

is as follows:

Sec. 1. Short title; table of contents.

Sec. 2. Findings.

TITLE I—IMPROVING MINORITY HEALTH AND REDUCING HEALTH DISPARITIES THROUGH NATIONAL INSTITUTES OF HEALTH; ESTABLISHMENT OF NATIONAL CENTER

Sec. 101. Establishment of National Center on Minority Health and Health Disparities. Sec. 102. Centers of excellence for research education and training.

Sec. 103. Extramural loan repayment program for minority health disparities research.

Sec. 104. General provisions regarding the Center.

Sec. 105. Report regarding resources of National Institutes of Health dedicated to

minority and other health disparities research.

TITLE II—HEALTH DISPARITIES RESEARCH BY AGENCY FOR HEALTHCARE

RESEARCH AND QUALITY

Sec. 201. Health disparities research by Agency for Healthcare Research and Quality.

TITLE III—DATA COLLECTION RELATING TO RACE OR ETHNICITY

Sec. 301. Study and report by National Academy of Sciences.

TITLE IV—HEALTH PROFESSIONS EDUCATION

Sec. 401. Health professions education in health disparities.

Sec. 402. National conference on health professions education and health disparities.

Sec. 403. Advisory responsibilities in health professions education in health disparities and cultural competency.

TITLE V—PUBLIC AWARENESS AND DISSEMINATION OF INFORMATION ON

HEALTH DISPARITIES

Sec. 501. Public awareness and information dissemination.

TITLE VI—MISCELLANEOUS PROVISIONS

Sec. 601. Departmental definition regarding minority individuals.

Sec. 602. Conforming provision regarding definitions.

Sec. 603. Effective date.

SEC. 2. FINDINGS.

The Congress finds as follows:

42 USC 287c–31

note.

42 USC 202 note.

Minority Health

and Health

Disparities

Research and

Education Act of

2000.

Nov. 22, 2000

[S. 1880]

114 STAT. 2496 PUBLIC LAW 106–525—NOV. 22, 2000

(1) Despite notable progress in the overall health of the

Nation, there are continuing disparities in the burden of illness

and death experienced by African Americans, Hispanics, Native

Americans, Alaska Natives, and Asian Pacific Islanders, compared to the United States population as a whole.

(2) The largest numbers of the medically underserved are

white individuals, and many of them have the same health

care access problems as do members of minority groups. Nearly

20,000,000 white individuals live below the poverty line with

many living in nonmetropolitan, rural areas such as

Appalachia, where the high percentage of counties designated

as health professional shortage areas (47 percent) and the

high rate of poverty contribute to disparity outcomes. However,

there is a higher proportion of racial and ethnic minorities

in the United States represented among the medically underserved.

(3) There is a national need for minority scientists in

the fields of biomedical, clinical, behavioral, and health services

research. Ninety percent of minority physicians educated at

Historically Black Medical Colleges live and serve in minority

communities.

(4) Demographic trends inspire concern about the Nation’s

ability to meet its future scientific, technological, and

engineering workforce needs. Historically, non-Hispanic white

males have made up the majority of the United States scientific,

technological, and engineering workers.

(5) The Hispanic and Black population will increase significantly in the next 50 years. The scientific, technological, and

engineering workforce may decrease if participation by underrepresented minorities remains the same.

(6) Increasing rates of Black and Hispanic workers can

help ensure a strong scientific, technological, and engineering

workforce.

(7) Individuals such as underrepresented minorities and

women in the scientific, technological, and engineering

workforce enable society to address its diverse needs.

(8) If there had not been a substantial increase in the

number of science and engineering degrees awarded to women

and underrepresented minorities over the past few decades,

the United States would be facing even greater shortages in

scientific, technological, and engineering workers.

(9) In order to effectively promote a diverse and strong

21st century scientific, technological, and engineering

workforce, Federal agencies should expand or add programs

that effectively overcome barriers such as educational transition

from one level to the next and student requirements for financial resources.

(10) Federal agencies should work in concert with the private nonprofit sector to emphasize the recruitment and retention of qualified individuals from ethnic and gender groups

that are currently underrepresented in the scientific, technological, and engineering workforce.

(11) Behavioral and social sciences research has increased

awareness and understanding of factors associated with health

care utilization and access, patient attitudes toward health

services, and risk and protective behaviors that affect health

and illness. These factors have the potential to then be modified

PUBLIC LAW 106–525—NOV. 22, 2000 114 STAT. 2497

to help close the health disparities gap among ethnic minority

populations. In addition, there is a shortage of minority behavioral science researchers and behavioral health care professionals. According to the National Science Foundation, only

15.5 percent of behavioral research-oriented psychology doctorate degrees were awarded to minority students in 1997.

In addition, only 17.9 percent of practice-oriented psychology

doctorate degrees were awarded to ethnic minorities.

TITLE I—IMPROVING MINORITY

HEALTH AND REDUCING HEALTH DISPARITIES THROUGH NATIONAL INSTITUTES OF HEALTH; ESTABLISHMENT

OF NATIONAL CENTER

SEC. 101. ESTABLISHMENT OF NATIONAL CENTER ON MINORITY

HEALTH AND HEALTH DISPARITIES.

(a) IN GENERAL.—Part E of title IV of the Public Health Service

Act (42 U.S.C. 287 et seq.) is amended by adding at the end

the following subpart:

‘‘Subpart 6—National Center on Minority Health and Health

Disparities

‘‘SEC. 485E. PURPOSE OF CENTER.

‘‘(a) IN GENERAL.—The general purpose of the National Center

on Minority Health and Health Disparities (in this subpart referred

to as the ‘Center’) is the conduct and support of research, training,

dissemination of information, and other programs with respect to

minority health conditions and other populations with health

disparities. ‘‘(b) PRIORITIES.—The Director of the Center shall in expending

amounts appropriated under this subpart give priority to conducting

and supporting minority health disparities research.

‘‘(c) MINORITY HEALTH DISPARITIES RESEARCH.—For purposes

of this subpart:

‘‘(1) The term ‘minority health disparities research’ means

basic, clinical, and behavioral research on minority health

conditions (as defined in paragraph (2)), including research

to prevent, diagnose, and treat such conditions.

‘‘(2) The term ‘minority health conditions’, with respect

to individuals who are members of minority groups, means

all diseases, disorders, and conditions (including with respect

to mental health and substance abuse)—

‘‘(A) unique to, more serious, or more prevalent in

such individuals;

‘‘(B) for which the factors of medical risk or types

of medical intervention may be different for such individuals, or for which it is unknown whether such factors

or types are different for such individuals; or

‘‘(C) with respect to which there has been insufficient

research involving such individuals as subjects or insufficient data on such individuals.

42 USC 287c–31.

114 STAT. 2498 PUBLIC LAW 106–525—NOV. 22, 2000

‘‘(3) The term ‘minority group’ has the meaning given the

term ‘racial and ethnic minority group’ in section 1707. ‘‘(4) The terms ‘minority’ and ‘minorities’ refer to individuals from a minority group.

‘‘(d) HEALTH DISPARITY POPULATIONS.—For purposes of this

subpart:‘‘(1) A population is a health disparity population if, as

determined by the Director of the Center after consultation

with the Director of the Agency for Healthcare Research and

Quality, there is a significant disparity in the overall rate

of disease incidence, prevalence, morbidity, mortality, or survival rates in the population as compared to the health status

of the general population. ‘‘(2) The Director shall give priority consideration to determining whether minority groups qualify as health disparity

populations under paragraph (1). ‘‘(3) The term ‘health disparities research’ means basic,

clinical, and behavioral research on health disparity populations

(including individual members and communities of such populations) that relates to health disparities as defined under

paragraph (1), including the causes of such disparities and

methods to prevent, diagnose, and treat such disparities.

‘‘(e) COORDINATION OF ACTIVITIES.—The Director of the Center

shall act as the primary Federal official with responsibility for

coordinating all minority health disparities research and other

health disparities research conducted or supported by the National

Institutes of Health, and—

‘‘(1) shall represent the health disparities research program

of the National Institutes of Health, including the minority

health disparities research program, at all relevant Executive

branch task forces, committees and planning activities; and

‘‘(2) shall maintain communications with all relevant Public

Health Service agencies, including the Indian Health Service,

and various other departments of the Federal Government to

ensure the timely transmission of information concerning

advances in minority health disparities research and other

health disparities research between these various agencies for

dissemination to affected communities and health care providers.

‘‘(f) COLLABORATIVE COMPREHENSIVE PLAN AND BUDGET.—

‘‘(1) IN GENERAL.—Subject to the provisions of this section

and other applicable law, the Director of NIH, the Director

of the Center, and the directors of the other agencies of the

National Institutes of Health in collaboration (and in consultation with the advisory council for the Center) shall—

‘‘(A) establish a comprehensive plan and budget for

the conduct and support of all minority health disparities

research and other health disparities research activities

of the agencies of the National Institutes of Health (which

plan and budget shall be first established under this subsection not later than 12 months after the date of the

enactment of this subpart);

‘‘(B) ensure that the plan and budget establish priorities among the health disparities research activities that

such agencies are authorized to carry out;

‘‘(C) ensure that the plan and budget establish objectives regarding such activities, describes the means for

Deadline.

PUBLIC LAW 106–525—NOV. 22, 2000 114 STAT. 2499

achieving the objectives, and designates the date by which

the objectives are expected to be achieved;

‘‘(D) ensure that, with respect to amounts appropriated

for activities of the Center, the plan and budget give priority in the expenditure of funds to conducting and supporting minority health disparities research;

‘‘(E) ensure that all amounts appropriated for such

activities are expended in accordance with the plan and

budget;

‘‘(F) review the plan and budget not less than annually,

and revise the plan and budget as appropriate;

‘‘(G) ensure that the plan and budget serve as a broad,

binding statement of policies regarding minority health

disparities research and other health disparities research

activities of the agencies, but do not remove the responsibility of the heads of the agencies for the approval of

specific programs or projects, or for other details of the

daily administration of such activities, in accordance with

the plan and budget; and

‘‘(H) promote coordination and collaboration among the

agencies conducting or supporting minority health or other

health disparities research.

‘‘(2) CERTAIN COMPONENTS OF PLAN AND BUDGET.—With

respect to health disparities research activities of the agencies

of the National Institutes of Health, the Director of the Center

shall ensure that the plan and budget under paragraph (1)

provide for—

‘‘(A) basic research and applied research, including

research and development with respect to products;

‘‘(B) research that is conducted by the agencies;

‘‘(C) research that is supported by the agencies;

‘‘(D) proposals developed pursuant to solicitations by

the agencies and for proposals developed independently

of such solicitations; and

‘‘(E) behavioral research and social sciences research,

which may include cultural and linguistic research in each

of the agencies.

‘‘(3) MINORITY HEALTH DISPARITIES RESEARCH.—The plan

and budget under paragraph (1) shall include a separate statement of the plan and budget for minority health disparities

research.

‘‘(g) PARTICIPATION IN CLINICAL RESEARCH.—The Director of

the Center shall work with the Director of NIH and the directors

of the agencies of the National Institutes of Health to carry out

the provisions of section 492B that relate to minority groups.

‘‘(h) RESEARCH ENDOWMENTS.—

‘‘(1) IN GENERAL.—The Director of the Center may carry

out a program to facilitate minority health disparities research

and other health disparities research by providing for research

endowments at centers of excellence under section 736.

‘‘(2) ELIGIBILITY.—The Director of the Center may provide

for a research endowment under paragraph (1) only if the

institution involved meets the following conditions:

‘‘(A) The institution does not have an endowment that

is worth in excess of an amount equal to 50 percent of

the national average of endowment funds at institutions

114 STAT. 2500 PUBLIC LAW 106–525—NOV. 22, 2000

that conduct similar biomedical research or training of

health professionals.

‘‘(B) The application of the institution under paragraph

(1) regarding a research endowment has been recommended

pursuant to technical and scientific peer review and has

been approved by the advisory council under subsection

(j).

‘‘(i) CERTAIN ACTIVITIES.—In carrying out subsection (a), the

Director of the Center—

‘‘(1) shall assist the Director of the National Center for

Research Resources in carrying out section 481(c)(3) and in

committing resources for construction at Institutions of

Emerging Excellence;

‘‘(2) shall establish projects to promote cooperation among

Federal agencies, State, local, tribal, and regional public health

agencies, and private entities in health disparities research;

and

‘‘(3) may utilize information from previous health initiatives

concerning minorities and other health disparity populations.

‘‘(j) ADVISORY COUNCIL.—

‘‘(1) IN GENERAL.—The Secretary shall, in accordance with

section 406, establish an advisory council to advise, assist,

consult with, and make recommendations to the Director of

the Center on matters relating to the activities described in

subsection (a), and with respect to such activities to carry

out any other functions described in section 406 for advisory

councils under such section. Functions under the preceding

sentence shall include making recommendations on budgetary

allocations made in the plan under subsection (f), and shall

include reviewing reports under subsection (k) before the

reports are submitted under such subsection.

‘‘(2) MEMBERSHIP.—With respect to the membership of the

advisory council under paragraph (1), a majority of the members

shall be individuals with demonstrated expertise regarding

minority health disparity and other health disparity issues;

representatives of communities impacted by minority and other

health disparities shall be included; and a diversity of health

professionals shall be represented. The membership shall in

addition include a representative of the Office of Behavioral

and Social Sciences Research under section 404A.

‘‘(k) ANNUAL REPORT.—The Director of the Center shall prepare

an annual report on the activities carried out or to be carried

out by the Center, and shall submit each such report to the Committee on Health, Education, Labor, and Pensions of the Senate,

the Committee on Commerce of the House of Representatives, the

Secretary, and the Director of NIH. With respect to the fiscal

year involved, the report shall—

‘‘(1) describe and evaluate the progress made in health

disparities research conducted or supported by the national

research institutes;

‘‘(2) summarize and analyze expenditures made for activities with respect to health disparities research conducted or

supported by the National Institutes of Health;

‘‘(3) include a separate statement applying the requirements of paragraphs (1) and (2) specifically to minority health

disparities research; and

PUBLIC LAW 106–525—NOV. 22, 2000 114 STAT. 2501

‘‘(4) contain such recommendations as the Director considers appropriate.

‘‘(l) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of

carrying out this subpart, there are authorized to be appropriated

$100,000,000 for fiscal year 2001, and such sums as may be necessary for each of the fiscal years 2002 through 2005. Such

authorization of appropriations is in addition to other authorizations

of appropriations that are available for the conduct and support

of minority health disparities research or other health disparities

research by the agencies of the National Institutes of Health.’’. (b) CONFORMING AMENDMENT.—Part A of title IV of the Public

Health Service Act (42 U.S.C. 281 et seq.) is amended— (1) in section 401(b)(2)— (A) in subparagraph (F), by moving the subparagraph

two ems to the left; and

(B) by adding at the end the following subparagraph: ‘‘(G) The National Center on Minority Health and Health

Disparities.’’; and

(2) by striking section 404.

SEC. 102. CENTERS OF EXCELLENCE FOR RESEARCH EDUCATION AND

TRAINING.

Subpart 6 of part E of title IV of the Public Health Service

Act, as added by section 101(a) of this Act, is amended by adding

at the end the following section:

‘‘SEC. 485F. CENTERS OF EXCELLENCE FOR RESEARCH EDUCATION

AND TRAINING.

‘‘(a) IN GENERAL.—The Director of the Center shall make

awards of grants or contracts to designated biomedical and behavioral research institutions under paragraph (1) of subsection (c),

or to consortia under paragraph (2) of such subsection, for the

purpose of assisting the institutions in supporting programs of

excellence in biomedical and behavioral research training for

individuals who are members of minority health disparity populations or other health disparity populations.

‘‘(b) REQUIRED USE OF FUNDS.—An award may be made under

subsection (a) only if the applicant involved agrees that the grant

will be expended—

‘‘(1) to train members of minority health disparity populations or other health disparity populations as professionals

in the area of biomedical or behavioral research or both; or

‘‘(2) to expand, remodel, renovate, or alter existing research

facilities or construct new research facilities for the purpose

of conducting minority health disparities research and other

health disparities research.

‘‘(c) CENTERS OF EXCELLENCE.—

‘‘(1) IN GENERAL.—For purposes of this section, a designated

biomedical and behavioral research institution is a biomedical

and behavioral research institution that—

‘‘(A) has a significant number of members of minority

health disparity populations or other health disparity populations enrolled as students in the institution (including

individuals accepted for enrollment in the institution);

‘‘(B) has been effective in assisting such students of

the institution to complete the program of education or

training and receive the degree involved;

Grants.

Contracts.

42 USC 287c–32.

42 USC 283b.

42 USC 281.

114 STAT. 2502 PUBLIC LAW 106–525—NOV. 22, 2000

‘‘(C) has made significant efforts to recruit minority

students to enroll in and graduate from the institution,

which may include providing means-tested scholarships

and other financial assistance as appropriate; and

‘‘(D) has made significant recruitment efforts to

increase the number of minority or other members of health

disparity populations serving in faculty or administrative

positions at the institution.

‘‘(2) CONSORTIUM.—Any designated biomedical and behavioral research institution involved may, with other biomedical

and behavioral institutions (designated or otherwise), including

tribal health programs, form a consortium to receive an award

under subsection (a). ‘‘(3) APPLICATION OF CRITERIA TO OTHER PROGRAMS.—In

the case of any criteria established by the Director of the

Center for purposes of determining whether institutions meet

the conditions described in paragraph (1), this section may

not, with respect to minority health disparity populations or

other health disparity populations, be construed to authorize,

require, or prohibit the use of such criteria in any program

other than the program established in this section.

‘‘(d) DURATION OF GRANT.—The period during which payments

are made under a grant under subsection (a) may not exceed

5 years. Such payments shall be subject to annual approval by

the Director of the Center and to the availability of appropriations

for the fiscal year involved to make the payments.

‘‘(e) MAINTENANCE OF EFFORT.—

‘‘(1) IN GENERAL.—With respect to activities for which an

award under subsection (a) is authorized to be expended, the

Director of the Center may not make such an award to a

designated research institution or consortium for any fiscal

year unless the institution, or institutions in the consortium,

as the case may be, agree to maintain expenditures of nonFederal amounts for such activities at a level that is not less

than the level of such expenditures maintained by the institutions involved for the fiscal year preceding the fiscal year

for which such institutions receive such an award.

‘‘(2) USE OF FEDERAL FUNDS.—With respect to any Federal

amounts received by a designated research institution or consortium and available for carrying out activities for which an

award under subsection (a) is authorized to be expended, the

Director of the Center may make such an award only if the

institutions involved agree that the institutions will, before

expending the award, expend the Federal amounts obtained

from sources other than the award.

‘‘(f) CERTAIN EXPENDITURES.—The Director of the Center may

authorize a designated biomedical and behavioral research institution to expend a portion of an award under subsection (a) for

research endowments.

‘‘(g) DEFINITIONS.—For purposes of this section:

‘‘(1) The term ‘designated biomedical and behavioral

research institution’ has the meaning indicated for such term

in subsection (c)(1). Such term includes any health professions

school receiving an award of a grant or contract under section

736.

‘‘(2) The term ‘program of excellence’ means any program

carried out by a designated biomedical and behavioral research

PUBLIC LAW 106–525—NOV. 22, 2000 114 STAT. 2503

institution with an award under subsection (a), if the program

is for purposes for which the institution involved is authorized

in subsection (b) to expend the grant.

‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of

making grants under subsection (a), there are authorized to be

appropriated such sums as may be necessary for each of the fiscal

years 2001 through 2005.’’.

SEC. 103. EXTRAMURAL LOAN REPAYMENT PROGRAM FOR MINORITY

HEALTH DISPARITIES RESEARCH.

Subpart 6 of part E of title IV of the Public Health Service

Act, as amended by section 102 of this Act, is amended by adding

at the end the following section:

‘‘SEC. 485G. LOAN REPAYMENT PROGRAM FOR MINORITY HEALTH

DISPARITIES RESEARCH.

‘‘(a) IN GENERAL.—The Director of the Center shall establish

a program of entering into contracts with qualified health professionals under which such health professionals agree to engage

in minority health disparities research or other health disparities

research in consideration of the Federal Government agreeing to

repay, for each year of engaging in such research, not more than

$35,000 of the principal and interest of the educational loans of

such health professionals. ‘‘(b) SERVICE PROVISIONS.—The provisions of sections 338B,

338C, and 338E shall, except as inconsistent with subsection (a),

apply to the program established in such subsection to the same

extent and in the same manner as such provisions apply to the

National Health Service Corps Loan Repayment Program established in subpart III of part D of title III.

‘‘(c) REQUIREMENT REGARDING HEALTH DISPARITY POPULATIONS.—The Director of the Center shall ensure that not fewer

than 50 percent of the contracts entered into under subsection

(a) are for appropriately qualified health professionals who are

members of a health disparity population.

‘‘(d) PRIORITY.—With respect to minority health disparities

research and other health disparities research under subsection

(a), the Secretary shall ensure that priority is given to conducting

projects of biomedical research.

‘‘(e) FUNDING.—

‘‘(1) AUTHORIZATION OF APPROPRIATIONS.—For the purpose

of carrying out this section, there are authorized to be appropriated such sums as may be necessary for each of the fiscal

years 2001 through 2005.

‘‘(2) AVAILABILITY OF APPROPRIATIONS.—Amounts available

for carrying out this section shall remain available until the

expiration of the second fiscal year beginning after the fiscal

year for which the amounts were made available.’’.

SEC. 104. GENERAL PROVISIONS REGARDING THE CENTER.

Subpart 6 of part E of title IV of the Public Health Service

Act, as amended by section 103 of this Act, is amended by adding

at the end the following section:

‘‘SEC. 485H. GENERAL PROVISIONS REGARDING THE CENTER.

‘‘(a) ADMINISTRATIVE SUPPORT FOR CENTER.—The Secretary,

acting through the Director of the National Institutes of Health,

shall provide administrative support and support services to the

42 USC 287c–34.

Contracts.

42 USC 287c–33.

114 STAT. 2504 PUBLIC LAW 106–525—NOV. 22, 2000

Director of the Center and shall ensure that such support takes

maximum advantage of existing administrative structures at the

agencies of the National Institutes of Health. ‘‘(b) EVALUATION AND REPORT.— ‘‘(1) EVALUATION.—Not later than 5 years after the date

of the enactment of this subpart, the Secretary shall conduct

an evaluation to— ‘‘(A) determine the effect of this subpart on the planning and coordination of health disparities research programs at the agencies of the National Institutes of Health; ‘‘(B) evaluate the extent to which this subpart has

eliminated the duplication of administrative resources

among such Institutes, centers and divisions; and ‘‘(C) provide, to the extent determined by the Secretary

to be appropriate, recommendations concerning future

legislative modifications with respect to this subpart, for

both minority health disparities research and other health

disparities research.

‘‘(2) MINORITY HEALTH DISPARITIES RESEARCH.—The evaluation under paragraph (1) shall include a separate statement

that applies subparagraphs (A) and (B) of such paragraph to

minority health disparities research.

‘‘(3) REPORT.—Not later than 1 year after the date on

which the evaluation is commenced under paragraph (1), the

Secretary shall prepare and submit to the Committee on Health,

Education, Labor, and Pensions of the Senate, and the Committee on Commerce of the House of Representatives, a report

concerning the results of such evaluation.’’.

SEC. 105. REPORT REGARDING RESOURCES OF NATIONAL INSTITUTES OF HEALTH DEDICATED TO MINORITY AND OTHER

HEALTH DISPARITIES RESEARCH.

Not later than December 1, 2003, the Director of the National

Center on Minority Health and Health Disparities (established by

the amendment made by section 101(a)), after consultation with

the advisory council for such Center, shall submit to the Congress,

the Secretary of Health and Human Services, and the Director

of the National Institutes of Health a report that provides the

following:

(1) Recommendations for the methodology that should be

used to determine the extent of the resources of the National

Institutes of Health that are dedicated to minority health

disparities research and other health disparities research,

including determining the amount of funds that are used to

conduct and support such research. With respect to such methodology, the report shall address any discrepancies between

the methodology used by such Institutes as of the date of

the enactment of this Act and the methodology used by the

Institute of Medicine as of such date.

(2) A determination of whether and to what extent, relative

to fiscal year 1999, there has been an increase in the level

of resources of the National Institutes of Health that are dedicated to minority health disparities research, including the

amount of funds used to conduct and support such research.

The report shall include provisions describing whether and

to what extent there have been increases in the number and

amount of awards to minority serving institutions.

Deadline.

42 USC 287c–31

note.

Deadline.

Deadline.

PUBLIC LAW 106–525—NOV. 22, 2000 114 STAT. 2505

TITLE II—HEALTH DISPARITIES RESEARCH BY AGENCY FOR HEALTHCARE RESEARCH AND QUALITY

SEC. 201. HEALTH DISPARITIES RESEARCH BY AGENCY FOR HEALTHCARE RESEARCH AND QUALITY.

(a) IN GENERAL.—Part A of title IX of the Public Health Service

Act (42 U.S.C. 299 et seq.) is amended—

(1) in section 902, by striking subsection (g); and

(2) by adding at the end the following:

‘‘SEC. 903. RESEARCH ON HEALTH DISPARITIES.

‘‘(a) IN GENERAL.—The Director shall—

‘‘(1) conduct and support research to identify populations

for which there is a significant disparity in the quality, outcomes, cost, or use of health care services or access to and

satisfaction with such services, as compared to the general

population;

‘‘(2) conduct and support research on the causes of and

barriers to reducing the health disparities identified in paragraph (1), taking into account such factors as socioeconomic

status, attitudes toward health, the language spoken, the extent

of formal education, the area or community in which the population resides, and other factors the Director determines to

be appropriate;

‘‘(3) conduct and support research and support demonstration projects to identify, test, and evaluate strategies for

reducing or eliminating health disparities, including development or identification of effective service delivery models, and

disseminate effective strategies and models;

‘‘(4) develop measures and tools for the assessment and

improvement of the outcomes, quality, and appropriateness of

health care services provided to health disparity populations;

‘‘(5) in carrying out section 902(c), provide support to

increase the number of researchers who are members of health

disparity populations, and the health services research capacity

of institutions that train such researchers; and

‘‘(6) beginning with fiscal year 2003, annually submit to

the Congress a report regarding prevailing disparities in health

care delivery as it relates to racial factors and socioeconomic

factors in priority populations.

‘‘(b) RESEARCH AND DEMONSTRATION PROJECTS.—

‘‘(1) IN GENERAL.—In carrying out subsection (a), the

Director shall conduct and support research and support demonstrations to—

‘‘(A) identify the clinical, cultural, socioeconomic,

geographic, and organizational factors that contribute to

health disparities, including minority health disparity

populations, which research shall include behavioral

research, such as examination of patterns of clinical

decisionmaking, and research on access, outreach, and the

availability of related support services (such as cultural

and linguistic services);

‘‘(B) identify and evaluate clinical and organizational

strategies to improve the quality, outcomes, and access

Reports.

42 USC 299a–1.

42 USC 299a.

114 STAT. 2506 PUBLIC LAW 106–525—NOV. 22, 2000

to care for health disparity populations, including minority

health disparity populations; ‘‘(C) test such strategies and widely disseminate those

strategies for which there is scientific evidence of effectiveness; and

‘‘(D) determine the most effective approaches for

disseminating research findings to health disparity populations, including minority populations.

‘‘(2) USE OF CERTAIN STRATEGIES.—In carrying out this

section, the Director shall implement research strategies and

mechanisms that will enhance the involvement of individuals

who are members of minority health disparity populations or

other health disparity populations, health services researchers

who are such individuals, institutions that train such individuals as researchers, members of minority health disparity populations or other health disparity populations for whom the

Agency is attempting to improve the quality and outcomes

of care, and representatives of appropriate tribal or other

community-based organizations with respect to health disparity

populations. Such research strategies and mechanisms may

include the use of— ‘‘(A) centers of excellence that can demonstrate, either

individually or through consortia, a combination of multidisciplinary expertise in outcomes or quality improvement

research, linkages to relevant sites of care, and a demonstrated capacity to involve members and communities

of health disparity populations, including minority health

disparity populations, in the planning, conduct, dissemination, and translation of research;

‘‘(B) provider-based research networks, including

health plans, facilities, or delivery system sites of care

(especially primary care), that make extensive use of health

care providers who are members of health disparity populations or who serve patients in such populations and have

the capacity to evaluate and promote quality improvement;

‘‘(C) service delivery models (such as health centers

under section 330 and the Indian Health Service) to reduce

health disparities; and

‘‘(D) innovative mechanisms or strategies that will

facilitate the translation of past research investments into

clinical practices that can reasonably be expected to benefit

these populations.

‘‘(c) QUALITY MEASUREMENT DEVELOPMENT.—

‘‘(1) IN GENERAL.—To ensure that health disparity populations, including minority health disparity populations, benefit

from the progress made in the ability of individuals to measure

the quality of health care delivery, the Director shall support

the development of quality of health care measures that assess

the experience of such populations with health care systems,

such as measures that assess the access of such populations

to health care, the cultural competence of the care provided,

the quality of the care provided, the outcomes of care, or other

aspects of health care practice that the Director determines

to be important.

‘‘(2) EXAMINATION OF CERTAIN PRACTICES.—The Director

shall examine the practices of providers that have a record

of reducing health disparities or have experience in providing

PUBLIC LAW 106–525—NOV. 22, 2000 114 STAT. 2507

culturally competent health services to minority health disparity populations or other health disparity populations. In

examining such practices of providers funded under the authorities of this Act, the Director shall consult with the heads

of the relevant agencies of the Public Health Service. ‘‘(3) REPORT.—Not later than 36 months after the date

of the enactment of this section, the Secretary, acting through

the Director, shall prepare and submit to the appropriate

committees of Congress a report describing the state-of-theart of quality measurement for minority and other health disparity populations that will identify critical unmet needs, the

current activities of the Department to address those needs,

and a description of related activities in the private sector.

‘‘(d) DEFINITION.—For purposes of this section: ‘‘(1) The term ‘health disparity population’ has the meaning

given such term in section 485E, except that in addition to

the meaning so given, the Director may determine that such

term includes populations for which there is a significant disparity in the quality, outcomes, cost, or use of health care

services or access to or satisfaction with such services as compared to the general population. ‘‘(2) The term ‘minority’, with respect to populations, refers

to racial and ethnic minority groups as defined in section 1707.’’. (b) FUNDING.—Section 927 of the Public Health Service Act

(42 U.S.C. 299c–6) is amended by adding at the end the following: ‘‘(d) HEALTH DISPARITIES RESEARCH.—For the purpose of carrying out the activities under section 903, there are authorized

to be appropriated $50,000,000 for fiscal year 2001, and such sums

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

2005.’’.

TITLE III—DATA COLLECTION

RELATING TO RACE OR ETHNICITY

SEC. 301. STUDY AND REPORT BY NATIONAL ACADEMY OF SCIENCES.

(a) STUDY.—The National Academy of Sciences shall conduct

a comprehensive study of the Department of Health and Human

Services’ data collection systems and practices, and any data collection or reporting systems required under any of the programs

or activities of the Department, relating to the collection of data

on race or ethnicity, including other Federal data collection systems

(such as the Social Security Administration) with which the Department interacts to collect relevant data on race and ethnicity.

(b) REPORT.—Not later than 1 year after the date of enactment

of this Act, the National Academy of Sciences shall prepare and

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

of the Senate and the Committee on Commerce of the House of

Representatives, a report that— (1) identifies the data needed to support efforts to evaluate

the effects of socioeconomic status, race and ethnicity on access

to health care and other services and on disparity in health

and other social outcomes and the data needed to enforce

existing protections for equal access to health care;

(2) examines the effectiveness of the systems and practices

of the Department of Health and Human Services described

in subsection (a), including pilot and demonstration projects

Deadline.

42 USC 3501

note.

Deadline.

114 STAT. 2508 PUBLIC LAW 106–525—NOV. 22, 2000

of the Department, and the effectiveness of selected systems

and practices of other Federal, State, and tribal agencies and

the private sector, in collecting and analyzing such data;

(3) contains recommendations for ensuring that the Department of Health and Human Services, in administering its entire

array of programs and activities, collects, or causes to be collected, reliable and complete information relating to race and

ethnicity; and

(4) includes projections about the costs associated with

the implementation of the recommendations described in paragraph (3), and the possible effects of the costs on program

operations.

(c) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of

carrying out this section, there are authorized to be appropriated

such sums as may be necessary for fiscal year 2001.

TITLE IV—HEALTH PROFESSIONS

EDUCATION

SEC. 401. HEALTH PROFESSIONS EDUCATION IN HEALTH DISPARITIES.

(a) IN GENERAL.—Part B of title VII of the Public Health

Service Act (42 U.S.C. 293 et seq.) is amended by inserting after

section 740 the following:

‘‘SEC. 741. GRANTS FOR HEALTH PROFESSIONS EDUCATION.

‘‘(a) GRANTS FOR HEALTH PROFESSIONS EDUCATION IN HEALTH

DISPARITIES AND CULTURAL COMPETENCY.—

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

Administrator of the Health Resources and Services Administration, may make awards of grants, contracts, or cooperative

agreements to public and nonprofit private entities (including

tribal entities) for the purpose of carrying out research and

demonstration projects (including research and demonstration

projects for continuing health professions education) for training

and education of health professionals for the reduction of

disparities in health care outcomes and the provision of culturally competent health care.

‘‘(2) ELIGIBLE ENTITIES.—Unless specifically required otherwise in this title, the Secretary shall accept applications for

grants or contracts under this section from health professions

schools, academic health centers, State or local governments,

or other appropriate public or private nonprofit entities (or

consortia of entities, including entities promoting multidisciplinary approaches) for funding and participation in health

professions training activities. The Secretary may accept

applications from for-profit private entities as determined

appropriate by the Secretary.

‘‘(b) AUTHORIZATION OF APPROPRIATIONS.—There are authorized

to be appropriated to carry out subsection (a), $3,500,000 for fiscal

year 2001, $7,000,000 for fiscal year 2002, $7,000,000 for fiscal

year 2003, and $3,500,000 for fiscal year 2004.’’.

(b) NURSING EDUCATION.—Part A of title VIII of the Public

Health Service Act (42 U.S.C. 296 et seq.) is amended—

(1) by redesignating section 807 as section 808; and

42 USC 296e–1. (2) by inserting after section 806 the following:

42 USC 296f.

42 USC 293e.

PUBLIC LAW 106–525—NOV. 22, 2000 114 STAT. 2509

‘‘SEC. 807. GRANTS FOR HEALTH PROFESSIONS EDUCATION.

‘‘(a) GRANTS FOR HEALTH PROFESSIONS EDUCATION IN HEALTH

DISPARITIES AND CULTURAL COMPETENCY.—The Secretary, acting

through the Administrator of the Health Resources and Services

Administration, may make awards of grants, contracts, or cooperative agreements to eligible entities for the purpose of carrying

out research and demonstration projects (including research and

demonstration projects for continuing health professions education)

for training and education for the reduction of disparities in health

care outcomes and the provision of culturally competent health

care. Grants under this section shall be the same as provided

in section 741.’’.

‘‘(b) AUTHORIZATION OF APPROPRIATIONS.—There are to be

appropriated to carry out subsection (a) such sums as may be

necessary for each of the fiscal years 2001 through 2004.’’.

SEC. 402. NATIONAL CONFERENCE ON HEALTH PROFESSIONS EDUCATION AND HEALTH DISPARITIES.

(a) IN GENERAL.—Not later than 1 year after the date of enactment of this Act, the Secretary of Health and Human Services

(in this section referred to as the ‘‘Secretary’’), acting through the

Administrator of the Health Resources and Services Administration,

shall convene a national conference on health professions education

as a method for reducing disparities in health outcomes.

(b) PARTICIPANTS.—The Secretary shall include in the national

conference convened under subsection (a) advocacy groups and educational entities as described in section 741 of the Public Health

Service Act (as added by section 401), tribal health programs,

health centers under section 330 of such Act, and other interested

parties.

(c) ISSUES.—The national conference convened under subsection

(a) shall include, but is not limited to, issues that address the

role and impact of health professions education on the reduction

of disparities in health outcomes, including the role of education

on cultural competency. The conference shall focus on methods

to achieve reductions in disparities in health outcomes through

health professions education (including continuing education programs) and strategies for outcomes measurement to assess the

effectiveness of education in reducing disparities.

(d) PUBLICATION OF FINDINGS.—Not later than 6 months after

the national conference under subsection (a) has convened, the

Secretary shall publish in the Federal Register a summary of the

proceedings and findings of the conference.

(e) AUTHORIZATION OF APPROPRIATIONS.—There is authorized

to be appropriated such sums as may be necessary to carry out

this section.

SEC. 403. ADVISORY RESPONSIBILITIES IN HEALTH PROFESSIONS

EDUCATION IN HEALTH DISPARITIES AND CULTURAL

COMPETENCY.

Section 1707 of the Public Health Service Act (42 U.S.C. 300u– 6) is amended—

(1) in subsection (b), by adding at the end the following

paragraph:

‘‘(10) Advise in matters related to the development,

implementation, and evaluation of health professions education

in decreasing disparities in health care outcomes, including

Deadline.

Federal Register,

publication.

Deadline.

42 USC 293e

note.

114 STAT. 2510 PUBLIC LAW 106–525—NOV. 22, 2000

cultural competency as a method of eliminating health disparities.’’;

(2) in subsection (c)(2), by striking ‘‘paragraphs (1) through

(9)’’ and inserting ‘‘paragraphs (1) through (10)’’; and

(3) in subsection (d), by amending paragraph (1) to read

as follows:

‘‘(1) RECOMMENDATIONS REGARDING LANGUAGE.—

‘‘(A) PROFICIENCY IN SPEAKING ENGLISH.—The Deputy

Assistant Secretary shall consult with the Director of the

Office of International and Refugee Health, the Director

of the Office of Civil Rights, and the Directors of other

appropriate departmental entities regarding recommendations for carrying out activities under subsection (b)(9).

‘‘(B) HEALTH PROFESSIONS EDUCATION REGARDING

HEALTH DISPARITIES.—The Deputy Assistant Secretary

shall carry out the duties under subsection (b)(10) in

collaboration with appropriate personnel of the Department

of Health and Human Services, other Federal agencies,

and other offices, centers, and institutions, as appropriate,

that have responsibilities under the Minority Health and

Health Disparities Research and Education Act of 2000.’’.

TITLE V—PUBLIC AWARENESS AND DISSEMINATION OF INFORMATION ON

HEALTH DISPARITIES

SEC. 501. PUBLIC AWARENESS AND INFORMATION DISSEMINATION.

(a) PUBLIC AWARENESS ON HEALTH DISPARITIES.—The Secretary

of Health and Human Services (in this section referred to as the

‘‘Secretary’’) shall conduct a national campaign to inform the public

and health care professionals about health disparities in minority

and other underserved populations by disseminating information

and materials available on specific diseases affecting these populations and programs and activities to address these disparities.

The campaign shall—

(1) have a specific focus on minority and other underserved

communities with health disparities; and

(2) include an evaluation component to assess the impact

of the national campaign in raising awareness of health disparities and information on available resources.

(b) DISSEMINATION OF INFORMATION ON HEALTH DISPARITIES.—

The Secretary shall develop and implement a plan for the dissemination of information and findings with respect to health disparities

under titles I, II, III, and IV of this Act. The plan shall—

(1) include the participation of all agencies of the Department of Health and Human Services that are responsible for

serving populations included in the health disparities research;

and

(2) have agency-specific strategies for disseminating relevant findings and information on health disparities and

improving health care services to affected communities.

42 USC 287c–31

note.

PUBLIC LAW 106–525—NOV. 22, 2000 114 STAT. 2511

LEGISLATIVE HISTORY—S. 1880 (H.R. 3250):

HOUSE REPORTS: No. 106–986 accompanying H.R. 3250 (Comm. on Commerce).

CONGRESSIONAL RECORD, Vol. 146 (2000):

Oct. 26, considered and passed Senate.

Oct. 31, considered and passed House.

WEEKLY COMPILATION OF PRESIDENTIAL DOCUMENTS, Vol. 36 (2000):

Nov. 22, Presidential statement.

Æ

TITLE VI—MISCELLANEOUS

PROVISIONS

SEC. 601. DEPARTMENTAL DEFINITION REGARDING MINORITY

INDIVIDUALS.

Section 1707(g)(1) of the Public Health Service Act (42 U.S.C.

300u–6) is amended— (1) by striking ‘‘Asian Americans and’’ and inserting ‘‘Asian

Americans;’’; and

(2) by inserting ‘‘Native Hawaiians and other’’ before ‘‘Pacific Islanders;’’.

SEC. 602. CONFORMING PROVISION REGARDING DEFINITIONS.

For purposes of this Act, the term ‘‘racial and ethnic minority

group’’ has the meaning given such term in section 1707 of the

Public Health Service Act.

SEC. 603. EFFECTIVE DATE.

This Act and the amendments made by this Act take effect

October 1, 2000, or upon the date of the enactment of this Act,

whichever occurs later.

Approved November 22, 2000.

42 USC 281 note.