I 

116TH CONGRESS 

2D SESSION H. R. 8200 

To improve the health of minority individuals during the COVID–19 

pandemic, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

SEPTEMBER 11, 2020 

Ms. KELLY of Illinois (for herself, Ms. BASS, Mr. CASTRO of Texas, Ms. JUDY

CHU of California, Mr. GARCI ́A of Illinois, Ms. HAALAND, Ms. LEE of 

California, Mr. SOTO, Ms. SEWELL of Alabama, Mr. BUTTERFIELD, Mr. 

SABLAN, Ms. BARRAGA ́N, Ms. CLARKE of New York, Mr. CA ́RDENAS, Mr. 

SARBANES, Ms. PRESSLEY, Mr. THOMPSON of Mississippi, Ms. ESCOBAR, 

Mr. BRENDAN F. BOYLE of Pennsylvania, Mr. CARSON of Indiana, Mr. 

CLAY, Mrs. BEATTY, Mr. KHANNA, Ms. GARCIA of Texas, Mr. SAN NICOLAS, Mr. ESPAILLAT, Ms. JAYAPAL, Mrs. DEMINGS, Mr. HASTINGS, Mrs. 

WATSON COLEMAN, Ms. JOHNSON of Texas, Mr. GRIJALVA, Ms. 

BONAMICI, and Mr. LYNCH) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to 

the Committees on Ways and Means, the Judiciary, Transportation and 

Infrastructure, Education and Labor, Agriculture, Natural Resources, 

House Administration, Oversight and Reform, the Budget, and Small 

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

each case for consideration of such provisions as fall within the jurisdiction of the committee concerned 

A BILL 

To improve the health of minority individuals during the 

COVID–19 pandemic, 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, 


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Ending Health Dis3 parities During COVID–19 Act of 2020’’ or the ‘‘EHDC 

4 Act of 2020’’. 

5 SEC. 2. TABLE OF CONTENTS. 

Sec. 1. Short title. 

Sec. 2. Table of contents. 

TITLE I—RACIAL AND ETHNICITY DATA COLLECTION 

Subtitle A—Collection and Reporting 

Sec. 101. Equitable data collection and disclosure on COVID–19 Act. 

Sec. 102. COVID–19 reporting portal. 

Sec. 103. Regular CDC reporting on demographic data. 

Sec. 104. Amendment to the Public Health Service Act. 

Sec. 105. Elimination of prerequisite of direct appropriations for data collection 

and analysis. 

Sec. 106. Collection of data for the Medicare program. 

Sec. 107. Revision of HIPAA claims standards. 

Sec. 108. Disparities data collected by the Federal Government. 

Sec. 109. Standards for measuring sexual orientation, gender identity, and socioeconomic status in collection of health data. 

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

Islanders. 

Subtitle B—Improvements and Modernization 

Sec. 121. Federal modernization for health inequities data. 

Sec. 122. Modernization of State and local health inequities data. 

Sec. 123. Additional reporting to Congress on the race and ethnicity rates of 

COVID–19 testing, hospitalizations, and mortalities. 

TITLE II—EQUITABLE TESTING AND TRACING 

Subtitle A—Free Testing for Patients 

Sec. 201. Sooner coverage of testing for COVID–19. 

Subtitle B—National Testing Strategy 

Sec. 211. COVID–19 testing strategy. 

Sec. 212. Coronavirus immigrant families protection. 

Sec. 213. ICE detention. 

Subtitle C—Contact Tracing 

Sec. 221. COVID–19 Testing, reaching, and contacting everyone. 

Sec. 222. National system for COVID–19 testing, contact tracing, surveillance, 

containment, and mitigation. 

Sec. 223. Grants. 

Sec. 224. Grants to State and Tribal workforce agencies. 


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TITLE III—FREE TREATMENT FOR ALL AMERICANS 

Sec. 301. Coverage at no cost sharing of COVID–19 vaccine and treatment. 

Sec. 302. Optional coverage at no cost sharing of COVID–19 treatment and 

vaccines under Medicaid for uninsured individuals. 

Sec. 303. Coverage of treatments for COVID–19 at no cost sharing under the 

Medicare Advantage program. 

Sec. 304. Requiring coverage under Medicare PDPS and MA–PD plans, without the imposition of cost sharing or utilization management 

requirements, of drugs intended to treat COVID–19 during 

certain emergencies. 

Sec. 305. Coverage of COVID–19 related treatment at no cost sharing. 

Sec. 306. Reimbursement for additional health services relating to coronavirus. 

TITLE IV—FEDERAL HEALTH EQUITY OVERSIGHT 

Sec. 401. COVID-19 Racial and Ethnic Disparities Task Force Act of 2020. 

Sec. 402. Protection of the HHS Offices of Minority Health. 

Sec. 403. Establish an interagency counsel and grant programs on social determinants of health. 

Sec. 404. Accountability and transparency within the Department of Health 

and Human Services. 

TITLE V—EXPANDED INSURANCE ACCESS 

Sec. 501. Medicare special enrollment period for individuals residing in COVID19 emergency areas. 

Sec. 502. Special enrollment period through exchanges; Federal exchange outreach and educational activities. 

Sec. 503. MOMMA’s Act. 

Sec. 504. Allowing for medical assistance under Medicaid for inmates during 

30-day period preceding release. 

Sec. 505. Providing for immediate Medicaid eligibility for former foster youth. 

Sec. 506. Expanded coverage for former foster youth. 

Sec. 507. Removing citizenship and immigration barriers to access to affordable 

health care under ACA. 

Sec. 508. Medicaid in the territories. 

Sec. 509. Removing Medicare barrier to health care. 

Sec. 510. Removing barriers to health care and nutrition assistance for children, pregnant persons, and lawfully present individuals. 

Sec. 511. Repeal of requirement for documentation evidencing citizenship or 

nationality under the Medicaid program. 

TITLE VI—COMMUNITY BASED GRANTS 

Sec. 601. Grants for racial and ethnic approaches to community health. 

Sec. 602. Grants to promote health for underserved communities. 

Sec. 603. Addressing COVID–19 health inequities and improving health equity. 

Sec. 604. Improving social determinants of health. 

Sec. 605. Funding to States, localities, and community-based organizations for 

emergency aid and services. 

Sec. 606. Supplemental nutrition assistance program. 

TITLE VII—CULTURALLY AND LINGUISTICALLY COMPETENT 

CARE 


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Sec. 701. Ensuring standards for culturally and linguistically appropriate services in health care. 

Sec. 702. Culturally and linguistically appropriate health care in the Public 

Health Service Act. 

Sec. 703. Training tomorrow’s doctors for culturally and linguistically appropriate care: graduate medical education. 

Sec. 704. Federal reimbursement for culturally and linguistically appropriate 

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

Health Insurance Programs. 

Sec. 705. Requirements for health programs or activities receiving Federal 

funds. 

Sec. 706. Report on Federal efforts to provide culturally and linguistically appropriate health care services. 

Sec. 707. Health professions competencies to address racial and ethnic mental 

health disparities. 

Sec. 708. Study on the uninsured. 

TITLE VIII—AID TO PROVIDERS SERVING MINORITY 

COMMUNITIES 

Sec. 801. Temporary increase in Medicaid DSH allotments. 

Sec. 802. COVID–19-related temporary increase of Medicaid FMAP. 

Sec. 803. Appropriation for primary health care. 

Sec. 804. Amendment to the Public Health Service Act. 

Sec. 805. Pandemic premium pay for essential workers. 

Sec. 806. COVID–19 Heroes Fund grants. 

Sec. 807. Enforcement and outreach. 

TITLE IX—HEALTH IT AND BRIDGING THE DIGITAL DIVIDE IN 

HEALTH CARE 

Sec. 901. HRSA assistance to health centers for promotion of Health IT. 

Sec. 902. Assessment of impact of Health IT on racial and ethnic minority 

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

Sec. 903. Extending funding to strengthen the Health IT infrastructure in racial and ethnic minority communities. 

Sec. 904. 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. 905. Authorization of appropriations. 

Sec. 906. Data collection and assessments conducted in coordination with minority-serving institutions. 

Sec. 907. Study of health information technology in medically underserved communities. 

Sec. 908. Study on the effects of changes to telehealth under the Medicare and 

Medicaid programs during the COVID-19 emergency. 

Sec. 909. COVID–19 designation of immediate special authority of spectrum 

for Tribes’ emergency response in Indian Country. 

Sec. 910. Facilitating the provision of telehealth services across State lines. 

TITLE X—PUBLIC AWARENESS 

Sec. 1001. Awareness campaigns. 

Sec. 1002. Increasing understanding of and improving health literacy. 

Sec. 1003. English for speakers of other languages. 


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Sec. 1004. Influenza, COVID–19, and pneumonia vaccination campaign. 

TITLE XI—RESEARCH 

Sec. 1101. Research and development. 

Sec. 1102. CDC field studies pertaining to specific health inequities. 

Sec. 1103. Expanding capacity for health outcomes. 

Sec. 1104. Data collection and analysis grants to minority-serving institutions. 

Sec. 1105. Safety and effectiveness of drugs with respect to racial and ethnic 

background. 

Sec. 1106. GAO and NIH reports. 

Sec. 1107. Health impact assessments. 

Sec. 1108. Tribal funding to research health inequities including COVID–19. 

Sec. 1109. Research endowments at both current and former centers of excellence. 

TITLE XII—EDUCATION 

Sec. 1201. Grants for schools of medicine in diverse and underserved areas. 

Sec. 1202. Amendment to the Public Health Service Act. 

Sec. 1203. Hispanic-serving institutions, Historically Black Colleges and Universities, Asian American and Native American Pacific Islander-serving institutions, Tribal colleges, regional communitybased organizations, and national minority medical associations. 

Sec. 1204. Loan repayment program of Centers for Disease Control and Prevention. 

Sec. 1205. Study and report on strategies for increasing diversity. 

Sec. 1206. Amendments to the Pandemic EBT Act. 

TITLE XIII—PUBLIC HEALTH ASSISTANCE TO TRIBES 

Sec. 1301. Appropriations for the Indian Health Service. 

Sec. 1302. Improving State, local, and Tribal public health security. 

Sec. 1303. Provision of items to Indian programs and facilities. 

Sec. 1304. Health care access for urban native veterans. 

Sec. 1305. Proper and reimbursed care for native veterans. 

1 TITLE I—RACIAL AND 

2 ETHNICITY DATA COLLECTION 

3 Subtitle A—Collection and 

4 Reporting 

5 SEC. 101. EQUITABLE DATA COLLECTION AND DISCLOSURE 

6 ON COVID–19 ACT. 

7 (a) FINDINGS.—Congress makes the following find8 ings: 


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1 (1) The World Health Organization (WHO) de2 clared COVID–19 a ‘‘Public Health Emergency of 

3 International Concern’’ on January 30, 2020. By 

4 late March 2020, there have been over 470,000 con5 firmed cases of, and 20,000 deaths associated with, 

6 COVID–19 worldwide. 

7 (2) In the United States, cases of COVID–19 

8 have quickly surpassed those across the world, and 

9 as of April 12, 2020, over 500,000 cases and 20,000 

10 deaths have been reported in the United States 

11 alone. 

12 (3) Early reporting on racial inequities in 

13 COVID–19 testing and treatment have renewed calls 

14 for the Centers for Disease Control and Prevention 

15 and other relevant subagencies within the Depart16 ment of Health and Human Services to publicly re17 lease racial and demographic information to better 

18 inform the pandemic response, specifically in com19 munities of color and in Limited English Proficient 

20 (LEP) communities. 

21 (4) The burden of morbidity and mortality in 

22 the United States has historically fallen dispropor23 tionately on marginalized communities (those who 

24 suffer the most from great public health needs and 

25 are the most medically underserved). 


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1 (5) Historically, structures and systems, such 

2 as racism, ableism and class oppression, have ren3 dered affected individuals more vulnerable to inequi4 ties and have prevented people from achieving their 

5 optimal health even when there is not a crisis of 

6 pandemic proportions. 

7 (6) Significant differences in access to health 

8 care, specifically to primary health care providers, 

9 health care information, and greater perceived dis10 crimination in health care place communities of 

11 color, individuals with disabilities, and LEP individ12 uals at greater risk of receiving delayed, and per13 haps poorer, health care. 

14 (7) Stark racial inequities across the United 

15 States, including unequal access to stable housing, 

16 quality education, and decent employment signifi17 cantly impact the ability of individuals to take care 

18 of their most basic health needs. Communities of 

19 color are more likely to experience homelessness and 

20 struggle with low-paying jobs or unemployment. To 

21 date, experts have cited that 2 in 5 Latino residents 

22 in New York City, the current epicenter of the 

23 COVID–19 pandemic, are recently unemployed as a 

24 direct consequence of COVID–19. And at a time 

25 when sheltering in place will save lives, less than 1 


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1 in 5 Black workers and roughly 1 in 6 Latino work2 ers are able to work from home. 

3 (8) Communities of color experience higher 

4 rates of chronic disease and disabilities, such as dia5 betes, hypertension, and asthma, than non-Hispanic 

6 White communities, which predisposes them to 

7 greater risk of complications and mortality should 

8 they contract COVID–19. 

9 (9) Such communities are made even more vul10 nerable to the uncertainty of the preparation, re11 sponse, and events surrounding the pandemic public 

12 health crisis, COVID–19. For instance, in the recent 

13 past, multiple epidemiologic studies and reviews have 

14 reported higher rates of hospitalization due to the 

15 2009 H1N1 pandemic among the poor, individuals 

16 with disabilities and preexisting conditions, those liv17 ing in impoverished neighborhoods, and individuals 

18 of color and ethnic backgrounds in the United 

19 States. These findings highlight the urgency to 

20 adapt the COVID–19 response to monitor and act 

21 on these inequities via data collection and research 

22 by race and ethnicity. 

23 (10) Research experts recognize that there are 

24 underlying differences in illness and death when 

25 each of these factors are examined through socioVerDate Sep 11 2014 00:31 Nov 13, 2020 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H8200.IH H8200

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1 economic and racial or ethnic lenses. These socially 

2 determinant factors of health accelerate disease and 

3 degradation. 

4 (11) Language barriers are highly correlated 

5 with medication noncompliance and inconsistent en6 gagement with health systems. Without language ac7 cessibility data and research around COVID–19, 

8 these communities are less likely to receive critical 

9 testing and preventive health services. Yet, to date, 

10 the Centers for Disease Control and Prevention do 

11 not disseminate COVID–19 messaging in critical 

12 languages, including Mandarin Chinese, Spanish, 

13 and Korean within the same timeframe as informa14 tion in English despite requirements to ensure lim15 ited English proficient populations are not discrimi16 nated against under title VI of the Civil Rights Act 

17 of 1964 and subsequent laws and Federal policies. 

18 (12) Further, it is critical to disaggregate data 

19 further by ancestry to address disparities among 

20 Asian American, Native Hawaiian, and Pacific Is21 lander groups. According to the National Equity 

22 Atlas, while 13 percent of the Asian population over23 all lived in poverty in 2015, 39 percent of Burmese 

24 people, 29 percent of Hmong people, and 21 percent 

25 of Pacific Islanders lived in poverty. 


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1 (13) Utilizing disaggregation of enrollment in 

2 Affordable Care Act-sponsored health insurance, the 

3 Asian and Pacific Islander American Health Forum 

4 found that prior to the passage of the Patient Pro5 tection and Affordable Care Act (Public Law 111– 

6 148), Korean Americans had a high uninsured rate 

7 of 23 percent, compared to just 12 percent for all 

8 Asian Americans. Developing targeted outreach ef9 forts assisted 1,000,000 people and resulted in a 56- 

10 percent decrease in the uninsured among the Asian, 

11 Native Hawaiian, and Pacific Islander population. 

12 Such efforts show that disaggregated data is essen13 tial to public health mobilizations efforts. 

14 (14) Without clear understanding of how 

15 COVID–19 impacts marginalized racial and ethnic 

16 communities, there will be exacerbated risk of en17 dangering the most historically vulnerable of our 

18 Nation. 

19 (15) The consequences of misunderstanding the 

20 racial and ethnic impact of COVID–19 expound be21 yond communities of color such that it would impact 

22 all. 

23 (16) Race and ethnicity are valuable research 

24 and practice variables when used and interpreted ap25 propriately. Health data collected on patients by 


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1 race and ethnicity will boost and more efficiently di2 rect critical resources and inform risk communica3 tion development in languages and at appropriate 

4 health literacy levels, which resonate with historically 

5 vulnerable communities of color. 

6 (17) To date, there is no public standardized 

7 and comprehensive race and ethnicity data reposi8 tory of COVID–19 testing, hospitalizations, or mor9 tality. The inconsistency of data collection by Fed10 eral, State, and local health authorities, and the in11 ability to access data by public research institutions 

12 and academic organizations, poses a threat to anal13 ysis and synthesis of the pandemic impact on com14 munities of color. However, research and medical ex15 perts of Historically Black Colleges and Universities, 

16 academic health care institutions which are histori17 cally and geographically embedded in minoritized 

18 and marginalized communities, generally also pos19 sess rapport with the communities they serve. They 

20 are well-positioned, as trusted thought leaders and 

21 health care service providers, to collect data and con22 duct research toward creating holistic solutions to 

23 remedy the inequitable impact of this and future 

24 public health crises. 


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1 (18) Well-designed, ethically sound research 

2 aligns with the goals of medicine, addresses ques3 tions relevant to the population among whom the 

4 study will be carried out, balances the potential for 

5 benefit against the potential for harm, employs 

6 study designs that will yield scientifically valid and 

7 significant data, and generates useful knowledge. 

8 (19) The dearth of racially and ethnically 

9 disaggregated data reflecting the health of commu10 nities of color underlies the challenges of a fully in11 formed public health response. 

12 (20) Without collecting race and ethnicity data 

13 associated with COVID–19 testing, hospitalizations, 

14 morbidities, and mortalities, as well as publicly dis15 closing it, communities of color will remain at great16 er risk of disease and death. 

17 (b) EMERGENCY FUNDING FOR FEDERAL DATA COL18 LECTION ON THE RACIAL, ETHNIC, AND OTHER DEMO19 GRAPHIC DISPARITIES OF COVID–19.—To conduct or 

20 support data collection on the racial, ethnic, and other de21 mographic implications of COVID–19 in the United States 

22 and its territories, including support to assist in the capac23 ity building for State and local public health departments 

24 to collect and transmit racial, ethnic, and other demo25 graphic data to the relevant Department of Health and 


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1 Human Services agencies, there is authorized to be appro2 priated— 

3 (1) to the Centers for Disease Control and Pre4 vention, $12,000,000; 

5 (2) to State, territorial, and Tribal public 

6 health agencies, distributed proportionally based on 

7 the total population of their residents who are en8 rolled in Medicaid or who have no health insurance, 

9 $15,000,000; 

10 (3) to the Indian Health Service, Indian Tribes 

11 and Tribal organizations (as defined in section 4 of 

12 the Indian Self-Determination and Education Assist13 ance Act), and urban Indian organizations (as de14 fined in section 4 of the Indian Health Care Im15 provement Act), $3,000,000; 

16 (4) to the Centers for Medicare & Medicaid 

17 Services, $5,000,000; 

18 (5) to the Food and Drug Administration, 

19 $5,000,000; 

20 (6) to the Agency for Healthcare Research and 

21 Quality, $5,000,000; and 

22 (7) to the Office of the National Coordinator 

23 for Health Information Technology, $5,000,000. 

24 (c) COVID–19 DATA COLLECTION AND DISCLO25 SURE.— 


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1 (1) DATA COLLECTION.—The Secretary of 

2 Health and Human Services (referred to in this sec3 tion as the ‘‘Secretary’’), acting through the Direc4 tor of the Centers for Disease Control and Preven5 tion and the Administrator of the Centers for Medi6 care & Medicaid Services, shall make publicly avail7 able on the website of the Centers for Disease Con8 trol and Prevention data collected across all surveil9 lance systems relating to COVID–19, disaggregated 

10 by race, ethnicity, sex, age, primary language, socio11 economic status, disability status, and county, in12 cluding the following: 

13 (A) Data related to all COVID–19 testing, 

14 including the number of individuals tested and 

15 the number of tests that were positive. 

16 (B) Data related to treatment for COVID– 

17 19, including hospitalizations and intensive care 

18 unit admissions. 

19 (C) Data related to COVID–19 outcomes, 

20 including total fatalities and case fatality rates 

21 (expressed as the proportion of individuals who 

22 were infected with COVID–19 and died from 

23 the virus). 

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1 section shall follow standards developed by the De2 partment of Health and Human Services Office of 

3 Minority Health and be collected, analyzed, and re4 ported in accordance with the standards promul5 gated by the Assistant Secretary for Planning and 

6 Evaluation under title XXXI of the Public Health 

7 Service Act (42 U.S.C. 300kk et seq.). 

8 (3) TIMELINE.—The data made available under 

9 this subsection shall be updated on a daily basis 

10 throughout the public health emergency. 

11 (4) PRIVACY.—In publishing data under this 

12 subsection, the Secretary shall take all necessary 

13 steps to protect the privacy of individuals whose in14 formation is included in such data, including— 

15 (A) complying with privacy protections 

16 provided under the regulations promulgated 

17 under section 264(c) of the Health Insurance 

18 Portability and Accountability Act of 1996; and 

19 (B) protections from all inappropriate in20 ternal use by an entity that collects, stores, or 

21 receives the data, including use of such data in 

22 determinations of eligibility (or continued eligi23 bility) in health plans, and from inappropriate 

24 uses. 


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1 (5) CONSULTATION WITH TRIBES.—The Indian 

2 Health Service shall consult with Indian Tribes and 

3 confer with urban Indian organizations on data col4 lection and reporting. 

5 (6) REPORT.—Not later than 60 days after the 

6 date on which the Secretary certifies that the public 

7 health emergency related to COVID–19 has ended, 

8 the Secretary shall make publicly available a sum9 mary of the final statistics related to COVID–19. 

10 (7) REPORT.—Not later than 60 days after the 

11 date on which the Secretary certifies that the public 

12 health emergency related to COVID–19 has ended, 

13 the Department of Health and Human Services shall 

14 compile and submit to the Committee on Health, 

15 Education, Labor, and Pensions and the Committee 

16 on Finance of the Senate and the Committee on En17 ergy and Commerce and the Committee on Ways 

18 and Means of the House of Representatives a pre19 liminary report— 

20 (A) describing the testing, hospitalization, 

21 mortality rates, and preferred language of pa22 tients associated with COVID–19 by race and 

23 ethnicity; and 


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1 (B) proposing evidenced-based response 

2 strategies to safeguard the health of these com3 munities in future pandemics. 

4 (d) COMMISSION ON ENSURING HEALTH EQUITY

5 DURING THE COVID–19 PUBLIC HEALTH EMER6 GENCY.— 

7 (1) IN GENERAL.—Not later than 30 days after 

8 the date of enactment of this Act, the Secretary 

9 shall establish a commission, to be known as the 

10 ‘‘Commission on Ensuring Health Equity During 

11 the COVID–19 Public Health Emergency’’ (referred 

12 to in this subsection as the ‘‘Commission’’) to pro13 vide clear and robust guidance on how to improve 

14 the collection, analysis, and use of demographic data 

15 in responding to future waves of the coronavirus. 

16 (2) MEMBERSHIP AND CHAIRPERSON.— 

17 (A) MEMBERSHIP.—The Commission shall 

18 be composed of— 

19 (i) the Director of the Centers for 

20 Disease Control and Prevention; 

21 (ii) the Director of the National Insti22 tutes of Health; 

23 (iii) the Commissioner of Food and 

24 Drugs; 


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1 (iv) the Administrator of the Federal 

2 Emergency Management Agency; 

3 (v) the Director of the National Insti4 tute on Minority Health and Health Dis5 parities; 

6 (vi) the Director of the Indian Health 

7 Service; 

8 (vii) the Administrator of the Centers 

9 for Medicare & Medicaid Services; 

10 (viii) the Director of the Agency for 

11 Healthcare Research and Quality; 

12 (ix) the Surgeon General; 

13 (x) the Administrator of the Health 

14 Resources and Services Administration; 

15 (xi) the Director of the Office of Mi16 nority Health; 

17 (xii) the Director of the Office of 

18 Women’s Health; 

19 (xiii) the Chairperson of the National 

20 Council on Disability; 

21 (xiv) at least 4 State, local, territorial, 

22 and Tribal public health officials rep23 resenting departments of public health, 

24 who shall represent jurisdictions from dif25 ferent regions of the United States with 


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1 relatively high concentrations of histori2 cally marginalized populations, to be ap3 pointed by the Secretary; and 

4 (xv) racially and ethnically diverse 

5 representation from at least 3 independent 

6 experts with knowledge or field experience 

7 with racial and ethnic disparities in public 

8 health appointed by the Secretary. 

9 (B) CHAIRPERSON.—The President of the 

10 National Academies of Sciences, Engineering, 

11 and Medicine, or designee, shall serve as the 

12 chairperson of the Commission. 

13 (3) DUTIES.—The Commission shall— 

14 (A) examine barriers to collecting, ana15 lyzing, and using demographic data; 

16 (B) determine how to best use such data 

17 to promote health equity across the United 

18 States and reduce racial, Tribal, and other de19 mographic disparities in COVID–19 prevalence 

20 and outcomes; 

21 (C) gather available data related to 

22 COVID–19 treatment of individuals with dis23 abilities, including denial of treatment for pre24 existing conditions, removal or denial of dis25 ability related equipment (including ventilators 


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1 and CPAP), and data on completion of DNR 

2 orders, and identify barriers to obtaining accu3 rate and timely data related to COVID–19 

4 treatment of such individuals; 

5 (D) solicit input from public health offi6 cials, community-connected organizations, 

7 health care providers, State and local agency of8 ficials, and other experts on barriers to, and 

9 best practices for, collecting demographic data; 

10 and 

11 (E) recommend policy changes that the 

12 data indicates are necessary to reduce dispari13 ties. 

14 (4) REPORT.—Not later than 60 days after the 

15 date of enactment of this Act, and every 180 days 

16 thereafter until the Secretary certifies that the pub17 lic health emergency related to COVID–19 has 

18 ended, the Commission shall submit a written report 

19 of its findings and recommendations to Congress 

20 and post such report on a website of the Department 

21 of Health and Human Services. Such reports shall 

22 contain information concerning— 

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

24 and Tribal capacity to conduct public health re25 search on COVID–19, with a focus on expanded 


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1 capacity to analyze data on disparities cor2 related with race, ethnicity, income, sex, age, 

3 disability status, specific geographic areas, and 

4 other relevant demographic characteristics, and 

5 an analysis of what demographic data is cur6 rently being collected about COVID–19, the ac7 curacy of that data and any gaps, how this data 

8 is currently being used to inform efforts to com9 bat COVID–19, and what resources are needed 

10 to supplement existing public health data collec11 tion; 

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

13 the public the data described in subparagraph 

14 (A) in a way that maintains individual privacy 

15 while helping direct the State and local re16 sponse to the virus; 

17 (C) how to improve demographic data col18 lection related to COVID–19 in the short- and 

19 long-term, including how to continue to grow 

20 and value the Tribal sovereignty of data and in21 formation concerning Tribal communities; 

22 (D) to the extent possible, a preliminary 

23 analysis of racial and other demographic dis24 parities in COVID–19 mortality, including an 

25 analysis of comorbidities and case fatality rates; 


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1 (E) to the extent possible, a preliminary 

2 analysis of sex, gender, sexual orientation, and 

3 gender identity disparities in COVID–19 treat4 ment and mortality; 

5 (F) an analysis of COVID–19 treatment of 

6 individuals with disabilities, including equity of 

7 access to treatment and equipment and inter8 sections of disability status with other demo9 graphic factors, including race, and rec10 ommendations for how to improve transparency 

11 and equity of treatment for such individuals 

12 during the COVID–19 public health emergency 

13 and future emergencies; 

14 (G) how to support State, local, and Tribal 

15 capacity to eliminate barriers to COVID–19 

16 testing and treatment; and 

17 (H) to the extent possible, a preliminary 

18 analysis of Federal Government policies that 

19 disparately exacerbate the COVID–19 impact, 

20 and recommendations to improve racial and 

21 other demographic disparities in health out22 comes. 

23 (5) AUTHORIZATION OF APPROPRIATIONS.— 

24 There is authorized to be appropriated such sums as 

25 may be necessary to carry out this subsection. 


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1 SEC. 102. COVID–19 REPORTING PORTAL. 

2 (a) IN GENERAL.—Not later than 15 days after the 

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

4 Human Services (referred to in this section as the ‘‘Sec5 retary’’) shall establish and maintain an online portal for 

6 use by eligible health care entities to track and transmit 

7 data regarding their personal protective equipment and 

8 medical supply inventory and capacity related to COVID– 

9 19. 

10 (b) ELIGIBLE HEALTH CARE ENTITIES.—In this sec11 tion, the term ‘‘eligible health care entity’’ means a li12 censed acute care hospital, hospital system, or long-term 

13 care facility with confirmed cases of COVID–19. 

14 (c) SUBMISSION.—An eligible health care entity shall 

15 report using the portal under this section on a biweekly 

16 basis in order to assist the Secretary in tracking usage 

17 and need of COVID–related supplies and personnel in a 

18 regular and real-time manner. 

19 (d) INCLUDED INFORMATION.—The Secretary shall 

20 design the portal under this section to include information 

21 on personal protective equipment and medical supply in22 ventory and capacity related to COVID–19, including with 

23 respect to the following: 

24 (1) PERSONAL PROTECTIVE EQUIPMENT.— 

25 Total personal protective equipment inventory, in26 cluding, in units, the numbers of N95 masks and 


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1 authorized equivalent respirator masks, surgical 

2 masks, exam gloves, face shields, isolation gowns, 

3 and coveralls. 

4 (2) MEDICAL SUPPLY.— 

5 (A) Total ventilator inventory, including, in 

6 units, the number of universal, adult, pediatric, 

7 and infant ventilators. 

8 (B) Total diagnostic and serological test 

9 inventory, including, in units, the number of 

10 test platforms, tests, test kits, reagents, trans11 port media, swabs, and other materials or sup12 plies determined necessary by the Secretary. 

13 (3) CAPACITY.— 

14 (A) Case count measurements, including 

15 confirmed positive cases and persons under in16 vestigation. 

17 (B) Total number of staffed beds, includ18 ing medical surgical beds, intensive care beds, 

19 and critical care beds. 

20 (C) Available beds, including medical sur21 gical beds, intensive care beds, and critical care 

22 beds. 

23 (D) Total number of COVID–19 patients 

24 currently utilizing a ventilator. 


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1 (E) Average number of days a COVID–19 

2 patient is utilizing a ventilator. 

3 (F) Total number of additionally needed 

4 professionals in each of the following categories: 

5 intensivists, critical care physicians, respiratory 

6 therapists, registered nurses, certified registered 

7 nurse anesthetists, and laboratory personnel. 

8 (G) Total number of hospital personnel 

9 currently not working due to self-isolation fol10 lowing a known or presumed COVID–19 expo11 sure. 

12 (e) ACCESS TO INFORMATION RELATED TO INVEN13 TORY AND CAPACITY.—The Secretary shall ensure that 

14 relevant agencies and officials, including the Centers for 

15 Disease Control and Prevention, the Assistant Secretary 

16 for Preparedness and Response, and the Federal Emer17 gency Management Agency, have access to information re18 lated to inventory and capacity submitted under this sec19 tion. 

20 (f) WEEKLY REPORT TO CONGRESS.—On a weekly 

21 basis, the Secretary shall transmit information related to 

22 inventory and capacity submitted under this section to the 

23 appropriate committees of the House and Senate. 


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1 SEC. 103. REGULAR CDC REPORTING ON DEMOGRAPHIC 

2 DATA. 

3 Not later than 14 days after the date of enactment 

4 of this Act, the Secretary of Health and Human Services, 

5 in coordination with the Director of the Centers for Dis6 ease Control and Prevention, shall amend the reporting 

7 under the heading ‘‘Department of Health and Human 

8 Services—Office of the Secretary—Public Health and So9 cial Service Emergency Fund’’ in title I of division B of 

10 the Paycheck Protection Program and Health Care En11 hancement Act (Public Law 116–139; 134 Stat. 620, 626) 

12 on the demographic characteristics, including race, eth13 nicity (including breakdowns of major ethnic groups and 

14 Tribal affiliations within minority populations), age, sex, 

15 gender, geographic region, primary written and spoken 

16 language, disability status, sexual orientation, socio17 economic status, occupation, and other relevant factors of 

18 individuals tested for or diagnosed with COVID–19, to in19 clude— 

20 (1) providing technical assistance to State, 

21 local, Tribal, and territorial health departments to 

22 improve the collection and reporting of such demo23 graphic data; 

24 (2) if such data is not so collected or reported, 

25 the reason why the State, local, Tribal, or territorial 


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1 department of health has not been able to collect or 

2 provide such information; and 

3 (3) making a copy of such report available pub4 licly on the website of the Centers for Disease Con5 trol and Prevention. 

6 SEC. 104. AMENDMENT TO THE PUBLIC HEALTH SERVICE 

7 ACT. 

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

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

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

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

12 and socioeconomic status among federally supported 

13 health programs. 

14 (b) AMENDMENT.—The Public Health Service Act is 

15 amended by adding at the end the following: 

16 ‘‘TITLE XXXIV—STRENGTHENING 

17 DATA COLLECTION, IMPROV18 ING DATA ANALYSIS, AND EX19 PANDING DATA REPORTING 

20 ‘‘SEC. 3400. HEALTH DISPARITY DATA. 

21 ‘‘(a) REQUIREMENTS.— 

22 ‘‘(1) IN GENERAL.—Each health-related pro23 gram shall— 

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

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1 nicity, sex, primary language, sexual orienta2 tion, disability status, gender identity, age, and 

3 socioeconomic status of each applicant for and 

4 recipient of health-related assistance under such 

5 program, including— 

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

7 for data collection on race, ethnicity, sex, 

8 primary language, sexual orientation, gen9 der identity, age, socioeconomic status, and 

10 disability status as each are developed 

11 under section 3101; 

12 ‘‘(ii) collecting data for additional 

13 population groups if such groups can be 

14 aggregated into the race and ethnicity cat15 egories outlined by standards developed 

16 under section 3101; 

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

18 standards developed by the Health and 

19 Medicine Division of the National Acad20 emies of Sciences, Engineering, and Medi21 cine (formerly known as the ‘Institute of 

22 Medicine’) in the 2009 publication, entitled 

23 ‘Race, Ethnicity, and Language Data: 

24 Standardization for Health Care Quality 

25 Improvement’; and 


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1 ‘‘(iv) where practicable, collecting 

2 such data through self-reporting; 

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

4 data described in subparagraph (A), for appli5 cants and recipients who are minors, require 

6 communication assistance in speech or writing, 

7 and for applicants and recipients who are other8 wise legally incapacitated, require that— 

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

10 parent or legal guardian of such an appli11 cant or recipient; and 

12 ‘‘(ii) the primary language of the par13 ent or legal guardian of such an applicant 

14 or recipient be collected; 

15 ‘‘(C) systematically analyze such data 

16 using the smallest appropriate units of analysis 

17 feasible to detect racial and ethnic disparities, 

18 as well as disparities along the lines of primary 

19 language, sex, disability status, sexual orienta20 tion, gender identity, age, and socioeconomic 

21 status in health and health care, and report the 

22 results of such analysis to the Secretary, the 

23 Director of the Office for Civil Rights, each 

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1 sions and the Committee on Finance of the 

2 Senate, and the Committee on Energy and 

3 Commerce and the Committee on Ways and 

4 Means of the House of Representatives; 

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

6 at least an annual basis; and 

7 ‘‘(E) ensure that the provision of assist8 ance to an applicant or recipient of assistance 

9 is not denied or otherwise adversely affected be10 cause of the failure of the applicant or recipient 

11 to provide race, ethnicity, primary language, 

12 sex, sexual orientation, disability status, gender 

13 identity, age, and socioeconomic status data. 

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

15 this subsection shall be construed to— 

16 ‘‘(A) permit the use of information col17 lected under this subsection in a manner that 

18 would adversely affect any individual providing 

19 any such information; or 

20 ‘‘(B) diminish any requirements, including 

21 such requirements in effect on or after the date 

22 of enactment of this section, on health care pro23 viders to collect data. 

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

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1 vider, Federal official, or other entity to compel the 

2 disclosure of any data collected under this title. The 

3 disclosure of any such data by an individual pursu4 ant to this title shall be strictly voluntary. 

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

6 ensure (through the promulgation of regulations or other7 wise) that all data collected pursuant to subsection (a) are 

8 protected— 

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

10 Secretary applies to other health data under the reg11 ulations promulgated under section 264(c) of the 

12 Health Insurance Portability and Accountability Act 

13 of 1996 relating to the privacy of individually identi14 fiable health information and other protections; and 

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

16 entity that collects, stores, or receives the data, in17 cluding use of such data in determinations of eligi18 bility (or continued eligibility) in health plans, and 

19 from other inappropriate uses, as defined by the 

20 Secretary. 

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

22 Secretary shall develop and implement a national plan to 

23 ensure the collection of data in a culturally and linguis24 tically appropriate manner, to improve the collection, anal25 ysis, and reporting of racial, ethnic, sex, primary lanVerDate Sep 11 2014 00:31 Nov 13, 2020 Jkt 019200 PO 00000 Frm 00031 Fmt 6652 Sfmt 6201 E:\BILLS\H8200.IH H8200

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1 guage, sexual orientation, disability status, gender iden2 tity, age, and socioeconomic status data at the Federal, 

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

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

5 data collection activities carried out under this section are 

6 in compliance with standards developed under section 

7 3101. The Data Council of the Department of Health and 

8 Human Services, in consultation with the National Com9 mittee on Vital Health Statistics, the Office of Minority 

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

11 public and private entities, shall make recommendations 

12 to the Secretary concerning the development, implementa13 tion, and revision of the national plan. Such plan shall 

14 include recommendations on how to— 

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

16 the cost and administrative burdens of data collec17 tion and reporting; 

18 ‘‘(2) expand knowledge among Federal agen19 cies, States, territories, Indian Tribes, counties, mu20 nicipalities, health providers, health plans, and the 

21 general public that data collection, analysis, and re22 porting by race, ethnicity, sex, primary language, 

23 sexual orientation, gender identity, age, socio24 economic status, and disability status is legal and 


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1 necessary to assure equity and nondiscrimination in 

2 the quality of health care services; 

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

4 follow Federal standards promulgated under the 

5 Health Information Technology for Economic and 

6 Clinical Health Act for the collection and meaningful 

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

8 primary language, sexual orientation, gender iden9 tity, age, socioeconomic status, and disability status; 

10 ‘‘(4) improve health and health care data collec11 tion and analysis for more population groups if such 

12 groups can be aggregated into the minimum race 

13 and ethnicity categories, including exploring the fea14 sibility of enhancing collection efforts in States, 

15 counties, and municipalities for racial and ethnic 

16 groups that comprise a significant proportion of the 

17 population of the State, county, or municipality; 

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

19 racial, ethnic, primary language, sex, sexual orienta20 tion, gender identity, age, socioeconomic status data, 

21 and disability status data, subject to all applicable 

22 privacy and confidentiality requirements, including 

23 HIPAA privacy and security law as defined in sec24 tion 3009; and 


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

2 collected under subsection (a). 

3 ‘‘(d) COMPLIANCE WITH STANDARDS.—Data col4 lected under subsection (a) shall be obtained, maintained, 

5 and presented (including for reporting purposes) in ac6 cordance with standards developed under section 3101. 

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

8 Secretary, acting through the Director of the Agency for 

9 Healthcare Research and Quality and in coordination with 

10 the Assistant Secretary for Planning and Evaluation, the 

11 Administrator of the Centers for Medicare & Medicaid 

12 Services, the Director of the National Center for Health 

13 Statistics, and the Director of the National Institutes of 

14 Health, shall provide technical assistance to agencies of 

15 the Department of Health and Human Services in meeting 

16 Federal standards for health disparity data collection and 

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

18 health and health care in programs conducted or sup19 ported by such agencies by— 

20 ‘‘(1) identifying appropriate quality assurance 

21 mechanisms to monitor for health disparities; 

22 ‘‘(2) specifying the clinical, diagnostic, or thera23 peutic measures which should be monitored; 

24 ‘‘(3) developing new quality measures relating 

25 to racial and ethnic disparities and their overlap 


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1 with other disparity factors in health and health 

2 care; 

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

4 should be conducted; and 

5 ‘‘(5) sharing data with external organizations 

6 for research and quality improvement purposes. 

7 ‘‘(f) DEFINITIONS.—In this section— 

8 ‘‘(1) the term ‘health-related program’ means a 

9 program that is operated by the Secretary, or that 

10 receives funding or reimbursement, in whole or in 

11 part, either directly or indirectly from the Sec12 retary— 

13 ‘‘(A) for activities under the Social Secu14 rity Act for health care services; or 

15 ‘‘(B) for providing Federal financial assist16 ance for health care, biomedical research, or 

17 health services research or for otherwise im18 proving the health of the public; 

19 ‘‘(2) the term ‘primary language data’ includes 

20 spoken and written primary language data; and 

21 ‘‘(3) the term ‘primary language data collection 

22 activities’ includes identifying, collecting, storing, 

23 tracking, and analyzing primary language data and 

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1 guage access needs of individuals with limited 

2 English proficiency. 

3 ‘‘(g) 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 2021 through 2025. 

7 ‘‘SEC. 3401. ESTABLISHING GRANTS FOR DATA COLLECTION 

8 IMPROVEMENT ACTIVITIES. 

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

10 the Director of the Agency for Healthcare Research and 

11 Quality and in consultation with the Deputy Assistant 

12 Secretary for Minority Health, the Director of the Na13 tional Institutes of Health, the Assistant Secretary for 

14 Planning and Evaluation, and the Director of the National 

15 Center for Health Statistics, shall establish a technical as16 sistance program under which the Secretary provides 

17 grants to eligible entities to assist such entities in com18 plying with section 3431. 

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

20 under this section may be used to— 

21 ‘‘(1) enhance or upgrade computer technology 

22 that will facilitate collection, analysis, and reporting 

23 of racial, ethnic, primary language, sexual orienta24 tion, sex, gender identity, socioeconomic status, and 

25 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; and 

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

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

18 Indian Tribe, municipality, county, health provider, health 

19 care organization, or health plan making a demonstrated 

20 effort to bring data collections into compliance with sec21 tion 3431. 

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

23 are authorized to be appropriated to carry out this section 

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

25 2021 through 2025. 


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1 ‘‘SEC. 3402. OVERSAMPLING OF UNDERREPRESENTED 

2 GROUPS IN FEDERAL HEALTH SURVEYS. 

3 ‘‘(a) NATIONAL STRATEGY.— 

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

5 through the Director of the National Center for 

6 Health Statistics of the Centers for Disease Control 

7 and Prevention, and other agencies within the De8 partment of Health and Human Services as the Sec9 retary determines appropriate, shall develop and im10 plement an ongoing and sustainable national strat11 egy for oversampling underrepresented populations 

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

13 language, sexual orientation, disability status, gen14 der identity, and socioeconomic status as determined 

15 appropriate by the Secretary in Federal health sur16 veys and program data collections. Such national 

17 strategy shall include a strategy for oversampling of 

18 Native Americans, Asian Americans, Native Hawai19 ians, and Pacific Islanders. 

20 ‘‘(2) CONSULTATION.—In developing and imple21 menting a national strategy, as described in para22 graph (1), not later than 180 days after the date of 

23 the enactment of this section, the Secretary shall— 

24 ‘‘(A) consult with representatives of com25 munity groups, nonprofit organizations, non26 governmental organizations, and government 


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1 agencies working with underrepresented popu2 lations; 

3 ‘‘(B) solicit the participation of representa4 tives from other Federal departments and agen5 cies, including subagencies of the Department 

6 of Health and Human Services; and 

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

8 2014 National Health Interview Survey over9 sample of Native Hawaiian and Pacific Islander 

10 populations and the 2017 Behavioral Risk Fac11 tor Surveillance System oversample of American 

12 Indian and Alaska Native communities. 

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

14 after the date of the enactment of this section, the Sec15 retary shall submit to the Congress a progress report, 

16 which shall include the national strategy described in sub17 section (a)(1). 

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

19 carry out this section, there are authorized to be appro20 priated such sums as may be necessary for fiscal years 

21 2021 through 2025.’’. 


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1 SEC. 105. ELIMINATION OF PREREQUISITE OF DIRECT AP2 PROPRIATIONS FOR DATA COLLECTION AND 

3 ANALYSIS. 

4 Section 3101 of the Public Health Service Act (42 

5 U.S.C. 300kk) is amended— 

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

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

8 (h). 

9 SEC. 106. COLLECTION OF DATA FOR THE MEDICARE PRO10 GRAM. 

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

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

13 the following: 

14 ‘‘COLLECTION OF DATA FOR THE MEDICARE PROGRAM

15 ‘‘SEC. 1150C. 

16 ‘‘(a) REQUIREMENT.— 

17 ‘‘(1) IN GENERAL.—The Commissioner of So18 cial Security, in consultation with the Administrator 

19 of the Centers for Medicare & Medicaid Services, 

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

21 language, sexual orientation, gender identity, socio22 economic status, and disability status of all appli23 cants for Social Security benefits under title II or 

24 Medicare benefits under title XVIII. 

25 ‘‘(2) DATA COLLECTION STANDARDS.—In col26 lecting data under paragraph (1), the Commissioner 


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1 of Social Security shall at least use the standards 

2 for data collection developed under section 3101 of 

3 the Public Health Service Act or the standards de4 veloped by the Office of Management and Budget, 

5 whichever is more disaggregated. In the event there 

6 are no standards for the demographic groups listed 

7 under paragraph (1), the Commissioner shall consult 

8 with stakeholder groups representing the various 

9 identities as well as with the Office of Minority 

10 Health within the Centers for Medicare & Medicaid 

11 Services to develop appropriate standards. 

12 ‘‘(3) DATA FOR ADDITIONAL POPULATION

13 GROUPS.—Where practicable, the information col14 lected by the Commissioner of Social Security under 

15 paragraph (1) shall include data for additional popu16 lation groups if such groups can be aggregated into 

17 the race and ethnicity categories outlined by the 

18 data collection standards described in paragraph (2). 

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

20 LEGALLY INCAPACITATED INDIVIDUALS.—With re21 spect to the collection of the data described in para22 graph (1) of applicants who are under 18 years of 

23 age or otherwise legally incapacitated, the Commis24 sioner of Social Security shall require that— 


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1 ‘‘(A) such data be collected from the par2 ent or legal guardian of such an applicant; and 

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

4 or legal guardian of such an applicant or recipi5 ent be used in collecting the data. 

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

7 Social Security shall periodically review the quality 

8 and completeness of the data collected under para9 graph (1) and make adjustments as necessary to im10 prove both. 

11 ‘‘(6) TRANSMISSION OF DATA.—Upon enroll12 ment in Medicare benefits under title XVIII, the 

13 Commissioner of Social Security shall transmit an 

14 individual’s demographic data as collected under 

15 paragraph (1) to the Centers for Medicare and Med16 icaid Services. 

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

18 With respect to data transmitted under paragraph 

19 (5), the Administrator of the Centers for Medicare 

20 and Medicaid Services, in consultation with the 

21 Commissioner of Social Security shall— 

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

23 analyzed and that such analysis be reported at 

24 least annually to Congress; 


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1 ‘‘(B) incorporate such data in other anal2 ysis and reporting on health disparities as ap3 propriate; 

4 ‘‘(C) make such data available to research5 ers, under the protections outlined in paragraph 

6 (7); 

7 ‘‘(D) provide opportunities to individuals 

8 enrolled in Medicare to submit updated data; 

9 and 

10 ‘‘(E) ensure that the provision of assist11 ance or benefits to an applicant is not denied 

12 or otherwise adversely affected because of the 

13 failure of the applicant to provide any of the 

14 data collected under paragraph (1). 

15 ‘‘(8) PROTECTION OF DATA.—The Commis16 sioner of Social Security shall ensure (through the 

17 promulgation of regulations or otherwise) that all 

18 data collected pursuant to subsection (a) is pro19 tected— 

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

21 the Secretary applies to health data under the 

22 regulations promulgated under section 264(c) of 

23 the Health Insurance Portability and Account24 ability Act of 1996 (relating to the privacy of 


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1 individually identifiable health information and 

2 other protections); and 

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

4 any entity that collects, stores, or receives the 

5 data, including use of such data in determina6 tions of eligibility (or continued eligibility) in 

7 health plans, and from other inappropriate 

8 uses, as defined by the Secretary. 

9 ‘‘(b) RULE OF CONSTRUCTION.—Nothing in this sec10 tion shall be construed to permit the use of information 

11 collected under this section in a manner that would ad12 versely affect any individual providing any such informa13 tion. 

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

15 either directly or by grant or contract, provide technical 

16 assistance to enable any entity to comply with the require17 ments of this section or with regulations implementing this 

18 section. 

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

20 are authorized to be appropriated to carry out this section 

21 $500 million for 2020 and $100 million for each fiscal 

22 year thereafter.’’. 

23 SEC. 107. REVISION OF HIPAA CLAIMS STANDARDS. 

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

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


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1 Human Services shall revise the regulations promulgated 

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

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

4 on race, ethnicity, and primary language in a health-re5 lated transaction, to require— 

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

7 data collection on race, ethnicity, primary language, 

8 disability, sex, sexual orientation, gender identity, 

9 and socioeconomic status developed under section 

10 3101 of the Public Health Service Act (42 U.S.C. 

11 300kk); and 

12 (2) in consultation with the Office of the Na13 tional Coordinator for Health Information Tech14 nology, the designation of the appropriate racial, 

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

16 code sets as required for claims and enrollment data. 

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

18 Human Services shall disseminate the new standards de19 veloped under subsection (a) to all entities that are subject 

20 to the regulations described in such subsection and provide 

21 technical assistance with respect to the collection of the 

22 data involved. 

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

24 Human Services shall require that entities comply with the 

25 new standards developed under subsection (a) not later 


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1 than 2 years after the final promulgation of such stand2 ards. 

3 SEC. 108. DISPARITIES DATA COLLECTED BY THE FEDERAL 

4 GOVERNMENT. 

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

7 with the departments, agencies, or offices described in 

8 subsection (b), shall establish a centralized electronic re9 pository of Government data on factors related to the 

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

11 States. 

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

13 days after the date of the enactment of this Act, and Jan14 uary 31 of each year thereafter, each department, agency, 

15 and office of the Federal Government that has collected 

16 data on race, ethnicity, sex, primary language, sexual ori17 entation, disability status, gender identity, age, or socio18 economic status during the preceding calendar year shall 

19 submit such data to the repository of Government data 

20 established under subsection (a). 

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

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

23 thereafter, the Secretary of Health and Human Services, 

24 acting through the Assistant Secretary for Planning and 

25 Evaluation, the Assistant Secretary for Health, the DirecVerDate Sep 11 2014 00:31 Nov 13, 2020 Jkt 019200 PO 00000 Frm 00046 Fmt 6652 Sfmt 6201 E:\BILLS\H8200.IH H8200

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1 tor of the Agency for Healthcare Research and Quality, 

2 the Director of the National Center for Health Statistics, 

3 the Administrator of the Centers for Medicare & Medicaid 

4 Services, the Director of the National Institute on Minor5 ity Health and Health Disparities, and the Deputy Assist6 ant Secretary for Minority Health, shall— 

7 (1) prepare and make available datasets for 

8 public use that relate to disparities in health status, 

9 health care access, health care quality, health out10 comes, public health, and other areas of health and 

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

12 sex, primary language, sexual orientation, disability 

13 status, gender identity, 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. 109. STANDARDS FOR MEASURING SEXUAL ORIENTA21 TION, GENDER IDENTITY, AND SOCIO22 ECONOMIC STATUS IN COLLECTION OF 

23 HEALTH DATA. 

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

25 U.S.C. 300kk(a)) is amended— 


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

2 orientation, gender identity, socioeconomic status,’’ 

3 before ‘‘and disability status’’; 

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

5 orientation, gender identity, socioeconomic status,’’ 

6 before ‘‘and disability status’’; and 

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

8 orientation, gender identity, socioeconomic status,’’ 

9 before ‘‘and disability status’’. 

10 SEC. 110. IMPROVING HEALTH DATA REGARDING NATIVE 

11 HAWAIIANS AND OTHER 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 317U the following: 

15 ‘‘SEC. 317V. NATIVE HAWAIIAN AND OTHER PACIFIC IS16 LANDER HEALTH DATA. 

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

18 ‘‘(1) COMMUNITY GROUP.—The term ‘commu19 nity group’ means a group of NHOPI who are orga20 nized at the community level, and may include a 

21 church group, social service group, national advocacy 

22 organization, or cultural group. 

23 ‘‘(2) NONPROFIT, NONGOVERNMENTAL ORGANI24 ZATION.—The term ‘nonprofit, nongovernmental or25 ganization’ means a group of NHOPI with a demVerDate Sep 11 2014 00:31 Nov 13, 2020 Jkt 019200 PO 00000 Frm 00048 Fmt 6652 Sfmt 6201 E:\BILLS\H8200.IH H8200

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1 onstrated history of addressing NHOPI issues, in2 cluding a NHOPI coalition. 

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

4 ‘designated organization’ means an entity estab5 lished to represent NHOPI populations and which 

6 has statutory responsibilities to provide, or has com7 munity support for providing, health care. 

8 ‘‘(4) GOVERNMENT REPRESENTATIVES OF

9 NHOPI POPULATIONS.—The term ‘government rep10 resentatives of NHOPI populations’ means rep11 resentatives from Hawaii, American Samoa, the 

12 Commonwealth of the Northern Mariana Islands, 

13 the Federated States of Micronesia, Guam, the Re14 public of Palau, and the Republic of the Marshall Is15 lands. 

16 ‘‘(5) NATIVE HAWAIIANS AND OTHER PACIFIC

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

18 and Other Pacific Islanders’ or ‘NHOPI’ means peo19 ple having origins in any of the original peoples of 

20 American Samoa, the Commonwealth of the North21 ern Mariana Islands, the Federated States of Micro22 nesia, Guam, Hawaii, the Republic of the Marshall 

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

24 Island. 


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

2 means Guam, the Commonwealth of Northern Mar3 iana Islands, American Samoa, the United States 

4 Virgin Islands, the Federated States of Micronesia, 

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

7 ‘‘(b) NATIONAL STRATEGY.— 

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

9 through the Director of the National Center for 

10 Health Statistics (referred to in this section as 

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

12 Prevention, and other agencies within the Depart13 ment of Health and Human Services as the Sec14 retary determines appropriate, shall develop and im15 plement an ongoing and sustainable national strat16 egy for identifying and evaluating the health status 

17 and health care needs of NHOPI populations living 

18 in the continental United States, Hawaii, American 

19 Samoa, the Commonwealth of the Northern Mariana 

20 Islands, the Federated States of Micronesia, Guam, 

21 the Republic of Palau, and the Republic of the Mar22 shall 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 Ending Health Disparities During 

2 COVID–19 Act of 2020, the Secretary— 

3 ‘‘(A) shall consult with representatives of 

4 community groups, designated organizations, 

5 and nonprofit, nongovernmental organizations 

6 and with government representatives of NHOPI 

7 populations; and 

8 ‘‘(B) may solicit the participation of rep9 resentatives from other Federal departments. 

10 ‘‘(c) PRELIMINARY HEALTH SURVEY.— 

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

12 through the Director of NCHS, shall conduct a pre13 liminary health survey in order to identify the major 

14 areas and regions in the continental United States, 

15 Hawaii, American Samoa, the Commonwealth of the 

16 Northern Mariana Islands, the Federated States of 

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

18 Republic of the Marshall Islands in which NHOPI 

19 people reside. 

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

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

22 other data the Secretary determines to be— 

23 ‘‘(A) useful in determining health status 

24 and health care needs; or 


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1 ‘‘(B) required for developing or imple2 menting a national strategy. 

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

4 health survey described in paragraph (1), including 

5 plans for designing questions, implementation, sam6 pling, and analysis, shall be developed in consulta7 tion with community groups, designated organiza8 tions, nonprofit, nongovernmental organizations, and 

9 government representatives of NHOPI populations, 

10 as determined by the Secretary. 

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

12 this subsection shall be completed not later than 18 

13 months after the date of enactment of the Ending 

14 Health Disparities During COVID–19 Act of 2020. 

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

16 after the date of enactment of the Ending Health Dispari17 ties During COVID–19 Act of 2020, the Secretary shall 

18 submit to Congress a progress report, which shall include 

19 the national strategy described in subsection (b)(1). 

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

21 MEDICINE DIVISION.— 

22 ‘‘(1) IN GENERAL.—The Secretary shall enter 

23 into an agreement with the Health and Medicine Di24 vision of the National Academies of Sciences, Engi25 neering, and Medicine to conduct a study, with input 


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1 from stakeholders in insular areas, on each of the 

2 following: 

3 ‘‘(A) The standards and definitions of 

4 health care applied to health care systems in in5 sular areas and the appropriateness of such 

6 standards and definitions. 

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

8 care systems in insular areas, evaluated based 

9 upon standards and definitions, as the Sec10 retary determines appropriate. 

11 ‘‘(C) The effectiveness of donor aid in ad12 dressing health care needs and priorities in in13 sular areas. 

14 ‘‘(D) The progress toward implementation 

15 of recommendations of the Committee on 

16 Health Care Services in the United States—As17 sociated Pacific Basin that are set forth in the 

18 1998 report entitled ‘Pacific Partnerships for 

19 Health: Charting a New Course’. 

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

21 paragraph (1) shall require the Health and Medicine 

22 Division to submit to the Secretary and to Congress, 

23 not later than 2 years after the date of the enact24 ment of the Ending Health Disparities During 

25 COVID–19 Act of 2020, a report containing a deVerDate Sep 11 2014 00:31 Nov 13, 2020 Jkt 019200 PO 00000 Frm 00053 Fmt 6652 Sfmt 6201 E:\BILLS\H8200.IH H8200

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1 scription of the results of the study conducted under 

2 paragraph (1), including the conclusions and rec3 ommendations of the Health and Medicine Division 

4 for each of the items described in subparagraphs (A) 

5 through (D) of such paragraph. 

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

7 carry out this section, there are authorized to be appro8 priated such sums as may be necessary for fiscal years 

9 2021 through 2025.’’. 

10 Subtitle B—Improvements and 

11 Modernization 

12 SEC. 121. FEDERAL MODERNIZATION FOR HEALTH INEQUI13 TIES DATA. 

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

15 Human Services shall work with covered agencies to sup16 port the modernization of data collection methods and in17 frastructure at such agencies for the purpose of increasing 

18 data collection related to health inequities, such as racial, 

19 ethnic (including breakdowns of major ethnic groups and 

20 Tribal affiliations within minority populations), socio21 economic, sex, gender, age, geographic region, primary 

22 written and spoken language, sexual orientation, occupa23 tion, and disability status disparities. 


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1 (b) COVERED AGENCY DEFINED.—In this section, 

2 the term ‘‘covered agency’’ means each of the following 

3 Federal agencies: 

4 (1) The Agency for Healthcare Research and 

5 Quality. 

6 (2) The Centers for Disease Control and Pre7 vention. 

8 (3) The Centers for Medicare & Medicaid Serv9 ices. 

10 (4) The Food and Drug Administration. 

11 (5) The Office of the National Coordinator for 

12 Health Information Technology. 

13 (6) The National Institutes of Health. 

14 (c) AUTHORIZATION OF APPROPRIATIONS.—There is 

15 authorized to be appropriated to each covered agency to 

16 carry out this section $4,000,000, to remain available 

17 until expended. 

18 SEC. 122. MODERNIZATION OF STATE AND LOCAL HEALTH 

19 INEQUITIES DATA. 

20 (a) IN GENERAL.—Not later than 6 months after the 

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

22 Human Services (referred to in this section as the ‘‘Sec23 retary’’), acting through the Director of the Centers for 

24 Disease Control and Prevention, shall award grants to 

25 State, local, Tribal, and territorial health departments in 


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1 order to support the modernization of data collection 

2 methods and infrastructure for the purposes of increasing 

3 data related to health inequities, such as racial, ethnic (in4 cluding breakdowns of major ethnic groups and Tribal af5 filiations within minority populations), socioeconomic, sex, 

6 gender, age, geographic region, primary written and spo7 ken language, sexual orientation, occupation, and dis8 ability status disparities. The Secretary shall— 

9 (1) provide guidance, technical assistance, and 

10 information to grantees under this section on best 

11 practices regarding culturally competent, accurate, 

12 and increased data collection and transmission; and 

13 (2) track performance of grantees under this 

14 section to help improve their health inequities data 

15 collection by identifying gaps and taking effective 

16 steps to support States, localities, and territories in 

17 addressing the gaps. 

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

19 on which the first grant is awarded under this section, 

20 the Secretary shall submit to the Committee on Energy 

21 and Commerce of the House of Representatives and the 

22 Committee on Health, Education, Labor, and Pensions of 

23 the Senate an initial report detailing— 


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1 (1) nationwide best practices for ensuring 

2 States and localities collect and transmit health in3 equities data; 

4 (2) nationwide trends which hinder the collec5 tion and transmission of health inequities data; 

6 (3) Federal best practices for working with 

7 States and localities to ensure culturally competent, 

8 accurate, and increased data collection and trans9 mission; and 

10 (4) any recommended changes to legislative or 

11 regulatory authority to help improve and increase 

12 health inequities data collection. 

13 (c) FINAL REPORT.—Not later than December 31, 

14 2023, the Secretary shall— 

15 (1) update and finalize the initial report under 

16 subsection (b); and 

17 (2) submit such final report to the committees 

18 specified in such subsection. 

19 (d) AUTHORIZATION OF APPROPRIATIONS.—There is 

20 authorized to be appropriated to carry out this section 

21 $100,000,000, to remain available until expended. 


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1 SEC. 123. ADDITIONAL REPORTING TO CONGRESS ON THE 

2 RACE AND ETHNICITY RATES OF COVID–19 

3 TESTING, HOSPITALIZATIONS, AND MORTALI4 TIES. 

5 (a) IN GENERAL.—Not later than August 1, 2020, 

6 the Secretary of Health and Human Services (referred to 

7 in this section as the ‘‘Secretary’’) shall submit to the 

8 Committee on Appropriations and the Committee on En9 ergy and Commerce of the House of Representatives and 

10 the Committee on Appropriations and the Committee on 

11 Health, Education, Labor, and Pensions of the Senate an 

12 initial report— 

13 (1) describing the testing, positive diagnoses, 

14 hospitalization, intensive care admissions, and mor15 tality rates associated with COVID–19, 

16 disaggregated by race, ethnicity (including break17 downs of major ethnic groups and Tribal affiliations 

18 within minority populations), age, sex, gender, geo19 graphic region, primary written and spoken lan20 guage, disability status, sexual orientation, socio21 economic status, occupation, and other relevant fac22 tors as determined by the Secretary; 

23 (2) including an analysis of any variances of 

24 testing, positive diagnoses, hospitalizations, and 

25 deaths by demographic characteristics; and 


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1 (3) including proposals for evidenced-based re2 sponse strategies to reduce disparities related to 

3 COVID–19. 

4 (b) FINAL REPORT.—Not later than December 31, 

5 2024, the Secretary shall— 

6 (1) update and finalize the initial report under 

7 subsection (a); and 

8 (2) submit such final report to the committees 

9 specified in such subsection. 

10 (c) COORDINATION.—In preparing the report sub11 mitted under this section, the Secretary shall take into ac12 count and otherwise coordinate such report with reporting 

13 required under section 103 and under the heading ‘‘De14 partment of Health and Human Services—Office of the 

15 Secretary—Public Health and Social Service Emergency 

16 Fund’’ in title I of division B of the Paycheck Protection 

17 Program and Health Care Enhancement Act (Public Law 

18 116–139; 134 Stat. 620, 626). 

19 TITLE II—EQUITABLE TESTING 

20 AND TRACING 

21 Subtitle A—Free Testing for 

22 Patients 

23 SEC. 201. SOONER COVERAGE OF TESTING FOR COVID–19. 

24 Section 6001(a) of division F of the Families First 

25 Coronavirus Response Act (42 U.S.C. 1320b–5 note) is 


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1 amended by striking ‘‘beginning on or after’’ and inserting 

2 ‘‘beginning before, on, or after’’. 

3 Subtitle B—National Testing 

4 Strategy 

5 SEC. 211. COVID–19 TESTING STRATEGY. 

6 (a) STRATEGY.—Not later than June 15, 2020, the 

7 Secretary of Health and Human Services (referred to in 

8 this section as the ‘‘Secretary’’) shall update the COVID– 

9 19 strategic testing plan under the heading ‘‘Department 

10 of Health and Human Services—Office of the Secretary— 

11 Public Health and Social Service Emergency Fund’’ in 

12 title I of division B of the Paycheck Protection Program 

13 and Health Care Enhancement Act (Public Law 116–139, 

14 134 Stat. 620, 626–627) and submit to the appropriate 

15 congressional committees such updated national plan iden16 tifying— 

17 (1) what level of, types of, and approaches to 

18 testing (including predicted numbers of tests, popu19 lations to be tested, and frequency of testing and the 

20 appropriate setting whether a health care setting 

21 (such as hospital-based, high-complexity laboratory, 

22 point-of-care, mobile testing units, pharmacies or 

23 community health centers) or non-health care setting 

24 (such as workplaces, schools, or child care centers)) 

25 are necessary— 


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1 (A) to sufficiently monitor and contribute 

2 to the control of the transmission of SARS– 

3 CoV–2 in the United States; 

4 (B) to ensure that any reduction in social 

5 distancing efforts, when determined appropriate 

6 by public health officials, can be undertaken in 

7 a manner that optimizes the health and safety 

8 of the people of the United States, and reduces 

9 disparities (including disparities related to race, 

10 ethnicity, sex, age, disability status, socio11 economic status, primary written and spoken 

12 language, occupation, and geographic location) 

13 in the prevalence of, incidence of, and health 

14 outcomes with respect to, COVID–19; and 

15 (C) to provide for ongoing surveillance suf16 ficient to support contact tracing, case identi17 fication, quarantine, and isolation to prevent fu18 ture outbreaks of COVID–19; 

19 (2) specific plans and benchmarks, each with 

20 clear timelines, to ensure— 

21 (A) such level of, types of, and approaches 

22 to testing as are described in paragraph (1), 

23 with respect to optimizing health and safety; 

24 (B) sufficient availability of all necessary 

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1 tion and testing kits, reagents, transport media, 

2 swabs, instruments, analysis equipment, per3 sonal protective equipment if necessary for test4 ing (including point-of-care testing), and other 

5 equipment; 

6 (C) allocation of testing materials and sup7 plies in a manner that optimizes public health, 

8 including by considering the variable impact of 

9 SARS–CoV–2 on specific States, territories, In10 dian Tribes, Tribal organizations, urban Indian 

11 organizations, communities, industries, and pro12 fessions; 

13 (D) sufficient evidence of validation for 

14 tests that are deployed as a part of such strat15 egy; 

16 (E) sufficient laboratory and analytical ca17 pacity, including target turnaround time for 

18 test results; 

19 (F) sufficient personnel, including per20 sonnel to collect testing samples, conduct and 

21 analyze results, and conduct testing follow-up, 

22 including contact tracing, as appropriate; and 

23 (G) enforcement of the Families First 

24 Coronavirus Response Act (Public Law 116– 


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1 127) to ensure patients who are tested are not 

2 subject to cost sharing; 

3 (3) specific plans to ensure adequate testing in 

4 rural areas, frontier areas, health professional short5 age areas, and medically underserved areas (as de6 fined in section 330I(a) of the Public Health Service 

7 Act (42 U.S.C. 254c–14(a))), and for underserved 

8 populations, Native Americans (including Indian 

9 Tribes, Tribal organizations, and urban Indian orga10 nizations), and populations at increased risk related 

11 to COVID–19; 

12 (4) specific plans to ensure accessibility of test13 ing to people with disabilities, older individuals, indi14 viduals with limited English proficiency, and individ15 uals with underlying health conditions or weakened 

16 immune systems; and 

17 (5) specific plans for broadly developing and 

18 implementing testing for potential immunity in the 

19 United States, as appropriate, in a manner suffi20 cient— 

21 (A) to monitor and contribute to the con22 trol of SARS–CoV–2 in the United States; 

23 (B) to ensure that any reduction in social 

24 distancing efforts, when determined appropriate 

25 by public health officials, can be undertaken in 


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1 a manner that optimizes the health and safety 

2 of the people of the United States; and 

3 (C) to reduce disparities (including dispari4 ties related to race, ethnicity, sex, age, dis5 ability status, socioeconomic status, primary 

6 written and spoken language, occupation, and 

7 geographic location) in the prevalence of, inci8 dence of, and health outcomes with respect to, 

9 COVID–19. 

10 (b) COORDINATION.—The Secretary shall carry out 

11 this section— 

12 (1) in coordination with the Administrator of 

13 the Federal Emergency Management Agency; 

14 (2) in collaboration with other agencies and de15 partments, as appropriate; and 

16 (3) taking into consideration the State plans for 

17 COVID–19 testing prepared as required under the 

18 heading ‘‘Department of Health and Human Serv19 ices—Office of the Secretary—Public Health and 

20 Social Service Emergency Fund’’ in title I of divi21 sion B of the Paycheck Protection Program and 

22 Health Care Enhancement Act (Public Law 116– 

23 139; 134 Stat. 620, 624). 

24 (c) UPDATES.— 


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1 (1) FREQUENCY.—The updated national plan 

2 under subsection (a) shall be updated every 30 days 

3 until the end of the public health emergency first de4 clared by the Secretary under section 319 of the 

5 Public Health Service Act (42 U.S.C. 247d) on Jan6 uary 31, 2020, with respect to COVID–19. 

7 (2) RELATION TO OTHER LAW.—Paragraph (1) 

8 applies in lieu of the requirement (for updates every 

9 90 days until funds are expended) in the second to 

10 last proviso under the heading ‘‘Department of 

11 Health and Human Services—Office of the Sec12 retary—Public Health and Social Service Emergency 

13 Fund’’ in title I of division B of the Paycheck Pro14 tection Program and Health Care Enhancement Act 

15 (Public Law 116–139; 134 Stat. 620, 627). 

16 (d) APPROPRIATE CONGRESSIONAL COMMITTEES.— 

17 In this section, the term ‘‘appropriate congressional com18 mittees’’ means— 

19 (1) the Committee on Appropriations and the 

20 Committee on Energy and Commerce of the House 

21 of Representatives; and 

22 (2) the Committee on Appropriations and the 

23 Committee on Health, Education, Labor, and Pen24 sions of the Senate. 


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1 SEC. 212. CORONAVIRUS IMMIGRANT FAMILIES PROTEC2 TION. 

3 (a) DEFINITIONS.—In this section: 

4 (1) CORONAVIRUS PUBLIC HEALTH EMER5 GENCY.—The term ‘‘coronavirus public health emer6 gency’’ means— 

7 (A) an emergency involving Federal pri8 mary responsibility determined to exist by the 

9 President under section 501(b) of the Robert T. 

10 Stafford Disaster Relief and Emergency Assist11 ance Act (42 U.S.C. 5191(b)) with respect to 

12 COVID–19 or any other coronavirus with pan13 demic potential; 

14 (B) an emergency declared by a Federal 

15 official with respect to coronavirus (as defined 

16 in section 506 of the Coronavirus Preparedness 

17 and Response Supplemental Appropriations 

18 Act, 2020 (Public Law 116–123)); 

19 (C) a national emergency declared by the 

20 President under the National Emergencies Act 

21 (50 U.S.C. 1601 et seq.) with respect to 

22 COVID–19 or any other coronavirus with pan23 demic potential; and 

24 (D) a public health emergency declared by 

25 the Secretary of Health and Human Services 

26 pursuant to section 319 of the Public Health 


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1 Service Act (42 U.S.C. 247(d)) with respect to 

2 COVID–19 or any other coronavirus with pan3 demic potential. 

4 (2) CORONAVIRUS RESPONSE LAW.—The term 

5 ‘‘coronavirus response law’’ means— 

6 (A) the Coronavirus Preparedness and Re7 sponse Supplemental Appropriations Act, 2020 

8 (Public Law 116–123); 

9 (B) the Families First Coronavirus Re10 sponse Act (Public Law 116–127); 

11 (C) the Coronavirus Aid, Relief, and Eco12 nomic Security Act (Public Law 116–136); and 

13 (D) any subsequent law enacted as a re14 sponse to a coronavirus public health emer15 gency. 

16 (3) COVID–19.—The term ‘‘COVID–19’’ 

17 means the Coronavirus Disease 2019. 

18 (4) ENFORCEMENT ACTION.—The term ‘‘en19 forcement action’’ means an apprehension, an arrest, 

20 a search, an interview, a request for identification, 

21 or surveillance for the purposes of immigration en22 forcement. 

23 (5) SENSITIVE LOCATION.—The term ‘‘sensitive 

24 location’’ means all physical space located within 

25 1,000 feet of— 


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1 (A) a medical treatment or health care fa2 cility, including a hospital, an office of a health 

3 care practitioner, an accredited health clinic, an 

4 alcohol or drug treatment center, an emergent 

5 or urgent care facility, and a community health 

6 center; 

7 (B) a location at which emergency service 

8 providers distribute food or provide shelter; 

9 (C) an organization that provides— 

10 (i) disaster or emergency social serv11 ices and assistance; 

12 (ii) services for individuals experi13 encing homelessness, including food banks 

14 and shelters; or 

15 (iii) assistance for children, pregnant 

16 women, victims of crime or abuse, or indi17 viduals with significant mental or physical 

18 disabilities; 

19 (D) a public assistance office, including 

20 any Federal, State, or municipal location at 

21 which individuals may apply for or receive un22 employment compensation or report violations 

23 of labor and employment laws; 


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1 (E) a Federal, State, or local courthouse, 

2 including the office of the legal counsel or rep3 resentative of an individual; 

4 (F) a domestic violence shelter, rape crisis 

5 center, supervised visitation center, family jus6 tice center, or victim services provider; 

7 (G) an office of the Social Security Admin8 istration; 

9 (H) a childcare facility or a school, includ10 ing a preschool, primary school, secondary 

11 school, post-secondary school up to and includ12 ing a college or university, and any other insti13 tution of learning such as a vocational or trade 

14 school; 

15 (I) a church, synagogue, mosque or any 

16 other institution of worship, such as a building 

17 rented for the purpose of a religious service; 

18 (J) the site of a funeral, wedding, or any 

19 other public religious ceremony; 

20 (K) in the case of a jurisdiction in which 

21 a shelter-in-place order is in effect during a 

22 coronavirus public health emergency, any busi23 ness location considered to provide an essential 

24 service, such as a pharmacy or a grocery store; 

25 and 


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1 (L) any other location specified by the Sec2 retary of Homeland Security. 

3 (b) SUSPENSION OF ADVERSE IMMIGRATION AC4 TIONS THAT DETER IMMIGRANT COMMUNITIES FROM

5 SEEKING HEALTH SERVICES IN A PUBLIC HEALTH

6 EMERGENCY.— 

7 (1) IN GENERAL.—Beginning on the date on 

8 which a coronavirus public health emergency is de9 clared and ending on the date that is 60 days after 

10 the date on which the coronavirus public health 

11 emergency expires— 

12 (A) the Secretary of Homeland Security, 

13 the Secretary of State, and the Attorney Gen14 eral shall not— 

15 (i) implement the final rule of the De16 partment of Homeland Security entitled 

17 ‘‘Inadmissibility on Public Charge 

18 Grounds’’ (84 Fed. Reg. 41292 (August 

19 14, 2019)); 

20 (ii) implement the interim final rule of 

21 the Department of State entitled ‘‘Visas: 

22 Ineligibility Based on Public Charge 

23 Grounds’’ (84 Fed. Reg. 54996 (October 

24 11, 2019)); 


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1 (iii) implement the proposed rule of 

2 the Department of Justice entitled ‘‘Inad3 missibility on Public Charge Grounds’’ 

4 published in the Fall 2018 Uniform Regu5 latory Agenda; 

6 (iv) conduct any enforcement action 

7 against an individual at, or in transit to or 

8 from, a sensitive location unless the en9 forcement action is conducted pursuant to 

10 a valid judicial warrant; 

11 (v) detain or remove— 

12 (I) a survivor of domestic vio13 lence, sexual assault, or human traf14 ficking, or any other individual, who 

15 has a pending application under sec16 tion 101(a)(15)(T), 101(a)(15)(U), 

17 106, 240A(b)(2) of the Immigration 

18 and Nationality Act (8 U.S.C. 

19 1101(a)(15)(T), 1101(a)(15)(U), 

20 1105a, 1229b(b)(2)) or section 

21 244(a)(3) of that Act (as in effect on 

22 March 31, 1997); or 

23 (II) a VAWA self-petitioner de24 scribed in section 101(a)(51) of that 


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1 Act (8 U.S.C. 1101(a)(51)) who has a 

2 pending application for relief under— 

3 (aa) a provision referred to 

4 in any of subparagraphs (A) 

5 through (G) of that section; or 

6 (bb) section 101(a)(27)(J) 

7 of that Act (8 U.S.C. 

8 1101(a)(27)(J)); and 

9 (vi) require an individual subject to 

10 supervision by U.S. Immigration and Cus11 toms Enforcement to report in person. 

12 (B) The Attorney General shall conduct 

13 fully telephonic bond hearings and allow sup14 porting documents to be faxed and emailed to 

15 the appropriate clerk. 

16 (C) The Secretary of Homeland Security, 

17 to the extent practicable, shall stipulate to bond 

18 determinations on written motions. 

19 (2) USE OF BENEFITS FUNDED BY

20 CORONAVIRUS RESPONSE LAW.—The Secretary of 

21 Homeland Security, the Secretary of State, and the 

22 Attorney General shall not consider in any deter23 mination affecting the current or future immigration 

24 status of any individual the use of any benefit of any 

25 program or activity funded in whole or in part by 


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1 amounts made available under a coronavirus re2 sponse law. 

3 (c) ACCESS TO COVID–19 TESTING AND TREAT4 MENT FOR ALL COMMUNITIES.— 

5 (1) CLARIFICATION REGARDING EMERGENCY

6 SERVICES FOR CERTAIN INDIVIDUALS.—Section 

7 1903(v)(2) of the Social Security Act (42 U.S.C. 

8 1396b(v)(2)) is amended by adding at the end the 

9 following flush sentence: 

10 ‘‘For purposes of subparagraph (A), care and services 

11 described in such subparagraph include any in vitro diag12 nostic product described in section 1905(a)(3)(B) that is 

13 administered during any portion of the emergency period 

14 described in such section beginning on or after the date 

15 of the enactment of this sentence (and the administration 

16 of such product), any COVID–19 vaccine that is adminis17 tered during any such portion (and the administration of 

18 such vaccine), any item or service that is furnished during 

19 any such portion for the treatment of COVID–19 or a con20 dition that may complicate the treatment of COVID–19, 

21 and any services described in section 1916(a)(2)(G).’’. 

22 (2) EMERGENCY MEDICAID FOR INDIVIDUALS

23 WITH SUSPECTED COVID–19 INFECTIONS.—Section 

24 1903(v)(3) of the Social Security Act (42 U.S.C. 

25 1396b(v)(3)) is amended by striking ‘‘means a’’ and 


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1 inserting ‘‘means any concern that the individual 

2 may have contracted COVID–19 or another.’’. 

3 (3) TREATMENT OF ASSISTANCE AND SERVICES

4 PROVIDED.—For any period during which a 

5 coronavirus public health emergency is in effect— 

6 (A) the value of assistance or services pro7 vided to any person under a program with re8 spect to which a coronavirus response law es9 tablishes or expands eligibility or benefits shall 

10 not be considered income or resources; and 

11 (B)(i) any medical coverage or services 

12 shall be considered treatment for an emergency 

13 medical condition (as defined in section 

14 1903(v)(3) of the Social Security Act (42 

15 U.S.C. 1396b(v)(3))) for any purpose under 

16 any Federal, State, or local law, including law 

17 relating to taxation, welfare, and public assist18 ance programs; 

19 (ii) a participating State or political sub20 division of a State shall not decrease any assist21 ance otherwise provided to an individual be22 cause of the receipt of benefits under the Social 

23 Security Act (42 U.S.C. 301 et seq.); and 

24 (iii) assistance and services described in 

25 this subparagraph shall be considered noncash 


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1 disaster assistance, notwithstanding the form in 

2 which the assistance and services are provided, 

3 except that cash received by an individual or a 

4 household may be treated as income by any 

5 public benefit program under the rules applica6 ble before the date of the enactment of this Act. 

7 (4) NONDISCRIMINATION.—No person shall be, 

8 on the basis of actual or perceived immigration sta9 tus, excluded from participation in, denied the bene10 fits of, or subject to discrimination under, any pro11 gram or activity funded in whole or in part by 

12 amounts made available under a coronavirus re13 sponse law. 

14 (d) LANGUAGE ACCESS AND PUBLIC OUTREACH FOR

15 PUBLIC HEALTH.— 

16 (1) GRANTS AND COOPERATIVE AGREE17 MENTS.— 

18 (A) IN GENERAL.—The Director of the 

19 Centers for Disease Control and Prevention (re20 ferred to in this subsection as the ‘‘Director’’) 

21 shall provide grants to, or enter into cooperative 

22 agreements with, community-based organiza23 tions for the purpose of supporting culturally 

24 and linguistically appropriate preparedness, re25 sponse, and recovery activities, such as the deVerDate Sep 11 2014 00:31 Nov 13, 2020 Jkt 019200 PO 00000 Frm 00075 Fmt 6652 Sfmt 6201 E:\BILLS\H8200.IH H8200

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1 velopment of educational programs and mate2 rials to promote screening, testing, treatment, 

3 and public health practices. 

4 (B) DEFINITION OF COMMUNITY-BASED

5 ORGANIZATION.—In this paragraph, the term 

6 ‘‘community-based organization’’ means an en7 tity that has established relationships with 

8 hard-to-reach populations, including racial and 

9 ethnic minorities, individuals with limited 

10 English proficiency, and individuals with dis11 abilities. 

12 (2) TRANSLATION.— 

13 (A) IN GENERAL.—The Director shall pro14 vide for the translation of materials on aware15 ness, screening, testing, and treatment for 

16 COVID–19 into the languages described in the 

17 language access plan of the Federal Emergency 

18 Management Agency dated October 1, 2016, as 

19 the languages most frequently encountered. 

20 (B) PUBLIC AVAILABILITY.—Not later 

21 than 7 days after the date on which the mate22 rials described in subparagraph (A) are made 

23 available to the public in English, the Director 

24 shall ensure that the translations required by 


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1 that subparagraph are made available to the 

2 public. 

3 (3) HOTLINE.—The Director shall establish an 

4 informational hotline line that provides, in the lan5 guages referred to in paragraph (2)(A), information 

6 to the public directly on COVID–19. 

7 (4) INTERAGENCY COORDINATION.—With re8 spect to individuals with limited English proficiency, 

9 the Director shall facilitate interagency coordination 

10 among agencies activated through the National Re11 sponse Framework based on the language access 

12 standards established under the language access 

13 plans of the Federal Emergency Management Agen14 cy and the Department of Health and Human Serv15 ices. 

16 (5) AUTHORIZATION OF APPROPRIATIONS.— 

17 (A) IN GENERAL.—There is authorized to 

18 be appropriated to carry out this subsection 

19 $100,000,000 for fiscal year 2020, to be avail20 able until expended. 

21 (B) GRANTS AND COOPERATIVE AGREE22 MENTS.—Of the amount authorized to be ap23 propriated under subparagraph (A), not less 

24 than $50,000,000 shall be made available to 

25 carry out paragraph (1). 


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1 (e) ACCESS TO SUPPORT MEASURES FOR VULNER2 ABLE COMMUNITIES.— 

3 (1) DISASTER SUPPLEMENTAL NUTRITION AS4 SISTANCE PROGRAM BENEFITS.—The Robert T. 

5 Stafford Disaster Relief and Emergency Assistance 

6 Act (42 U.S.C. 5121 et seq.) is amended— 

7 (A) in section 102(1) (42 U.S.C. 5122(1)), 

8 by inserting ‘‘or pandemic’’ after ‘‘catastrophe’’; 

9 (B) in section 301 (42 U.S.C. 5141), by 

10 inserting ‘‘or an emergency due to a pandemic’’ 

11 after ‘‘major disaster’’ each place the term ap12 pears; 

13 (C) in section 412 (42 U.S.C. 5179)— 

14 (i) by inserting ‘‘or an emergency due 

15 to a pandemic’’ after ‘‘major disaster’’ 

16 each place the term appears; 

17 (ii) in subsection (a), by inserting 

18 ‘‘without regard to regular allotments’’ be19 fore ‘‘and to make surplus’’; and 

20 (iii) by adding at the end the fol21 lowing: 

22 ‘‘(d) ASSISTANCE DURING A PANDEMIC.—In the case 

23 of an emergency due to a pandemic, for purposes of pro24 viding benefits under this section, the Secretary of Agri25 culture shall remove or delay the requirement of an inVerDate Sep 11 2014 00:31 Nov 13, 2020 Jkt 019200 PO 00000 Frm 00078 Fmt 6652 Sfmt 6201 E:\BILLS\H8200.IH H8200

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1 person interview, and if an interview occurs, provide an 

2 alternative to the in-person interview requirement for all 

3 applicants. Assistance shall be provided based on need and 

4 not lost provisions. 

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

6 are authorized to be appropriated such sums as are nec7 essary to carry out this section, only if such sums are des8 ignated by Congress as being for an emergency require9 ment pursuant to section 251(b)(2)(A)(i) of the Balanced 

10 Budget and Emergency Deficit Control Act of 1985 (2 

11 U.S.C. 901(b)(2)(A)(i)).’’; and 

12 (D) in section 502(a) (42 U.S.C. 

13 5192(a))— 

14 (i) in paragraph (7), by striking 

15 ‘‘and’’ at the end; 

16 (ii) in paragraph (8)(B), by striking 

17 the period at the end and inserting a semi18 colon; and 

19 (iii) by adding at the end the fol20 lowing: 

21 ‘‘(9) provide assistance in accordance with sec22 tion 412.’’. 

23 (2) ACCESS TO BENEFITS USING INDIVIDUAL

24 TAXPAYER IDENTIFICATION NUMBER.—Subsection 

25 (g)(2)(A) of section 6428 of the Internal Revenue 


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1 Code of 1986, as added by section 2201 of the 

2 Coronavirus Aid, Relief, and Economic Security Act 

3 (Public Law 116–136), is amended by inserting be4 fore the period at the end ‘‘or a taxpayer identifica5 tion number’’. 

6 (3) EXTENSION OF IMMIGRATION STATUS AND

7 EMPLOYMENT AUTHORIZATION.— 

8 (A) IN GENERAL.—Notwithstanding any 

9 other provision of law, including the Immigra10 tion and Nationality Act (8 U.S.C. 1101 et 

11 seq.), the Secretary of Homeland Security shall 

12 automatically extend the immigration status 

13 and employment authorization, as applicable, of 

14 an alien described in subparagraph (B) for the 

15 same period for which the status and employ16 ment authorization was initially granted. 

17 (B) ALIEN DESCRIBED.—An alien de18 scribed in this subparagraph is an alien (as de19 fined in section 101(a) of the Immigration and 

20 Nationality Act (8 U.S.C. 1101(a))) whose im21 migration status, including permanent, tem22 porary, and deferred status, or whose employ23 ment authorization— 


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1 (i) expired during the 30-day period 

2 preceding the date of the enactment of this 

3 Act; or 

4 (ii) will expire not later than— 

5 (I) one year after such date of 

6 enactment; or 

7 (II) 90 days after the date on 

8 which the national emergency declared 

9 by the President under the National 

10 Emergencies Act (50 U.S.C. 1601 et 

11 seq.) with respect to the Coronavirus 

12 Disease 2019 (COVID–19) is re13 scinded. 

14 (4) LANGUAGE ACCESS.—Any agency receiving 

15 funding under a coronavirus response law shall en16 sure that all programs and opportunities made avail17 able to the general public provide translated mate18 rials describing the programs and opportunities into 

19 the languages described in the language access plan 

20 of the Federal Emergency Management Agency 

21 dated October 1, 2016, as the languages most fre22 quently encountered. 

23 SEC. 213. ICE DETENTION. 

24 (a) REVIEWING ICE DETENTION.—During the public 

25 health emergency declared by the Secretary of Health and 


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1 Human Services under section 319 of the Public Health 

2 Service Act (42 U.S.C. 247d) with respect to COVID–19, 

3 the Secretary of Homeland Security shall review the immi4 gration files of all individuals in the custody of U.S. Immi5 gration and Customs Enforcement to assess the need for 

6 continued detention. The Secretary of Homeland Security 

7 shall prioritize for release on recognizance or alternatives 

8 to detention individuals who are not subject to mandatory 

9 detention laws, unless the individual is a threat to public 

10 safety or national security. 

11 (b) ACCESS TO ELECTRONIC COMMUNICATIONS AND

12 HYGIENE PRODUCTS.—During the period described in 

13 subsection (c), the Secretary of Homeland Security shall 

14 ensure that— 

15 (1) all individuals in the custody of U.S. Immi16 gration and Customs Enforcement— 

17 (A) have access to telephonic or video com18 munication at no cost to the detained indi19 vidual; 

20 (B) have access to free, unmonitored tele21 phone calls, at any time, to contact attorneys or 

22 legal service providers in a sufficiently private 

23 space to protect confidentiality; 


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1 (C) are permitted to receive legal cor2 respondence by fax or email rather than postal 

3 mail; and 

4 (D) are provided sufficient soap, hand san5 itizer, and other hygiene products; and 

6 (2) nonprofit organizations providing legal ori7 entation programming or know-your-rights program8 ming to individuals in the custody of U.S. Immigra9 tion and Customs Enforcement are permitted broad 

10 and flexible access to such individuals— 

11 (A) to provide group presentations using 

12 remote videoconferencing; and 

13 (B) to schedule and provide individual ori14 entations using free telephone calls or remote 

15 videoconferencing. 

16 (c) PERIOD DESCRIBED.—The period described in 

17 this subsection— 

18 (1) begins on the first day of the public health 

19 emergency declared by the Secretary of Health and 

20 Human Services under section 319 of the Public 

21 Health Service Act (42 U.S.C. 247d) with respect to 

22 COVID–19; and 

23 (2) ends 90 days after the date on which such 

24 public health emergency terminates. 


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1 Subtitle C—Contact Tracing 

2 SEC. 221. COVID–19 TESTING, REACHING, AND CONTACTING 

3 EVERYONE. 

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

5 Human Services, acting through the Director of the Cen6 ters for Disease Control and Prevention, may award 

7 grants to eligible entities to conduct diagnostic testing for 

8 COVID–19, to trace and monitor the contacts of infected 

9 individuals, and to support the quarantine of such con10 tacts, through— 

11 (1) mobile health units; and 

12 (2) as necessary, testing individuals and pro13 viding individuals with services related to testing and 

14 quarantine at their residences. 

15 (b) PERMISSIBLE USES OF FUNDS.—A grant recipi16 ent under this section may use the grant funds, in support 

17 of the activities described in subsection (a)— 

18 (1) to hire, train, compensate, and pay the ex19 penses of individuals; and 

20 (2) to purchase personal protective equipment 

21 and other supplies. 

22 (c) PRIORITY.—In selecting grant recipients under 

23 this section, the Secretary shall give priority to— 


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1 (1) applicants proposing to conduct activities 

2 funded under this section in hot spots and medically 

3 underserved communities; and 

4 (2) applicants that agree, in hiring individuals 

5 to carry out activities funded under this section, to 

6 hire residents of the area or community where the 

7 activities will primarily occur, with higher priority 

8 among applicants described in this paragraph given 

9 based on the percentage of individuals to be hired 

10 from such area or community. 

11 (d) DISTRIBUTION.—In selecting grant recipients 

12 under this section, the Secretary shall ensure that grants 

13 are distributed across urban and rural areas. 

14 (e) FEDERAL PRIVACY REQUIREMENTS.—Nothing in 

15 this section shall be construed to supersede any Federal 

16 privacy or confidentiality requirement, including the regu17 lations promulgated under section 264(c) of the Health 

18 Insurance Portability and Accountability Act of 1996 

19 (Public Law 104–191; 110 Stat. 2033) and section 543 

20 of the Public Health Service Act (42 U.S.C. 290dd–2). 

21 (f) DEFINITIONS.—In this section: 

22 (1) The term ‘‘eligible entity’’ means— 

23 (A) a Federally qualified health center (as 

24 defined in section 1861(aa) of the Social Secu25 rity Act (42 U.S.C. 1395x(aa))); 


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1 (B) a school-based health clinic; 

2 (C) a disproportionate share hospital (as 

3 defined under the applicable State plan under 

4 title XIX of the Social Security Act (42 U.S.C. 

5 1396 et seq.) pursuant to section 1923(a)(1)(A) 

6 of such Act (42 U.S.C. 1396r–4)); 

7 (D) an academic medical center; 

8 (E) a nonprofit organization (including any 

9 such faith-based organization); 

10 (F) an institution of higher education (as 

11 defined in section 101 of the Higher Education 

12 Act of 1965 (20 U.S.C. 1001)); 

13 (G) a high school (as defined in section 

14 8101 of the Elementary and Secondary Edu15 cation Act of 1965 (20 U.S.C. 7801)); 

16 (H) any Tribal organization including the 

17 Indian Health Service and Native American 

18 servicing facilities; or 

19 (I) any other type of entity that is deter20 mined by the Secretary to be an eligible entity 

21 for purposes of this section. 

22 (2) The term ‘‘emergency period’’ has the 

23 meaning given to that term in section 1135(g)(1)(B) 

24 of the Social Security Act (42 U.S.C. 1320b– 

25 5(g)(1)(B)). 


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1 (3) The term ‘‘hot spot’’ means a geographic 

2 area where the rate of infection with the virus that 

3 causes COVID–19 exceeds the national average. 

4 (4) The term ‘‘medically underserved commu5 nity’’ has the meaning given to that term in section 

6 799B of the Public Health Service Act (42 U.S.C. 

7 295p). 

8 (5) The term ‘‘Secretary’’ means the Secretary 

9 of Health and Human Services. 

10 (g) AUTHORIZATION OF APPROPRIATIONS.—To carry 

11 out this section, there are authorized to be appropriated— 

12 (1) $100,000,000,000 for fiscal year 2020; and 

13 (2) such sums as may be necessary for each of 

14 fiscal year 2021 and any subsequent fiscal year dur15 ing which the emergency period continues. 

16 SEC. 222. NATIONAL SYSTEM FOR COVID–19 TESTING, CON17 TACT TRACING, SURVEILLANCE, CONTAIN18 MENT, AND MITIGATION. 

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

20 Human Services (referred to in this section as the ‘‘Sec21 retary’’), acting through the Director of the Centers for 

22 Disease Control and Prevention, and in coordination with 

23 State, local, Tribal, and territorial health departments, 

24 shall establish and implement a nationwide evidence-based 

25 system for— 


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1 (1) testing, contact tracing, surveillance, con2 tainment, and mitigation with respect to COVID–19; 

3 (2) offering guidance on voluntary isolation and 

4 quarantine of individuals infected with, or exposed to 

5 individuals infected with, the virus that causes 

6 COVID–19; and 

7 (3) public reporting on testing, contact tracing, 

8 surveillance, and voluntary isolation and quarantine 

9 activities with respect to COVID–19. 

10 (b) COORDINATION; TECHNICAL ASSISTANCE.—In 

11 carrying out the national system under this section, the 

12 Secretary shall— 

13 (1) coordinate State, local, Tribal, and terri14 torial activities related to testing, contact tracing, 

15 surveillance, containment, and mitigation with re16 spect to COVID–19, as appropriate; and 

17 (2) provide technical assistance for such activi18 ties, as appropriate. 

19 (c) CONSIDERATION.—In establishing and imple20 menting the national system under this section, the Sec21 retary shall take into consideration— 

22 (1) the State plans referred to in the heading 

23 ‘‘Public Health and Social Services Emergency 

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1 tection Program and Health Care Enhancement Act 

2 (Public Law 116–139); and 

3 (2) the testing strategy submitted under section 

4 211. 

5 (d) REPORTING.—The Secretary shall— 

6 (1) not later than December 31, 2020, submit 

7 to the Committee on Energy and Commerce of the 

8 House of Representatives and the Committee on 

9 Health, Education, Labor, and Pensions a prelimi10 nary report on the effectiveness of the activities car11 ried out pursuant to this subtitle; and 

12 (2) not later than December 21, 2021, submit 

13 to such committees a final report on such effective14 ness. 

15 SEC. 223. GRANTS. 

16 (a) IN GENERAL.—To implement the national system 

17 under section 222, the Secretary of Health and Human 

18 Services (referred to in this section as the ‘‘Secretary’’), 

19 acting through the Director of the Centers for Disease 

20 Control and Prevention, shall, subject to the availability 

21 of appropriations, award grants to State, local, Tribal, and 

22 territorial health departments that seek grants under this 

23 section to carry out coordinated testing, contact tracing, 

24 surveillance, containment, and mitigation with respect to 

25 COVID–19, including— 


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1 (1) diagnostic and surveillance testing and re2 porting; 

3 (2) community-based contact tracing efforts; 

4 and 

5 (3) policies related to voluntary isolation and 

6 quarantine of individuals infected with, or exposed to 

7 individuals infected with, the virus that causes 

8 COVID–19. 

9 (b) FLEXIBILITY.—The Secretary shall ensure that— 

10 (1) the grants under subsection (a) provide 

11 flexibility for State, local, Tribal, and territorial 

12 health departments to modify, establish, or maintain 

13 evidence-based systems; and 

14 (2) local health departments receive funding 

15 from State health departments or directly from the 

16 Centers for Disease Control and Prevention to con17 tribute to such systems, as appropriate. 

18 (c) ALLOCATIONS.— 

19 (1) FORMULA.—The Secretary, acting through 

20 the Director of the Centers for Disease Control and 

21 Prevention, shall allocate amounts made available 

22 pursuant to subsection (a) in accordance with a for23 mula to be established by the Secretary that pro24 vides a minimum level of funding to each State, 

25 local, Tribal, and territorial health department that 


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1 seeks a grant under this section and allocates addi2 tional funding based on the following prioritization: 

3 (A) The Secretary shall give highest pri4 ority to applicants proposing to serve popu5 lations in one or more geographic regions with 

6 a high burden of COVID–19 based on data pro7 vided by the Centers for Disease Control and 

8 Prevention, or other sources as determined by 

9 the Secretary. 

10 (B) The Secretary shall give second high11 est priority to applicants preparing for, or cur12 rently working to mitigate, a COVID–19 surge 

13 in a geographic region that does not yet have 

14 a high number of reported cases of COVID–19 

15 based on data provided by the Centers for Dis16 ease Control and Prevention, or other sources 

17 as determined by the Secretary. 

18 (C) The Secretary shall give third highest 

19 priority to applicants proposing to serve high 

20 numbers of low-income and uninsured popu21 lations, including medically underserved popu22 lations (as defined in section 330(b)(3) of the 

23 Public Health Service Act (42 U.S.C. 

24 254b(b)(3))), health professional shortage areas 

25 (as defined under section 332(a) of the Public 


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1 Health Service Act (42 U.S.C. 254e(a))), racial 

2 and ethnic minorities, or geographically diverse 

3 areas, as determined by the Secretary. 

4 (2) NOTIFICATION.—Not later than the date 

5 that is one week before first awarding grants under 

6 this section, the Secretary shall submit to the Com7 mittee on Energy and Commerce of the House of 

8 Representatives and the Committee on Health, Edu9 cation, Labor, and Pensions of the Senate a notifica10 tion detailing the formula established under para11 graph (1) for allocating amounts made available pur12 suant to subsection (a). 

13 (d) USE OF FUNDS.—A State, local, Tribal, and ter14 ritorial health department receiving a grant under this 

15 section shall, to the extent possible, use the grant funds 

16 for the following activities, or other activities deemed ap17 propriate by the Director of the Centers for Disease Con18 trol and Prevention: 

19 (1) TESTING.—To implement a coordinated 

20 testing system that— 

21 (A) leverages or modernizes existing test22 ing infrastructure and capacity; 

23 (B) is consistent with the updated testing 

24 strategy required under section 211; 


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1 (C) is coordinated with the State plan for 

2 COVID–19 testing prepared as required under 

3 the heading ‘‘Department of Health and 

4 Human Services—Office of the Secretary— 

5 Public Health and Social Service Emergency 

6 Fund’’ in title I of division B of the Paycheck 

7 Protection Program and Health Care Enhance8 ment Act (Public Law 116–139; 134 Stat. 620, 

9 624); 

10 (D) is informed by contact tracing and 

11 surveillance activities under this subtitle; 

12 (E) is informed by guidelines established 

13 by the Centers for Disease Control and Preven14 tion for which populations should be tested; 

15 (F) identifies how diagnostic and sero16 logical tests in such system shall be validated 

17 prior to use; 

18 (G) identifies how diagnostic and sero19 logical tests and testing supplies will be distrib20 uted to implement such system; 

21 (H) identifies specific strategies for ensur22 ing testing capabilities and accessibility in 

23 medically underserved populations (as defined 

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1 sional shortage areas (as defined under section 

2 332(a) of the Public Health Service Act (42 

3 U.S.C. 254e(a))), racial and ethnic minority 

4 populations, and geographically diverse areas, 

5 as determined by the Secretary; 

6 (I) identifies how testing may be used, and 

7 results may be reported, in both health care set8 tings (such as hospitals, laboratories for mod9 erate or high-complexity testing, pharmacies, 

10 mobile testing units, and community health cen11 ters) and non-health care settings (such as 

12 workplaces, schools, childcare centers, or drive13 throughs); 

14 (J) allows for testing in sentinel surveil15 lance programs, as appropriate; and 

16 (K) supports the procurement and dis17 tribution of diagnostic and serological tests and 

18 testing supplies to meet the goals of the system. 

19 (2) CONTACT TRACING.—To implement a co20 ordinated contact tracing system that— 

21 (A) leverages or modernizes existing con22 tact tracing systems and capabilities, including 

23 community health workers, health departments, 

24 and Federally qualified health centers; 


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1 (B) is able to investigate cases of COVID– 

2 19, and help to identify other potential cases of 

3 COVID–19, through tracing contacts of individ4 uals with positive diagnoses; 

5 (C) establishes culturally competent and 

6 multilingual strategies for contact tracing, 

7 which may include consultation with and sup8 port for cultural or civic organizations with es9 tablished ties to the community; 

10 (D) provides individuals identified under 

11 the contact tracing program with information 

12 and support for containment or mitigation; 

13 (E) enables State, local, Tribal, and terri14 torial health departments to work with a non15 governmental, community partner or partners 

16 and State and local workforce development sys17 tems (as defined in section 3(67) of Workforce 

18 Innovation and Opportunity Act (29 U.S.C. 

19 3102(67))) receiving grants under section 

20 224(b) of this Act to hire and compensate a lo21 cally sourced contact tracing workforce, if nec22 essary, to supplement the public health work23 force, to— 

24 (i) identify the number of contact 

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1 cality, territorial, or Tribal health depart2 ment to identify all cases of COVID–19 

3 currently in the jurisdiction and those an4 ticipated to emerge over the next 18 

5 months in such jurisdiction; 

6 (ii) outline qualifications necessary for 

7 contact tracers; 

8 (iii) train the existing and newly hired 

9 public health workforce on best practices 

10 related to tracing close contacts of individ11 uals diagnosed with COVID–19, including 

12 the protection of individual privacy and 

13 cybersecurity protection; and 

14 (iv) equip the public health workforce 

15 with tools and resources to enable a rapid 

16 response to new cases; 

17 (F) identifies the level of contact tracing 

18 needed within the State, locality, territory, or 

19 Tribal area to contain and mitigate the trans20 mission of COVID–19; 

21 (G) establishes statewide mechanisms to 

22 integrate regular evaluation to the Centers for 

23 Disease Control and Prevention regarding con24 tact tracing efforts, makes such evaluation pub25 licly available, and to the extent possible proVerDate Sep 11 2014 00:31 Nov 13, 2020 Jkt 019200 PO 00000 Frm 00096 Fmt 6652 Sfmt 6201 E:\BILLS\H8200.IH H8200

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1 vides for such evaluation at the county level; 

2 and 

3 (H) identifies specific strategies for ensur4 ing contact tracing activities in medically un5 derserved populations (as defined in section 

6 330(b)(3) of the Public Health Service Act (42 

7 U.S.C. 254b(b)(3))), health professional short8 age areas (as defined under section 332(a) of 

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

10 254e(a))), racial and ethnic minority popu11 lations, and geographically diverse areas, as de12 termined by the Secretary. 

13 (3) SURVEILLANCE.—To strengthen the exist14 ing public health surveillance system that— 

15 (A) leverages or modernizes existing sur16 veillance systems within the respective State, 

17 local, Tribal, or territorial health department 

18 and national surveillance systems; 

19 (B) detects and identifies trends in 

20 COVID–19 at the county level; 

21 (C) evaluates State, local, Tribal, and ter22 ritorial health departments in achieving surveil23 lance capabilities with respect to COVID–19; 

24 (D) integrates and improves disease sur25 veillance and immunization tracking; and 


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1 (E) identifies specific strategies for ensur2 ing disease surveillance in medically under3 served populations (as defined in section 

4 330(b)(3) of the Public Health Service Act (42 

5 U.S.C. 254b(b)(3))), health professional short6 age areas (as defined under section 332(a) of 

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

8 254e(a))), racial and ethnic minority popu9 lations, and geographically diverse areas, as de10 termined by the Secretary. 

11 (4) CONTAINMENT AND MITIGATION.—To im12 plement a coordinated containment and mitigation 

13 system that— 

14 (A) leverages or modernizes existing con15 tainment and mitigation strategies within the 

16 respective State, local, Tribal, or territorial gov17 ernments and national containment and mitiga18 tion strategies; 

19 (B) may provide for, connect to, and lever20 age existing social services and support for indi21 viduals who have been infected with or exposed 

22 to COVID–19 and who are isolated or quar23 antined in their homes, such as through— 

24 (i) food assistance programs; 


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1 (ii) guidance for household infection 

2 control; 

3 (iii) information and assistance with 

4 childcare services; and 

5 (iv) information and assistance per6 taining to support available under the 

7 CARES Act (Public Law 116–136) and 

8 this Act; 

9 (C) provides guidance on the establishment 

10 of safe, high-quality, facilities for the voluntary 

11 isolation of individuals infected with, or quar12 antine of the contacts of individuals exposed to 

13 COVID–19, where hospitalization is not re14 quired, which facilities should— 

15 (i) be prohibited from making inquir16 ies relating to the citizenship status of an 

17 individual isolated or quarantined; and 

18 (ii) be operated by a non-Federal, 

19 community partner or partners that— 

20 (I) have previously established re21 lationships in localities; 

22 (II) work with local places of 

23 worship, community centers, medical 

24 facilities, and schools to recruit local 

25 staff for such facilities; and 


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1 (III) are fully integrated into 

2 State, local, Tribal, or territorial con3 tainment and mitigation efforts; and 

4 (D) identifies specific strategies for ensur5 ing containment and mitigation activities in 

6 medically underserved populations (as defined 

7 in section 330(b)(3) of the Public Health Serv8 ice Act (42 U.S.C. 254b(b)(3))), health profes9 sional shortage areas (as defined under section 

10 332(a) of the Public Health Service Act (42 

11 U.S.C. 254e(a))), racial and ethnic minority 

12 populations, and geographically diverse areas, 

13 as determined by the Secretary. 

14 (e) REPORTING.—The Secretary shall facilitate 

15 mechanisms for timely, standardized reporting by grantees 

16 under this section regarding implementation of the sys17 tems established under this section and coordinated proc18 esses with the reporting as required and under the heading 

19 ‘‘Department of Health and Human Services—Office of 

20 the Secretary—Public Health and Social Service Emer21 gency Fund’’ in title I of division B of the Paycheck Pro22 tection Program and Health Care Enhancement Act (Pub23 lic Law 116–139, 134 Stat. 620), including— 

24 (1) a summary of county or local health depart25 ment level information from the States receiving 


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1 funding, and information from directly funded local2 ities, territories, and Tribal entities, about the activi3 ties that will be undertaken using funding awarded 

4 under this section, including subgrants; 

5 (2) any anticipated shortages of required mate6 rials for testing for COVID–19 under subsection (a); 

7 and 

8 (3) other barriers in the prevention, mitigation, 

9 or treatment of COVID–19 under this section. 

10 (f) PUBLIC LISTING OF AWARDS.—The Secretary 

11 shall— 

12 (1) not later than 7 days after first awarding 

13 grants under this section, post in a searchable, elec14 tronic format a list of all awards made by the Sec15 retary under this section, including the recipients 

16 and amounts of such awards; and 

17 (2) update such list not less than every 7 days 

18 until all funds made available to carry out this sec19 tion are expended. 

20 SEC. 224. GRANTS TO STATE AND TRIBAL WORKFORCE 

21 AGENCIES. 

22 (a) DEFINITIONS.—In this section: 

23 (1) IN GENERAL.—Except as otherwise pro24 vided, the terms in this section have the meanings 


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1 given the terms in section 3 of the Workforce Inno2 vation and Opportunity Act (29 U.S.C. 3102). 

3 (2) APPRENTICESHIP; APPRENTICESHIP PRO4 GRAM.—The term ‘‘apprenticeship’’ or ‘‘apprentice5 ship program’’ means an apprenticeship program 

6 registered under the Act of August 16, 1937 (com7 monly known as the ‘‘National Apprenticeship Act’’) 

8 (50 Stat. 664, chapter 663; 29 U.S.C. 50 et seq.), 

9 including any requirement, standard, or rule promul10 gated under such Act, as such requirement, stand11 ard, or rule was in effect on December 30, 2019. 

12 (3) CONTACT TRACING AND RELATED POSI13 TIONS.—The term ‘‘contact tracing and related posi14 tions’’ means employment related to contact tracing, 

15 surveillance, containment, and mitigation activities 

16 as described in paragraphs (2), (3), and (4) of sec17 tion 223(d). 

18 (4) ELIGIBLE ENTITY.—The term ‘‘eligible enti19 ty’’ means— 

20 (A) a State or territory, including the Dis21 trict of Columbia and Puerto Rico; 

22 (B) an Indian Tribe, Tribal organization, 

23 Alaska Native entity, Indian-controlled organi24 zations serving Indians, or Native Hawaiian or25 ganizations; 


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1 (C) an outlying area; or 

2 (D) a local board, if an eligible entity 

3 under subparagraphs (A) through (C) has not 

4 applied with respect to the area over which the 

5 local board has jurisdiction as of the date on 

6 which the local board submits an application 

7 under subsection (c). 

8 (5) ELIGIBLE INDIVIDUAL.—Notwithstanding 

9 section 170(b)(2) of the Workforce Innovation and 

10 Opportunity Act (29 U.S.C. 3225(b)(2)), the term 

11 ‘‘eligible individual’’ means an individual seeking or 

12 securing employment in contact tracing and related 

13 positions and served by an eligible entity or commu14 nity-based organization receiving funding under this 

15 section. 

16 (6) SECRETARY.—The term ‘‘Secretary’’ means 

17 the Secretary of Labor. 

18 (b) GRANTS.— 

19 (1) IN GENERAL.—Subject to the availability of 

20 appropriations under subsection (g), the Secretary 

21 shall award national dislocated worker grants under 

22 section 170(b)(1)(B) of the Workforce Innovation 

23 and Opportunity Act (29 U.S.C. 3225(b)(1)(B)) to 

24 each eligible entity that seeks a grant to assist local 

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1 rying out activities under subsections (f) and (d), re2 spectively, for the following purposes: 

3 (A) To support the recruitment, place4 ment, and training, as applicable, of eligible in5 dividuals seeking employment in contact tracing 

6 and related positions in accordance with the na7 tional system for COVID–19 testing, contact 

8 tracing, surveillance, containment, and mitiga9 tion established under section 222. 

10 (B) To assist with the employment transi11 tion to new employment or education and train12 ing of individuals employed under this section 

13 in preparation for and upon termination of such 

14 employment. 

15 (2) TIMELINE.—The Secretary of Labor shall— 

16 (A) issue application requirements under 

17 subsection (c) not later than 10 days after the 

18 date of enactment of this section; and 

19 (B) award grants to an eligible entity 

20 under paragraph (1) not later than 10 days 

21 after the date on which the Secretary receives 

22 an application from such entity. 

23 (c) GRANT APPLICATION.—An eligible entity apply24 ing for a grant under this section shall submit an applica25 tion to the Secretary, at such time and in such form and 


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1 manner as the Secretary may reasonably require, which 

2 shall include a description of— 

3 (1) how the eligible entity will support the re4 cruitment, placement, and training, as applicable, of 

5 eligible individuals seeking employment in contact 

6 tracing and related positions by partnering with— 

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

8 health department; or 

9 (B) one or more nonprofit or community10 based organizations partnering with such health 

11 departments; 

12 (2) how the activities described in paragraph 

13 (1) will support State efforts to address the demand 

14 for contact tracing and related positions with respect 

15 to— 

16 (A) the State plans referred to in the head17 ing ‘‘Public Health and Social Services Emer18 gency Fund’’ in title I of division B of the Pay19 check Protection Program and Health Care En20 hancement Act (Public Law 116–139); 

21 (B) the testing strategy submitted under 

22 section 211; and 

23 (C) the number of eligible individuals that 

24 the State plans to recruit and train under the 


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1 plans and strategies described in subparagraphs 

2 (A) and (B); 

3 (3) the specific strategies for recruiting and 

4 placement of eligible individuals from or residing 

5 within the communities in which they will work, in6 cluding— 

7 (A) plans for the recruitment of eligible in8 dividuals to serve as contact tracers and related 

9 positions, including dislocated workers, individ10 uals with barriers to employment, veterans, new 

11 entrants in the workforce, or underemployed or 

12 furloughed workers, who are from or reside in 

13 or near the local area in which they will serve, 

14 and who, to the extent practicable— 

15 (i) have experience or a background in 

16 industry-sectors and occupations such as 

17 public health, social services, customer 

18 service, case management, or occupations 

19 that require related qualifications, skills, or 

20 competencies, such as strong interpersonal 

21 and communication skills, needed for con22 tact tracing and related positions, as de23 scribed in section 223(d)(2)(E)(ii); or 

24 (ii) seek to transition to public health 

25 and public health related occupations upon 


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1 the conclusion of employment in contact 

2 tracing and related positions; and 

3 (B) how such strategies will take into ac4 count the diversity of such community, includ5 ing racial, ethnic, socioeconomic, linguistic, or 

6 geographic diversity; 

7 (4) the amount, timing, and mechanisms for 

8 distribution of funds provided to local boards or 

9 through subgrants as described in subsection (d); 

10 (5) for eligible entities described in subpara11 graphs (A) through (C) of subsection (a)(4), a de12 scription of how the eligible entity will ensure the eq13 uitable distribution of funds with respect to— 

14 (A) geography (such as urban and rural 

15 distribution); 

16 (B) medically underserved populations (as 

17 defined in section 33(b)(3) of the Public Health 

18 Service Act (42 U.S.C. 254b(b))); 

19 (C) health professional shortage areas (as 

20 defined under section 332(a) of the Public 

21 Health Service Act (42 U.S.C. 254e(a))); and 

22 (D) the racial and ethnic diversity of the 

23 area; and 

24 (6) for eligible entities who are local boards, a 

25 description of how a grant to such eligible entity 


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1 would serve the equitable distribution of funds as de2 scribed in paragraph (5). 

3 (d) SUBGRANT AUTHORIZATION AND APPLICATION

4 PROCESS.— 

5 (1) IN GENERAL.—An eligible entity may award 

6 a subgrant to one or more community-based organi7 zations for the purposes of partnering with a State 

8 or local board to conduct outreach and education ac9 tivities to inform potentially eligible individuals 

10 about employment opportunities in contact tracing 

11 and related positions. 

12 (2) APPLICATION.—A community-based organi13 zation shall submit an application at such time and 

14 in such manner as the eligible entity may reasonably 

15 require, including— 

16 (A) a demonstration of the community17 based organization’s established expertise and 

18 effectiveness in community outreach in the local 

19 area that such organization plans to serve; 

20 (B) a demonstration of the community21 based organization’s expertise in providing em22 ployment or public health information to the 

23 local areas in which such organization plans to 

24 serve; and 


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1 (C) a description of the expertise of the 

2 community-based organization in utilizing cul3 turally competent and multilingual strategies in 

4 the provision of services. 

5 (e) GRANT DISTRIBUTION.— 

6 (1) FEDERAL DISTRIBUTION.— 

7 (A) USE OF FUNDS.— The Secretary of 

8 Labor shall use the funds appropriated to carry 

9 out this section as follows: 

10 (i) Subject to clause (ii), the Secretary 

11 shall distribute funds among eligible enti12 ties in accordance with a formula to be es13 tablished by the Secretary that provides a 

14 minimum level of funding to each eligible 

15 entity that seeks a grant under this section 

16 and allocates additional funding as follows: 

17 (I) The formula shall give first 

18 priority based on the number and pro19 portion of contact tracing and related 

20 positions that the State plans to re21 cruit, place, and train individuals as a 

22 part of the State strategy described in 

23 subsection (c)(2)(A). 


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1 (II) Subject to subclause (I), the 

2 formula shall give priority in accord3 ance with section 223(c). 

4 (ii) Not more than 2 percent of the 

5 funding for administration of the grants 

6 and for providing technical assistance to 

7 recipients of funds under this section. 

8 (B) EQUITABLE DISTRIBUTION.—If the ge9 ographic region served by one or more eligible 

10 entities overlaps, the Secretary shall distribute 

11 funds among such entities in such a manner 

12 that ensures equitable distribution with respect 

13 to the factors under subsection (c)(5). 

14 (2) ELIGIBLE ENTITY USE OF FUNDS.—An eli15 gible entity described in subparagraphs (A) through 

16 (C) of subsection (a)(4)— 

17 (A) shall, not later than 30 days after the 

18 date on which the entity receives grant funds 

19 under this section, provide not less than 70 per20 cent of grant funds to local boards for the pur21 pose of carrying out activities in subsection (f); 

22 (B) may use up to 20 percent of such 

23 funds to make subgrants to community-based 

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1 reach, to potential eligible individuals, as de2 scribed in subsection (d); 

3 (C) in providing funds to local boards and 

4 awarding subgrants under this subsection shall 

5 ensure the equitable distribution with respect to 

6 the factors described in subsection (c)(5); and 

7 (D) may use not more than 10 percent of 

8 the funds awarded under this section for the 

9 administrative costs of carrying out the grant 

10 and for providing technical assistance to local 

11 boards and community-based organizations. 

12 (3) LOCAL BOARD USE OF FUNDS.—A local 

13 board, or an eligible entity that is a local board, 

14 shall use— 

15 (A) not less than 60 percent of the funds 

16 for recruitment and training for COVID–19 

17 testing, contact tracing, surveillance, contain18 ment, and mitigation established under section 

19 222; 

20 (B) not less than 30 percent of the funds 

21 to support the transition of individuals hired as 

22 contact tracers and related positions into an 

23 education or training program, or unsubsidized 

24 employment upon completion of such positions; 

25 and 


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1 (C) not more than 10 percent of the funds 

2 for administrative costs. 

3 (f) ELIGIBLE ACTIVITIES.—The State or local boards 

4 shall use funds awarded under this section to support the 

5 recruitment and placement of eligible individuals, training 

6 and employment transition as related to contact tracing 

7 and related positions, and for the following activities: 

8 (1) Establishing or expanding partnerships 

9 with— 

10 (A) State, local, Tribal, and territorial 

11 public health departments; 

12 (B) community-based health providers, in13 cluding community health centers and rural 

14 health clinics; 

15 (C) labor organizations or joint labor man16 agement organizations; 

17 (D) two-year and four-year institutions of 

18 higher education (as defined in section 101 of 

19 the Higher Education Act of 1965 (20 U.S.C. 

20 1001)), including institutions eligible to receive 

21 funds under section 371(a) of the Higher Edu22 cation Act of 1965 (20 U.S.C. 1067q(a)); and 

23 (E) community action agencies or other 

24 community-based organizations serving local 


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1 areas in which there is a demand for contact 

2 tracing and related positions. 

3 (2) Providing training for contact tracing and 

4 related positions in coordination with State, local, 

5 Tribal, or territorial health departments that is con6 sistent with the State or territorial testing and con7 tact tracing strategy, and ensuring that eligible indi8 viduals receive compensation while participating in 

9 such training. 

10 (3) Providing eligible individuals with— 

11 (A) adequate and safe equipment, environ12 ments, and facilities for training and super13 vision, as applicable; 

14 (B) information regarding the wages and 

15 benefits related to contact tracing and related 

16 positions, as compared to State, local, and na17 tional averages; 

18 (C) supplies and equipment needed by the 

19 eligible individuals to support placement of an 

20 individual in contact tracing and related posi21 tions, as applicable; 

22 (D) an individualized employment plan for 

23 each eligible individual, as applicable— 


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1 (i) in coordination with the entity em2 ploying the eligible individual in a contact 

3 tracing and related positions; and 

4 (ii) which shall include providing a 

5 case manager to work with each eligible in6 dividual to develop the plan, which may in7 clude— 

8 (I) identifying employment and 

9 career goals, and setting appropriate 

10 achievement objectives to attain such 

11 goals; and 

12 (II) exploring career pathways 

13 that lead to in-demand industries and 

14 sectors, including in public health and 

15 related occupations; and 

16 (E) services for the period during which 

17 the eligible individual is employed in a contact 

18 tracing and related position to ensure job reten19 tion, which may include— 

20 (i) supportive services throughout the 

21 term of employment; 

22 (ii) a continuation of skills training as 

23 related to employment in contact tracing 

24 and related positions, that is conducted in 


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1 collaboration with the employers of such 

2 individuals; 

3 (iii) mentorship services and job re4 tention support for eligible individuals; or 

5 (iv) targeted training for managers 

6 and workers working with eligible individ7 uals (such as mentors), and human re8 source representatives. 

9 (4) Supporting the transition and placement in 

10 unsubsidized employment for eligible individuals 

11 serving in contact tracing and related positions after 

12 such positions are no longer necessary in the State 

13 or local area, including— 

14 (A) any additional training and employ15 ment activities as described in section 170(d)(4) 

16 of the Workforce Innovation and Opportunity 

17 Act (29 U.S.C. 3225(d)(4)); 

18 (B) developing the appropriate combina19 tion of services to enable the eligible individual 

20 to achieve the employment and career goals 

21 identified under paragraph (3)(D)(ii)(I); and 

22 (C) services to assist eligible individuals in 

23 maintaining employment for not less than 12 

24 months after the completion of employment in 


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1 contact tracing and related positions, as appro2 priate. 

3 (5) Any other activities as described in sub4 sections (a)(3) and (b) of section 134 of the Work5 force Innovation and Opportunity Act (29 U.S.C. 

6 3174). 

7 (g) LIMITATION.—Notwithstanding section 

8 170(d)(3)(A) of the Workforce Innovation and Oppor9 tunity Act (29 U.S.C. 3225(d)(3)(A)), a person may be 

10 employed in a contact tracing and related positions using 

11 funds under this section for a period not greater than 2 

12 years. 

13 (h) REPORTING BY THE DEPARTMENT OF LABOR.— 

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

15 the enactment of this Act, and once grant funds 

16 have been expended under this section, the Secretary 

17 shall report to the Committee on Education and 

18 Labor of the House of Representatives and the Com19 mittee on Health, Education, Labor, and Pensions 

20 of the Senate, and make publicly available a report 

21 containing a description of— 

22 (A) the number of eligible individuals re23 cruited, hired, and trained in contact tracing 

24 and related positions; 


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1 (B) the number of individuals successfully 

2 transitioned to unsubsidized employment or 

3 training at the completion of employment in 

4 contact tracing and related positions using 

5 funds under this subtitle; 

6 (C) the number of such individuals who 

7 were unemployed prior to being hired, trained, 

8 or deployed as described in paragraph (1); 

9 (D) the performance of each program sup10 ported by funds under this subtitle with respect 

11 to the indicators of performance under section 

12 116 of the Workforce Innovation and Oppor13 tunity Act (29 U.S.C. 3141), as applicable; 

14 (E) the number of individuals in unsub15 sidized employment within six months and 1 

16 year, respectively, of the conclusion of employ17 ment in contact tracing and related positions 

18 and, of those, the number of individuals within 

19 a State, territorial, or local public health de20 partment in an occupation related to public 

21 health; 

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1 tional system for COVID–19 testing, contact 

2 tracing, surveillance, containment, and mitiga3 tion established under section 222 of this Act; 

4 and 

5 (G) best practices for improving and in6 creasing the transition of individuals employed 

7 in contract tracing and related positions to un8 subsidized employment. 

9 (2) DISAGGREGATION.—All data reported under 

10 paragraph (1) shall be disaggregated by race, eth11 nicity, sex, age, and, with respect to individuals with 

12 barriers to employment, subpopulation of such indi13 viduals, except for when the number of participants 

14 in a category is insufficient to yield statistically reli15 able information or when the results would reveal 

16 personally identifiable information about an indi17 vidual participant. 

18 (i) SPECIAL RULE.—Any funds used for programs 

19 under this section that are used to fund an apprenticeship 

20 or apprenticeship program shall only be used for, or pro21 vided to, an apprenticeship or apprenticeship program 

22 that meets the definition of such term subsection (a) of 

23 this section, including any funds awarded for the purposes 

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1 velopment, implementation, or administration, of an ap2 prenticeship or an apprenticeship program. 

3 (j) INFORMATION SHARING REQUIREMENT FOR

4 HHS.—The Secretary of Health and Human Services, 

5 acting through the Director of the Centers for Disease 

6 Control and Prevention, shall provide the Secretary of 

7 Labor, acting through the Assistant Secretary of the Em8 ployment and Training Administration, with information 

9 on grants under section 223, including— 

10 (1) the formula used to award such grants to 

11 State, local, Tribal, and territorial health depart12 ments; 

13 (2) the dollar amounts of and scope of the work 

14 funded under such grants; 

15 (3) the geographic areas served by eligible enti16 ties that receive such grants; and 

17 (4) the number of contact tracers and related 

18 positions to be hired using such grants. 

19 (k) AUTHORIZATION OF APPROPRIATIONS.—Of the 

20 amounts appropriated to carry out this subtitle, 

21 $500,000,000 shall be used by the Secretary of Labor to 

22 carry out subsections (a) through (h) of this section. 


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1 TITLE III—FREE TREATMENT 

2 FOR ALL AMERICANS 

3 SEC. 301. COVERAGE AT NO COST SHARING OF COVID–19 

4 VACCINE AND TREATMENT. 

5 (a) MEDICAID.— 

6 (1) IN GENERAL.—Section 1905(a)(4) of the 

7 Social Security Act (42 U.S.C. 1396d(a)(4)) is 

8 amended— 

9 (A) by striking ‘‘and (D)’’ and inserting 

10 ‘‘(D)’’; and 

11 (B) by striking the semicolon at the end 

12 and inserting ‘‘; (E) during the portion of the 

13 emergency period described in paragraph (1)(B) 

14 of section 1135(g) beginning on the date of the 

15 enactment of The Heroes Act, a COVID–19 

16 vaccine licensed under section 351 of the Public 

17 Health Service Act, or approved or authorized 

18 under sections 505 or 564 of the Federal Food, 

19 Drug, and Cosmetic Act, and administration of 

20 the vaccine; and (F) during such portion of the 

21 emergency period described in paragraph (1)(B) 

22 of section 1135(g), items or services for the 

23 prevention or treatment of COVID–19, includ24 ing drugs approved or authorized under such 

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1 gard to the requirements of section 

2 1902(a)(10)(B) (relating to comparability), in 

3 the case of an individual who is diagnosed with 

4 or presumed to have COVID–19, during such 

5 portion of such emergency period during which 

6 such individual is infected (or presumed in7 fected) with COVID–19, the treatment of a 

8 condition that may complicate the treatment of 

9 COVID–19;’’. 

10 (2) PROHIBITION OF COST SHARING.— 

11 (A) IN GENERAL.—Subsections (a)(2) and 

12 (b)(2) of section 1916 of the Social Security 

13 Act (42 U.S.C. 1396o) are each amended— 

14 (i) in subparagraph (F), by striking 

15 ‘‘or’’ at the end; 

16 (ii) in subparagraph (G), by striking 

17 ‘‘; and’’ and inserting ‘‘;’’; and 

18 (iii) by adding at the end the fol19 lowing subparagraphs: 

20 ‘‘(H) during the portion of the emergency 

21 period described in paragraph (1)(B) of section 

22 1135(g) beginning on the date of the enactment 

23 of this subparagraph, a COVID–19 vaccine li24 censed under section 351 of the Public Health 

25 Service Act, or approved or authorized under 


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1 section 505 or 564 of the Federal Food, Drug, 

2 and Cosmetic Act, and the administration of 

3 such vaccine; or 

4 ‘‘(I) during such portion of the emergency 

5 period described in paragraph (1)(B) of section 

6 1135(g), any item or service furnished for the 

7 treatment of COVID–19, including drugs ap8 proved or authorized under such section 505 or 

9 such section 564 or, in the case of an individual 

10 who is diagnosed with or presumed to have 

11 COVID–19, during the portion of such emer12 gency period during which such individual is in13 fected (or presumed infected) with COVID–19, 

14 the treatment of a condition that may com15 plicate the treatment of COVID–19; and’’. 

16 (B) APPLICATION TO ALTERNATIVE COST

17 SHARING.—Section 1916A(b)(3)(B) of the So18 cial Security Act (42 U.S.C. 1396o–1(b)(3)(B)) 

19 is amended— 

20 (i) in clause (xi), by striking ‘‘any 

21 visit’’ and inserting ‘‘any service’’; and 

22 (ii) by adding at the end the following 

23 clauses: 

24 ‘‘(xii) During the portion of the emer25 gency period described in paragraph (1)(B) 


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1 of section 1135(g) beginning on the date of 

2 the enactment of this clause, a COVID–19 

3 vaccine licensed under section 351 of the 

4 Public Health Service Act, or approved or 

5 authorized under section 505 or 564 of the 

6 Federal Food, Drug, and Cosmetic Act, 

7 and the administration of such vaccine. 

8 ‘‘(xiii) During such portion of the 

9 emergency period described in paragraph 

10 (1)(B) of section 1135(g), an item or serv11 ice furnished for the treatment of COVID– 

12 19, including drugs approved or authorized 

13 under such section 505 or such section 564 

14 or, in the case of an individual who is diag15 nosed with or presumed to have COVID– 

16 19, during such portion of such emergency 

17 period during which such individual is in18 fected (or presumed infected) with 

19 COVID–19, the treatment of a condition 

20 that may complicate the treatment of 

21 COVID–19.’’. 

22 (C) CLARIFICATION.—The amendments 

23 made by this subsection shall apply with respect 

24 to a State plan of a territory in the same man25 ner as a State plan of one of the 50 States. 


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1 (b) STATE PEDIATRIC VACCINE DISTRIBUTION PRO2 GRAM.—Section 1928 of the Social Security Act (42 

3 U.S.C. 1396s) is amended— 

4 (1) in subsection (a)(1)— 

5 (A) in subparagraph (A), by striking ‘‘; 

6 and’’ and inserting a semicolon; 

7 (B) in subparagraph (B), by striking the 

8 period and inserting ‘‘; and’’; and 

9 (C) by adding at the end the following sub10 paragraph: 

11 ‘‘(C) during the portion of the emergency 

12 period described in paragraph (1)(B) of section 

13 1135(g) beginning on the date of the enactment 

14 of this subparagraph, each vaccine-eligible child 

15 (as defined in subsection (b)) is entitled to re16 ceive a COVID–19 vaccine from a program-reg17 istered provider (as defined in subsection 

18 (h)(7)) without charge for— 

19 ‘‘(i) the cost of such vaccine; or 

20 ‘‘(ii) the administration of such vac21 cine.’’; 

22 (2) in subsection (c)(2)— 

23 (A) in subparagraph (C)(ii), by inserting ‘‘, 

24 but, during the portion of the emergency period 

25 described in paragraph (1)(B) of section 


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1 1135(g) beginning on the date of the enactment 

2 of The Heroes Act, may not impose a fee for 

3 the administration of a COVID–19 vaccine’’ be4 fore the period; and 

5 (B) by adding at the end the following sub6 paragraph: 

7 ‘‘(D) The provider will provide and admin8 ister an approved COVID–19 vaccine to a vac9 cine-eligible child in accordance with the same 

10 requirements as apply under the preceding sub11 paragraphs to the provision and administration 

12 of a qualified pediatric vaccine to such a 

13 child.’’; and 

14 (3) in subsection (d)(1), in the first sentence, 

15 by inserting ‘‘, including, during the portion of the 

16 emergency period described in paragraph (1)(B) of 

17 section 1135(g) beginning on the date of the enact18 ment of The Heroes Act, with respect to a COVID– 

19 19 vaccine licensed under section 351 of the Public 

20 Health Service Act, or approved or authorized under 

21 section 505 or 564 of the Federal Food, Drug, and 

22 Cosmetic Act’’ before the period. 

23 (c) CHIP.— 


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1 (1) IN GENERAL.—Section 2103(c) of the So2 cial Security Act (42 U.S.C. 1397cc(c)) is amended 

3 by adding at the end the following paragraph: 

4 ‘‘(11) COVERAGE OF COVID–19 VACCINES AND

5 TREATMENT.—Regardless of the type of coverage 

6 elected by a State under subsection (a), child health 

7 assistance provided under such coverage for targeted 

8 low-income children and, in the case that the State 

9 elects to provide pregnancy-related assistance under 

10 such coverage pursuant to section 2112, such preg11 nancy-related assistance for targeted low-income 

12 pregnant women (as defined in section 2112(d)) 

13 shall include coverage, during the portion of the 

14 emergency period described in paragraph (1)(B) of 

15 section 1135(g) beginning on the date of the enact16 ment of this paragraph, of— 

17 ‘‘(A) a COVID–19 vaccine licensed under 

18 section 351 of the Public Health Service Act, or 

19 approved or authorized under section 505 or 

20 564 of the Federal Food, Drug, and Cosmetic 

21 Act, and the administration of such vaccine; 

22 and 

23 ‘‘(B) any item or service furnished for the 

24 treatment of COVID–19, including drugs ap25 proved or authorized under such section 505 or 


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1 such section 564, or, in the case of an indi2 vidual who is diagnosed with or presumed to 

3 have COVID–19, during the portion of such 

4 emergency period during which such individual 

5 is infected (or presumed infected) with COVID– 

6 19, the treatment of a condition that may com7 plicate the treatment of COVID–19.’’. 

8 (2) PROHIBITION OF COST SHARING.—Section 

9 2103(e)(2) of the Social Security Act (42 U.S.C. 

10 1397cc(e)(2)), as amended by section 6004(b)(3) of 

11 the Families First Coronavirus Response Act, is 

12 amended— 

13 (A) in the paragraph header, by inserting 

14 ‘‘A COVID–19 VACCINE, COVID–19 TREATMENT,’’ 

15 before ‘‘OR PREGNANCY-RELATED ASSISTANCE’’; 

16 and 

17 (B) by striking ‘‘visits described in section 

18 1916(a)(2)(G), or’’ and inserting ‘‘services de19 scribed in section 1916(a)(2)(G), vaccines de20 scribed in section 1916(a)(2)(H) administered 

21 during the portion of the emergency period de22 scribed in paragraph (1)(B) of section 1135(g) 

23 beginning on the date of the enactment of The 

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1 tion 1916(a)(2)(I) furnished during such emer2 gency period, or’’. 

3 (d) CONFORMING AMENDMENTS.—Section 1937 of 

4 the Social Security Act (42 U.S.C. 1396u–7) is amend5 ed— 

6 (1) in subsection (a)(1)(B), by inserting ‘‘, 

7 under subclause (XXIII) of section 

8 1902(a)(10)(A)(ii),’’ after ‘‘section 

9 1902(a)(10)(A)(i)’’; and 

10 (2) in subsection (b)(5), by adding before the 

11 period the following: ‘‘, and, effective on the date of 

12 the enactment of The Heroes Act, must comply with 

13 subparagraphs (F) through (I) of subsections (a)(2) 

14 and (b)(2) of section 1916 and subsection (b)(3)(B) 

15 of section 1916A’’. 

16 (e) EFFECTIVE DATE.—The amendments made by 

17 this section shall take effect on the date of enactment of 

18 this Act and shall apply with respect to a COVID–19 vac19 cine beginning on the date that such vaccine is licensed 

20 under section 351 of the Public Health Service Act (42 

21 U.S.C. 262), or approved or authorized under section 505 

22 or 564 of the Federal Food, Drug, and Cosmetic Act. 


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1 SEC. 302. OPTIONAL COVERAGE AT NO COST SHARING OF 

2 COVID–19 TREATMENT AND VACCINES UNDER 

3 MEDICAID FOR UNINSURED INDIVIDUALS. 

4 (a) IN GENERAL.—Section 1902(a)(10) of the Social 

5 Security Act (42 U.S.C. 1396a(a)(10)) is amended, in the 

6 matter following subparagraph (G), by striking ‘‘and any 

7 visit described in section 1916(a)(2)(G)’’ and inserting the 

8 following: ‘‘, any COVID–19 vaccine that is administered 

9 during any such portion (and the administration of such 

10 vaccine), any item or service that is furnished during any 

11 such portion for the treatment of COVID–19, including 

12 drugs approved or authorized under section 505 or 564 

13 of the Federal Food, Drug, and Cosmetic Act, or, in the 

14 case of an individual who is diagnosed with or presumed 

15 to have COVID–19, during the period such individual is 

16 infected (or presumed infected) with COVID–19, the 

17 treatment of a condition that may complicate the treat18 ment of COVID–19, and any services described in section 

19 1916(a)(2)(G)’’. 

20 (b) DEFINITION OF UNINSURED INDIVIDUAL.— 

21 (1) IN GENERAL.—Subsection (ss) of section 

22 1902 of the Social Security Act (42 U.S.C. 1396a) 

23 is amended to read as follows: 

24 ‘‘(ss) UNINSURED INDIVIDUAL DEFINED.—For pur25 poses of this section, the term ‘uninsured individual’ 

26 means, notwithstanding any other provision of this title, 


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1 any individual who is not covered by minimum essential 

2 coverage (as defined in section 5000A(f)(1) of the Internal 

3 Revenue Code of 1986).’’. 

4 (2) EFFECTIVE DATE.—The amendment made 

5 by paragraph (1) shall take effect and apply as if in6 cluded in the enactment of the Families First 

7 Coronavirus Response Act (Public Law 116–127). 

8 (c) CLARIFICATION REGARDING EMERGENCY SERV9 ICES FOR CERTAIN INDIVIDUALS.—Section 1903(v)(2) of 

10 the Social Security Act (42 U.S.C. 1396b(v)(2)) is amend11 ed by adding at the end the following flush sentence: 

12 ‘‘For purposes of subparagraph (A), care and serv13 ices described in such subparagraph include any in 

14 vitro diagnostic product described in section 

15 1905(a)(3)(B) (and the administration of such prod16 uct), any COVID–19 vaccine (and the administra17 tion of such vaccine), any item or service that is fur18 nished for the treatment of COVID–19, including 

19 drugs approved or authorized under section 505 or 

20 564 of the Federal Food, Drug, and Cosmetic Act, 

21 or a condition that may complicate the treatment of 

22 COVID–19, and any services described in section 

23 1916(a)(2)(G).’’. 

24 (d) INCLUSION OF COVID–19 CONCERN AS AN

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1 cial Security Act (42 U.S.C. 1396b(v)(3)) is amended by 

2 adding at the end the following flush sentence: 

3 ‘‘Such term includes any indication that an alien de4 scribed in paragraph (1) may have contracted 

5 COVID–19.’’. 

6 SEC. 303. COVERAGE OF TREATMENTS FOR COVID–19 AT NO 

7 COST SHARING UNDER THE MEDICARE AD8 VANTAGE PROGRAM. 

9 (a) IN GENERAL.—Section 1852(a)(1)(B) of the So10 cial Security Act (42 U.S.C. 1395w–22(a)(1)(B)) is 

11 amended by adding at the end the following new clause: 

12 ‘‘(vii) SPECIAL COVERAGE RULES FOR

13 SPECIFIED COVID–19 TREATMENT SERV14 ICES.—Notwithstanding clause (i), in the 

15 case of a specified COVID–19 treatment 

16 service (as defined in section 30201(b) of 

17 The Heroes Act) that is furnished during 

18 a plan year occurring during any portion 

19 of the emergency period defined in section 

20 1135(g)(1)(B) beginning on or after the 

21 date of the enactment of this clause, a 

22 Medicare Advantage plan may not, with re23 spect to such service, impose— 

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1 ment, or coinsurance requirement); 

2 and 

3 ‘‘(II) in the case such service is a 

4 critical specified COVID–19 treat5 ment service (including ventilator 

6 services and intensive care unit serv7 ices), any prior authorization or other 

8 utilization management requirement. 

9 A Medicare Advantage plan may not take 

10 the application of this clause into account 

11 for purposes of a bid amount submitted by 

12 such plan under section 1854(a)(6).’’. 

13 (b) IMPLEMENTATION.—Notwithstanding any other 

14 provision of law, the Secretary of Health and Human 

15 Services may implement the amendments made by this 

16 section by program instruction or otherwise. 

17 SEC. 304. REQUIRING COVERAGE UNDER MEDICARE PDPS 

18 AND MA–PD PLANS, WITHOUT THE IMPOSI19 TION OF COST SHARING OR UTILIZATION 

20 MANAGEMENT REQUIREMENTS, OF DRUGS 

21 INTENDED TO TREAT COVID–19 DURING CER22 TAIN EMERGENCIES. 

23 (a) COVERAGE REQUIREMENT.—Section 1860D– 

24 4(b)(3) of the Social Security Act (42 U.S.C. 1395w– 


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1 104(b)(3)) is amended by adding at the end the following 

2 new subparagraph: 

3 ‘‘(I) REQUIRED INCLUSION OF DRUGS IN4 TENDED TO TREAT COVID–19.— 

5 ‘‘(i) IN GENERAL.—Notwithstanding 

6 any other provision of law, a PDP sponsor 

7 offering a prescription drug plan shall, 

8 with respect to a plan year, any portion of 

9 which occurs during the period described 

10 in clause (ii), be required to— 

11 ‘‘(I) include in any formulary— 

12 ‘‘(aa) all covered part D 

13 drugs with a medically accepted 

14 indication (as defined in section 

15 1860D–2(e)(4)) to treat COVID– 

16 19 that are marketed in the 

17 United States; and 

18 ‘‘(bb) all drugs authorized 

19 under section 564 or 564A of the 

20 Federal Food, Drug, and Cos21 metic Act to treat COVID–19; 

22 and 

23 ‘‘(II) not impose any prior au24 thorization or other utilization man25 agement requirement with respect to 


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1 such drugs described in item (aa) or 

2 (bb) of subclause (I) (other than such 

3 a requirement that limits the quantity 

4 of drugs due to safety). 

5 ‘‘(ii) PERIOD DESCRIBED.—For pur6 poses of clause (i), the period described in 

7 this clause is the period during which there 

8 exists the public health emergency declared 

9 by the Secretary pursuant to section 319 

10 of the Public Health Service Act on Janu11 ary 31, 2020, entitled ‘Determination that 

12 a Public Health Emergency Exists Nation13 wide as the Result of the 2019 Novel 

14 Coronavirus’ (including any renewal of 

15 such declaration pursuant to such sec16 tion).’’. 

17 (b) ELIMINATION OF COST SHARING.— 

18 (1) ELIMINATION OF COST SHARING FOR

19 DRUGS INTENDED TO TREAT COVID–19 UNDER

20 STANDARD AND ALTERNATIVE PRESCRIPTION DRUG

21 COVERAGE.—Section 1860D–2 of the Social Security 

22 Act (42 U.S.C. 1395w–102) is amended— 

23 (A) in subsection (b)— 


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1 (i) in paragraph (1)(A), by striking 

2 ‘‘The coverage’’ and inserting ‘‘Subject to 

3 paragraph (8), the coverage’’; 

4 (ii) in paragraph (2)— 

5 (I) in subparagraph (A), by in6 serting after ‘‘Subject to subpara7 graphs (C) and (D)’’ the following: 

8 ‘‘and paragraph (8)’’; 

9 (II) in subparagraph (C)(i), by 

10 striking ‘‘paragraph (4)’’ and insert11 ing ‘‘paragraphs (4) and (8)’’; and 

12 (III) in subparagraph (D)(i), by 

13 striking ‘‘paragraph (4)’’ and insert14 ing ‘‘paragraphs (4) and (8)’’; 

15 (iii) in paragraph (4)(A)(i), by strik16 ing ‘‘The coverage’’ and inserting ‘‘Subject 

17 to paragraph (8), the coverage’’; and 

18 (iv) by adding at the end the following 

19 new paragraph: 

20 ‘‘(8) ELIMINATION OF COST SHARING FOR

21 DRUGS INTENDED TO TREAT COVID–19.—The cov22 erage does not impose any deductible, copayment, 

23 coinsurance, or other cost-sharing requirement for 

24 drugs described in section 1860D–4(b)(3)(I)(i)(I) 

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1 curs during the period during which there exists the 

2 public health emergency declared by the Secretary 

3 pursuant to section 319 of the Public Health Service 

4 Act on January 31, 2020, entitled ‘Determination 

5 that a Public Health Emergency Exists Nationwide 

6 as the Result of the 2019 Novel Coronavirus’ (in7 cluding any renewal of such declaration pursuant to 

8 such section).’’; and 

9 (B) in subsection (c), by adding at the end 

10 the following new paragraph: 

11 ‘‘(4) SAME ELIMINATION OF COST SHARING FOR

12 DRUGS INTENDED TO TREAT COVID–19.—The cov13 erage is in accordance with subsection (b)(8).’’. 

14 (2) ELIMINATION OF COST SHARING FOR

15 DRUGS INTENDED TO TREAT COVID–19 DISPENSED

16 TO INDIVIDUALS WHO ARE SUBSIDY ELIGIBLE INDI17 VIDUALS.—Section 1860D–14(a) of the Social Secu18 rity Act (42 U.S.C. 1395w–114(a)) is amended— 

19 (A) in paragraph (1)— 

20 (i) in subparagraph (D)— 

21 (I) in clause (ii), by striking ‘‘In 

22 the case of’’ and inserting ‘‘Subject to 

23 subparagraph (F), in the case of’’; 

24 and 


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1 (II) in clause (iii), by striking 

2 ‘‘In the case of’’ and inserting ‘‘Sub3 ject to subparagraph (F), in the case 

4 of’’; and 

5 (ii) by adding at the end the following 

6 new subparagraph: 

7 ‘‘(F) ELIMINATION OF COST SHARING FOR

8 DRUGS INTENDED TO TREAT COVID–19.—Cov9 erage that is in accordance with section 

10 1860D–2(b)(8).’’; and 

11 (B) in paragraph (2)— 

12 (i) in subparagraph (B), by striking 

13 ‘‘A reduction’’ and inserting ‘‘Subject to 

14 subparagraph (F), a reduction’’; 

15 (ii) in subparagraph (D), by striking 

16 ‘‘The substitution’’ and inserting ‘‘Subject 

17 to subparagraph (F), the substitution’’; 

18 (iii) in subparagraph (E), by inserting 

19 after ‘‘Subject to’’ the following: ‘‘subpara20 graph (F) and’’; and 

21 (iv) by adding at the end the following 

22 new subparagraph: 

23 ‘‘(F) ELIMINATION OF COST SHARING FOR

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1 erage that is in accordance with section 

2 1860D–2(b)(8).’’. 

3 (c) IMPLEMENTATION.—Notwithstanding any other 

4 provision of law, the Secretary of Health and Human 

5 Services may implement the amendments made by this 

6 section by program instruction or otherwise. 

7 SEC. 305. COVERAGE OF COVID–19 RELATED TREATMENT 

8 AT NO COST SHARING. 

9 (a) IN GENERAL.—A group health plan and a health 

10 insurance issuer offering group or individual health insur11 ance coverage (including a grandfathered health plan (as 

12 defined in section 1251(e) of the Patient Protection and 

13 Affordable Care Act)) shall provide coverage, and shall not 

14 impose any cost sharing (including deductibles, copay15 ments, and coinsurance) requirements, for the following 

16 items and services furnished during any portion of the 

17 emergency period defined in paragraph (1)(B) of section 

18 1135(g) of the Social Security Act (42 U.S.C. 1320b– 

19 5(g)) beginning on or after the date of the enactment of 

20 this Act: 

21 (1) Medically necessary items and services (in22 cluding in-person or telehealth visits in which such 

23 items and services are furnished) that are furnished 

24 to an individual who has been diagnosed with (or 

25 after provision of the items and services is diagnosed 


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1 with) COVID–19 to treat or mitigate the effects of 

2 COVID–19. 

3 (2) Medically necessary items and services (in4 cluding in-person or telehealth visits in which such 

5 items and services are furnished) that are furnished 

6 to an individual who is presumed to have COVID– 

7 19 but is never diagnosed as such, if the following 

8 conditions are met: 

9 (A) Such items and services are furnished 

10 to the individual to treat or mitigate the effects 

11 of COVID–19 or to mitigate the impact of 

12 COVID–19 on society. 

13 (B) Health care providers have taken ap14 propriate steps under the circumstances to 

15 make a diagnosis, or confirm whether a diag16 nosis was made, with respect to such individual, 

17 for COVID–19, if possible. 

18 (b) ITEMS AND SERVICES RELATED TO COVID– 

19 19.—For purposes of this section— 

20 (1) not later than one week after the date of 

21 the enactment of this section, the Secretary of 

22 Health and Human Services, Secretary of Labor, 

23 and Secretary of the Treasury shall jointly issue 

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1 cally necessary items and services related to 

2 COVID–19; and 

3 (2) such items and services shall include all 

4 items or services that are relevant to the treatment 

5 or mitigation of COVID–19, regardless of whether 

6 such items or services are ordinarily covered under 

7 the terms of a group health plan or group or indi8 vidual health insurance coverage offered by a health 

9 insurance issuer. 

10 (c) ENFORCEMENT.— 

11 (1) APPLICATION WITH RESPECT TO PHSA, 

12 ERISA, AND IRC.—The provisions of this section 

13 shall be applied by the Secretary of Health and 

14 Human Services, Secretary of Labor, and Secretary 

15 of the Treasury to group health plans and health in16 surance issuers offering group or individual health 

17 insurance coverage as if included in the provisions of 

18 part A of title XXVII of the Public Health Service 

19 Act, part 7 of the Employee Retirement Income Se20 curity Act of 1974, and subchapter B of chapter 100 

21 of the Internal Revenue Code of 1986, as applicable. 

22 (2) PRIVATE RIGHT OF ACTION.—An individual 

23 with respect to whom an action is taken by a group 

24 health plan or health insurance issuer offering group 

25 or individual health insurance coverage in violation 


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1 of subsection (a) may commence a civil action 

2 against the plan or issuer for appropriate relief. The 

3 previous sentence shall not be construed as limiting 

4 any enforcement mechanism otherwise applicable 

5 pursuant to paragraph (1). 

6 (d) IMPLEMENTATION.—The Secretary of Health and 

7 Human Services, Secretary of Labor, and Secretary of the 

8 Treasury may implement the provisions of this section 

9 through sub-regulatory guidance, program instruction or 

10 otherwise. 

11 (e) TERMS.—The terms ‘‘group health plan’’, ‘‘health 

12 insurance issuer’’, ‘‘group health insurance coverage’’, and 

13 ‘‘individual health insurance coverage’’ have the meanings 

14 given such terms in section 2791 of the Public Health 

15 Service Act (42 U.S.C. 300gg–91), section 733 of the Em16 ployee Retirement Income Security Act of 1974 (29 

17 U.S.C. 1191b), and section 9832 of the Internal Revenue 

18 Code of 1986, as applicable. 

19 SEC. 306. REIMBURSEMENT FOR ADDITIONAL HEALTH 

20 SERVICES RELATING TO CORONAVIRUS. 

21 Title V of division A of the Families First 

22 Coronavirus Response Act (Public Law 116–127) is 

23 amended under the heading ‘‘Department of Health and 

24 Human Services—Office of the Secretary—Public Health 

25 and Social Services Emergency Fund’’ by inserting ‘‘, or 


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1 treatment related to SARS–CoV–2 or COVID–19 for un2 insured individuals’’ after ‘‘or visits described in para3 graph (2) of such section for uninsured individuals’’. 

4 TITLE IV—FEDERAL HEALTH 

5 EQUITY OVERSIGHT 

6 SEC. 401. COVID-19 RACIAL AND ETHNIC DISPARITIES TASK 

7 FORCE ACT OF 2020. 

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

9 Human Services (referred to in this section as the ‘‘Sec10 retary’’) shall establish an interagency task force, to be 

11 known as the ‘‘COVID–19 Racial and Ethnic Disparities 

12 Task Force’’ (referred to in this section as the ‘‘task 

13 force’’), to gather data about disproportionately affected 

14 communities and provide recommendations to combat the 

15 racial and ethnic disparities in the COVID–19 response 

16 throughout the United States and in response to future 

17 public health crises. 

18 (b) MEMBERSHIP.—The task force shall be composed 

19 of the following: 

20 (1) The Secretary of Health and Human Serv21 ices. 

22 (2) The Assistant Secretary for Planning and 

23 Evaluation of the Department of Health and Human 

24 Services. 


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1 (3) The Assistant Secretary for Preparedness 

2 and Response of the Department of Health and 

3 Human Services. 

4 (4) The Director of the Centers for Disease 

5 Control and Prevention. 

6 (5) The Director of the National Institutes of 

7 Health. 

8 (6) The Commissioner of Food and Drugs. 

9 (7) The Administrator of the Federal Emer10 gency Management Agency. 

11 (8) The Director of the National Institute on 

12 Minority Health and Health Disparities. 

13 (9) The Director of the Indian Health Service. 

14 (10) The Administrator of the Centers for 

15 Medicare & Medicaid Services. 

16 (11) The Director of the Agency for Healthcare 

17 Research and Quality. 

18 (12) The Surgeon General. 

19 (13) The Administrator of the Health Re20 sources and Services Administration. 

21 (14) The Director of the Office of Minority 

22 Health. 

23 (15) The Secretary of Housing and Urban De24 velopment. 

25 (16) The Secretary of Education. 


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1 (17) The Secretary of Labor. 

2 (18) The Secretary of Defense. 

3 (19) The Secretary of Transportation. 

4 (20) The Secretary of the Treasury. 

5 (21) The Administrator of the Small Business 

6 Administration. 

7 (22) The Administrator of the Environmental 

8 Protection Agency. 

9 (23) Five health care professionals with exper10 tise in addressing racial and ethnic disparities, with 

11 at least one representative from a rural area, to be 

12 appointed by the Secretary. 

13 (24) Five policy experts specializing in address14 ing racial and ethnic disparities in education or ra15 cial and ethnic economic inequality to be appointed 

16 by the Secretary. 

17 (25) Six representatives from community-based 

18 organizations specializing in providing culturally 

19 competent care or services and addressing racial and 

20 ethnic disparities, to be appointed by the Secretary, 

21 with at least one representative from an urban In22 dian organization and one representative from a na23 tional organization that represents Tribal govern24 ments with expertise in Tribal public health. 


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1 (26) Six State, local, territorial, or Tribal public 

2 health officials representing departments of public 

3 health, who shall represent jurisdictions from dif4 ferent regions of the United States with relatively 

5 high concentrations of historically marginalized pop6 ulations, to be appointed by the Secretary, with at 

7 least one territorial representative and one rep8 resentative of a Tribal public health department. 

9 (c) ADMINISTRATIVE PROVISIONS.— 

10 (1) APPOINTMENT OF NON-GOVERNMENT MEM11 BERS.—Notwithstanding any other provision of law, 

12 the Secretary shall appoint all non-government mem13 bers of the task force within 30 days of the date en14 actment of this section. 

15 (2) CHAIRPERSON.—The Secretary shall serve 

16 as the chairperson of the task force. The Director of 

17 the Office of Minority Health shall serve as the vice 

18 chairperson. 

19 (3) STAFF.—The task force shall have 10 full20 time staff members. 

21 (4) MEETINGS.—Not later than 45 days after 

22 the date of enactment of this section, the full task 

23 force shall have its first meeting. The task force 

24 shall convene at least once a month thereafter. 


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1 (5) SUBCOMMITTEES.—The chairperson and 

2 vice chairperson of the task force are authorized to 

3 establish subcommittees to consider specific issues 

4 related to the broader mission of addressing racial 

5 and ethnic disparities. 

6 (d) FEDERAL EMERGENCY MANAGEMENT AGENCY

7 RESOURCE ALLOCATION REPORTING AND RECOMMENDA8 TIONS.— 

9 (1) WEEKLY REPORTS.—Not later than 7 days 

10 after the task force first meets, and weekly there11 after, the task force shall submit to Congress and 

12 the Federal Emergency Management Agency a re13 port that includes— 

14 (A) a description of COVID–19 patient 

15 outcomes, including cases, hospitalizations, pa16 tients on ventilation, and mortality, 

17 disaggregated by race and ethnicity (where such 

18 data is missing, the task force shall utilize ap19 propriate authorities to improve data collec20 tion); 

21 (B) the identification of communities that 

22 lack resources to combat the COVID–19 pan23 demic, including personal protective equipment, 

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1 sources to conduct surveillance and contact 

2 tracing, funding, staffing, and other resources 

3 the task force deems essential as needs arise; 

4 (C) the identification of communities where 

5 racial and ethnic disparities in COVID–19 in6 fection, hospitalization, and death rates are out 

7 of proportion to the community’s population by 

8 a certain threshold, to be determined by the 

9 task force based on available public health data; 

10 (D) recommendations about how to best al11 locate critical COVID–19 resources to— 

12 (i) communities with disproportion13 ately high COVID–19 infection, hos14 pitalization, and death rates; and 

15 (ii) communities identified in subpara16 graph (C); 

17 (E) with respect to communities that are 

18 able to reduce racial and ethnic disparities ef19 fectively, a description of best practices in20 volved; and 

21 (F) an update with respect to the response 

22 of the Federal Emergency Management Agency 

23 to the task force’s previous weeks’ recommenda24 tions under this section. 


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1 (2) GENERAL CONSULTATION.—In submitting 

2 weekly reports and recommendations under this sub3 section, the task force shall consult with and notify 

4 State, local, territorial, and Tribal officials and com5 munity-based organizations from communities iden6 tified as disproportionately impacted by COVID–19. 

7 (3) CONSULTATION WITH INDIAN TRIBES.—In 

8 submitting weekly reports and recommendations 

9 under this subsection, the Director of Indian Health 

10 Service shall, in coordination with the task force, 

11 consult with Indian Tribes and Tribal organizations 

12 that are disproportionately affected by COVID–19 

13 on a government to government basis to identify 

14 specific needs and recommendations. 

15 (4) DISSEMINATION.—Reports under this sub16 section shall be disseminated to all relevant stake17 holders, including State, local, territorial, and Tribal 

18 officials, and public health departments. 

19 (5) TRIBAL DATA.—The task force, in consulta20 tion with Indian Tribes and Tribal organizations, 

21 shall ensure that an Indian Tribe consents to any 

22 public reporting of health data. 

23 (e) COVID–19 RELIEF OVERSIGHT AND IMPLEMEN24 TATION REPORTS.—Not later than 14 days after the task 

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1 after, the task force shall submit to Congress and the rel2 evant Federal agencies a report that includes— 

3 (1) an examination of funds distributed under 

4 COVID–19-related relief and stimulus laws (enacted 

5 prior to and after the date of enactment of this Act), 

6 including the Coronavirus Preparedness and Re7 sponse Emergency Supplemental Appropriations Act, 

8 2020 (Public Law 116–123), the Families First 

9 Coronavirus Response Act (Public Law 116–127), 

10 the Coronavirus Aid, Relief, and Economic Security 

11 Act (Public Law 116–136), and the Paycheck Pro12 tection Program and Health Care Enhancement Act 

13 (Public Law 116–139), and how that distribution 

14 impacted racial and ethnic disparities with respect to 

15 the COVID–19 pandemic; and 

16 (2) recommendations to relevant Federal agen17 cies about how to disburse any undisbursed funding 

18 from COVID–19-related relief and stimulus laws 

19 (enacted prior to and after the date of enactment of 

20 this Act), including those laws described in para21 graph (1), to address racial and ethnic disparities 

22 with respect to the COVID–19 pandemic, including 

23 recommendations to— 

24 (A) the Department of Health and Human 

25 Services about disbursement of funds under the 


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1 Public Health and Social Service Emergency 

2 Fund; 

3 (B) the Small Business Administration 

4 about disbursement of funds under the Pay5 check Protection Program and the Economic 

6 Injury Disaster Loan Program; and 

7 (C) the Department of Education about 

8 disbursement of funds under the Education 

9 Stabilization Fund. 

10 (f) FINAL COVID–19 REPORTS.—Not later than 90 

11 days after the date on which the President declares the 

12 end of the COVID–19 public health emergency first de13 clared by the Secretary on January 31, 2020, the task 

14 force shall submit to Congress a report that— 

15 (1) describes inequities within the health care 

16 system, implicit bias, structural racism, and social 

17 determinants of health (including housing, nutrition, 

18 education, economic, and environmental factors) that 

19 contributed to racial and ethnic health disparities 

20 with respect to the COVID–19 pandemic and how 

21 these factors contributed to such disparities; 

22 (2) examines the initial Federal response to the 

23 COVID–19 pandemic and its impact on the racial 

24 and ethnic disparities in COVID–19 infection, hos25 pitalization, and death rates; and 


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1 (3) contains recommendations to combat racial 

2 and ethnic disparities in future infectious disease re3 sponses, including future COVID–19 outbreaks. 

4 (g) SUNSET AND SUCCESSOR TASK FORCE.— 

5 (1) SUNSET.—The task force shall terminate on 

6 the date that is 90 days after the date on which the 

7 President declares the end of the COVID–19 public 

8 health emergency first declared by the Secretary on 

9 January 31, 2020. 

10 (2) SUCCESSOR.—Upon the termination of the 

11 task force under paragraph (1), the Secretary shall 

12 establish a permanent Infectious Disease Racial and 

13 Ethnic Disparities Task Force based on the mem14 bership, convening, and reporting requirements rec15 ommended by the task force in reports submitted 

16 under this section. 

17 (h) AUTHORIZATION OF APPROPRIATIONS.—There is 

18 authorized to be appropriated, such sums as may be nec19 essary to carry out this section. 

20 SEC. 402. PROTECTION OF THE HHS OFFICES OF MINORITY 

21 HEALTH. 

22 (a) IN GENERAL.—Pursuant to section 1707A of the 

23 Public Health Service Act (42 U.S.C. 300u–6a), the Of24 fices of Minority Health established within the Centers for 

25 Disease Control and Prevention, the Health Resources 


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1 and Services Administration, the Substance Abuse and 

2 Mental Health Services Administration, the Agency for 

3 Healthcare Research and Quality, the Food and Drug Ad4 ministration, and the Centers for Medicare & Medicaid 

5 Services, are offices that, regardless of change in the 

6 structure of the Department of Health and Human Serv7 ices, shall report to the Secretary of Health and Human 

8 Services. 

9 (b) SENSE OF CONGRESS.—It is the sense of the 

10 Congress that any effort to eliminate or consolidate such 

11 Offices of Minority Health undermines the progress 

12 achieved so far. 

13 SEC. 403. ESTABLISH AN INTERAGENCY COUNSEL AND 

14 GRANT PROGRAMS ON SOCIAL DETER15 MINANTS OF HEALTH. 

16 (a) SHORT TITLE.—This section may be cited as the 

17 ‘‘Social Determinants Accelerator Act of 2020’’. 

18 (b) FINDINGS; PURPOSES.— 

19 (1) FINDINGS.—Congress finds the following: 

20 (A) There is a significant body of evidence 

21 showing that economic and social conditions 

22 have a powerful impact on individual and popu23 lation health outcomes, including health dispari24 ties associated with public health emergencies, 

25 and well-being, as well as medical costs. 


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1 (B) State, local, and Tribal governments 

2 and the service delivery partners of such gov3 ernments face significant challenges in coordi4 nating benefits and services delivered through 

5 the Medicaid program and other social services 

6 programs because of the fragmented and com7 plex nature of Federal and State funding and 

8 administrative requirements. 

9 (C) The Federal Government should 

10 prioritize and proactively assist State and local 

11 governments to strengthen the capacity of State 

12 and local governments to improve health and 

13 social outcomes for individuals, thereby improv14 ing cost-effectiveness and return on investment. 

15 (2) PURPOSES.—The purposes of this Act are 

16 as follows: 

17 (A) To establish effective, coordinated Fed18 eral technical assistance to help State and local 

19 governments to improve outcomes and cost-ef20 fectiveness of, and return on investment from, 

21 health and social services programs. 

22 (B) To build a pipeline of State and locally 

23 designed, cross-sector interventions and strate24 gies that generate rigorous evidence about how 

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1 crease the cost-effectiveness of, and return on 

2 investment from, Federal, State, local, and 

3 Tribal health and social services programs. 

4 (C) To enlist State and local governments 

5 and the service providers of such governments 

6 as partners in identifying Federal statutory, 

7 regulatory, and administrative challenges in im8 proving the health and social outcomes of, cost9 effectiveness of, and return on investment from, 

10 Federal spending on individuals enrolled in 

11 Medicaid. 

12 (D) To develop strategies to improve 

13 health and social outcomes without denying 

14 services to, or restricting the eligibility of, vul15 nerable populations. 

16 (c) SOCIAL DETERMINANTS ACCELERATOR COUN17 CIL.— 

18 (1) ESTABLISHMENT.—The Secretary of Health 

19 and Human Services (referred to in this Act as the 

20 ‘‘Secretary’’), in coordination with the Administrator 

21 of the Centers for Medicare & Medicaid Services (re22 ferred to in this Act as the ‘‘Administrator’’), shall 

23 establish an interagency council, to be known as the 

24 Social Determinants Accelerator Interagency Council 


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1 (referred to in this Act as the ‘‘Council’’) to achieve 

2 the purposes listed in subsection (b)(1). 

3 (2) MEMBERSHIP.— 

4 (A) FEDERAL COMPOSITION.—The Council 

5 shall be composed of at least one designee from 

6 each of the following Federal agencies: 

7 (i) The Office of Management and 

8 Budget. 

9 (ii) The Department of Agriculture. 

10 (iii) The Department of Education. 

11 (iv) The Indian Health Service. 

12 (v) The Department of Housing and 

13 Urban Development. 

14 (vi) The Department of Labor. 

15 (vii) The Department of Transpor16 tation. 

17 (viii) Any other Federal agency the 

18 Chair of the Council determines necessary. 

19 (B) DESIGNATION.— 

20 (i) IN GENERAL.—The head of each 

21 agency specified in subparagraph (A) shall 

22 designate at least one employee to serve as 

23 a member of the Council. 


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1 (ii) RESPONSIBILITIES.—An employee 

2 described in this clause shall be a senior 

3 employee of the agency— 

4 (I) whose responsibilities relate 

5 to authorities, policies, and procedures 

6 with respect to the health and well7 being of individuals receiving medical 

8 assistance under a State plan (or a 

9 waiver of such plan) under title XIX 

10 of the Social Security Act (42 U.S.C. 

11 1396 et seq.); or 

12 (II) who has authority to imple13 ment and evaluate transformative ini14 tiatives that harness data or conducts 

15 rigorous evaluation to improve the im16 pact and cost-effectiveness of federally 

17 funded services and benefits. 

18 (C) HHS REPRESENTATION.—In addition 

19 to the designees under subparagraph (A), the 

20 Council shall include designees from at least 

21 three agencies within the Department of Health 

22 and Human Services, including the Centers for 

23 Medicare & Medicaid Services, at least one of 

24 whom shall meet the criteria under this section. 


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1 (D) OMB ROLE.—The Director of the Of2 fice of Management and Budget shall facilitate 

3 the timely resolution of Governmentwide and 

4 multiagency issues to help the Council achieve 

5 consensus recommendations described under 

6 this section. 

7 (E) NON-FEDERAL COMPOSITION.—The 

8 Comptroller General of the United States may 

9 designate up to 6 Council designees— 

10 (i) who have relevant subject matter 

11 expertise, including expertise implementing 

12 and evaluating transformative initiatives 

13 that harness data and conduct evaluations 

14 to improve the impact and cost-effective15 ness of Federal Government services; and 

16 (ii) that each represent— 

17 (I) State, local, and Tribal health 

18 and human services agencies; 

19 (II) public housing authorities or 

20 State housing finance agencies; 

21 (III) State and local government 

22 budget offices; 

23 (IV) State Medicaid agencies; or 

24 (V) national consumer advocacy 

25 organizations. 


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1 (F) CHAIR.— 

2 (i) IN GENERAL.—The Secretary shall 

3 select the Chair of the Council from among 

4 the members of the Council. 

5 (ii) INITIATING GUIDANCE.—The 

6 Chair, on behalf of the Council, shall iden7 tify and invite individuals from diverse en8 tities to provide the Council with advice 

9 and information pertaining to addressing 

10 social determinants of health, including— 

11 (I) individuals from State and 

12 local government health and human 

13 services agencies; 

14 (II) individuals from State Med15 icaid agencies; 

16 (III) individuals from State and 

17 local government budget offices; 

18 (IV) individuals from public 

19 housing authorities or State housing 

20 finance agencies; 

21 (V) individuals from nonprofit or22 ganizations, small businesses, and 

23 philanthropic organizations; 

24 (VI) advocates; 

25 (VII) researchers; and 


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1 (VIII) any other individuals the 

2 Chair determines to be appropriate. 

3 (3) DUTIES.—The duties of the Council are— 

4 (A) to make recommendations to the Sec5 retary and the Administrator regarding the cri6 teria for making awards under this section; 

7 (B) to identify Federal authorities and op8 portunities for use by States or local govern9 ments to improve coordination of funding and 

10 administration of Federal programs, the bene11 ficiaries of whom include individuals, and which 

12 may be unknown or underutilized and to make 

13 information on such authorities and opportuni14 ties publicly available; 

15 (C) to provide targeted technical assistance 

16 to States developing a social determinants ac17 celerator plan under this section, including 

18 identifying potential statutory or regulatory 

19 pathways for implementation of the plan and 

20 assisting in identifying potential sources of 

21 funding to implement the plan; 

22 (D) to report to Congress annually on the 

23 subjects set forth in this section; 

24 (E) to develop and disseminate evaluation 

25 guidelines and standards that can be used to 


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1 reliably assess the impact of an intervention or 

2 approach that may be implemented pursuant to 

3 this Act on outcomes, cost-effectiveness of, and 

4 return on investment from Federal, State, local, 

5 and Tribal governments, and to facilitate tech6 nical assistance, where needed, to help to im7 prove State and local evaluation designs and 

8 implementation; 

9 (F) to seek feedback from State, local, and 

10 Tribal governments, including through an an11 nual survey by an independent third party, on 

12 how to improve the technical assistance the 

13 Council provides to better equip State, local, 

14 and Tribal governments to coordinate health 

15 and social service programs; 

16 (G) to solicit applications for grants under 

17 this section; and 

18 (H) to coordinate with other cross-agency 

19 initiatives focused on improving the health and 

20 well-being of low-income and at-risk populations 

21 in order to prevent unnecessary duplication be22 tween agency initiatives. 

23 (4) SCHEDULE.—Not later than 60 days after 

24 the date of the enactment of this Act, the Council 

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1 rying out the duties described in this section, includ2 ing solicitation of applications for the grants under 

3 this section. 

4 (5) REPORT TO CONGRESS.—The Council shall 

5 submit an annual report to Congress, which shall in6 clude— 

7 (A) a list of the Council members; 

8 (B) activities and expenditures of the 

9 Council; 

10 (C) summaries of the interventions and ap11 proaches that will be supported by State, local, 

12 and Tribal governments that received a grant 

13 under this section, including— 

14 (i) the best practices and evidence15 based approaches such governments plan 

16 to employ to achieve the purposes listed in 

17 this section; and 

18 (ii) a description of how the practices 

19 and approaches will impact the outcomes, 

20 cost-effectiveness of, and return on invest21 ment from, Federal, State, local, and Trib22 al governments with respect to such pur23 poses; 

24 (D) the feedback received from State and 

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1 nical assistance of the Council, including find2 ings from a third-party survey and actions the 

3 Council plans to take in response to such feed4 back; and 

5 (E) the major statutory, regulatory, and 

6 administrative challenges identified by State, 

7 local, and Tribal governments that received a 

8 grant under subsection (d), and the actions that 

9 Federal agencies are taking to address such 

10 challenges. 

11 (6) FACA APPLICABILITY.—The Federal Advi12 sory Committee Act (5 U.S.C. App.) shall not apply 

13 to the Council. 

14 (7) COUNCIL PROCEDURES.—The Secretary, in 

15 consultation with the Comptroller General of the 

16 United States and the Director of the Office of Man17 agement and Budget, shall establish procedures for 

18 the Council to— 

19 (A) ensure that adequate resources are 

20 available to effectively execute the responsibil21 ities of the Council; 

22 (B) effectively coordinate with other rel23 evant advisory bodies and working groups to 

24 avoid unnecessary duplication; 


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1 (C) create transparency to the public and 

2 Congress with regard to Council membership, 

3 costs, and activities, including through use of 

4 modern technology and social media to dissemi5 nate information; and 

6 (D) avoid conflicts of interest that would 

7 jeopardize the ability of the Council to make de8 cisions and provide recommendations. 

9 (d) SOCIAL DETERMINANTS ACCELERATOR GRANTS

10 TO STATES OR LOCAL GOVERNMENTS.— 

11 (1) GRANTS TO STATES, LOCAL GOVERNMENTS, 

12 AND TRIBES.—Not later than 180 days after the 

13 date of the enactment of this Act, the Administrator, 

14 in consultation with the Secretary and the Council, 

15 shall award on a competitive basis not more than 25 

16 grants to eligible applicants described in this section, 

17 for the development of social determinants accel18 erator plans, as described in this section. 

19 (2) ELIGIBLE APPLICANT.—An eligible appli20 cant described in this section 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 section. 

10 (4) APPLICATION.—An eligible applicant seek11 ing a grant under this section shall include in the 

12 application the following information: 

13 (A) The target population (or populations) 

14 that would benefit from implementation of the 

15 social determinants accelerator plan proposed to 

16 be developed by the applicant. 

17 (B) A description of the objective or objec18 tives and outcome goals of such proposed plan, 

19 which shall include at least one health outcome 

20 and at least one other important social out21 come. 

22 (C) The sources and scope of inefficiencies 

23 that, if addressed by the plan, could result in 

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1 vestment from Federal, State, local, and Tribal 

2 governments. 

3 (D) A description of potential interventions 

4 that could be designed or enabled using such 

5 proposed plan. 

6 (E) The State, local, Tribal, academic, 

7 nonprofit, community-based organizations, and 

8 other private sector partners that would partici9 pate in the development of the proposed plan 

10 and subsequent implementation of programs or 

11 initiatives included in such proposed plan. 

12 (F) Such other information as the Admin13 istrator, in consultation with the Secretary and 

14 the Council, determines necessary to achieve the 

15 purposes of this Act. 

16 (5) USE OF FUNDS.—A recipient of a grant 

17 under this section may use funds received through 

18 the grant for the following purposes: 

19 (A) To convene and coordinate with rel20 evant government entities and other stake21 holders across sectors to assist in the develop22 ment of a social determinant accelerator plan. 

23 (B) To identify populations of individuals 

24 receiving medical assistance under a State plan 

25 (or a waiver of such plan) under title XIX of 


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1 the Social Security Act (42 U.S.C. 1396 et 

2 seq.) who may benefit from the proposed ap3 proaches to improving the health and well-being 

4 of such individuals through the implementation 

5 of the proposed social determinants accelerator 

6 plan. 

7 (C) To engage qualified research experts to 

8 advise on relevant research and to design a pro9 posed evaluation plan, in accordance with the 

10 standards and guidelines issued by the Admin11 istrator. 

12 (D) To collaborate with the Council to sup13 port the development of social determinants ac14 celerator plans. 

15 (E) To prepare and submit a final social 

16 determinants accelerator plan to the Council. 

17 (6) CONTENTS OF PLANS.—A social deter18 minant accelerator plan developed under this section 

19 shall include the following: 

20 (A) A description of the target population 

21 (or populations) that would benefit from imple22 mentation of the social determinants accelerator 

23 plan, including an analysis describing the pro24 jected impact on the well-being of individuals 

25 described in paragraph (5)(B). 


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1 (B) A description of the interventions or 

2 approaches designed under the social deter3 minants accelerator plan and the evidence for 

4 selecting such interventions or approaches. 

5 (C) The objectives and outcome goals of 

6 such interventions or approaches, including at 

7 least one health outcome and at least one other 

8 important social outcome. 

9 (D) A plan for accessing and linking rel10 evant data to enable coordinated benefits and 

11 services for the jurisdictions described in this 

12 section and an evaluation of the proposed inter13 ventions and approaches. 

14 (E) A description of the State, local, Trib15 al, academic, nonprofit, or community-based or16 ganizations, or any other private sector organi17 zations that would participate in implementing 

18 the proposed interventions or approaches, and 

19 the role each would play to contribute to the 

20 success of the proposed interventions or ap21 proaches. 

22 (F) The identification of the funding 

23 sources that would be used to finance the pro24 posed interventions or approaches. 


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1 (G) A description of any financial incen2 tives that may be provided, including outcome3 focused contracting approaches to encourage 

4 service providers and other partners to improve 

5 outcomes of, cost-effectiveness of, and return on 

6 investment from, Federal, State, local, or Tribal 

7 government spending. 

8 (H) The identification of the applicable 

9 Federal, State, local, or Tribal statutory and 

10 regulatory authorities, including waiver authori11 ties, to be leveraged to implement the proposed 

12 interventions or approaches. 

13 (I) A description of potential consider14 ations that would enhance the impact, 

15 scalability, or sustainability of the proposed 

16 interventions or approaches and the actions the 

17 grant awardee would take to address such con18 siderations. 

19 (J) A proposed evaluation plan, to be car20 ried out by an independent evaluator, to meas21 ure the impact of the proposed interventions or 

22 approaches on the outcomes of, cost-effective23 ness of, and return on investment from, Fed24 eral, State, local, and Tribal governments. 


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1 (K) Precautions for ensuring that vulner2 able populations will not be denied access to 

3 Medicaid or other essential services as a result 

4 of implementing the proposed plan. 

5 (e) FUNDING.— 

6 (1) IN GENERAL.—Out of any money in the 

7 Treasury not otherwise appropriated, there is appro8 priated to carry out this Act $25,000,000, of which 

9 up to $5,000,000 may be used to carry out this Act, 

10 to remain available for obligation until the date that 

11 is 5 years after the date of enactment of this Act. 

12 (2) RESERVATION OF FUNDS.— 

13 (A) IN GENERAL.—Of the funds made 

14 available under paragraph (1), the Secretary 

15 shall reserve not less than 20 percent to award 

16 grants to eligible applicants for the development 

17 of social determinants accelerator plans under 

18 this section intended to serve rural populations. 

19 (B) EXCEPTION.—In the case of a fiscal 

20 year for which the Secretary determines that 

21 there are not sufficient eligible applicants to 

22 award up to 25 grants under section 4 that are 

23 intended to serve rural populations and the Sec24 retary cannot satisfy the 20-percent require25 ment, the Secretary may reserve an amount 


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1 that is less than 20 percent of amounts made 

2 available under paragraph (1) to award grants 

3 for such purpose. 

4 (3) RULE OF CONSTRUCTION.—Nothing in this 

5 Act shall prevent Federal agencies represented on 

6 the Council from contributing additional funding 

7 from other sources to support activities to improve 

8 the effectiveness of the Council. 

9 SEC. 404. ACCOUNTABILITY AND TRANSPARENCY WITHIN 

10 THE DEPARTMENT OF HEALTH AND HUMAN 

11 SERVICES. 

12 Title XXXIV of the Public Health Service Act is 

13 amended by inserting after subtitle C the following: 

14 ‘‘Subtitle D—Strengthening 

15 Accountability 

16 ‘‘SEC. 3441. ELEVATION OF THE OFFICE OF CIVIL RIGHTS. 

17 ‘‘(a) IN GENERAL.—The Secretary shall establish 

18 within the Office for Civil Rights an Office of Health Dis19 parities, which shall be headed by a director to be ap20 pointed by the Secretary. 

21 ‘‘(b) PURPOSE.—The Office of Health Disparities 

22 shall ensure that the health programs, activities, and oper23 ations of health entities that receive Federal financial as24 sistance are in compliance with title VI of the Civil Rights 

25 Act, including through the following activities: 


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1 ‘‘(1) The development and implementation of 

2 an action plan to address racial and ethnic health 

3 care disparities, which shall address concerns relat4 ing to the Office for Civil Rights as released by the 

5 United States Commission on Civil Rights in the re6 port entitled ‘Health Care Challenge: Acknowledging 

7 Disparity, Confronting Discrimination, and Ensur8 ing Equity’ (September 1999) in conjunction with 

9 the reports by the National Academy of Sciences 

10 (formerly known as the Institute of Medicine) enti11 tled ‘Unequal Treatment: Confronting Racial and 

12 Ethnic Disparities in Health Care’, ‘Crossing the 

13 Quality Chasm: A New Health System for the 21st 

14 Century’, ‘In the Nation’s Compelling Interest: En15 suring Diversity in the Health Care Workforce’, 

16 ‘The National Partnership for Action to End Health 

17 Disparities’, and ‘The Health of Lesbian, Gay, Bi18 sexual, and Transgender People’, and other related 

19 reports by the National Academy of Sciences. This 

20 plan shall be publicly disclosed for review and com21 ment and the final plan shall address any comments 

22 or concerns that are received by the Office. 

23 ‘‘(2) Investigative and enforcement actions 

24 against intentional discrimination and policies and 

25 practices that have a disparate impact on minorities. 


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1 ‘‘(3) The review of racial, ethnic, gender iden2 tity, sexual orientation, sex, disability status, socio3 economic status, and primary language health data 

4 collected by Federal health agencies to assess health 

5 care disparities related to intentional discrimination 

6 and policies and practices that have a disparate im7 pact on minorities. Such review shall include an as8 sessment of health disparities in communities with a 

9 combination of these classes. 

10 ‘‘(4) Outreach and education activities relating 

11 to compliance with title VI of the Civil Rights Act. 

12 ‘‘(5) The provision of technical assistance for 

13 health entities to facilitate compliance with title VI 

14 of the Civil Rights Act. 

15 ‘‘(6) Coordination and oversight of activities of 

16 the civil rights compliance offices established under 

17 section 3442. 

18 ‘‘(7) Ensuring— 

19 ‘‘(A) at a minimum, compliance with the 

20 most recent version of the Office of Manage21 ment and Budget statistical policy directive en22 titled ‘Standards for Maintaining, Collecting, 

23 and Presenting Federal Data on Race and Eth24 nicity’; and 


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1 ‘‘(B) consideration of available data and 

2 language standards such as— 

3 ‘‘(i) the standards for collecting and 

4 reporting data under section 3101; and 

5 ‘‘(ii) the National Standards on Cul6 turally and Linguistically Appropriate 

7 Services of the Office of Minority Health. 

8 ‘‘(c) FUNDING AND STAFF.—The Secretary shall en9 sure the effectiveness of the Office of Health Disparities 

10 by ensuring that the Office is provided with— 

11 ‘‘(1) adequate funding to enable the Office to 

12 carry out its duties under this section; and 

13 ‘‘(2) staff with expertise in— 

14 ‘‘(A) epidemiology; 

15 ‘‘(B) statistics; 

16 ‘‘(C) health quality assurance; 

17 ‘‘(D) minority health and health dispari18 ties; 

19 ‘‘(E) cultural and linguistic competency; 

20 ‘‘(F) civil rights; and 

21 ‘‘(G) social, behavioral, and economic de22 terminants of health. 

23 ‘‘(d) REPORT.—Not later than December 31, 2021, 

24 and annually thereafter, the Secretary, in collaboration 

25 with the Director of the Office for Civil Rights and the 


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1 Deputy Assistant Secretary for Minority Health, shall 

2 submit a report to the Committee on Health, Education, 

3 Labor, and Pensions of the Senate and the Committee on 

4 Energy and Commerce of the House of Representatives 

5 that includes— 

6 ‘‘(1) the number of cases filed, broken down by 

7 category; 

8 ‘‘(2) the number of cases investigated and 

9 closed by the office; 

10 ‘‘(3) the outcomes of cases investigated; 

11 ‘‘(4) the staffing levels of the office including 

12 staff credentials; 

13 ‘‘(5) the number of other lingering and emerg14 ing cases in which civil rights inequities can be dem15 onstrated; and 

16 ‘‘(6) the number of cases remaining open and 

17 an explanation for their open status. 

18 ‘‘(e) 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 2021 through 2026. 


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1 ‘‘SEC. 3442. ESTABLISHMENT OF HEALTH PROGRAM OF2 FICES FOR CIVIL RIGHTS WITHIN FEDERAL 

3 HEALTH AND HUMAN SERVICES AGENCIES. 

4 ‘‘(a) IN GENERAL.—The Secretary shall establish 

5 civil rights compliance offices in each agency within the 

6 Department of Health and Human Services that admin7 isters health programs. 

8 ‘‘(b) PURPOSE OF OFFICES.—Each office established 

9 under subsection (a) shall ensure that recipients of Fed10 eral financial assistance under Federal health programs 

11 administer programs, services, and activities in a manner 

12 that— 

13 ‘‘(1) does not discriminate, either intentionally 

14 or in effect, on the basis of race, national origin, lan15 guage, ethnicity, sex, age, disability, sexual orienta16 tion, and gender identity; and 

17 ‘‘(2) promotes the reduction and elimination of 

18 disparities in health and health care based on race, 

19 national origin, language, ethnicity, sex, age, dis20 ability, sexual orientation, and gender identity. 

21 ‘‘(c) POWERS AND DUTIES.—The offices established 

22 in subsection (a) shall have the following powers and du23 ties: 

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1 istered by the applicable agency, including the estab2 lishment of disparity reduction standards to encom3 pass disparities in health and health care related to 

4 race, national origin, language, ethnicity, sex, age, 

5 disability, sexual orientation, and gender identity. 

6 ‘‘(2) The development and implementation of 

7 program-specific guidelines that interpret and apply 

8 Department of Health and Human Services guid9 ance under title VI of the Civil Rights Act of 1964 

10 and section 1557 of the Patient Protection and Af11 fordable Care Act to each Federal health program 

12 administered by the agency. 

13 ‘‘(3) The development of a disparity-reduction 

14 impact analysis methodology that shall be applied to 

15 every rule issued by the agency and published as 

16 part of the formal rulemaking process under sections 

17 555, 556, and 557 of title 5, United States Code. 

18 ‘‘(4) Oversight of data collection, analysis, and 

19 publication requirements for all recipients of Federal 

20 financial assistance under each Federal health pro21 gram administered by the agency; compliance with, 

22 at a minimum, the most recent version of the Office 

23 of Management and Budget statistical policy direc24 tive entitled ‘Standards for Maintaining, Collecting, 

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1 nicity’; and consideration of available data and lan2 guage standards such as— 

3 ‘‘(A) the standards for collecting and re4 porting data under section 3101; and 

5 ‘‘(B) the National Standards on Culturally 

6 and Linguistically Appropriate Services of the 

7 Office of Minority Health. 

8 ‘‘(5) The conduct of publicly available studies 

9 regarding discrimination within Federal health pro10 grams administered by the agency as well as dis11 parity reduction initiatives by recipients of Federal 

12 financial assistance under Federal health programs. 

13 ‘‘(6) Annual reports to the Committee on 

14 Health, Education, Labor, and Pensions and the 

15 Committee on Finance of the Senate and the Com16 mittee on Energy and Commerce and the Committee 

17 on Ways and Means of the House of Representatives 

18 on the progress in reducing disparities in health and 

19 health care through the Federal programs adminis20 tered by the agency. 

21 ‘‘(d) RELATIONSHIP TO OFFICE FOR CIVIL RIGHTS

22 IN THE DEPARTMENT OF JUSTICE.— 

23 ‘‘(1) DEPARTMENT OF HEALTH AND HUMAN

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1 vide standard-setting and compliance review inves2 tigation support services to the Civil Rights Compli3 ance Office for each agency described in subsection 

4 (a), subject to paragraph (2). 

5 ‘‘(2) DEPARTMENT OF JUSTICE.—The Office 

6 for Civil Rights of the Department of Justice may, 

7 as appropriate, institute formal proceedings when a 

8 civil rights compliance office established under sub9 section (a) determines that a recipient of Federal fi10 nancial assistance is not in compliance with the dis11 parity reduction standards of the applicable agency. 

12 ‘‘(e) DEFINITION.—In this section, the term ‘Federal 

13 health programs’ mean programs— 

14 ‘‘(1) under the Social Security Act (42 U.S.C. 

15 301 et seq.) that pay for health care and services; 

16 and 

17 ‘‘(2) under this Act that provide Federal finan18 cial assistance for health care, biomedical research, 

19 health services research, and programs designed to 

20 improve the public’s health, including health service 

21 programs.’’. 


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1 TITLE V—EXPANDED 

2 INSURANCE ACCESS 

3 SEC. 501. MEDICARE SPECIAL ENROLLMENT PERIOD FOR 

4 INDIVIDUALS RESIDING IN COVID-19 EMER5 GENCY AREAS. 

6 (a) IN GENERAL.—Section 1837(i) of the Social Se7 curity Act (42 U.S.C. 1395p(i)) is amended by adding at 

8 the end the following new paragraph: 

9 ‘‘(5)(A) In the case of an individual who— 

10 ‘‘(i) is eligible under section 1836 to enroll 

11 in the medical insurance program established by 

12 this part, 

13 ‘‘(ii) did not enroll (or elected not to be 

14 deemed enrolled) under this section during an 

15 enrollment period, and 

16 ‘‘(iii) during the emergency period (as de17 scribed in section 1135(g)(1)(B)), resided in an 

18 emergency area (as described in such section), 

19 there shall be a special enrollment period de20 scribed in subparagraph (B). 

21 ‘‘(B) The special enrollment period re22 ferred to in subparagraph (A) is the period that 

23 begins not later than July 1, 2020, and ends on 

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1 gency period (as described in section 

2 1135(g)(1)(B)) ends.’’. 

3 (b) COVERAGE PERIOD FOR INDIVIDUALS

4 TRANSITIONING FROM OTHER COVERAGE.—Section 

5 1838(e) of the Social Security Act (42 U.S.C. 1395q(e)) 

6 is amended— 

7 (1) by striking ‘‘pursuant to section 1837(i)(3) 

8 or 1837(i)(4)(B)—’’ and inserting the following: 

9 ‘‘pursuant to— 

10 ‘‘(1) section 1837(i)(3) or 1837(i)(4)(B)—’’; 

11 (2) by redesignating paragraphs (1) and (2) as 

12 subparagraphs (A) and (B), respectively, and mov13 ing the indentation of each such subparagraph 2 

14 ems to the right; 

15 (3) by striking the period at the end of the sub16 paragraph (B), as so redesignated, and inserting ‘‘; 

17 or’’; and 

18 (4) by adding at the end the following new 

19 paragraph: 

20 ‘‘(2) section 1837(i)(5), the coverage period 

21 shall begin on the first day of the month following 

22 the month in which the individual so enrolls.’’. 

23 (c) FUNDING.—The Secretary of Health and Human 

24 Services shall provide for the transfer from the Federal 

25 Hospital Insurance Trust Fund (as described in section 


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1 1817 of the Social Security Act (42 U.S.C. 1395i)) and 

2 the Federal Supplementary Medical Insurance Trust 

3 Fund (as described in section 1841 of such Act (42 U.S.C. 

4 1395t)), in such proportions as determined appropriate by 

5 the Secretary, to the Social Security Administration, of 

6 $30,000,000, to remain available until expended, for pur7 poses of carrying out the amendments made by this sec8 tion. 

9 (d) IMPLEMENTATION.—Notwithstanding any other 

10 provision of law, the Secretary of Health and Human 

11 Services may implement the amendments made by this 

12 section by program instruction or otherwise. 

13 SEC. 502. SPECIAL ENROLLMENT PERIOD THROUGH EX14 CHANGES; FEDERAL EXCHANGE OUTREACH 

15 AND EDUCATIONAL ACTIVITIES. 

16 (a) SPECIAL ENROLLMENT PERIOD THROUGH EX17 CHANGES.—Section 1311(c) of the Patient Protection and 

18 Affordable Care Act (42 U.S.C. 18031(c)) is amended— 

19 (1) in paragraph (6)— 

20 (A) in subparagraph (C), by striking at the 

21 end ‘‘and’’; 

22 (B) in subparagraph (D), by striking at 

23 the end the period and inserting ‘‘; and’’; and 

24 (C) by adding at the end the following new 

25 subparagraph: 


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1 ‘‘(E) subject to subparagraph (B) of para2 graph (8), the special enrollment period de3 scribed in subparagraph (A) of such para4 graph.’’; and 

5 (2) by adding at the end the following new 

6 paragraph: 

7 ‘‘(8) SPECIAL ENROLLMENT PERIOD FOR CER8 TAIN PUBLIC HEALTH EMERGENCY.— 

9 ‘‘(A) IN GENERAL.—The Secretary shall, 

10 subject to subparagraph (B), require an Ex11 change to provide— 

12 ‘‘(i) for a special enrollment period 

13 during the emergency period described in 

14 section 1135(g)(1)(B) of the Social Secu15 rity Act— 

16 ‘‘(I) which shall begin on the 

17 date that is one week after the date of 

18 the enactment of this paragraph and 

19 which, in the case of an Exchange es20 tablished or operated by the Secretary 

21 within a State pursuant to section 

22 1321(c), shall be an 8-week period; 

23 and 

24 ‘‘(II) during which any individual 

25 who is otherwise eligible to enroll in a 


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1 qualified health plan through the Ex2 change may enroll in such a qualified 

3 health plan; and 

4 ‘‘(ii) that, in the case of an individual 

5 who enrolls in a qualified health plan 

6 through the Exchange during such enroll7 ment period, the coverage period under 

8 such plan shall begin, at the option of the 

9 individual, on April 1, 2020, or on the first 

10 day of the month following the day the in11 dividual selects a plan through such special 

12 enrollment period. 

13 ‘‘(B) EXCEPTION.—The requirement of 

14 subparagraph (A) shall not apply to a State-op15 erated or State-established Exchange if such 

16 Exchange, prior to the date of the enactment of 

17 this paragraph, established or otherwise pro18 vided for a special enrollment period to address 

19 access to coverage under qualified health plans 

20 offered through such Exchange during the 

21 emergency period described in section 

22 1135(g)(1)(B) of the Social Security Act.’’. 

23 (b) FEDERAL EXCHANGE OUTREACH AND EDU24 CATIONAL ACTIVITIES.—Section 1321(c) of the Patient 

25 Protection and Affordable Care Act (42 U.S.C. 18041(c)) 


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1 is amended by adding at the end the following new para2 graph: 

3 ‘‘(3) OUTREACH AND EDUCATIONAL ACTIVI4 TIES.— 

5 ‘‘(A) IN GENERAL.—In the case of an Ex6 change established or operated by the Secretary 

7 within a State pursuant to this subsection, the 

8 Secretary shall carry out outreach and edu9 cational activities for purposes of informing po10 tential enrollees in qualified health plans offered 

11 through the Exchange of the availability of cov12 erage under such plans and financial assistance 

13 for coverage under such plans. Such outreach 

14 and educational activities shall be provided in a 

15 manner that is culturally and linguistically ap16 propriate to the needs of the populations being 

17 served by the Exchange (including hard-to18 reach populations, such as racial and sexual mi19 norities, limited English proficient populations, 

20 and young adults). 

21 ‘‘(B) LIMITATION ON USE OF FUNDS.—No 

22 funds appropriated under this paragraph shall 

23 be used for expenditures for promoting non24 ACA compliant health insurance coverage. 


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1 ‘‘(C) NON-ACA COMPLIANT HEALTH IN2 SURANCE COVERAGE.—For purposes of sub3 paragraph (B): 

4 ‘‘(i) The term ‘non-ACA compliant 

5 health insurance coverage’ means health 

6 insurance coverage, or a group health plan, 

7 that is not a qualified health plan. 

8 ‘‘(ii) Such term includes the following: 

9 ‘‘(I) An association health plan. 

10 ‘‘(II) Short-term limited duration 

11 insurance. 

12 ‘‘(D) FUNDING.—There are appropriated, 

13 out of any funds in the Treasury not otherwise 

14 appropriated, $25,000,000, to remain available 

15 until expended— 

16 ‘‘(i) to carry out this paragraph; and 

17 ‘‘(ii) at the discretion of the Sec18 retary, to carry out section 1311(i), with 

19 respect to an Exchange established or op20 erated by the Secretary within a State pur21 suant to this subsection.’’. 

22 (c) IMPLEMENTATION.—The Secretary of Health and 

23 Human Services may implement the provisions of (includ24 ing amendments made by) this section through subregu25 latory guidance, program instruction, or otherwise. 


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1 SEC. 503. MOMMA’S ACT. 

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

3 ‘‘Mothers and Offspring Mortality and Morbidity Aware4 ness Act’’ or the ‘‘MOMMA’s Act’’. 

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

6 (1) Every year, across the United States, 

7 4,000,000 women give birth, about 700 women suf8 fer fatal complications during pregnancy, while giv9 ing birth or during the postpartum period, and 

10 70,000 women suffer near-fatal, partum-related 

11 complications. 

12 (2) The maternal mortality rate is often used as 

13 a proxy to measure the overall health of a popu14 lation. While the infant mortality rate in the United 

15 States has reached its lowest point, the risk of death 

16 for women in the United States during pregnancy, 

17 childbirth, or the postpartum period is higher than 

18 such risk in many other developed nations. The esti19 mated maternal mortality rate (per 100,000 live 

20 births) for the 48 contiguous States and Wash21 ington, DC increased from 18.8 percent in 2000 to 

22 23.8 percent in 2014 to 26.6 percent in 2018. This 

23 estimated rate is on par with such rate for under24 developed nations such as Iraq and Afghanistan. 

25 (3) International studies estimate the 2015 ma26 ternal mortality rate in the United States as 26.4 


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1 per 100,000 live births, which is almost twice the 

2 2015 World Health Organization estimation of 14 

3 per 100,000 live births. 

4 (4) It is estimated that more than 60 percent 

5 of maternal deaths in the United States are prevent6 able. 

7 (5) According to the Centers for Disease Con8 trol and Prevention, the maternal mortality rate var9 ies drastically for women by race and ethnicity. 

10 There are 12.7 deaths per 100,000 live births for 

11 White women, 43.5 deaths per 100,000 live births 

12 for African-American women, and 14.4 deaths per 

13 100,000 live births for women of other ethnicities. 

14 While maternal mortality disparately impacts Afri15 can-American women, this urgent public health crisis 

16 traverses race, ethnicity, socioeconomic status, edu17 cational background, and geography. 

18 (6) African-American women are 3 to 4 times 

19 more likely to die from causes related to pregnancy 

20 and childbirth compared to non-Hispanic White 

21 women. 

22 (7) The findings described in paragraphs (1) 

23 through (6) are of major concern to researchers, 

24 academics, members of the business community, and 

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1 resented by organizations such as March of Dimes; 

2 the Preeclampsia Foundation; the American College 

3 of Obstetricians and Gynecologists; the Society for 

4 Maternal-Fetal Medicine; the Association of Wom5 en’s Health, Obstetric, and Neonatal Nurses; the 

6 California Maternal Quality Care Collaborative; 

7 Black Women’s Health Imperative; the National 

8 Birth Equity Collaborative; Black Mamas Matter Al9 liance; EverThrive Illinois; the National Association 

10 of Certified Professional Midwives; PCOS Challenge: 

11 The National Polycystic Ovary Syndrome Associa12 tion; and the American College of Nurse Midwives. 

13 (8) Hemorrhage, cardiovascular and coronary 

14 conditions, cardiomyopathy, infection, embolism, 

15 mental health conditions, preeclampsia and eclamp16 sia, polycystic ovary syndrome, infection and sepsis, 

17 and anesthesia complications are the predominant 

18 medical causes of maternal-related deaths and com19 plications. Most of these conditions are largely pre20 ventable or manageable. 

21 (9) Oral health is an important part of 

22 perinatal health. Reducing bacteria in a woman’s 

23 mouth during pregnancy can significantly reduce her 

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1 dence suggests that women with periodontal disease 

2 during pregnancy could be at greater risk for poor 

3 birth outcomes, such as preeclampsia, pre-term 

4 birth, and low-birth weight. Furthermore, a woman’s 

5 oral health during pregnancy is a good predictor of 

6 her newborn’s oral health, and since mothers can 

7 unintentionally spread oral bacteria to their babies, 

8 putting their children at higher risk for tooth decay, 

9 prevention efforts should happen even before chil10 dren are born, as a matter of pre-pregnancy health 

11 and prenatal care during pregnancy. 

12 (10) The United States has not been able to 

13 submit a formal maternal mortality rate to inter14 national data repositories since 2007. Thus, no offi15 cial maternal mortality rate exists for the United 

16 States. There can be no maternal mortality rate 

17 without streamlining maternal mortality-related data 

18 from the State level and extrapolating such data to 

19 the Federal level. 

20 (11) In the United States, death reporting and 

21 analysis is a State function rather than a Federal 

22 process. States report all deaths—including mater23 nal deaths—on a semi-voluntary basis, without 

24 standardization across States. While the Centers for 

25 Disease Control and Prevention has the capacity and 


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1 system for collecting death-related data based on 

2 death certificates, these data are not sufficiently re3 ported by States in an organized and standard for4 mat across States such that the Centers for Disease 

5 Control and Prevention is able to identify causes of 

6 maternal death and best practices for the prevention 

7 of such death. 

8 (12) Vital statistics systems often underesti9 mate maternal mortality and are insufficient data 

10 sources from which to derive a full scope of medical 

11 and social determinant factors contributing to ma12 ternal deaths. While the addition of pregnancy 

13 checkboxes on death certificates since 2003 have 

14 likely improved States’ abilities to identify preg15 nancy-related deaths, they are not generally com16 pleted by obstetrical providers or persons trained to 

17 recognize pregnancy-related mortality. Thus, these 

18 vital forms may be missing information or may cap19 ture inconsistent data. Due to varying maternal 

20 mortality-related analyses, lack of reliability, and 

21 granularity in data, current maternal mortality 

22 informatics do not fully encapsulate the myriad med23 ical and socially determinant factors that contribute 

24 to such high maternal mortality rates within the 

25 United States compared to other developed nations. 


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1 Lack of standardization of data and data sharing 

2 across States and between Federal entities, health 

3 networks, and research institutions keep the Nation 

4 in the dark about ways to prevent maternal deaths. 

5 (13) Having reliable and valid State data ag6 gregated at the Federal level are critical to the Na7 tion’s ability to quell surges in maternal death and 

8 imperative for researchers to identify long-lasting 

9 interventions. 

10 (14) Leaders in maternal wellness highly rec11 ommend that maternal deaths be investigated at the 

12 State level first, and that standardized, streamlined, 

13 de-identified data regarding maternal deaths be sent 

14 annually to the Centers for Disease Control and Pre15 vention. Such data standardization and collection 

16 would be similar in operation and effect to the Na17 tional Program of Cancer Registries of the Centers 

18 for Disease Control and Prevention and akin to the 

19 Confidential Enquiry in Maternal Deaths Pro20 gramme in the United Kingdom. Such a maternal 

21 mortalities and morbidities registry and surveillance 

22 system would help providers, academicians, law23 makers, and the public to address questions con24 cerning the types of, causes of, and best practices to 


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1 thwart, pregnancy-related or pregnancy-associated 

2 mortality and morbidity. 

3 (15) The United Nations’ Millennium Develop4 ment Goal 5a aimed to reduce by 75 percent, be5 tween 1990 and 2015, the maternal mortality rate, 

6 yet this metric has not been achieved. In fact, the 

7 maternal mortality rate in the United States has 

8 been estimated to have more than doubled between 

9 2000 and 2014. Yet, because national data are not 

10 fully available, the United States does not have an 

11 official maternal mortality rate. 

12 (16) Many States have struggled to establish or 

13 maintain Maternal Mortality Review Committees 

14 (referred to in this section as ‘‘MMRC’’). On the 

15 State level, MMRCs have lagged because States have 

16 not had the resources to mount local reviews. State17 level reviews are necessary as only the State depart18 ments of health have the authority to request med19 ical records, autopsy reports, and police reports crit20 ical to the function of the MMRC. 

21 (17) The United Kingdom regards maternal 

22 deaths as a health systems failure and a national 

23 committee of obstetrics experts review each maternal 

24 death or near-fatal childbirth complication. Such 

25 committee also establishes the predominant course of 


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1 maternal-related deaths from conditions such as 

2 preeclampsia. Consequently, the United Kingdom 

3 has been able to reduce its incidence of preeclampsia 

4 to less than one in 10,000 women—its lowest rate 

5 since 1952. 

6 (18) The United States has no comparable, co7 ordinated Federal process by which to review cases 

8 of maternal mortality, systems failures, or best prac9 tices. Many States have active MMRCs and leverage 

10 their work to impact maternal wellness. For exam11 ple, the State of California has worked extensively 

12 with their State health departments, health and hos13 pital systems, and research collaborative organiza14 tions, including the California Maternal Quality Care 

15 Collaborative and the Alliance for Innovation on Ma16 ternal Health, to establish MMRCs, wherein such 

17 State has determined the most prevalent causes of 

18 maternal mortality and recorded and shared data 

19 with providers and researchers, who have developed 

20 and implemented safety bundles and care protocols 

21 related to preeclampsia, maternal hemorrhage, and 

22 the like. In this way, the State of California has 

23 been able to leverage its maternal mortality review 

24 board system, generate data, and apply those data 

25 to effect changes in maternal care-related protocol. 


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1 To date, the State of California has reduced its ma2 ternal mortality rate, which is now comparable to 

3 the low rates of the United Kingdom. 

4 (19) Hospitals and health systems across the 

5 United States lack standardization of emergency ob6 stetrical protocols before, during, and after delivery. 

7 Consequently, many providers are delayed in recog8 nizing critical signs indicating maternal distress that 

9 quickly escalate into fatal or near-fatal incidences. 

10 Moreover, any attempt to address an obstetrical 

11 emergency that does not consider both clinical and 

12 public health approaches falls woefully under the 

13 mark of excellent care delivery. State-based maternal 

14 quality collaborative organizations, such as the Cali15 fornia Maternal Quality Care Collaborative or enti16 ties participating in the Alliance for Innovation on 

17 Maternal Health (AIM), have formed obstetrical pro18 tocols, tool kits, and other resources to improve sys19 tem care and response as they relate to maternal 

20 complications and warning signs for such conditions 

21 as maternal hemorrhage, hypertension, and 

22 preeclampsia. 

23 (20) The Centers for Disease Control and Pre24 vention reports that nearly half of all maternal 

25 deaths occur in the immediate postpartum period— 


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1 the 42 days following a pregnancy—whereas more 

2 than one-third of pregnancy-related or pregnancy-as3 sociated deaths occur while a person is still preg4 nant. Yet, for women eligible for the Medicaid pro5 gram on the basis of pregnancy, such Medicaid cov6 erage lapses at the end of the month on which the 

7 60th postpartum day lands. 

8 (21) The experience of serious traumatic 

9 events, such as being exposed to domestic violence, 

10 substance use disorder, or pervasive racism, can 

11 over-activate the body’s stress-response system. 

12 Known as toxic stress, the repetition of high-doses 

13 of cortisol to the brain, can harm healthy neuro14 logical development, which can have cascading phys15 ical and mental health consequences, as documented 

16 in the Adverse Childhood Experiences study of the 

17 Centers for Disease Control and Prevention. 

18 (22) A growing body of evidence-based research 

19 has shown the correlation between the stress associ20 ated with one’s race—the stress of racism—and 

21 one’s birthing outcomes. The stress of sex and race 

22 discrimination and institutional racism has been 

23 demonstrated to contribute to a higher risk of ma24 ternal mortality, irrespective of one’s gestational 

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1 vidual-level health risk factors, including poverty, 

2 limited access to prenatal care, and poor physical 

3 and mental health (although these are not nominal 

4 factors). African-American women remain the most 

5 at risk for pregnancy-associated or pregnancy-re6 lated causes of death. When it comes to 

7 preeclampsia, for example, which is related to obe8 sity, African-American women of normal weight re9 main the most at risk of dying during the perinatal 

10 period compared to non-African-American obese 

11 women. 

12 (23) The rising maternal mortality rate in the 

13 United States is driven predominantly by the dis14 proportionately high rates of African-American ma15 ternal mortality. 

16 (24) African-American women are 3 to 4 times 

17 more likely to die from pregnancy or maternal-re18 lated distress than are White women, yielding one of 

19 the greatest and most disconcerting racial disparities 

20 in public health. 

21 (25) Compared to women from other racial and 

22 ethnic demographics, African-American women 

23 across the socioeconomic spectrum experience pro24 longed, unrelenting stress related to racial and gen25 der discrimination, contributing to higher rates of 


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1 maternal mortality, giving birth to low-weight ba2 bies, and experiencing pre-term birth. Racism is a 

3 risk-factor for these aforementioned experiences. 

4 This cumulative stress often extends across the life 

5 course and is situated in everyday spaces where Afri6 can-American women establish livelihood. Structural 

7 barriers, lack of access to care, and genetic pre8 dispositions to health vulnerabilities exacerbate Afri9 can-American women’s likelihood to experience poor 

10 or fatal birthing outcomes, but do not fully account 

11 for the great disparity. 

12 (26) African-American women are twice as like13 ly to experience postpartum depression, and dis14 proportionately higher rates of preeclampsia com15 pared to White women. 

16 (27) Racism is deeply ingrained in United 

17 States systems, including in health care delivery sys18 tems between patients and providers, often resulting 

19 in disparate treatment for pain, irreverence for cul20 tural norms with respect to health, and 

21 dismissiveness. Research has demonstrated that pa22 tients respond more warmly and adhere to medical 

23 treatment plans at a higher degree with providers of 

24 the same race or ethnicity or with providers with 

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1 vider pool is not primed with many people of color, 

2 nor are providers (whether student-doctors in train3 ing or licensed practitioners) consistently required to 

4 undergo implicit bias, cultural competency, or empa5 thy training on a consistent, on-going basis. 

6 (c) IMPROVING FEDERAL EFFORTS WITH RESPECT

7 TO PREVENTION OF MATERNAL MORTALITY.— 

8 (1) TECHNICAL ASSISTANCE FOR STATES WITH

9 RESPECT TO REPORTING MATERNAL MORTALITY.— 

10 Not later than one year after the date of enactment 

11 of this Act, the Director of the Centers for Disease 

12 Control and Prevention (referred to in this section 

13 as the ‘‘Director’’), in consultation with the Admin14 istrator of the Health Resources and Services Ad15 ministration, shall provide technical assistance to 

16 States that elect to report comprehensive data on 

17 maternal mortality, including oral, mental, and 

18 breastfeeding health information, for the purpose of 

19 encouraging uniformity in the reporting of such data 

20 and to encourage the sharing of such data among 

21 the respective States. 

22 (2) BEST PRACTICES RELATING TO PREVEN23 TION OF MATERNAL MORTALITY.— 

24 (A) IN GENERAL.—Not later than one year 

25 after the date of enactment of this Act— 


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1 (i) the Director, in consultation with 

2 relevant patient and provider groups, shall 

3 issue best practices to State maternal mor4 tality review committees on how best to 

5 identify and review maternal mortality 

6 cases, taking into account any data made 

7 available by States relating to maternal 

8 mortality, including data on oral, mental, 

9 and breastfeeding health, and utilization of 

10 any emergency services; and 

11 (ii) the Director, working in collabora12 tion with the Health Resources and Serv13 ices Administration, shall issue best prac14 tices to hospitals, State professional society 

15 groups, and perinatal quality collaboratives 

16 on how best to prevent maternal mortality. 

17 (B) AUTHORIZATION OF APPROPRIA18 TIONS.—For purposes of carrying out this sub19 section, there is authorized to be appropriated 

20 $5,000,000 for each of fiscal years 2021 

21 through 2025. 

22 (3) ALLIANCE FOR INNOVATION ON MATERNAL

23 HEALTH GRANT PROGRAM.— 

24 (A) IN GENERAL.—Not later than one year 

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1 retary of Health and Human Services (referred 

2 to in this subsection as the ‘‘Secretary’’), acting 

3 through the Associate Administrator of the Ma4 ternal and Child Health Bureau of the Health 

5 Resources and Services Administration, shall 

6 establish a grant program to be known as the 

7 Alliance for Innovation on Maternal Health 

8 Grant Program (referred to in this subsection 

9 as ‘‘AIM’’) under which the Secretary shall 

10 award grants to eligible entities for the purpose 

11 of— 

12 (i) directing widespread adoption and 

13 implementation of maternal safety bundles 

14 through collaborative State-based teams; 

15 and 

16 (ii) collecting and analyzing process, 

17 structure, and outcome data to drive con18 tinuous improvement in the implementa19 tion of such safety bundles by such State20 based teams with the ultimate goal of 

21 eliminating preventable maternal mortality 

22 and severe maternal morbidity in the 

23 United States. 


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1 (B) ELIGIBLE ENTITIES.—In order to be 

2 eligible for a grant under paragraph (1), an en3 tity shall— 

4 (i) submit to the Secretary an applica5 tion at such time, in such manner, and 

6 containing such information as the Sec7 retary may require; and 

8 (ii) demonstrate in such application 

9 that the entity is an interdisciplinary, 

10 multi-stakeholder, national organization 

11 with a national data-driven maternal safety 

12 and quality improvement initiative based 

13 on implementation approaches that have 

14 been proven to improve maternal safety 

15 and outcomes in the United States. 

16 (C) USE OF FUNDS.—An eligible entity 

17 that receives a grant under paragraph (1) shall 

18 use such grant funds— 

19 (i) to develop and implement, through 

20 a robust, multi-stakeholder process, mater21 nal safety bundles to assist States and 

22 health care systems in aligning national, 

23 State, and hospital-level quality improve24 ment efforts to improve maternal health 

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1 ternal mortality and severe maternal mor2 bidity; 

3 (ii) to ensure, in developing and im4 plementing maternal safety bundles under 

5 subparagraph (A), that such maternal 

6 safety bundles— 

7 (I) satisfy the quality improve8 ment needs of a State or health care 

9 system by factoring in the results and 

10 findings of relevant data reviews, such 

11 as reviews conducted by a State ma12 ternal mortality review committee; 

13 and 

14 (II) address topics such as— 

15 (aa) obstetric hemorrhage; 

16 (bb) maternal mental health; 

17 (cc) the maternal venous 

18 system; 

19 (dd) obstetric care for 

20 women with substance use dis21 orders, including opioid use dis22 order; 

23 (ee) postpartum care basics 

24 for maternal safety; 


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1 (ff) reduction of peripartum 

2 racial and ethnic disparities; 

3 (gg) reduction of primary 

4 caesarean birth; 

5 (hh) severe hypertension in 

6 pregnancy; 

7 (ii) severe maternal mor8 bidity reviews; 

9 (jj) support after a severe 

10 maternal morbidity event; 

11 (kk) thromboembolism; 

12 (ll) optimization of support 

13 for breastfeeding; and 

14 (mm) maternal oral health; 

15 and 

16 (iii) to provide ongoing technical as17 sistance at the national and State levels to 

18 support implementation of maternal safety 

19 bundles under subparagraph (A). 

20 (D) MATERNAL SAFETY BUNDLE DE21 FINED.—For purposes of this subsection, the 

22 term ‘‘maternal safety bundle’’ means standard23 ized, evidence-informed processes for maternal 

24 health care. 


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1 (E) AUTHORIZATION OF APPROPRIA2 TIONS.—For purposes of carrying out this sub3 section, there is authorized to be appropriated 

4 $10,000,000 for each of fiscal years 2021 

5 through 2025. 

6 (4) FUNDING FOR STATE-BASED PERINATAL

7 QUALITY COLLABORATIVES DEVELOPMENT AND SUS8 TAINABILITY.— 

9 (A) IN GENERAL.—Not later than one year 

10 after the date of enactment of this Act, the Sec11 retary of Health and Human Services (referred 

12 to in this subsection as the ‘‘Secretary’’), acting 

13 through the Division of Reproductive Health of 

14 the Centers for Disease Control and Prevention, 

15 shall establish a grant program to be known as 

16 the State-Based Perinatal Quality Collaborative 

17 grant program under which the Secretary 

18 awards grants to eligible entities for the pur19 pose of development and sustainability of 

20 perinatal quality collaboratives in every State, 

21 the District of Columbia, and eligible terri22 tories, in order to measurably improve perinatal 

23 care and perinatal health outcomes for preg24 nant and postpartum women and their infants. 


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1 (B) GRANT AMOUNTS.—Grants awarded 

2 under this subsection shall be in amounts not to 

3 exceed $250,000 per year, for the duration of 

4 the grant period. 

5 (C) STATE-BASED PERINATAL QUALITY

6 COLLABORATIVE DEFINED.—For purposes of 

7 this subsection, the term ‘‘State-based perinatal 

8 quality collaborative’’ means a network of mul9 tidisciplinary teams that— 

10 (i) work to improve measurable out11 comes for maternal and infant health by 

12 advancing evidence-informed clinical prac13 tices using quality improvement principles; 

14 (ii) work with hospital-based or out15 patient facility-based clinical teams, ex16 perts, and stakeholders, including patients 

17 and families, to spread best practices and 

18 optimize resources to improve perinatal 

19 care and outcomes; 

20 (iii) employ strategies that include the 

21 use of the collaborative learning model to 

22 provide opportunities for hospitals and 

23 clinical teams to collaborate on improve24 ment strategies, rapid-response data to 

25 provide timely feedback to hospital and 


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1 other clinical teams to track progress, and 

2 quality improvement science to provide 

3 support and coaching to hospital and clin4 ical teams; and 

5 (iv) have the goal of improving popu6 lation-level outcomes in maternal and in7 fant health. 

8 (D) AUTHORIZATION OF APPROPRIA9 TIONS.—For purposes of carrying out this sub10 section, there is authorized to be appropriated 

11 $14,000,000 per year for each of fiscal years 

12 2021 through 2025. 

13 (5) EXPANSION OF MEDICAID AND CHIP COV14 ERAGE FOR PREGNANT AND POSTPARTUM WOMEN.— 

15 (A) REQUIRING COVERAGE OF ORAL

16 HEALTH SERVICES FOR PREGNANT AND

17 POSTPARTUM WOMEN.— 

18 (i) MEDICAID.—Section 1905 of the 

19 Social Security Act (42 U.S.C. 1396d) is 

20 amended— 

21 (I) in subsection (a)(4)— 

22 (aa) by striking ‘‘; and (D)’’ 

23 and inserting ‘‘; (D)’’; and 

24 (bb) by inserting ‘‘; and (E) 

25 oral health services for pregnant 


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1 and postpartum women (as de2 fined in subsection (ee))’’ after 

3 ‘‘subsection (bb))’’; and 

4 (II) by adding at the end the fol5 lowing new subsection: 

6 ‘‘(ee) ORAL HEALTH SERVICES FOR PREGNANT AND

7 POSTPARTUM WOMEN.— 

8 ‘‘(1) IN GENERAL.—For purposes of this title, 

9 the term ‘oral health services for pregnant and 

10 postpartum women’ means dental services necessary 

11 to prevent disease and promote oral health, restore 

12 oral structures to health and function, and treat 

13 emergency conditions that are furnished to a woman 

14 during pregnancy (or during the 1-year period be15 ginning on the last day of the pregnancy). 

16 ‘‘(2) COVERAGE REQUIREMENTS.—To satisfy 

17 the requirement to provide oral health services for 

18 pregnant and postpartum women, a State shall, at 

19 a minimum, provide coverage for preventive, diag20 nostic, periodontal, and restorative care consistent 

21 with recommendations for perinatal oral health care 

22 and dental care during pregnancy from the Amer23 ican Academy of Pediatric Dentistry and the Amer24 ican College of Obstetricians and Gynecologists.’’. 


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1 (ii) CHIP.—Section 2103(c)(5)(A) of 

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

3 1397cc(c)(5)(A)) is amended by inserting 

4 ‘‘or a targeted low-income pregnant 

5 woman’’ after ‘‘targeted low-income child’’. 

6 (B) EXTENDING MEDICAID COVERAGE FOR

7 PREGNANT AND POSTPARTUM WOMEN.—Section 

8 1902 of the Social Security Act (42 U.S.C. 

9 1396a) is amended— 

10 (i) in subsection (e)— 

11 (I) in paragraph (5)— 

12 (aa) by inserting ‘‘(including 

13 oral health services for pregnant 

14 and postpartum women (as de15 fined in section 1905(ee))’’ after 

16 ‘‘postpartum medical assistance 

17 under the plan’’; and 

18 (bb) by striking ‘‘60-day’’ 

19 and inserting ‘‘1-year’’; and 

20 (II) in paragraph (6), by striking 

21 ‘‘60-day’’ and inserting ‘‘1-year’’; and 

22 (ii) in subsection (l)(1)(A), by striking 

23 ‘‘60-day’’ and inserting ‘‘1-year’’. 

24 (C) EXTENDING MEDICAID COVERAGE FOR

25 LAWFUL RESIDENTS.—Section 1903(v)(4)(A) of 


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

2 1396b(v)(4)(A)) is amended by striking ‘‘60- 

3 day’’ and inserting ‘‘1-year’’. 

4 (D) EXTENDING CHIP COVERAGE FOR

5 PREGNANT AND POSTPARTUM WOMEN.—Section 

6 2112(d)(2)(A) of the Social Security Act (42 

7 U.S.C. 1397ll(d)(2)(A)) is amended by striking 

8 ‘‘60-day’’ and inserting ‘‘1-year’’. 

9 (E) MAINTENANCE OF EFFORT.— 

10 (i) MEDICAID.—Section 1902(l) of the 

11 Social Security Act (42 U.S.C. 1396a(l)) is 

12 amended by adding at the end the fol13 lowing new paragraph: 

14 ‘‘(5) During the period that begins on the date of 

15 enactment of this paragraph and ends on the date that 

16 is five years after such date of enactment, as a condition 

17 for receiving any Federal payments under section 1903(a) 

18 for calendar quarters occurring during such period, a 

19 State shall not have in effect, with respect to women who 

20 are eligible for medical assistance under the State plan 

21 or under a waiver of such plan on the basis of being preg22 nant or having been pregnant, eligibility standards, meth23 odologies, or procedures under the State plan or waiver 

24 that are more restrictive than the eligibility standards, 

25 methodologies, or procedures, respectively, under such 


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1 plan or waiver that are in effect on the date of enactment 

2 of this paragraph.’’. 

3 (ii) CHIP.—Section 2105(d) of the 

4 Social Security Act (42 U.S.C. 1397ee(d)) 

5 is amended by adding at the end the fol6 lowing new paragraph: 

7 ‘‘(4) IN ELIGIBILITY STANDARDS FOR TAR8 GETED LOW-INCOME PREGNANT WOMEN.—During 

9 the period that begins on the date of enactment of 

10 this paragraph and ends on the date that is five 

11 years after such date of enactment, as a condition 

12 of receiving payments under subsection (a) and sec13 tion 1903(a), a State that elects to provide assist14 ance to women on the basis of being pregnant (in15 cluding pregnancy-related assistance provided to tar16 geted low-income pregnant women (as defined in 

17 section 2112(d)), pregnancy-related assistance pro18 vided to women who are eligible for such assistance 

19 through application of section 1902(v)(4)(A)(i) 

20 under section 2107(e)(1), or any other assistance 

21 under the State child health plan (or a waiver of 

22 such plan) which is provided to women on the basis 

23 of being pregnant) shall not have in effect, with re24 spect to such women, eligibility standards, meth25 odologies, or procedures under such plan (or waiver) 


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1 that are more restrictive than the eligibility stand2 ards, methodologies, or procedures, respectively, 

3 under such plan (or waiver) that are in effect on the 

4 date of enactment of this paragraph.’’. 

5 (F) INFORMATION ON BENEFITS.—The 

6 Secretary of Health and Human Services shall 

7 make publicly available on the internet website 

8 of the Department of Health and Human Serv9 ices, information regarding benefits available to 

10 pregnant and postpartum women and under the 

11 Medicaid program and the Children’s Health 

12 Insurance Program, including information on— 

13 (i) benefits that States are required to 

14 provide to pregnant and postpartum 

15 women under such programs; 

16 (ii) optional benefits that States may 

17 provide to pregnant and postpartum 

18 women under such programs; and 

19 (iii) the availability of different kinds 

20 of benefits for pregnant and postpartum 

21 women, including oral health and mental 

22 health benefits, under such programs. 

23 (G) FEDERAL FUNDING FOR COST OF EX24 TENDED MEDICAID AND CHIP COVERAGE FOR

25 POSTPARTUM WOMEN.— 


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1 (i) MEDICAID.—Section 1905 of the 

2 Social Security Act (42 U.S.C. 1396d), as 

3 amended by paragraph (1), is further 

4 amended— 

5 (I) in subsection (b), by striking 

6 ‘‘and (aa)’’ and inserting ‘‘(aa), and 

7 (ff)’’; and 

8 (II) by adding at the end the fol9 lowing: 

10 ‘‘(ff) INCREASED FMAP FOR EXTENDED MEDICAL

11 ASSISTANCE FOR POSTPARTUM WOMEN.—Notwith12 standing subsection (b), the Federal medical assistance 

13 percentage for a State, with respect to amounts expended 

14 by such State for medical assistance for a woman who is 

15 eligible for such assistance on the basis of being pregnant 

16 or having been pregnant that is provided during the 305- 

17 day period that begins on the 60th day after the last day 

18 of her pregnancy (including any such assistance provided 

19 during the month in which such period ends), shall be 

20 equal to— 

21 ‘‘(1) 100 percent for the first 20 calendar quar22 ters during which this subsection is in effect; and 

23 ‘‘(2) 90 percent for calendar quarters there24 after.’’. 


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1 (ii) CHIP.—Section 2105(c) of the 

2 Social Security Act (42 U.S.C. 1397ee(c)) 

3 is amended by adding at the end the fol4 lowing new paragraph: 

5 ‘‘(12) ENHANCED PAYMENT FOR EXTENDED

6 ASSISTANCE PROVIDED TO PREGNANT WOMEN.— 

7 Notwithstanding subsection (b), the enhanced 

8 FMAP, with respect to payments under subsection 

9 (a) for expenditures under the State child health 

10 plan (or a waiver of such plan) for assistance pro11 vided under the plan (or waiver) to a woman who is 

12 eligible for such assistance on the basis of being 

13 pregnant (including pregnancy-related assistance 

14 provided to a targeted low-income pregnant woman 

15 (as defined in section 2112(d)), pregnancy-related 

16 assistance provided to a woman who is eligible for 

17 such assistance through application of section 

18 1902(v)(4)(A)(i) under section 2107(e)(1), or any 

19 other assistance under the plan (or waiver) provided 

20 to a woman who is eligible for such assistance on the 

21 basis of being pregnant) during the 305-day period 

22 that begins on the 60th day after the last day of her 

23 pregnancy (including any such assistance provided 

24 during the month in which such period ends), shall 

25 be equal to— 


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1 ‘‘(A) 100 percent for the first 20 calendar 

2 quarters during which this paragraph is in ef3 fect; and 

4 ‘‘(B) 90 percent for calendar quarters 

5 thereafter.’’. 

6 (H) EFFECTIVE DATE.— 

7 (i) IN GENERAL.—Subject to subpara8 graph (B), the amendments made by this 

9 subsection shall take effect on the first day 

10 of the first calendar quarter that begins on 

11 or after the date that is one year after the 

12 date of enactment of this Act. 

13 (ii) EXCEPTION FOR STATE LEGISLA14 TION.—In the case of a State plan under 

15 title XIX of the Social Security Act or a 

16 State child health plan under title XXI of 

17 such Act that the Secretary of Health and 

18 Human Services determines requires State 

19 legislation in order for the respective plan 

20 to meet any requirement imposed by 

21 amendments made by this subsection, the 

22 respective plan shall not be regarded as 

23 failing to comply with the requirements of 

24 such title solely on the basis of its failure 

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1 fore the first day of the first calendar 

2 quarter beginning after the close of the 

3 first regular session of the State legislature 

4 that begins after the date of enactment of 

5 this Act. For purposes of the previous sen6 tence, in the case of a State that has a 2- 

7 year legislative session, each year of the 

8 session shall be considered to be a separate 

9 regular session of the State legislature. 

10 (6) REGIONAL CENTERS OF EXCELLENCE.— 

11 Part P of title III of the Public Health Service Act 

12 is amended by adding at the end the following new 

13 section: 

14 ‘‘SEC. 399V–7. 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 and cultural com24 petency in patient-provider interactions education for the 

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1 fessionals are educated in implicit bias and delivering cul2 turally 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, dental school, social 

11 work school, school of professional psychology, or 

12 any other health professional school or program at 

13 an institution of higher education (as defined in sec14 tion 101 of the Higher Education Act of 1965) fo15 cused on the prevention, treatment, or recovery of 

16 health conditions that contribute to maternal mor17 tality and the prevention of maternal mortality and 

18 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 ‘‘(3) provide to the Secretary such information, 

23 at such time and in such manner, as the Secretary 

24 may require. 


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1 ‘‘(c) DIVERSITY.—In awarding a cooperative agree2 ment under subsection (a), the Secretary shall take into 

3 account any regional differences among eligible entities 

4 and make an effort to ensure geographic diversity among 

5 award recipients. 

6 ‘‘(d) DISSEMINATION OF INFORMATION.— 

7 ‘‘(1) PUBLIC AVAILABILITY.—The Secretary 

8 shall make publicly available on the internet website 

9 of the Department of Health and Human Services 

10 information submitted to the Secretary under sub11 section (b)(3). 

12 ‘‘(2) EVALUATION.—The Secretary shall evalu13 ate each regional center of excellence established or 

14 supported pursuant to subsection (a) and dissemi15 nate the findings resulting from each such evalua16 tion to the appropriate public and private entities. 

17 ‘‘(3) DISTRIBUTION.—The Secretary shall share 

18 evaluations and overall findings with State depart19 ments of health and other relevant State level offices 

20 to inform State and local best practices. 

21 ‘‘(e) MATERNAL MORTALITY DEFINED.—In this sec22 tion, the term ‘maternal mortality’ means death of a 

23 woman that occurs during pregnancy or within the one24 year period following the end of such pregnancy. 


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1 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—For 

2 purposes of carrying out this section, there is authorized 

3 to be appropriated $5,000,000 for each of fiscal years 

4 2021 through 2025.’’. 

5 (7) SPECIAL SUPPLEMENTAL NUTRITION PRO6 GRAM FOR WOMEN, INFANTS, AND CHILDREN.—Sec7 tion 17(d)(3)(A)(ii) of the Child Nutrition Act of 

8 1966 (42 U.S.C. 1786(d)(3)(A)(ii)) is amended— 

9 (A) by striking the clause designation and 

10 heading and all that follows through ‘‘A State’’ 

11 and inserting the following: 

12 ‘‘(ii) WOMEN.— 

13 ‘‘(I) BREASTFEEDING WOMEN.— 

14 A State’’; 

15 (B) in subclause (I) (as so designated), by 

16 striking ‘‘1 year’’ and all that follows through 

17 ‘‘earlier’’ and inserting ‘‘2 years postpartum’’; 

18 and 

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

20 ‘‘(II) POSTPARTUM WOMEN.—A 

21 State may elect to certify a 

22 postpartum woman for a period of 2 

23 years.’’. 

24 (8) DEFINITIONS.—In this section: 


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1 (A) MATERNAL MORTALITY.—The term 

2 ‘‘maternal mortality’’ means death of a woman 

3 that occurs during pregnancy or within the one4 year period following the end of such preg5 nancy. 

6 (B) SEVERE MATERNAL MORBIDITY.—The 

7 term ‘‘severe maternal morbidity’’ includes un8 expected outcomes of labor and delivery that re9 sult in significant short-term or long-term con10 sequences to a woman’s health. 

11 (d) INCREASING EXCISE TAXES ON CIGARETTES AND

12 ESTABLISHING EXCISE TAX EQUITY AMONG ALL TO13 BACCO PRODUCT TAX RATES.— 

14 (1) TAX PARITY FOR ROLL-YOUR-OWN TO15 BACCO.—Section 5701(g) of the Internal Revenue 

16 Code of 1986 is amended by striking ‘‘$24.78’’ and 

17 inserting ‘‘$49.56’’. 

18 (2) TAX PARITY FOR PIPE TOBACCO.—Section 

19 5701(f) of the Internal Revenue Code of 1986 is 

20 amended by striking ‘‘$2.8311 cents’’ and inserting 

21 ‘‘$49.56’’. 

22 (3) TAX PARITY FOR SMOKELESS TOBACCO.— 

23 (A) Section 5701(e) of the Internal Rev24 enue Code of 1986 is amended— 


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1 (i) in paragraph (1), by striking 

2 ‘‘$1.51’’ and inserting ‘‘$26.84’’; 

3 (ii) in paragraph (2), by striking 

4 ‘‘50.33 cents’’ and inserting ‘‘$10.74’’; and 

5 (iii) by adding at the end the fol6 lowing: 

7 ‘‘(3) SMOKELESS TOBACCO SOLD IN DISCRETE

8 SINGLE-USE UNITS.—On discrete single-use units, 

9 $100.66 per thousand.’’. 

10 (B) Section 5702(m) of such Code is 

11 amended— 

12 (i) in paragraph (1), by striking ‘‘or 

13 chewing tobacco’’ and inserting ‘‘, chewing 

14 tobacco, or discrete single-use unit’’; 

15 (ii) in paragraphs (2) and (3), by in16 serting ‘‘that is not a discrete single-use 

17 unit’’ before the period in each such para18 graph; and 

19 (iii) by adding at the end the fol20 lowing: 

21 ‘‘(4) DISCRETE SINGLE-USE UNIT.—The term 

22 ‘discrete single-use unit’ means any product con23 taining tobacco that— 

24 ‘‘(A) is not intended to be smoked; and 


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1 ‘‘(B) is in the form of a lozenge, tablet, 

2 pill, pouch, dissolvable strip, or other discrete 

3 single-use or single-dose unit.’’. 

4 (4) TAX PARITY FOR SMALL CIGARS.—Para5 graph (1) of section 5701(a) of the Internal Revenue 

6 Code of 1986 is amended by striking ‘‘$50.33’’ and 

7 inserting ‘‘$100.66’’. 

8 (5) TAX PARITY FOR LARGE CIGARS.— 

9 (A) IN GENERAL.—Paragraph (2) of sec10 tion 5701(a) of the Internal Revenue Code of 

11 1986 is amended by striking ‘‘52.75 percent’’ 

12 and all that follows through the period and in13 serting the following: ‘‘$49.56 per pound and a 

14 proportionate tax at the like rate on all frac15 tional parts of a pound but not less than 

16 10.066 cents per cigar.’’. 

17 (B) GUIDANCE.—The Secretary of the 

18 Treasury, or the Secretary’s delegate, may issue 

19 guidance regarding the appropriate method for 

20 determining the weight of large cigars for pur21 poses of calculating the applicable tax under 

22 section 5701(a)(2) of the Internal Revenue 

23 Code of 1986. 

24 (6) TAX PARITY FOR ROLL-YOUR-OWN TOBACCO

25 AND CERTAIN PROCESSED TOBACCO.—Subsection (o) 


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1 of section 5702 of the Internal Revenue Code of 

2 1986 is amended by inserting ‘‘, and includes proc3 essed tobacco that is removed for delivery or deliv4 ered to a person other than a person with a permit 

5 provided under section 5713, but does not include 

6 removals of processed tobacco for exportation’’ after 

7 ‘‘wrappers thereof’’. 

8 (7) CLARIFYING TAX RATE FOR OTHER TO9 BACCO PRODUCTS.— 

10 (A) IN GENERAL.—Section 5701 of the In11 ternal Revenue Code of 1986 is amended by 

12 adding at the end the following new subsection: 

13 ‘‘(i) OTHER TOBACCO PRODUCTS.—Any product not 

14 otherwise described under this section that has been deter15 mined to be a tobacco product by the Food and Drug Ad16 ministration through its authorities under the Family 

17 Smoking Prevention and Tobacco Control Act shall be 

18 taxed at a level of tax equivalent to the tax rate for ciga19 rettes on an estimated per use basis as determined by the 

20 Secretary.’’. 

21 (B) ESTABLISHING PER USE BASIS.—For 

22 purposes of section 5701(i) of the Internal Rev23 enue Code of 1986, not later than 12 months 

24 after the later of the date of the enactment of 

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1 termined to be a tobacco product by the Food 

2 and Drug Administration, the Secretary of the 

3 Treasury (or the Secretary of the Treasury’s 

4 delegate) shall issue final regulations estab5 lishing the level of tax for such product that is 

6 equivalent to the tax rate for cigarettes on an 

7 estimated per use basis. 

8 (8) CLARIFYING DEFINITION OF TOBACCO

9 PRODUCTS.— 

10 (A) IN GENERAL.—Subsection (c) of sec11 tion 5702 of the Internal Revenue Code of 1986 

12 is amended to read as follows: 

13 ‘‘(c) TOBACCO PRODUCTS.—The term ‘tobacco prod14 ucts’ means— 

15 ‘‘(1) cigars, cigarettes, smokeless tobacco, pipe 

16 tobacco, and roll-your-own tobacco, and 

17 ‘‘(2) any other product subject to tax pursuant 

18 to section 5701(i).’’. 

19 (B) CONFORMING AMENDMENTS.—Sub20 section (d) of section 5702 of such Code is 

21 amended by striking ‘‘cigars, cigarettes, smoke22 less tobacco, pipe tobacco, or roll-your-own to23 bacco’’ each place it appears and inserting ‘‘to24 bacco products’’. 

25 (9) INCREASING TAX ON CIGARETTES.— 


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1 (A) SMALL CIGARETTES.—Section 

2 5701(b)(1) of such Code is amended by striking 

3 ‘‘$50.33’’ and inserting ‘‘$100.66’’. 

4 (B) LARGE CIGARETTES.—Section 

5 5701(b)(2) of such Code is amended by striking 

6 ‘‘$105.69’’ and inserting ‘‘$211.38’’. 

7 (10) TAX RATES ADJUSTED FOR INFLATION.— 

8 Section 5701 of such Code, as amended by sub9 section (g), is amended by adding at the end the fol10 lowing new subsection: 

11 ‘‘(j) INFLATION ADJUSTMENT.— 

12 ‘‘(1) IN GENERAL.—In the case of any calendar 

13 year beginning after 2021, the dollar amounts pro14 vided under this chapter shall each be increased by 

15 an amount equal to— 

16 ‘‘(A) such dollar amount, multiplied by 

17 ‘‘(B) the cost-of-living adjustment deter18 mined under section 1(f)(3) for the calendar 

19 year, determined by substituting ‘calendar year 

20 2017’ for ‘calendar year 2016’ in subparagraph 

21 (A)(ii) thereof. 

22 ‘‘(2) ROUNDING.—If any amount as adjusted 

23 under paragraph (1) is not a multiple of $0.01, such 

24 amount shall be rounded to the next highest multiple 

25 of $0.01.’’. 


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1 (11) FLOOR STOCKS TAXES.— 

2 (A) IMPOSITION OF TAX.—On tobacco 

3 products manufactured in or imported into the 

4 United States which are removed before any tax 

5 increase date and held on such date for sale by 

6 any person, there is hereby imposed a tax in an 

7 amount equal to the excess of— 

8 (i) the tax which would be imposed 

9 under section 5701 of the Internal Rev10 enue Code of 1986 on the article if the ar11 ticle had been removed on such date, over 

12 (ii) the prior tax (if any) imposed 

13 under section 5701 of such Code on such 

14 article. 

15 (B) CREDIT AGAINST TAX.—Each person 

16 shall be allowed as a credit against the taxes 

17 imposed by paragraph (1) an amount equal to 

18 $500. Such credit shall not exceed the amount 

19 of taxes imposed by paragraph (1) on such date 

20 for which such person is liable. 

21 (C) LIABILITY FOR TAX AND METHOD OF

22 PAYMENT.— 

23 (i) LIABILITY FOR TAX.—A person 

24 holding tobacco products on any tax in25 crease date to which any tax imposed by 


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1 paragraph (1) applies shall be liable for 

2 such tax. 

3 (ii) METHOD OF PAYMENT.—The tax 

4 imposed by paragraph (1) shall be paid in 

5 such manner as the Secretary shall pre6 scribe by regulations. 

7 (iii) TIME FOR PAYMENT.—The tax 

8 imposed by paragraph (1) shall be paid on 

9 or before the date that is 120 days after 

10 the effective date of the tax rate increase. 

11 (D) ARTICLES IN FOREIGN TRADE

12 ZONES.—Notwithstanding the Act of June 18, 

13 1934 (commonly known as the Foreign Trade 

14 Zone Act, 48 Stat. 998, 19 U.S.C. 81a et seq.), 

15 or any other provision of law, any article which 

16 is located in a foreign trade zone on any tax in17 crease date shall be subject to the tax imposed 

18 by paragraph (1) if— 

19 (i) internal revenue taxes have been 

20 determined, or customs duties liquidated, 

21 with respect to such article before such 

22 date pursuant to a request made under the 

23 1st proviso of section 3(a) of such Act; or 

24 (ii) such article is held on such date 

25 under the supervision of an officer of the 


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1 United States Customs and Border Protec2 tion of the Department of Homeland Secu3 rity pursuant to the 2d proviso of such sec4 tion 3(a). 

5 (E) DEFINITIONS.—For purposes of this 

6 subsection— 

7 (i) IN GENERAL.—Any term used in 

8 this subsection which is also used in sec9 tion 5702 of such Code shall have the 

10 same meaning as such term has in such 

11 section. 

12 (ii) TAX INCREASE DATE.—The term 

13 ‘‘tax increase date’’ means the effective 

14 date of any increase in any tobacco prod15 uct excise tax rate pursuant to the amend16 ments made by this section (other than 

17 subsection (j) thereof). 

18 (iii) SECRETARY.—The term ‘‘Sec19 retary’’ means the Secretary of the Treas20 ury or the Secretary’s delegate. 

21 (F) CONTROLLED GROUPS.—Rules similar 

22 to the rules of section 5061(e)(3) of such Code 

23 shall apply for purposes of this subsection. 

24 (G) OTHER LAWS APPLICABLE.—All provi25 sions of law, including penalties, applicable with 


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1 respect to the taxes imposed by section 5701 of 

2 such Code shall, insofar as applicable and not 

3 inconsistent with the provisions of this sub4 section, apply to the floor stocks taxes imposed 

5 by paragraph (1), to the same extent as if such 

6 taxes were imposed by such section 5701. The 

7 Secretary may treat any person who bore the 

8 ultimate burden of the tax imposed by para9 graph (1) as the person to whom a credit or re10 fund under such provisions may be allowed or 

11 made. 

12 (12) EFFECTIVE DATES.— 

13 (A) IN GENERAL.—Except as provided in 

14 paragraphs (2) through (4), the amendments 

15 made by this section shall apply to articles re16 moved (as defined in section 5702(j) of the In17 ternal Revenue Code of 1986) after the last day 

18 of the month which includes the date of the en19 actment of this Act. 

20 (B) DISCRETE SINGLE-USE UNITS AND

21 PROCESSED TOBACCO.—The amendments made 

22 by subsections (c)(1)(C), (c)(2), and (f) shall 

23 apply to articles removed (as defined in section 

24 5702(j) of the Internal Revenue Code of 1986) 


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1 after the date that is 6 months after the date 

2 of the enactment of this Act. 

3 (C) LARGE CIGARS.—The amendments 

4 made by subsection (e) shall apply to articles 

5 removed after December 31, 2021. 

6 (D) OTHER TOBACCO PRODUCTS.—The 

7 amendments made by subsection (g)(1) shall 

8 apply to products removed after the last day of 

9 the month which includes the date that the Sec10 retary of the Treasury (or the Secretary of the 

11 Treasury’s delegate) issues final regulations es12 tablishing the level of tax for such product. 

13 SEC. 504. ALLOWING FOR MEDICAL ASSISTANCE UNDER 

14 MEDICAID FOR INMATES DURING 30-DAY PE15 RIOD PRECEDING RELEASE. 

16 (a) IN GENERAL.—The subdivision (A) following 

17 paragraph (30) of section 1905(a) of the Social Security 

18 Act (42 U.S.C. 1396d(a)) is amended by inserting ‘‘and 

19 except during the 30-day period preceding the date of re20 lease of such individual from such public institution’’ after 

21 ‘‘medical institution’’. 

22 (b) REPORT.—Not later than June 30, 2022, the 

23 Medicaid and CHIP Payment and Access Commission 

24 shall submit a report to Congress on the Medicaid inmate 

25 exclusion under the subdivision (A) following paragraph 


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1 (30) of section 1905(a) of the Social Security Act (42 

2 U.S.C. 1396d(a)). Such report may, to the extent prac3 ticable, include the following information: 

4 (1) The number of incarcerated individuals who 

5 would otherwise be eligible to enroll for medical as6 sistance under a State plan approved under title 

7 XIX of the Social Security Act (42 U.S.C. 1396 et 

8 seq.) (or a waiver of such a plan). 

9 (2) Access to health care for incarcerated indi10 viduals, including a description of medical services 

11 generally available to incarcerated individuals. 

12 (3) A description of current practices related to 

13 the discharge of incarcerated individuals, including 

14 how prisons interact with State Medicaid agencies to 

15 ensure that such individuals who are eligible to en16 roll for medical assistance under a State plan or 

17 waiver described in paragraph (1) are so enrolled. 

18 (4) If determined appropriate by the Commis19 sion, recommendations for Congress, the Depart20 ment of Health and Human Services, or States re21 garding the Medicaid inmate exclusion. 

22 (5) Any other information that the Commission 

23 determines would be useful to Congress. 


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1 SEC. 505. PROVIDING FOR IMMEDIATE MEDICAID ELIGI2 BILITY FOR FORMER FOSTER YOUTH. 

3 Section 1002(a)(2) of the SUPPORT for Patients 

4 and Communities Act (Public Law 115–271) is amended 

5 by striking ‘‘January 1, 2023’’ and inserting ‘‘the date 

6 of enactment of the Ending Health Disparities During 

7 COVID–19 Act of 2020’’. 

8 SEC. 506. EXPANDED COVERAGE FOR FORMER FOSTER 

9 YOUTH. 

10 (a) COVERAGE CONTINUITY FOR FORMER FOSTER

11 CARE CHILDREN UP TO AGE 26.— 

12 (1) IN GENERAL.—Section 1002(a)(1)(B) of the 

13 SUPPORT for Patients and Communities Act (Pub14 lic Law 115–271) is amended by striking all that 

15 follows after ‘‘item (cc),’’ and inserting the following: 

16 ‘‘by striking ‘responsibility of the State’ and all that 

17 follows through ‘475(8)(B)(iii); and’ and inserting 

18 ‘responsibility of a State on the date of attaining 18 

19 years of age (or such higher age as such State has 

20 elected under section 475(8)(B)(iii)), or who were in 

21 such care at any age but subsequently left such care 

22 to enter into a legal guardianship with a kinship 

23 caregiver (without regard to whether kinship guard24 ianship payments are being made on behalf of the 

25 child under this part) or were emancipated from 

26 such care prior to attaining age 18;’ ’’. 


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1 (2) AMENDMENTS TO SOCIAL SECURITY ACT.— 

2 (A) IN GENERAL.—Section 

3 1902(a)(10)(A)(i)(IX) of the Social Security 

4 Act (42 U.S.C. 1396a(a)(10)(A)(i)(IX)), as 

5 amended by section 1002(a) of the SUPPORT 

6 for Patients and Communities Act (Public Law 

7 115–271), is amended— 

8 (i) in item (bb), by striking the semi9 colon at the end and inserting ‘‘; and’’; and 

10 (ii) by striking item (dd). 

11 (B) EFFECTIVE DATE.—The amendments 

12 made by this paragraph shall take effect on 

13 January 1, 2023. 

14 (b) OUTREACH EFFORTS FOR ENROLLMENT OF

15 FORMER FOSTER CHILDREN.—Section 1902(a) of the So16 cial Security Act (42 U.S.C. 1396a(a)) is amended— 

17 (1) in paragraph (85), by striking ‘‘; and’’ and 

18 inserting a semicolon; 

19 (2) in paragraph (86), by striking the period at 

20 the end and inserting ‘‘; and’’; and 

21 (3) by inserting after paragraph (86) the fol22 lowing new paragraph: 

23 ‘‘(87) not later than January 1, 2020, establish 

24 an outreach and enrollment program, in coordination 

25 with the State agency responsible for administering 


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1 the State plan under part E of title IV and any 

2 other appropriate or interested agencies, designed to 

3 increase the enrollment of individuals who are eligi4 ble for medical assistance under the State plan 

5 under paragraph (10)(A)(i)(IX) in accordance with 

6 best practices established by the Secretary.’’. 

7 SEC. 507. REMOVING CITIZENSHIP AND IMMIGRATION BAR8 RIERS TO ACCESS TO AFFORDABLE HEALTH 

9 CARE UNDER ACA. 

10 (a) IN GENERAL.— 

11 (1) PREMIUM TAX CREDITS.—Section 36B of 

12 the Internal Revenue Code of 1986 is amended— 

13 (A) in subsection (c)(1)(B)— 

14 (i) by amending the heading to read 

15 as follows: ‘‘SPECIAL RULE FOR CERTAIN

16 INDIVIDUALS INELIGIBLE FOR MEDICAID

17 DUE TO STATUS’’, and 

18 (ii) in clause (ii), by striking ‘‘lawfully 

19 present in the United States, but’’ and in20 serting ‘‘who’’, and 

21 (B) by striking subsection (e). 

22 (2) COST-SHARING REDUCTIONS.—Section 1402 

23 of the Patient Protection and Affordable Care Act 

24 (42 U.S.C. 18071) is amended by striking sub25 section (e). 


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1 (3) BASIC HEALTH PROGRAM ELIGIBILITY.— 

2 Section 1331(e)(1)(B) of the Patient Protection and 

3 Affordable Care Act (42 U.S.C. 18051(e)(1)(B)) is 

4 amended by striking ‘‘lawfully present in the United 

5 States’’. 

6 (4) RESTRICTIONS ON FEDERAL PAYMENTS.— 

7 Section 1412 of the Patient Protection and Afford8 able Care Act (42 U.S.C. 18082) is amended by 

9 striking subsection (d). 

10 (5) REQUIREMENT TO MAINTAIN MINIMUM ES11 SENTIAL COVERAGE.—Section 5000A(d) of the In12 ternal Revenue Code of 1986 is amended by striking 

13 paragraph (3) and by redesignating paragraph (4) 

14 as paragraph (3). 

15 (b) CONFORMING AMENDMENTS.— 

16 (1) Section 1411(a) of the Patient Protection 

17 and Affordable Care Act (42 U.S.C. 18081(a)) is 

18 amended by striking paragraph (1) and redesig19 nating paragraphs (2), (3), and (4) as paragraphs 

20 (1), (2), and (3), respectively. 

21 (2) Section 1312(f) of the Patient Protection 

22 and Affordable Care Act (42 U.S.C. 18032(f)) is 

23 amended— 


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1 (A) in the heading, by striking ‘‘; ACCESS

2 LIMITED TO CITIZENS AND LAWFUL RESI3 DENTS’’; and 

4 (B) by striking paragraph (3). 

5 SEC. 508. MEDICAID IN THE TERRITORIES. 

6 (a) ELIMINATION OF GENERAL MEDICAID FUNDING

7 LIMITATIONS (‘‘CAP’’) FOR TERRITORIES.— 

8 (1) IN GENERAL.—Section 1108 of the Social 

9 Security Act (42 U.S.C. 1308) is amended— 

10 (A) in subsection (f), in the matter pre11 ceding paragraph (1), by striking ‘‘subsection 

12 (g)’’ and inserting ‘‘subsections (g) and (h)’’; 

13 (B) in subsection (g)(2), in the matter pre14 ceding subparagraph (A), by inserting ‘‘and 

15 subsection (h)’’ after ‘‘paragraphs (3) and (5)’’; 

16 and 

17 (C) by adding at the end the following new 

18 subsection: 

19 ‘‘(h) SUNSET OF MEDICAID FUNDING LIMITATIONS

20 FOR PUERTO RICO, THE VIRGIN ISLANDS OF THE

21 UNITED STATES, GUAM, THE NORTHERN MARIANA IS22 LANDS, AND AMERICAN SAMOA.—Subsections (f) and (g) 

23 shall not apply to Puerto Rico, the Virgin Islands of the 

24 United States, Guam, the Northern Mariana Islands, and 

25 American Samoa beginning with fiscal year 2020.’’. 


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1 (2) CONFORMING AMENDMENTS.— 

2 (A) Section 1902(j) of the Social Security 

3 Act (42 U.S.C. 1396a(j)) is amended by strik4 ing ‘‘, the limitation in section 1108(f),’’. 

5 (B) Section 1903(u) of the Social Security 

6 Act (42 U.S.C. 1396b(u)) is amended by strik7 ing paragraph (4). 

8 (C) Section 1323(c)(1) of the Patient Pro9 tection and Affordable Care Act (42 U.S.C. 

10 18043(c)(1)) is amended by striking ‘‘2019’’ 

11 and inserting ‘‘2018’’. 

12 (3) EFFECTIVE DATE.—The amendments made 

13 by this section shall apply beginning with fiscal year 

14 2021. 

15 (b) ELIMINATION OF SPECIFIC FEDERAL MEDICAL

16 ASSISTANCE PERCENTAGE (FMAP) LIMITATION FOR

17 TERRITORIES.—Section 1905(b) of the Social Security 

18 Act (42 U.S.C. 1396d(b)) is amended, in clause (2), by 

19 inserting ‘‘for fiscal years before fiscal year 2020’’ after 

20 ‘‘American Samoa’’. 

21 (c) APPLICATION OF MEDICAID WAIVER AUTHORITY

22 TO ALL OF THE TERRITORIES.— 

23 (1) IN GENERAL.—Section 1902(j) of the Social 

24 Security Act (42 U.S.C. 1396a(j)) is amended— 


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1 (A) by striking ‘‘American Samoa and the 

2 Northern Mariana Islands’’ and inserting 

3 ‘‘Puerto Rico, the Virgin Islands of the United 

4 States, Guam, the Northern Mariana Islands, 

5 and American Samoa’’; 

6 (B) by striking ‘‘American Samoa or the 

7 Northern Mariana Islands’’ and inserting 

8 ‘‘Puerto Rico, the Virgin Islands of the United 

9 States, Guam, the Northern Mariana Islands, 

10 or American Samoa’’; 

11 (C) by inserting ‘‘(1)’’ after ‘‘(j)’’; 

12 (D) by inserting ‘‘except as otherwise pro13 vided in this subsection,’’ after ‘‘Notwith14 standing any other requirement of this title’’; 

15 and 

16 (E) by adding at the end the following: 

17 ‘‘(2) The Secretary may not waive under this 

18 subsection the requirement of subsection 

19 (a)(10)(A)(i)(IX) (relating to coverage of adults for20 merly under foster care) with respect to any terri21 tory.’’. 

22 (2) EFFECTIVE DATE.—The amendments made 

23 by this section shall apply beginning October 1, 

24 2021. 


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1 (d) PERMITTING MEDICAID DSH ALLOTMENTS FOR

2 TERRITORIES.—Section 1923(f) of the Social Security Act 

3 (42 U.S.C. 1396r–4) is amended— 

4 (1) in paragraph (6), by adding at the end the 

5 following new subparagraph: 

6 ‘‘(C) TERRITORIES.— 

7 ‘‘(i) FISCAL YEAR 2020.—For fiscal 

8 year 2020, the DSH allotment for Puerto 

9 Rico, the Virgin Islands of the United 

10 States, Guam, the Northern Mariana Is11 lands, and American Samoa shall bear the 

12 same ratio to $300,000,000 as the ratio of 

13 the number of individuals who are low-in14 come or uninsured and residing in such re15 spective territory (as estimated from time 

16 to time by the Secretary) bears to the 

17 sums of the number of such individuals re18 siding in all of the territories. 

19 ‘‘(ii) SUBSEQUENT FISCAL YEAR.— 

20 For each subsequent fiscal year, the DSH 

21 allotment for each such territory is subject 

22 to an increase in accordance with para23 graph (2).’’; and 

24 (2) in paragraph (9), by inserting before the pe25 riod at the end the following: ‘‘, and includes, beginVerDate Sep 11 2014 00:31 Nov 13, 2020 Jkt 019200 PO 00000 Frm 00238 Fmt 6652 Sfmt 6201 E:\BILLS\H8200.IH H8200

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1 ning with fiscal year 2021, Puerto Rico, the Virgin 

2 Islands of the United States, Guam, the Northern 

3 Mariana Islands, and American Samoa’’. 

4 SEC. 509. REMOVING MEDICARE BARRIER TO HEALTH 

5 CARE. 

6 (a) PART A.—Section 1818(a)(3) of the Social Secu7 rity Act (42 U.S.C. 1395i–2(a)(3)) is amended by striking 

8 ‘‘an alien’’ and all that follows through ‘‘under this sec9 tion’’ and inserting ‘‘an individual who is lawfully present 

10 in the United States’’. 

11 (b) PART B.—Section 1836(2) of the Social Security 

12 Act (42 U.S.C. 1395o(2)) is amended by striking ‘‘an 

13 alien’’ and all that follows through ‘‘under this part’’ and 

14 inserting ‘‘an individual who is lawfully present in the 

15 United States’’. 

16 SEC. 510. REMOVING BARRIERS TO HEALTH CARE AND NU17 TRITION ASSISTANCE FOR CHILDREN, PREG18 NANT PERSONS, AND LAWFULLY PRESENT IN19 DIVIDUALS. 

20 (a) MEDICAID.—Section 1903(v) of the Social Secu21 rity Act (42 U.S.C. 1396b(v)) is amended by striking 

22 paragraph (4) and inserting the following new paragraph: 

23 ‘‘(4)(A) Notwithstanding sections 401(a), 402(b), 

24 403, and 421 of the Personal Responsibility and Work Op25 portunity Reconciliation Act of 1996 and paragraph (1), 


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1 payment shall be made to a State under this section for 

2 medical assistance furnished to an alien under this title 

3 (including an alien described in such paragraph) who 

4 meets any of the following conditions: 

5 ‘‘(i) The alien is otherwise eligible for such as6 sistance under the State plan approved under this 

7 title (other than the requirement of the receipt of 

8 aid or assistance under title IV, supplemental secu9 rity income benefits under title XVI, or a State sup10 plementary payment) within either or both of the 

11 following eligibility categories: 

12 ‘‘(I) Children under 21 years of age, in13 cluding any optional targeted low-income child 

14 (as such term is defined in section 

15 1905(u)(2)(B)). 

16 ‘‘(II) Pregnant persons during pregnancy 

17 and during the 12-month period beginning on 

18 the last day of the pregnancy. 

19 ‘‘(ii) The alien is lawfully present in the United 

20 States. 

21 ‘‘(B) No debt shall accrue under an affidavit of sup22 port against any sponsor of an alien who meets the condi23 tions specified in subparagraph (A) on the basis of the 

24 provision of medical assistance to such alien under this 


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1 paragraph and the cost of such assistance shall not be con2 sidered as an unreimbursed cost.’’. 

3 (b) SCHIP.—Subparagraph (N) of section 

4 2107(e)(1) of the Social Security Act (42 U.S.C. 

5 1397gg(e)(1)) is amended to read as follows: 

6 ‘‘(N) Paragraph (4) of section 1903(v) (re7 lating to coverage of categories of children, 

8 pregnant persons, and other lawfully present in9 dividuals).’’. 

10 (c) SUPPLEMENTAL NUTRITION ASSISTANCE.—Not11 withstanding sections 401(a), 402(a), and 403(a) of the 

12 Personal Responsibility and Work Opportunity Reconcili13 ation Act of 1996 (8 U.S.C. 1611(a); 1612(a); 1613(a)) 

14 and section 6(f) of the Food and Nutrition Act of 2008 

15 (7 U.S.C. 2015(f)), persons who are lawfully present in 

16 the United States shall be not be ineligible for benefits 

17 under the supplemental nutrition assistance program on 

18 the basis of their immigration status or date of entry into 

19 the United States. 

20 (d) ELIGIBILITY FOR FAMILIES WITH CHILDREN.— 

21 Section 421(d)(3) of the Personal Responsibility and 

22 Work Opportunity Reconciliation Act of 1996 (8 U.S.C. 

23 1631(d)(3)) is amended by striking ‘‘to the extent that 

24 a qualified alien is eligible under section 402(a)(2)(J)’’ 

25 and inserting, ‘‘to the extent that a child is a member of 


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1 a household under the supplemental nutrition assistance 

2 program’’. 

3 (e) ENSURING PROPER SCREENING.—Section 

4 11(e)(2)(B) of the Food and Nutrition Act of 2008 (7 

5 U.S.C. 2020(e)(2)(B)) is amended— 

6 (1) by redesignating clauses (vi) and (vii) as 

7 clauses (vii) and (viii); and 

8 (2) by inserting after clause (v) the following: 

9 ‘‘(vi) shall provide a method for imple10 menting section 421 of the Personal Re11 sponsibility and Work Opportunity Rec12 onciliation Act of 1996 (8 U.S.C. 1631) 

13 that does not require any unnecessary in14 formation from persons who may be ex15 empt from that provision;’’. 

16 SEC. 511. REPEAL OF REQUIREMENT FOR DOCUMENTA17 TION EVIDENCING CITIZENSHIP OR NATION18 ALITY UNDER THE MEDICAID PROGRAM. 

19 (a) REPEAL.—Subsections (i)(22) and (x) of section 

20 1903 of the Social Security Act (42 U.S.C. 1396b) are 

21 each repealed. 

22 (b) CONFORMING AMENDMENTS.— 

23 (1) STATE PAYMENTS FOR MEDICAL ASSIST24 ANCE.—Section 1902 of the Social Security Act (42 

25 U.S.C. 1396a) is amended— 


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1 (A) by amending paragraph (46) of sub2 section (a) to read as follows: 

3 ‘‘(46) provide that information is requested and 

4 exchanged for purposes of income and eligibility 

5 verification in accordance with a State system which 

6 meets the requirements of section 1137 of this 

7 Act;’’; 

8 (B) in subsection (e)(13)(A)(i)— 

9 (i) in the matter preceding subclause 

10 (I), by striking ‘‘sections 1902(a)(46)(B) 

11 and 1137(d)’’ and inserting ‘‘section 

12 1137(d)’’; and 

13 (ii) in subclause (IV), by striking 

14 ‘‘1902(a)(46)(B) or’’; and 

15 (C) by striking subsection (ee). 

16 (2) PAYMENT TO STATES.—Section 1903 of the 

17 Social Security Act (42 U.S.C. 1396b) is amended— 

18 (A) in subsection (i), by redesignating 

19 paragraphs (23) through (26) as paragraphs 

20 (22) through (25), respectively; and 

21 (B) by redesignating subsections (y) and 

22 (z) as subsections (x) and (y), respectively. 

23 (3) REPEAL.—Subsection (c) of section 6036 of 

24 the Deficit Reduction Act of 2005 (42 U.S.C. 1396b 

25 note) is repealed. 


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1 (c) EFFECTIVE DATE.—The amendments made by 

2 this section shall take effect as if included in the enact3 ment of the Deficit Reduction Act of 2005. 

4 TITLE VI—COMMUNITY BASED 

5 GRANTS 

6 SEC. 601. GRANTS FOR RACIAL AND ETHNIC APPROACHES 

7 TO COMMUNITY HEALTH. 

8 (a) PURPOSE.—It is the purpose of this section to 

9 award grants to assist communities in mobilizing and or10 ganizing resources in support of effective and sustainable 

11 programs that will reduce or eliminate disparities in health 

12 and health care experienced by racial and ethnic minority 

13 individuals. 

14 (b) AUTHORITY TO AWARD GRANTS.—The Secretary 

15 of Health and Human Services, acting through the Ad16 ministrator of the Health Resources and Services Admin17 istration (referred to in this section as the ‘‘Secretary’’), 

18 shall award grants to eligible entities to assist in design19 ing, implementing, and evaluating culturally and linguis20 tically appropriate, science-based, and community-driven 

21 sustainable strategies to eliminate racial and ethnic health 

22 and health care disparities. 

23 (c) ELIGIBLE ENTITIES.—To be eligible to receive a 

24 grant under this section, an entity shall— 

25 (1) represent a coalition— 


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1 (A) whose principal purpose is to develop 

2 and implement interventions to reduce or elimi3 nate a health or health care disparity in a tar4 geted racial or ethnic minority group in the 

5 community served by the coalition; and 

6 (B) that includes— 

7 (i) members selected from among— 

8 (I) public health departments; 

9 (II) community-based organiza10 tions; 

11 (III) university and research or12 ganizations; 

13 (IV) Indian tribes or tribal orga14 nizations (as such terms are defined 

15 in section 4 of the Indian Self-Deter16 mination and Education Assistance 

17 Act (25 U.S.C. 5304)), the Indian 

18 Health Service, or any other organiza19 tion that serves Alaska Natives; and 

20 (V) interested public or private 

21 health care providers or organizations 

22 as determined appropriate by the Sec23 retary; and 

24 (ii) at least 1 member from a commu25 nity-based organization that represents the 


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1 targeted racial or ethnic minority group; 

2 and 

3 (2) submit to the Secretary an application at 

4 such time, in such manner, and containing such in5 formation as the Secretary may require, which shall 

6 include— 

7 (A) a description of the targeted racial or 

8 ethnic populations in the community to be 

9 served under the grant; 

10 (B) a description of at least 1 health dis11 parity that exists in the racial or ethnic tar12 geted populations, including health issues such 

13 as infant mortality, breast and cervical cancer 

14 screening and management, musculoskeletal 

15 diseases and obesity, prostate cancer screening 

16 and management, cardiovascular disease, diabe17 tes, child and adult immunization levels, oral 

18 disease, or other health priority areas as des19 ignated by the Secretary; and 

20 (C) a demonstration of a proven record of 

21 accomplishment of the coalition members in 

22 serving and working with the targeted commu23 nity. 

24 (d) SUSTAINABILITY.—The Secretary shall give pri25 ority to an eligible entity under this section if the entity 


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1 agrees that, with respect to the costs to be incurred by 

2 the entity in carrying out the activities for which the grant 

3 was awarded, the entity (and each of the participating 

4 partners in the coalition represented by the entity) will 

5 maintain its expenditures of non-Federal funds for such 

6 activities at a level that is not less than the level of such 

7 expenditures during the fiscal year immediately preceding 

8 the first fiscal year for which the grant is awarded. 

9 (e) NONDUPLICATION.—Any funds provided to an eli10 gible entity through a grant under this section shall— 

11 (1) supplement, not supplant, any other Federal 

12 funds made available to the entity for the purposes 

13 of this section; and 

14 (2) not be used to duplicate the activities of any 

15 other health disparity grant program under this Act, 

16 including an amendment made by this Act. 

17 (f) TECHNICAL ASSISTANCE.—The Secretary may, 

18 either directly or by grant or contract, provide any entity 

19 that receives a grant under this section with technical and 

20 other nonfinancial assistance necessary to meet the re21 quirements of this section. 

22 (g) DISSEMINATION.—The Secretary shall encourage 

23 and enable eligible entities receiving grants under this sec24 tion to share best practices, evaluation results, and reports 

25 with communities not affiliated with such entities, by 


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1 using the Internet, conferences, and other pertinent infor2 mation regarding the projects funded by this section, in3 cluding through using outreach efforts of the Office of Mi4 nority Health and the Centers for Disease Control and 

5 Prevention. 

6 (h) ADMINISTRATIVE BURDENS.—The Secretary 

7 shall make every effort to minimize duplicative or unneces8 sary administrative burdens on eligible entities receiving 

9 grants under this section. 

10 (i) AUTHORIZATION OF APPROPRIATIONS.—There 

11 are authorized to be appropriated such sums as may be 

12 necessary to carry out this section. 

13 SEC. 602. GRANTS TO PROMOTE HEALTH FOR UNDER14 SERVED COMMUNITIES. 

15 Part Q of title III of the Public Health Service Act 

16 (42 U.S.C. 280g et seq.) is amended by adding at the end 

17 the following: 

18 ‘‘SEC. 399Z–3. GRANTS TO PROMOTE HEALTH FOR UNDER19 SERVED COMMUNITIES. 

20 ‘‘(a) GRANTS AUTHORIZED.—The Secretary, in col21 laboration with the Administrator of the Health Resources 

22 and Services Administration and other Federal officials 

23 determined appropriate by the Secretary, is authorized to 

24 award grants to eligible entities— 


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1 ‘‘(1) to promote health for underserved commu2 nities, with preference given to projects that benefit 

3 racial and ethnic minority women, racial and ethnic 

4 minority children, adolescents, and lesbian, gay, bi5 sexual, transgender, queer, or questioning commu6 nities; and 

7 ‘‘(2) to strengthen health outreach initiatives in 

8 medically underserved communities, including lin9 guistically isolated populations. 

10 ‘‘(b) USE OF FUNDS.—Grants awarded pursuant to 

11 subsection (a) may be used to support the activities of 

12 community health workers, including such activities— 

13 ‘‘(1) to educate and provide outreach regarding 

14 enrollment in health insurance including the State 

15 Children’s Health Insurance Program under title 

16 XXI of the Social Security Act, Medicare under title 

17 XVIII of such Act, and Medicaid under title XIX of 

18 such Act; 

19 ‘‘(2) to educate and provide outreach in a com20 munity setting regarding health problems prevalent 

21 among underserved communities, and especially 

22 among racial and ethnic minority women, racial and 

23 ethnic minority children, adolescents, and lesbian, 

24 gay, bisexual, transgender, queer, or questioning 

25 communities; 


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1 ‘‘(3) to educate and provide experiential learn2 ing opportunities and target risk factors and healthy 

3 behaviors that impede or contribute to achieving 

4 positive health outcomes, including— 

5 ‘‘(A) healthy nutrition; 

6 ‘‘(B) physical activity; 

7 ‘‘(C) overweight or obesity; 

8 ‘‘(D) tobacco use, including the use of e9 cigarettes and vaping; 

10 ‘‘(E) alcohol and substance use; 

11 ‘‘(F) injury and violence; 

12 ‘‘(G) sexual health; 

13 ‘‘(H) mental health; 

14 ‘‘(I) musculoskeletal health and arthritis; 

15 ‘‘(J) prenatal and postnatal care; 

16 ‘‘(K) dental and oral health; 

17 ‘‘(L) understanding informed consent; 

18 ‘‘(M) stigma; and 

19 ‘‘(N) environmental hazards; 

20 ‘‘(4) to promote community wellness and aware21 ness; and 

22 ‘‘(5) to educate and refer target populations to 

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1 crease access to quality health care services, includ2 ing preventive health services. 

3 ‘‘(c) APPLICATION.— 

4 ‘‘(1) IN GENERAL.—Each eligible entity that 

5 desires to receive a grant under subsection (a) shall 

6 submit an application to the Secretary, at such time, 

7 in such manner, and accompanied by such additional 

8 information as the Secretary may require. 

9 ‘‘(2) CONTENTS.—Each application submitted 

10 pursuant to paragraph (1) shall— 

11 ‘‘(A) describe the activities for which as12 sistance under this section is sought; 

13 ‘‘(B) contain an assurance that, with re14 spect to each community health worker pro15 gram receiving funds under the grant awarded, 

16 such program provides in-language training and 

17 supervision to community health workers to en18 able such workers to provide authorized pro19 gram activities in (at least) the most commonly 

20 used languages within a particular geographic 

21 region; 

22 ‘‘(C) contain an assurance that the appli23 cant will evaluate the effectiveness of commu24 nity health worker programs receiving funds 

25 under the grant; 


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1 ‘‘(D) contain an assurance that each com2 munity health worker program receiving funds 

3 under the grant will provide culturally com4 petent services in the linguistic context most 

5 appropriate for the individuals served by the 

6 program; 

7 ‘‘(E) contain a plan to document and dis8 seminate project descriptions and results to 

9 other States and organizations as identified by 

10 the Secretary; and 

11 ‘‘(F) describe plans to enhance the capac12 ity of individuals to utilize health services and 

13 health-related social services under Federal, 

14 State, and local programs by— 

15 ‘‘(i) assisting individuals in estab16 lishing eligibility under the programs and 

17 in receiving the services or other benefits 

18 of the programs; and 

19 ‘‘(ii) providing other services, as the 

20 Secretary determines to be appropriate, 

21 which may include transportation and 

22 translation services. 

23 ‘‘(d) PRIORITY.—In awarding grants under sub24 section (a), the Secretary shall give priority to those appli25 cants— 


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1 ‘‘(1) who propose to target geographic areas 

2 that— 

3 ‘‘(A)(i) have a high percentage of residents 

4 who are uninsured or underinsured (if the tar5 geted geographic area is located in a State that 

6 has elected to make medical assistance available 

7 under section 1902(a)(10)(A)(i)(VIII) of the 

8 Social Security Act to individuals described in 

9 such section); 

10 ‘‘(ii) have a high percentage of under11 insured residents in a particular geographic 

12 area (if the targeted geographic area is located 

13 in a State that has not so elected); or 

14 ‘‘(iii) have a high number of households ex15 periencing extreme poverty; and 

16 ‘‘(B) have a high percentage of families for 

17 whom English is not their primary language or 

18 including smaller limited English-proficient 

19 communities within the region that are not oth20 erwise reached by linguistically appropriate 

21 health services; 

22 ‘‘(2) with experience in providing health or 

23 health-related social services to individuals who are 

24 underserved with respect to such services; and 


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1 ‘‘(3) with documented community activity and 

2 experience with community health workers. 

3 ‘‘(e) COLLABORATION WITH ACADEMIC INSTITU4 TIONS.—The Secretary shall encourage community health 

5 worker programs receiving funds under this section to col6 laborate with academic institutions, including minority7 serving institutions. Nothing in this section shall be con8 strued to require such collaboration. 

9 ‘‘(f) QUALITY ASSURANCE AND COST EFFECTIVE10 NESS.—The Secretary shall establish guidelines for ensur11 ing the quality of the training and supervision of commu12 nity health workers under the programs funded under this 

13 section and for ensuring the cost effectiveness of such pro14 grams. 

15 ‘‘(g) MONITORING.—The Secretary shall monitor 

16 community health worker programs identified in approved 

17 applications and shall determine whether such programs 

18 are in compliance with the guidelines established under 

19 subsection (f). 

20 ‘‘(h) TECHNICAL ASSISTANCE.—The Secretary may 

21 provide technical assistance to community health worker 

22 programs identified in approved applications with respect 

23 to planning, developing, and operating programs under the 

24 grant. 

25 ‘‘(i) REPORT TO CONGRESS.— 


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1 ‘‘(1) IN GENERAL.—Not later than 4 years 

2 after the date on which the Secretary first awards 

3 grants under subsection (a), the Secretary shall sub4 mit to Congress a report regarding the grant 

5 project. 

6 ‘‘(2) CONTENTS.—The report required under 

7 paragraph (1) shall include the following: 

8 ‘‘(A) A description of the programs for 

9 which grant funds were used. 

10 ‘‘(B) The number of individuals served. 

11 ‘‘(C) An evaluation of— 

12 ‘‘(i) the effectiveness of these pro13 grams; 

14 ‘‘(ii) the cost of these programs; and 

15 ‘‘(iii) the impact of these programs on 

16 the health outcomes of the community resi17 dents. 

18 ‘‘(D) Recommendations for sustaining the 

19 community health worker programs developed 

20 or assisted under this section. 

21 ‘‘(E) Recommendations regarding training 

22 to enhance career opportunities for community 

23 health workers. 

24 ‘‘(j) DEFINITIONS.—In this section: 


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1 ‘‘(1) COMMUNITY HEALTH WORKER.—The term 

2 ‘community health worker’ means an individual who 

3 promotes health or nutrition within the community 

4 in which the individual resides— 

5 ‘‘(A) by serving as a liaison between com6 munities and health care agencies; 

7 ‘‘(B) by providing guidance and social as8 sistance to community residents; 

9 ‘‘(C) by enhancing community residents’ 

10 ability to effectively communicate with health 

11 care providers; 

12 ‘‘(D) by providing culturally and linguis13 tically appropriate health or nutrition edu14 cation; 

15 ‘‘(E) by advocating for individual and com16 munity health, including dental, oral, mental, 

17 and environmental health, or nutrition needs; 

18 ‘‘(F) by taking into consideration the 

19 needs of the communities served, including the 

20 prevalence rates of risk factors that impede 

21 achieving positive healthy outcomes among 

22 women and children, especially among racial 

23 and ethnic minority women and children; and 

24 ‘‘(G) by providing referral and followup 

25 services. 


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1 ‘‘(2) COMMUNITY SETTING.—The term ‘commu2 nity setting’ means a home or a community organi3 zation that serves a population. 

4 ‘‘(3) ELIGIBLE ENTITY.—The term ‘eligible en5 tity’ means— 

6 ‘‘(A) a unit of State, territorial, local, or 

7 Tribal government (including a federally recog8 nized Tribe or Alaska Native village); or 

9 ‘‘(B) a community-based organization. 

10 ‘‘(4) MEDICALLY UNDERSERVED COMMUNITY.— 

11 The term ‘medically underserved community’ means 

12 a community— 

13 ‘‘(A) that has a substantial number of in14 dividuals who are members of a medically un15 derserved population, as defined by section 

16 330(b)(3); 

17 ‘‘(B) a significant portion of which is a 

18 health professional shortage area as designated 

19 under section 332; and 

20 ‘‘(C) that includes populations that are lin21 guistically isolated, such as geographic areas 

22 with a shortage of health professionals able to 

23 provide linguistically appropriate services. 

24 ‘‘(5) SUPPORT.—The term ‘support’ means the 

25 provision of training, supervision, and materials 


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1 needed to effectively deliver the services described in 

2 subsection (b), reimbursement for services, and 

3 other benefits. 

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

5 are authorized to be appropriated to carry out this section 

6 $15,000,000 for each of fiscal years 2021 through 2025.’’. 

7 SEC. 603. ADDRESSING COVID–19 HEALTH INEQUITIES AND 

8 IMPROVING HEALTH EQUITY. 

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

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

11 Human Services (referred to in this section as the ‘‘Sec12 retary’’), acting through the Director of the Centers for 

13 Disease Control and Prevention, shall award grants to eli14 gible entities to establish or expand programs to improve 

15 health equity regarding COVID–19 and reduce or elimi16 nate inequities, including racial and ethnic inequities, in 

17 the incidence, prevalence, and health outcomes of COVID– 

18 19. 

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

20 under subsection (a), an entity shall— 

21 (1) be a nongovernmental entity or consortium 

22 of entities that works to improve health and health 

23 equity in populations or communities disproportion24 ately affected by adverse health outcomes, includ25 ing— 


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1 (A) racial and ethnic minority commu2 nities; 

3 (B) Indian Tribes, Tribal organizations, 

4 and urban Indian organizations; 

5 (C) people with disabilities; 

6 (D) English language learners; 

7 (E) older adults; 

8 (F) low-income communities; 

9 (G) justice-involved communities; 

10 (H) immigrant communities; and 

11 (I) communities on the basis of their sex12 ual orientation or gender identity; 

13 (2) have demonstrated experience in success14 fully working in and partnering with such commu15 nities, and have an established record of accomplish16 ment in improving health outcomes or preventing, 

17 reducing or eliminating health inequities, including 

18 racial and ethnic inequities, in those communities; 

19 (3) communicate with State, local, and Tribal 

20 health departments to coordinate grant activities, as 

21 appropriate; and 

22 (4) submit to the Secretary an application at 

23 such time, in such manner, and containing such in24 formation as the Secretary may require. 


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1 (c) USE OF FUNDS.—An entity shall use amounts re2 ceived under grant under this section to establish, improve 

3 upon, or expand programs to improve health equity re4 garding COVID–19 and reduce or eliminate inequities, in5 cluding racial and ethnic inequities, in the incidence, prev6 alence, and health outcomes of COVID–19. Such uses may 

7 include— 

8 (1) acquiring and distributing medical supplies, 

9 such as personal protective equipment, to commu10 nities that are at an increased risk of COVID–19; 

11 (2) helping people enroll in a health insurance 

12 plan that meets minimum essential coverage; 

13 (3) increasing the availability of COVID–19 

14 testing and any future COVID–19 treatments or 

15 vaccines in communities that are at an increased 

16 risk of COVID–19; 

17 (4) aiding communities and individuals in fol18 lowing guidelines and best practices in regards to 

19 COVID–19, including physical distancing guidelines; 

20 (5) helping communities and COVID–19 sur21 vivors recover and cope with the long-term health 

22 impacts of COVID–19; 

23 (6) addressing social determinants of health, 

24 such as transportation, nutrition, housing, discrimi25 nation, health care access, including mental health 


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1 care and substance use disorder prevention, treat2 ment, and recovery, health literacy, employment sta3 tus, and working conditions, education, income, and 

4 stress, that impact COVID–19 incidence, prevalence, 

5 and health outcomes, and facilitating or providing 

6 access to needed services; 

7 (7) the provision of anti-racism and implicit 

8 and explicit bias training for health care providers 

9 and other relevant professionals; 

10 (8) creating and disseminating culturally in11 formed, linguistically appropriate, accessible, and 

12 medically accurate outreach and education regarding 

13 COVID–19; 

14 (9) acquiring, retaining, and training a diverse 

15 workforce; and 

16 (10) improving the accessibility to health care, 

17 including accessibility to health care providers, men18 tal health care, and COVID–19 testing for people 

19 with disabilities. 

20 (d) ADMINISTRATION.— 

21 (1) PRIORITY.—In awarding grants under this 

22 section, the Secretary shall give priority to eligible 

23 entities that are a community-based organization or 

24 have an established history of successfully working 

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1 lations which the entity intends to provide services 

2 under the grant. The Secretary shall also utilize 

3 available demographic data to give priority to eligible 

4 entities working with populations or communities 

5 disproportionately affected by COVID–19. 

6 (2) GEOGRAPHICAL DIVERSITY.—The Secretary 

7 shall seek to ensure geographical diversity among 

8 grant recipients. 

9 (3) REDUCTION OF BURDENS.—In admin10 istering the grant program under this section, the 

11 Secretary shall make every effort to minimize unnec12 essary administrative burdens on eligible entities re13 ceiving such grants. 

14 (4) TECHNICAL ASSISTANCE.—The Secretary 

15 shall provide technical assistance to eligible entities 

16 on best practices for applying grants under this sec17 tion. 

18 (e) DURATION.—A grant awarded under this section 

19 shall be for a period of 3 years. 

20 (f) REPORTING.— 

21 (1) BY GRANTEE.—Not later than 180 days 

22 after the end of a grant period under this section, 

23 the grantee shall submit to the Secretary a report on 

24 the activities conducted under the grant, including— 


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1 (A) a description of the impact of grant 

2 activities, including on— 

3 (i) outreach and education related to 

4 COVID–19; and 

5 (ii) improving public health activities 

6 related to COVID–19, including physical 

7 distancing; 

8 (B) the number of individuals reached by 

9 the activities under the grant and, to the extent 

10 known, the disaggregated demographic data of 

11 such individuals, such as by race, ethnicity, sex 

12 (including sexual orientation and gender iden13 tity), income, disability status, or primary lan14 guage; and 

15 (C) any other information the Secretary 

16 determines is necessary. 

17 (2) BY SECRETARY.—Not later than 1 year 

18 after the end of the grant program under this sec19 tion, the Secretary shall submit to Congress a report 

20 on the grant program, including a summary of the 

21 information gathered under paragraph (1). 

22 (g) SUPPLEMENT, NOT SUPPLANT.—Grants awarded 

23 under this Act shall be used to supplement and not sup24 plant any other Federal funds made available to carry out 

25 the activities described in this Act. 


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1 (h) FUNDING.—Out of funds in the Treasury not oth2 erwise appropriated, there are appropriated to carry out 

3 this section, $500,000,000 for each of fiscal years 2020 

4 through 2022. 

5 SEC. 604. IMPROVING SOCIAL DETERMINANTS OF HEALTH. 

6 (a) FINDINGS.—Congress finds the following: 

7 (1) Healthy People 2020 defines social deter8 minants of health as conditions in the environments 

9 in which people live, learn, work, play, worship, and 

10 age that affect a wide range of health, functioning, 

11 and quality-of-life outcomes and risks. 

12 (2) One of the overarching goals of Healthy 

13 People 2020 is to ‘‘create social and physical envi14 ronments that promote good health for all’’. 

15 (3) Healthy People 2020 developed a ‘‘place16 based’’ organizing framework, reflecting five key 

17 areas of social determinants of health namely— 

18 (A) economic stability; 

19 (B) education; 

20 (C) social and community context; 

21 (D) health and health care; and 

22 (E) neighborhood and built environment. 

23 (4) It is estimated that medical care accounts 

24 for only 10 to 20 percent of the modifiable contribu25 tors to healthy outcomes for a population. 


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1 (5) The Centers for Medicare & Medicaid Serv2 ices has indicated the importance of the social deter3 minants in its work stating that, ‘‘As we seek to fos4 ter innovation, rethink rural health, find solutions to 

5 the opioid epidemic, and continue to put patients 

6 first, we need to take into account social deter7 minants of health and recognize their importance.’’. 

8 (6) The Department of Health and Human 

9 Services’ Public Health 3.0 initiative recognizes the 

10 role of public health in working across sectors on so11 cial determinants of health, as well as the role of 

12 public health as chief health strategist in commu13 nities. 

14 (7) Through its Health Impact in 5 Years ini15 tiative, the Centers for Disease Control and Preven16 tion has highlighted nonclinical, community-wide ap17 proaches that show positive health impacts, results 

18 within five years, and cost effectiveness or cost sav19 ings over the lifetime of the population or earlier. 

20 (8) Health departments and the Centers for 

21 Disease Control and Prevention are not funded for 

22 such cross-cutting work. 

23 (9) Providing grants to public health depart24 ments and other eligible entities to coordinate cross25 sector collaboration will allow a community-wide, eviVerDate Sep 11 2014 00:31 Nov 13, 2020 Jkt 019200 PO 00000 Frm 00265 Fmt 6652 Sfmt 6201 E:\BILLS\H8200.IH H8200

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1 dence-based approach to address underlying social 

2 determinants of health. 

3 (b) 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 relevant programs consider and incorporate so2 cial determinants of health in grant awards and 

3 other activities. 

4 (B) Awarding grants under subsection (c) 

5 to State, local, territorial, and Tribal health 

6 agencies and organizations, and to other eligible 

7 entities, to address social determinants of 

8 health in target communities. 

9 (C) Awarding grants under subsection (d) 

10 to nonprofit organizations and public or other 

11 nonprofit institutions of higher education— 

12 (i) to conduct research on best prac13 tices to improve social determinants of 

14 health; 

15 (ii) to provide technical assistance, 

16 training, and evaluation assistance to 

17 grantees under subsection (c); and 

18 (iii) to disseminate best practices to 

19 grantees under subsection (c). 

20 (D) Coordinating, supporting, and aligning 

21 activities of the Centers for Disease Control and 

22 Prevention related to social determinants of 

23 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 (c) GRANTS TO ADDRESS SOCIAL DETERMINANTS OF

6 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 inadequate food; 

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); 

8 (iii) other relevant stakeholders and 

9 initiatives in areas of need, such as the Ac10 countable Health Communities Model of 

11 the Centers for Medicare & Medicaid Serv12 ices, health homes under the Medicaid pro13 gram under title XIX of the Social Secu14 rity Act (42 U.S.C. 1396 et seq.), commu15 nity-based organizations, and human serv16 ices organizations; 

17 (iv) other non-health care sector orga18 nizations, including organizations focusing 

19 on transportation, housing, or food access; 

20 and 

21 (v) local employers; and 

22 (D) identify key health inequities in the 

23 target community and demonstrate how the 

24 proposed efforts of the eligible entity would ad25 dress such inequities. 


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1 (6) MONITORING AND EVALUATION.—As a con2 dition of receipt of a grant under this subsection, a 

3 grantee shall agree to submit an annual report to 

4 the Director describing the activities carried out 

5 through the grant and the outcomes of such activi6 ties. 

7 (7) INDEPENDENT NATIONAL EVALUATION.— 

8 (A) IN GENERAL.—Not later than 5 years 

9 after the first grants are awarded under this 

10 subsection, the Director shall provide for the 

11 commencement of an independent national eval12 uation of the Program under this subsection. 

13 (B) REPORT TO CONGRESS.—Not later 

14 than 60 days after receiving the results of such 

15 independent national evaluation, the Director 

16 shall report such results to the Congress. 

17 (d) RESEARCH AND TRAINING.—The Director, as 

18 part of the Program— 

19 (1) shall award grants to nonprofit organiza20 tions and public or other nonprofit institutions of 

21 higher education— 

22 (A) to conduct research on best practices 

23 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 (c); and 

4 (C) to disseminate best practices to grant5 ees under subsection (c); 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 (c) but not receiving funds through such subsection. 

10 (e) 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 2021 through 2026. 

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 (c) and (d). 

18 SEC. 605. FUNDING TO STATES, LOCALITIES, AND COMMU19 NITY-BASED ORGANIZATIONS FOR EMER20 GENCY AID AND SERVICES. 

21 (a) FUNDING FOR STATES.— 

22 (1) INCREASE IN FUNDING FOR SOCIAL SERV23 ICES BLOCK GRANT PROGRAM.— 

24 (A) APPROPRIATION.—Out of any money 

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1 wise appropriated, there are appropriated 

2 $9,600,000,000, which shall be available for 

3 payments under section 2002 of the Social Se4 curity Act. 

5 (B) DEADLINE FOR DISTRIBUTION OF

6 FUNDS.—Within 45 days after the date of the 

7 enactment of this Act, the Secretary of Health 

8 and Human Services shall distribute the funds 

9 made available by this paragraph, which shall 

10 be made available to States on an emergency 

11 basis for immediate obligation and expenditure. 

12 (C) SUBMISSION OF REVISED PRE-EX13 PENDITURE REPORT.—Within 90 days after a 

14 State receives funds made available by this 

15 paragraph, the State shall submit to the Sec16 retary a revised pre-expenditure report pursu17 ant to title XX of the Social Security Act that 

18 describes how the State plans to administer the 

19 funds. 

20 (D) OBLIGATION OF FUNDS BY STATES.— 

21 A State to which funds made available by this 

22 paragraph are distributed shall obligate the 

23 funds not later than December 31, 2020. 

24 (E) EXPENDITURE OF FUNDS BY

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1 grantee to which a grantee) provides funds 

2 made available by this paragraph shall expend 

3 the funds not later than December 31, 2021. 

4 (2) RULES GOVERNING USE OF ADDITIONAL

5 FUNDS.—A State to which funds made available by 

6 paragraph (1)(B) are distributed shall use the funds 

7 in accordance with the following: 

8 (A) PURPOSE.— 

9 (i) IN GENERAL.—The State shall use 

10 the funds only to support the provision of 

11 emergency services to disadvantaged chil12 dren, families, and households. 

13 (ii) DISADVANTAGED DEFINED.—In 

14 this paragraph, the term ‘‘disadvantaged’’ 

15 means, with respect to an entity, that the 

16 entity— 

17 (I) is an individual, or is located 

18 in a community, that is experiencing 

19 material hardship; 

20 (II) is a household in which there 

21 is a child (as defined in section 12(d) 

22 of the Richard B. Russell National 

23 School Lunch Act) or a child served 

24 under section 11(a)(1) of such Act, 

25 who, if not for the closure of the 


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1 school attended by the child during a 

2 public health emergency designation 

3 and due to concerns about a COVID– 

4 19 outbreak, would receive free or re5 duced price school meals pursuant to 

6 such Act; 

7 (III) is an individual, or is lo8 cated in a community, with barriers to 

9 employment; or 

10 (IV) is located in a community 

11 that, as of the date of the enactment 

12 of this Act, is not experiencing a 56- 

13 day downward trajectory of— 

14 (aa) influenza-like illnesses; 

15 (bb) COVID-like syndromic 

16 cases; 

17 (cc) documented COVID–19 

18 cases; or 

19 (dd) positive test results as 

20 a percentage of total COVID–19 

21 tests. 

22 (B) PASS-THROUGH TO LOCAL ENTI23 TIES.— 

24 (i) In the case of a State in which a 

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1 cially to the non-Federal share of the 

2 amounts expended in carrying out a State 

3 program funded under title IV of the So4 cial Security Act, the State may pass funds 

5 so made available through to— 

6 (I) the chief elected official of the 

7 city or urban county that administers 

8 the program; or 

9 (II) local government and com10 munity-based organizations. 

11 (ii) In the case of any other State, the 

12 State shall— 

13 (I) pass the funds through to— 

14 (aa)(AA) local governments 

15 that will expend or distribute the 

16 funds in consultation with com17 munity-based organizations with 

18 experience serving disadvantaged 

19 families or individuals; or 

20 (BB) community-based or21 ganizations with experience serv22 ing disadvantaged families and 

23 individuals; and 

24 (bb) sub-State areas in pro25 portions based on the population 


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1 of disadvantaged individuals liv2 ing in the areas; and 

3 (II) report to the Secretary on 

4 how the State determined the 

5 amounts passed through pursuant to 

6 this clause. 

7 (C) METHODS.— 

8 (i) IN GENERAL.—The State shall use 

9 the funds only for— 

10 (I) administering emergency serv11 ices; 

12 (II) providing short-term cash, 

13 non-cash, or in-kind emergency dis14 aster relief; 

15 (III) providing services with dem16 onstrated need in accordance with ob17 jective criteria that are made available 

18 to the public; 

19 (IV) operational costs directly re20 lated to providing services described 

21 in subclauses (I), (II), and (III); 

22 (V) local government emergency 

23 social service operations; and 

24 (VI) providing emergency social 

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1 nities that may not have access to 

2 other emergency funding streams. 

3 (ii) ADMINISTERING EMERGENCY

4 SERVICES DEFINED.—In clause (i), the 

5 term ‘‘administering emergency services’’ 

6 means— 

7 (I) providing basic disaster relief, 

8 economic, and well-being necessities to 

9 ensure communities are able to safely 

10 observe shelter-in-place and social 

11 distancing orders; 

12 (II) providing necessary supplies 

13 such as masks, gloves, and soap, to 

14 protect the public against infectious 

15 disease; and 

16 (III) connecting individuals, chil17 dren, and families to services or pay18 ments for which they may already be 

19 eligible. 

20 (D) PROHIBITIONS.— 

21 (i) NO INDIVIDUAL ELIGIBILITY DE22 TERMINATIONS BY GRANTEES OR SUB23 GRANTEES.—Neither a grantee to which 

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1 dividual eligibility determinations for the 

2 purpose of administering short-term, non3 cash, in-kind emergency disaster relief to 

4 communities. 

5 (ii) APPLICABILITY OF CERTAIN SO6 CIAL SERVICES BLOCK GRANT FUNDS USE

7 LIMITATIONS.—The State shall use the 

8 funds subject to the limitations in section 

9 2005 of the Social Security Act, except 

10 that, for purposes of this clause, section 

11 2005(a)(2) and 2005(a)(8) of such Act 

12 shall not apply. 

13 (iii) NO SUPPLANTATION OF CERTAIN

14 STATE FUNDS.—The State may use the 

15 funds to supplement, not supplant, State 

16 general revenue funds for social services. 

17 (iv) BAN ON USE FOR CERTAIN COSTS

18 REIMBURSABLE BY FEMA.—The State may 

19 not use the funds for costs that are reim20 bursable by the Federal Emergency Man21 agement Agency, under a contract for in22 surance, or by self-insurance. 

23 (b) FUNDING FOR FEDERALLY RECOGNIZED INDIAN

24 TRIBES AND TRIBAL ORGANIZATIONS.— 

25 (1) GRANTS.— 


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1 (A) IN GENERAL.—Within 90 days after 

2 the date of the enactment of this Act, the Sec3 retary of Health and Human Services shall 

4 make grants to federally recognized Indian 

5 Tribes and Tribal organizations. 

6 (B) AMOUNT OF GRANT.—The amount of 

7 the grant for an Indian Tribe or Tribal organi8 zation shall bear the same ratio to the amount 

9 appropriated by paragraph (3) as the total 

10 amount of grants awarded to the Indian Tribe 

11 or Tribal organization under the Low-Income 

12 Home Energy Assistance Act of 1981 and the 

13 Community Service Block Grant for fiscal year 

14 2020 bears to the total amount of grants 

15 awarded to all Indian Tribes and Tribal organi16 zations under such Act and such Grant for the 

17 fiscal year. 

18 (2) RULES GOVERNING USE OF FUNDS.—An 

19 entity to which a grant is made under paragraph (1) 

20 shall obligate the funds not later than December 31, 

21 2020, and the funds shall be expended by grantees 

22 and subgrantees not later than December 31, 2021, 

23 and used in accordance with the following: 

24 (A) PURPOSE.— 


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1 (i) IN GENERAL.—The grantee shall 

2 use the funds only to support the provision 

3 of emergency services to disadvantaged 

4 households. 

5 (ii) DISADVANTAGED DEFINED.—In 

6 clause (i), the term ‘‘disadvantaged’’ 

7 means, with respect to an entity, that the 

8 entity— 

9 (I) is an individual, or is located 

10 in a community, that is experiencing 

11 material hardship; 

12 (II) is a household in which there 

13 is a child (as defined in section 12(d) 

14 of the Richard B. Russell National 

15 School Lunch Act) or a child served 

16 under section 11(a)(1) of such Act, 

17 who, if not for the closure of the 

18 school attended by the child during a 

19 public health emergency designation 

20 and due to concerns about a COVID– 

21 19 outbreak, would receive free or re22 duced price school meals pursuant to 

23 such Act; 


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1 (III) is an individual, or is lo2 cated in a community, with barriers to 

3 employment; or 

4 (IV) is located in a community 

5 that, as of the date of the enactment 

6 of this Act, is not experiencing a 56- 

7 day downward trajectory of— 

8 (aa) influenza-like illnesses; 

9 (bb) COVID-like syndromic 

10 cases; 

11 (cc) documented COVID–19 

12 cases; or 

13 (dd) positive test results as 

14 a percentage of total COVID–19 

15 tests. 

16 (B) METHODS.— 

17 (i) IN GENERAL.—The grantee shall 

18 use the funds only for— 

19 (I) administering emergency serv20 ices; 

21 (II) providing short-term, non22 cash, in-kind emergency disaster re23 lief; and 

24 (III) tribal emergency social serv25 ice operations. 


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1 (ii) ADMINISTERING EMERGENCY

2 SERVICES DEFINED.—In clause (i), the 

3 term ‘‘administering emergency services’’ 

4 means— 

5 (I) providing basic economic and 

6 well-being necessities to ensure com7 munities are able to safely observe 

8 shelter-in-place and social distancing 

9 orders; 

10 (II) providing necessary supplies 

11 such as masks, gloves, and soap, to 

12 protect the public against infectious 

13 disease; and 

14 (III) connecting individuals, chil15 dren, and families to services or pay16 ments for which they may already be 

17 eligible. 

18 (C) PROHIBITIONS.— 

19 (i) NO INDIVIDUAL ELIGIBILITY DE20 TERMINATIONS BY GRANTEES OR SUB21 GRANTEES.—Neither the grantee nor any 

22 subgrantee may exercise individual eligi23 bility determinations for the purpose of ad24 ministering short-term, non-cash, in-kind 

25 emergency disaster relief to communities. 


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1 (ii) BAN ON USE FOR CERTAIN COSTS

2 REIMBURSABLE BY FEMA.—The grantee 

3 may not use the funds for costs that are 

4 reimbursable by the Federal Emergency 

5 Management Agency, under a contract for 

6 insurance, or by self-insurance. 

7 (3) APPROPRIATION.—Out of any money in the 

8 Treasury of the United States not otherwise appro9 priated, there are appropriated to the Secretary of 

10 Health and Human Services $400,000,000 to carry 

11 out this subsection. 

12 SEC. 606. SUPPLEMENTAL NUTRITION ASSISTANCE PRO13 GRAM. 

14 (a) VALUE OF BENEFITS.—Notwithstanding any 

15 other provision of law, beginning on June 1, 2020, and 

16 for each subsequent month through September 30, 2021, 

17 the value of benefits determined under section 8(a) of the 

18 Food and Nutrition Act of 2008 (7 U.S.C. 2017(a)), and 

19 consolidated block grants for Puerto Rico and American 

20 Samoa determined under section 19(a) of such Act (7 

21 U.S.C. 2028(a)), shall be calculated using 115 percent of 

22 the June 2019 value of the thrifty food plan (as defined 

23 in section 3 of such Act (7 U.S.C. 2012)) if the value of 

24 the benefits and block grants would be greater under that 

25 calculation than in the absence of this subsection. 


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1 (b) MINIMUM AMOUNT.— 

2 (1) IN GENERAL.—The minimum value of bene3 fits determined under section 8(a) of the Food and 

4 Nutrition Act of 2008 (7 U.S.C. 2017(a)) for a 

5 household of not more than 2 members shall be $30. 

6 (2) EFFECTIVENESS.—Paragraph (1) shall re7 main in effect until the date on which 8 percent of 

8 the value of the thrifty food plan for a household 

9 containing 1 member, rounded to the nearest whole 

10 dollar increment, is equal to or greater than $30. 

11 (c) REQUIREMENTS FOR THE SECRETARY.—In car12 rying out this section, the Secretary shall— 

13 (1) consider the benefit increases described in 

14 each of subsections (a) and (b) to be a ‘‘mass 

15 change’’; 

16 (2) require a simple process for States to notify 

17 households of the increase in benefits; 

18 (3) consider section 16(c)(3)(A) of the Food 

19 and Nutrition Act of 2008 (7 U.S.C. 2025(c)(3)(A)) 

20 to apply to any errors in the implementation of this 

21 section, without regard to the 120-day limit de22 scribed in that section; 

23 (4) disregard the additional amount of benefits 

24 that a household receives as a result of this section 

25 in determining the amount of overissuances under 


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1 section 13 of the Food and Nutrition Act of 2008 

2 (7 U.S.C. 2022); and 

3 (5) set the tolerance level for excluding small 

4 errors for the purposes of section 16(c) of the Food 

5 and Nutrition Act of 2008 (7 U.S.C. 2025(c)) at 

6 $50 through September 30, 2021. 

7 (d) PROVISIONS FOR IMPACTED WORKERS.—Not8 withstanding any other provision of law, the requirements 

9 under subsections (d)(1)(A)(ii) and (o) of section 6 of the 

10 Food and Nutrition Act of 2008 (7 U.S.C. 2015) shall 

11 not be in effect during the period beginning on June 1, 

12 2020, and ending 2 years after the date of enactment of 

13 this Act. 

14 (e) ADMINISTRATIVE EXPENSES.— 

15 (1) IN GENERAL.—For the costs of State ad16 ministrative expenses associated with carrying out 

17 this section and administering the supplemental nu18 trition assistance program established under the 

19 Food and Nutrition Act of 2008 (7 U.S.C. 2011 et 

20 seq.), the Secretary shall make available 

21 $150,000,000 for fiscal year 2020 and 

22 $150,000,000 for fiscal year 2021. 

23 (2) TIMING FOR FISCAL YEAR 2020.—Not later 

24 than 60 days after the date of the enactment of this 


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1 Act, the Secretary shall make available to States 

2 amounts for fiscal year 2020 under paragraph (1). 

3 (3) ALLOCATION OF FUNDS.—Funds described 

4 in paragraph (1) shall be made available as grants 

5 to State agencies for each fiscal year as follows: 

6 (A) 75 percent of the amounts available 

7 for each fiscal year shall be allocated to States 

8 based on the share of each State of households 

9 that participate in the supplemental nutrition 

10 assistance program as reported to the Depart11 ment of Agriculture for the most recent 12- 

12 month period for which data are available, ad13 justed by the Secretary (as of the date of the 

14 enactment of this Act) for participation in dis15 aster programs under section 5(h) of the Food 

16 and Nutrition Act of 2008 (7 U.S.C. 2014(h)); 

17 and 

18 (B) 25 percent of the amounts available 

19 for each fiscal year shall be allocated to States 

20 based on the increase in the number of house21 holds that participate in the supplemental nu22 trition assistance program as reported to the 

23 Department of Agriculture over the most recent 

24 12-month period for which data are available, 

25 adjusted by the Secretary (as of the date of the 


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1 enactment of this Act) for participation in dis2 aster programs under section 5(h) of the Food 

3 and Nutrition Act of 2008 (7 U.S.C. 2014(h)). 

4 (f) SNAP RULES.—No funds (including fees) made 

5 available under this Act or any other Act for any fiscal 

6 year may be used to finalize, implement, administer, en7 force, carry out, or otherwise give effect to— 

8 (1) the final rule entitled ‘‘Supplemental Nutri9 tion Assistance Program: Requirements for Able10 Bodied Adults Without Dependents’’ published in 

11 the Federal Register on December 5, 2019 (84 Fed. 

12 Reg. 66782); 

13 (2) the proposed rule entitled ‘‘Revision of Cat14 egorical Eligibility in the Supplemental Nutrition 

15 Assistance Program (SNAP)’’ published in the Fed16 eral Register on July 24, 2019 (84 Fed. Reg. 

17 35570); or 

18 (3) the proposed rule entitled ‘‘Supplemental 

19 Nutrition Assistance Program: Standardization of 

20 State Heating and Cooling Standard Utility Allow21 ances’’ published in the Federal Register on October 

22 3, 2019 (84 Fed. Reg. 52809). 

23 (g) CERTAIN EXCLUSIONS FROM SNAP INCOME.— 

24 A Federal pandemic unemployment compensation pay25 ment made to an individual under section 2104 of the 


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1 CARES Act (Public Law 116–136) shall not be regarded 

2 as income and shall not be regarded as a resource for the 

3 month of receipt and the following 9 months, for the pur4 pose of determining eligibility for such individual or any 

5 other individual for benefits or assistance, or the amount 

6 of benefits or assistance, under any programs authorized 

7 under the Food and Nutrition Act of 2008 (7 U.S.C. 2011 

8 et seq.). 

9 (h) PUBLIC AVAILABILITY.—Not later than 10 days 

10 after the date of the receipt or issuance of each document 

11 listed below, the Secretary shall make publicly available 

12 on the website of the Department of Agriculture the fol13 lowing documents: 

14 (1) Any State agency request to participate in 

15 the supplemental nutrition assistance program on16 line program under section 7(k). 

17 (2) Any State agency request to waive, adjust, 

18 or modify statutory or regulatory requirements 

19 under the Food and Nutrition Act of 2008 related 

20 to the COVID–19 outbreak. 

21 (3) The Secretary’s approval or denial of each 

22 such request under paragraphs (1) or (2). 

23 (i) FUNDING.—There are hereby appropriated to the 

24 Secretary, out of any money not otherwise appropriated, 

25 such sums as may be necessary to carry out this section. 


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1 TITLE VII—CULTURALLY AND 

2 LINGUISTICALLY COM3 PETENT CARE 

4 SEC. 701. ENSURING STANDARDS FOR CULTURALLY AND 

5 LINGUISTICALLY APPROPRIATE SERVICES IN 

6 HEALTH CARE. 

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

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

9 Federal financial assistance, including credits, subsidies, 

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

11 is administered by an executive agency or any entity estab12 lished under title I of the Patient Protection and Afford13 able Care Act (42 U.S.C. 18001 et seq.) (or amendments 

14 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 organiza8 tional assessments of culturally and linguistically ap9 propriate services-related activities and integrate 

10 valid linguistic, competence-related National Stand11 ards for Culturally and Linguistically Appropriate 

12 Services (CLAS) measures into the internal audits, 

13 performance improvement programs, patient satis14 faction assessments, continuous quality improvement 

15 activities, and outcomes-based evaluations of the 

16 program or activity and develop ways to standardize 

17 the assessments, and such assessments must occur 

18 at least yearly; 

19 (7) shall ensure that, consistent with the pri20 vacy protections provided for under the regulations 

21 promulgated under section 264(c) of the Health In22 surance Portability and Accountability Act of 1996 

23 (42 U.S.C. 1320–2 note), data on an individual re24 quired to be collected pursuant to section 3101, inVerDate Sep 11 2014 00:31 Nov 13, 2020 Jkt 019200 PO 00000 Frm 00293 Fmt 6652 Sfmt 6201 E:\BILLS\H8200.IH H8200

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1 cluding the individual’s alternative format pref2 erences and policy modification needs, are— 

3 (A) collected in health records; 

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

6 (C) periodically updated; 

7 (8) shall maintain a current demographic, cul8 tural, and epidemiological profile of the community, 

9 conduct regular assessments of community health 

10 assets and needs, and use the results of such assess11 ments to accurately plan for and implement services 

12 that respond to the cultural and linguistic character13 istics of the service area of the program or activity; 

14 (9) shall develop participatory, collaborative 

15 partnerships with communities and utilize a variety 

16 of formal and informal mechanisms to facilitate 

17 community and patient involvement in designing, 

18 implementing, and evaluating policies and practices 

19 to ensure culturally and linguistically appropriate 

20 service-related activities; 

21 (10) shall ensure that conflict and grievance 

22 resolution processes are culturally and linguistically 

23 appropriate and capable of identifying, preventing, 

24 and resolving cross-cultural conflicts or complaints 

25 by patients; 


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1 (11) shall regularly make available to the public 

2 information about their progress and successful in3 novations in implementing the standards under this 

4 section and provide public notice in their commu5 nities about the availability of this information; and 

6 (12) shall, if requested, regularly make avail7 able to the head of each Federal entity from which 

8 Federal funds are provided, information about the 

9 progress and successful innovations of the program 

10 or activity in implementing the standards under this 

11 section as required by the head of such entity. 

12 (c) COMMENTS ACCEPTED THROUGH NOTICE AND

13 COMMENT RULEMAKING.—An agency carrying out a pro14 gram described in subsection (a) shall ensure that com15 ments with respect to such program that are accepted 

16 through notice and comment rulemaking be accepted in 

17 all languages, may not require such comments to be sub18 mitted only in English, and must ensure these comments 

19 are considered equally as comments submitted in English 

20 during the agency’s review of comments submitted. 


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1 SEC. 702. CULTURALLY AND LINGUISTICALLY APPRO2 PRIATE HEALTH CARE IN THE PUBLIC 

3 HEALTH SERVICE ACT. 

4 Title XXXIV of the Public Health Service Act, as 

5 amended by section 104, is further amended by adding 

6 at the end the following: 

7 ‘‘Subtitle B—CULTURALLY AND 

8 LINGUISTICALLY APPRO9 PRIATE HEALTH CARE 

10 ‘‘SEC. 3403. DEFINITIONS. 

11 ‘‘(a) IN GENERAL.—In this title: 

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

13 respect to an individual, means a person who has 

14 sufficient degree of proficiency in 2 languages. 

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

16 relating to integrated patterns of human behavior 

17 that include the language, thoughts, communica18 tions, actions, customs, beliefs, values, and institu19 tions of racial, ethnic, religious, or social groups, in20 cluding lesbian, gay, bisexual, transgender, queer, 

21 and questioning individuals, and individuals with 

22 physical and mental disabilities. 

23 ‘‘(3) CULTURALLY AND LINGUISTICALLY AP24 PROPRIATE.—The term ‘culturally and linguistically 

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1 sive to the cultural and linguistic needs of all indi2 viduals. 

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

4 ‘effective communication’ means an exchange of in5 formation between the provider of health care or 

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

7 services who is limited in English proficiency, or has 

8 a communication impairment such as a hearing, vi9 sion, speaking, or learning impairment, that enables 

10 access to, understanding of, and benefit from health 

11 care or health-care-related services, and full partici12 pation in the development of their treatment plan. 

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

14 term ‘grievance resolution process’ means all aspects 

15 of dispute resolution including filing complaints, 

16 grievance and appeal procedures, and court action. 

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

18 care group’ means a group of physicians organized, 

19 at least in part, for the purposes of providing physi20 cian services under the Medicaid program under title 

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

22 Health Insurance Program under title XXI of such 

23 Act, or the Medicare program under title XVIII of 

24 such Act and may include a hospital and any other 

25 individual or entity furnishing services covered under 


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1 any such program that is affiliated with the health 

2 care group. 

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

4 ‘health care services’ means services that address 

5 physical as well as mental health conditions in all 

6 care settings. 

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

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

9 social services programs or activities that provide ac10 cess, referrals, or links to health care. 

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

12 educator’ includes a professional with a bacca13 laureate degree who is responsible for designing, im14 plementing, and evaluating individual and population 

15 health promotion and chronic disease prevention pro16 grams. 

17 ‘‘(10) INDIAN; INDIAN TRIBE.—The terms ‘In18 dian’ and ‘Indian Tribe’ have the meanings given 

19 such terms in section 4 of the Indian Self-Deter20 mination and Education Assistance Act. 

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

22 term ‘individual with a disability’ means any indi23 vidual who has a disability as defined for the pur24 pose of section 504 of the Rehabilitation Act of 

25 1973. 


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1 ‘‘(12) INDIVIDUAL WITH LIMITED ENGLISH

2 PROFICIENCY.—The term ‘individual with limited 

3 English proficiency’ means an individual whose pri4 mary language for communication is not English 

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

6 or understand English. 

7 ‘‘(13) INTEGRATED HEALTH CARE DELIVERY

8 SYSTEM.—The term ‘integrated health care delivery 

9 system’ means an interdisciplinary system that 

10 brings together providers from the primary health, 

11 mental health, substance use disorder, and related 

12 disciplines to improve the health outcomes of an in13 dividual. Such providers may include hospitals, 

14 health, mental health, or substance use disorder clin15 ics and providers, home health agencies, ambulatory 

16 surgery centers, skilled nursing facilities, rehabilita17 tion centers, and employed, independent, or con18 tracted physicians. 

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

20 terms ‘interpreting’ and ‘interpretation’ mean the 

21 transmission of a spoken, written, or signed message 

22 from one language or format into another, faithfully, 

23 accurately, and objectively. 

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

25 access’ means the provision of language services to 


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1 an individual with limited English proficiency or an 

2 individual with communication disabilities designed 

3 to enhance that individual’s access to, understanding 

4 of, or benefit from health care services or health5 care-related services. 

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

7 term ‘language assistance services’ includes— 

8 ‘‘(A) oral language assistance, including in9 terpretation in non-English languages provided 

10 in-person or remotely by a qualified interpreter 

11 for an individual with limited English pro12 ficiency, and the use of qualified bilingual or 

13 multilingual staff to communicate directly with 

14 individuals with limited English proficiency; 

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

16 qualified and competent translator, of written 

17 content in paper or electronic form into lan18 guages other than English; and 

19 ‘‘(C) taglines. 

20 ‘‘(17) MINORITY.— 

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

22 and ‘minorities’ refer to individuals from a mi23 nority group. 

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

25 with respect to populations, refers to racial and 


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1 ethnic minority groups, members of sexual and 

2 gender minority groups, and individuals with a 

3 disability. 

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

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

6 ethnic minority group’. 

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

8 ‘onsite interpretation’ means a method of inter9 preting or interpretation for which the interpreter is 

10 in the physical presence of the provider of health 

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

12 recipient of such services who is limited in English 

13 proficiency or has a communication impairment such 

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

15 ‘‘(20) QUALIFIED INDIVIDUAL WITH A DIS16 ABILITY.—The term ‘qualified individual with a dis17 ability’ means, with respect to a health program or 

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

19 without reasonable modifications to policies, prac20 tices, or procedures, the removal of architectural, 

21 communication, or transportation barriers, or the 

22 provision of auxiliary aids and services, meets the es23 sential eligibility requirements for the receipt of aids, 

24 benefits, or services offered or provided by the health 

25 program or activity. 


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

3 interpreter for an individual with a disability’, for an 

4 individual with a disability— 

5 ‘‘(A) means an interpreter who by means 

6 of a remote interpreting service or an on-site 

7 appearance; 

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

10 confidentiality; and 

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

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

16 ‘‘(B) may include sign language inter17 preters, oral transliterators (individuals who 

18 represent or spell in the characters of another 

19 alphabet), and cued language transliterators 

20 (individuals who represent or spell by using a 

21 small number of handshapes). 

22 ‘‘(22) QUALIFIED INTERPRETER FOR AN INDI23 VIDUAL WITH LIMITED ENGLISH PROFICIENCY.— 

24 The term ‘qualified interpreter for an individual with 

25 limited English proficiency’ means an interpreter 


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1 who via a remote interpreting service or an on-site 

2 appearance— 

3 ‘‘(A) adheres to generally accepted inter4 preter ethics principles, including client con5 fidentiality; 

6 ‘‘(B) has demonstrated proficiency in 

7 speaking and understanding both spoken 

8 English and one or more other spoken lan9 guages; and 

10 ‘‘(C) is able to interpret effectively, accu11 rately, and impartially, both receptively and ex12 pressly, to and from such languages and 

13 English, using any necessary specialized vocab14 ulary, terminology, and phraseology. 

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

16 ‘qualified translator’ means a translator who— 

17 ‘‘(A) adheres to generally accepted trans18 lator ethics principles, including client confiden19 tiality; 

20 ‘‘(B) has demonstrated proficiency in writ21 ing and understanding both written English 

22 and one or more other written non-English lan23 guages; and 

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1 guages and English, using any necessary spe2 cialized vocabulary, terminology, and phrase3 ology. 

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

5 The term ‘racial and ethnic minority group’ means 

6 Indians and Alaska Natives, African Americans (in7 cluding Caribbean Blacks, Africans, and other 

8 Blacks), Asian Americans, Hispanics (including 

9 Latinos), and Native Hawaiians and other Pacific 

10 Islanders. 

11 ‘‘(25) SEXUAL AND GENDER MINORITY

12 GROUP.—The term ‘sexual and gender minority 

13 group’ encompasses lesbian, gay, bisexual, and 

14 transgender populations, as well as those whose sex15 ual orientation, gender identity and expression, or 

16 reproductive development varies from traditional, so17 cietal, cultural, or physiological norms. 

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

19 translation’ means the transmission of a written 

20 message in one language into a spoken or signed 

21 message in another language, or an alternative for22 mat in English or another language. 

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

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

25 District of Columbia, the Commonwealth of Puerto 


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1 Rico, the United States Virgin Islands, Guam, 

2 American Samoa, and the Commonwealth of the 

3 Northern Mariana Islands. 

4 ‘‘(28) TELEPHONIC INTERPRETATION.—The 

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

6 the phone interpretation’ or ‘OPI’) means, with re7 spect to interpretation for an individual with limited 

8 English proficiency, a method of interpretation in 

9 which the interpreter is not in the physical presence 

10 of the provider of health care services or health-care11 related services and such individual receiving such 

12 services, but the interpreter is connected via tele13 phone. 

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

15 means the transmission of a written message in one 

16 language into a written or signed message in an17 other language, and includes translation into an18 other language or alternative format, such as large 

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

20 ‘‘(30) VIDEO REMOTE INTERPRETING SERV21 ICES.—The term ‘video remote interpreting services’ 

22 means the provision, in health care services or 

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1 ficiency, of video remote interpreting services that 

2 are— 

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

4 audio over a dedicated high-speed, wide-band5 width video connection or wireless connection 

6 that delivers high quality video images that do 

7 not produce lags, choppy, blurry, or grainy im8 ages, or irregular pauses in communication; and 

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

10 large enough to display. 

11 ‘‘(31) VITAL DOCUMENT.—The term ‘vital doc12 ument’ includes applications for government pro13 grams that provide health care services, medical or 

14 financial consent forms, financial assistance docu15 ments, letters containing important information re16 garding patient instructions (such as prescriptions, 

17 referrals to other providers, and discharge plans) 

18 and participation in a program (such as a Medicaid 

19 managed care program), notices pertaining to the 

20 reduction, denial, or termination of services or bene21 fits, notices of the right to appeal such actions, and 

22 notices advising individuals with limited English pro23 ficiency with communication disabilities of the avail24 ability of free language services, alternative formats, 

25 and other outreach materials. 


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

2 a regulatory provision applicable to a ‘handicapped indi3 vidual’, the term ‘handicapped individual’ in such provi4 sion shall have the same meaning as the term ‘individual 

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

6 ‘‘CHAPTER 1—RESOURCES AND INNOVA7 TION FOR CULTURALLY AND LINGUIS8 TICALLY APPROPRIATE HEALTH CARE 

9 ‘‘SEC. 3404. ROBERT T. MATSUI CENTER FOR CULTURALLY 

10 AND LINGUISTICALLY APPROPRIATE HEALTH 

11 CARE. 

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

13 through the Director of the Agency for Healthcare Re14 search and Quality, shall establish and support a center 

15 to be known as the ‘Robert T. Matsui Center for Cul16 turally and Linguistically Appropriate Health Care’ (re17 ferred to in this section as the ‘Center’) to carry out each 

18 of the following activities: 

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

20 shall provide resources via the internet to identify 

21 and link health care providers to competent inter22 preter and translation services. 

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

24 ‘‘(A) VITAL DOCUMENTS.—The Center 

25 shall provide, directly or through contract, vital 


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1 documents from competent translation services 

2 for providers of health care services and health3 care-related services at no cost to such pro4 viders. Such documents may be submitted by 

5 covered entities (as defined in section 92.4 of 

6 title 42, Code of Federal Regulations, as in ef7 fect on May 16, 2016) for translation into non8 English languages or alternative formats at a 

9 fifth-grade reading level. Such translation serv10 ices shall be provided in a timely and reason11 able manner. The quality of such translation 

12 services shall be monitored and reported pub13 licly. 

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

15 revised by the Secretary that will be used by in16 dividuals with limited English proficiency in 

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

18 Center shall translate the form, at a minimum, 

19 into the top 15 non-English languages in the 

20 United States according to the most recent data 

21 from the American Community Survey or its re22 placement. The translation shall be completed 

23 within 45 calendar days of the Secretary receiv24 ing final approval of the form from the Office 

25 of Management and Budget. The Center shall 


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1 post all translated forms on its website so that 

2 other entities may use the same translations. 

3 ‘‘(3) TOLL-FREE CUSTOMER SERVICE TELE4 PHONE NUMBER.—The Center shall provide, 

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

6 for individuals with limited English proficiency— 

7 ‘‘(A) to obtain information about federally 

8 conducted or funded health programs, including 

9 the Medicare program under title XVIII of the 

10 Social Security Act, the Medicaid program 

11 under title XIX of such Act, and the State Chil12 dren’s Health Insurance Program under title 

13 XXI of such Act, marketplace coverage avail14 able pursuant to title XXVII of this Act and 

15 the Patient Protection and Affordable Care Act, 

16 and other sources of free or reduced care in17 cluding federally qualified health centers, title 

18 X clinics, and public health departments; 

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

20 or accessing these programs and understanding 

21 Federal notices written in English; and 

22 ‘‘(C) to learn how to access language serv23 ices. 

24 ‘‘(4) HEALTH INFORMATION CLEARING25 HOUSE.— 


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1 ‘‘(A) IN GENERAL.—The Center shall de2 velop and maintain an information clearing3 house to facilitate the provision of language 

4 services by providers of health care services and 

5 health-care-related services to reduce medical 

6 errors, improve medical outcomes, improve cul7 tural competence, reduce health care costs 

8 caused by miscommunication with individuals 

9 with limited English proficiency, and reduce or 

10 eliminate the duplication of efforts to translate 

11 materials. The clearinghouse shall include the 

12 information described in subparagraphs (B) 

13 through (F) and make such information avail14 able on the internet and in print. 

15 ‘‘(B) DOCUMENT TEMPLATES.—The Cen16 ter shall collect and evaluate for accuracy, de17 velop, and make available templates for stand18 ard documents that are necessary for patients 

19 and consumers to access and make educated de20 cisions about their health care, including tem21 plates for each of the following: 

22 ‘‘(i) Administrative and legal docu23 ments, including— 

24 ‘‘(I) intake forms; 


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1 ‘‘(II) forms related to the Medi2 care program under title XVIII of the 

3 Social Security Act, the Medicaid pro4 gram under title XIX of such Act, 

5 and the State Children’s Health In6 surance Program under title XXI of 

7 such Act, including eligibility informa8 tion for such programs; 

9 ‘‘(III) forms informing patients 

10 of the compliance and consent re11 quirements pursuant to the regula12 tions under section 264(c) of the 

13 Health Insurance Portability and Ac14 countability Act of 1996 (42 U.S.C. 

15 1320–2 note); and 

16 ‘‘(IV) documents concerning in17 formed consent, advanced directives, 

18 and waivers of rights. 

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

20 to take medications, how to prevent trans21 mission of a contagious disease, and other 

22 prevention and treatment instructions. 

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

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1 tion notices, health warnings, or screening 

2 notices. 

3 ‘‘(iv) Additional health or health-care4 related materials as determined appro5 priate by the Director of the Center. 

6 ‘‘(C) STRUCTURE OF FORMS.—In oper7 ating the clearinghouse, the Center shall— 

8 ‘‘(i) ensure that the documents posted 

9 in English and non-English languages are 

10 culturally and linguistically appropriate; 

11 ‘‘(ii) allow public review of the docu12 ments before dissemination in order to en13 sure that the documents are understand14 able and culturally and linguistically ap15 propriate for the target populations; 

16 ‘‘(iii) allow health care providers to 

17 customize the documents for their use; 

18 ‘‘(iv) facilitate access to these docu19 ments; 

20 ‘‘(v) provide technical assistance with 

21 respect to the access and use of such infor22 mation; and 

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

24 Secretary determines to be useful to fulfill 

25 the purposes of the clearinghouse. 


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1 ‘‘(D) LANGUAGE ASSISTANCE PRO2 GRAMS.—The Center shall provide for the col3 lection and dissemination of information on cur4 rent examples of language assistance programs 

5 and strategies to improve language services for 

6 individuals with limited English proficiency, in7 cluding case studies using de-identified patient 

8 information, program summaries, and program 

9 evaluations. 

10 ‘‘(E) CULTURALLY AND LINGUISTICALLY

11 APPROPRIATE MATERIALS.—The Center shall 

12 provide information relating to culturally and 

13 linguistically appropriate health care for minor14 ity populations residing in the United States to 

15 all health care providers and health-care-related 

16 services at no cost. Such information shall in17 clude— 

18 ‘‘(i) tenets of culturally and linguis19 tically appropriate care; 

20 ‘‘(ii) culturally and linguistically ap21 propriate self-assessment tools; 

22 ‘‘(iii) culturally and linguistically ap23 propriate training tools; 

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1 ferent types of providers of health care 

2 services and health-care-related services, 

3 including regional collaborations among 

4 health care organizations; and 

5 ‘‘(v) culturally and linguistically ap6 propriate information for educators, practi7 tioners, and researchers. 

8 ‘‘(F) TRANSLATION GLOSSARIES.—The 

9 Center shall— 

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

11 translation glossaries that provide stand12 ardized translations of commonly used 

13 terms and phrases utilized in documents 

14 translated by the Center; and 

15 ‘‘(ii) make these glossaries available— 

16 ‘‘(I) free of charge; 

17 ‘‘(II) in the 15 languages in 

18 which the Center translates materials; 

19 and 

20 ‘‘(III) in alternative formats in 

21 accordance with the Americans with 

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

23 12101 et seq.). 

24 ‘‘(G) INFORMATION ABOUT PROGRESS.— 

25 The Center shall regularly collect and make 


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1 publicly available information about the 

2 progress of entities receiving grants under sec3 tion 3402 regarding successful innovations in 

4 implementing the obligations under this sub5 section and provide public notice in the entities’ 

6 communities about the availability of this infor7 mation. 

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

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

10 to, the Director of the Agency for Healthcare Research 

11 and Quality. 

12 ‘‘(c) AVAILABILITY OF LANGUAGE ACCESS.—The Di13 rector shall collaborate with the Deputy Assistant Sec14 retary for Minority Health, the Administrator of the Cen15 ters for Medicare & Medicaid Services, and the Adminis16 trator of the Health Resources and Services Administra17 tion to notify health care providers and health care organi18 zations about the availability of language access services 

19 by the Center. 

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

21 through contract, shall undertake a national education 

22 campaign to inform providers, individuals with limited 

23 English proficiency, individuals with hearing or vision im24 pairments, health professionals, graduate schools, and 

25 community health centers about— 


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1 ‘‘(1) Federal and State laws and guidelines gov2 erning access to language services; 

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

4 interpreters and the risks associated with using fam5 ily members, friends, minors, and untrained bilin6 gual staff; 

7 ‘‘(3) funding sources for developing and imple8 menting language services; and 

9 ‘‘(4) promising practices to effectively provide 

10 language services. 

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

12 are authorized to be appropriated to carry out this section 

13 $5,000,000 for each of fiscal years 2021 through 2025. 

14 ‘‘SEC. 3405. INNOVATIONS IN CULTURALLY AND LINGUIS15 TICALLY APPROPRIATE HEALTH CARE 

16 GRANTS. 

17 ‘‘(a) IN GENERAL.— 

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

19 the Director of the Agency for Healthcare Research 

20 and Quality, shall award grants to eligible entities to 

21 enable such entities to design, implement, and evalu22 ate innovative, cost-effective programs to improve 

23 culturally and linguistically appropriate access to 

24 health care services for individuals with limited 

25 English proficiency. 


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

2 Agency for Healthcare Research and Quality shall 

3 coordinate with, and ensure the participation of, 

4 other agencies including the Health Resources and 

5 Services Administration, the National Institute on 

6 Minority Health and Health Disparities at the Na7 tional Institutes of Health, and the Office of Minor8 ity Health, regarding the design and evaluation of 

9 the grants program. 

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

11 under subsection (a), an entity shall— 

12 ‘‘(1) be— 

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

14 subdivision thereof; 

15 ‘‘(B) an organization described in section 

16 501(c)(3) of the Internal Revenue Code of 1986 

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

18 such Code; 

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

20 or substance use disorder center or clinic; 

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

22 ‘‘(E) an integrated health care delivery 

23 system; 

24 ‘‘(F) a public hospital; 


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

2 college; or 

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

4 Secretary; and 

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

6 application, at such time, in such manner, and con7 taining such additional information as the Secretary 

8 may reasonably require. 

9 ‘‘(c) USE OF FUNDS.—An entity shall use funds re10 ceived through a grant under this section to— 

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

12 providing competent interpretation services through 

13 onsite interpretation, telephonic interpretation, or 

14 video remote interpreting services; 

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

16 promote individuals at all levels of the organization 

17 to maintain a diverse staff and leadership that can 

18 promote and provide language services to patient 

19 populations of the service area of the entity; 

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

21 that identifies the current demographic, cultural, 

22 and epidemiological profile of the community to ac23 curately plan for and implement language services 

24 needed in the service area of the entity; 


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1 ‘‘(4) develop a strategic plan to implement lan2 guage services; 

3 ‘‘(5) develop participatory, collaborative part4 nerships with communities encompassing the patient 

5 populations of individuals with limited English pro6 ficiency served by the grant to gain input in design7 ing and implementing language services; 

8 ‘‘(6) develop and implement grievance resolu9 tion processes that are culturally and linguistically 

10 appropriate and capable of identifying, preventing, 

11 and resolving complaints by individuals with limited 

12 English proficiency; 

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

14 health interpretation training courses and incentives 

15 for bilingual health care staff who are asked to pro16 vide interpretation services in the workplace; 

17 ‘‘(8) develop formal training programs, includ18 ing continued professional development and edu19 cation programs as well as supervision, for individ20 uals interested in becoming dedicated health care in21 terpreters and culturally and linguistically appro22 priate providers; 

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

24 which shall include information on the practical limi25 tations of such instruction for nonnative speakers; 


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1 ‘‘(10) develop policies that address compensa2 tion in salary for staff who receive training to be3 come either a staff interpreter or bilingual provider; 

4 ‘‘(11) develop other language assistance services 

5 as determined appropriate by the Secretary; 

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

7 of improving cultural competence, including cultural 

8 competence programs for community health workers; 

9 and 

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

11 protections provided for under the regulations pro12 mulgated under section 264(c) of the Health Insur13 ance Portability and Accountability Act of 1996 and 

14 any applicable State privacy laws, data on the indi15 vidual patient or recipient’s race, ethnicity, and pri16 mary language are collected (and periodically up17 dated) in health records and integrated into the or18 ganization’s information management systems or 

19 any similar system used to store and retrieve data. 

20 ‘‘(d) PRIORITY.—In awarding grants under this sec21 tion, the Secretary shall give priority to entities that pri22 marily engage in providing direct care and that have devel23 oped partnerships with community organizations or with 

24 agencies with experience in improving language access. 

25 ‘‘(e) EVALUATION.— 


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

2 grant under this section shall submit to the Sec3 retary an evaluation that describes, in the manner 

4 and to the extent required by the Secretary, the ac5 tivities carried out with funds received under the 

6 grant, and how such activities improved access to 

7 health care services and health-care-related services 

8 and the quality of health care for individuals with 

9 limited English proficiency. Such evaluation shall be 

10 collected and disseminated through the Robert T. 

11 Matsui Center for Culturally and Linguistically Ap12 propriate Health Care established under section 

13 3401. The Director of the Agency for Healthcare 

14 Research and Quality shall notify grantees of the 

15 availability of technical assistance for the evaluation 

16 and provide such assistance upon request. 

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

18 Agency for Healthcare Research and Quality shall 

19 evaluate or arrange with other individuals or organi20 zations to evaluate projects funded under this sec21 tion. 

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

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

24 $5,000,000 for each of fiscal years 2021 through 2025. 


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1 ‘‘SEC. 3406. RESEARCH ON CULTURAL AND LANGUAGE COM2 PETENCE. 

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

4 the Director of the Agency for Healthcare Research and 

5 Quality, shall expand research concerning language access 

6 in the provision of health care services. 

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

8 Healthcare Research and Quality may conduct the re9 search described in subsection (a) or enter into contracts 

10 with other individuals or organizations to conduct such re11 search. 

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

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

14 following: 

15 ‘‘(1) To identify the barriers to mental and be16 havioral services that are faced by individuals with 

17 limited English proficiency. 

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

19 health administrators’ attitudes, knowledge, and 

20 awareness of the barriers to quality health care serv21 ices that are faced by individuals with limited 

22 English proficiency. 

23 ‘‘(3) To identify optimal approaches for deliv24 ering language access. 

25 ‘‘(4) To identify best practices for data collec26 tion, including— 


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

2 care services and health-care-related services of 

3 data on the race, ethnicity, and primary lan4 guage of recipients of such services, taking into 

5 account existing research conducted by the Gov6 ernment or private sector; 

7 ‘‘(B) the development and implementation 

8 of data collection and reporting systems; and 

9 ‘‘(C) effective privacy safeguards for col10 lected data. 

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

12 for primary language. 

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

14 which the Secretary can create or coordinate, and 

15 subsidize or otherwise fund, telephonic interpretation 

16 services for health care providers, taking into consid17 eration, among other factors, the flexibility necessary 

18 for such a system to accommodate variations in— 

19 ‘‘(A) provider type; 

20 ‘‘(B) languages needed and their frequency 

21 of use; 

22 ‘‘(C) type of encounter; 

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

24 business hours and after hours; and 

25 ‘‘(E) location of encounter. 


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

2 are authorized to be appropriated to carry out this section 

3 $5,000,000 for each of fiscal years 2021 through 2025.’’. 

4 SEC. 703. TRAINING TOMORROW’S DOCTORS FOR CUL5 TURALLY AND LINGUISTICALLY APPRO6 PRIATE CARE: GRADUATE MEDICAL EDU7 CATION. 

8 (a) DIRECT GRADUATE MEDICAL EDUCATION.—Sec9 tion 1886(h)(4) of the Social Security Act (42 U.S.C. 

10 1395ww(h)(4)) is amended by adding at the end the fol11 lowing new subparagraph: 

12 ‘‘(L) TREATMENT OF CULTURALLY AND

13 LINGUISTICALLY APPROPRIATE TRAINING.—In 

14 determining a hospital’s number of full-time 

15 equivalent residents for purposes of this sub16 section, all the time that is spent by an intern 

17 or resident in an approved medical residency 

18 training program for education and training in 

19 culturally and linguistically appropriate service 

20 delivery, which shall include all diverse popu21 lations including people with disabilities and the 

22 Lesbian, gay, bisexual, transgender, queer, 

23 questioning, questioning and intersex 

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1 ward the determination of full-time equiva2 lency.’’. 

3 (b) INDIRECT MEDICAL EDUCATION.—Section 

4 1886(d)(5)(B) of the Social Security Act (42 U.S.C. 

5 1395ww(d)(5)(B)) is amended— 

6 (1) by redesignating the clause (x) added by 

7 section 5505(b) of the Patient Protection and Af8 fordable Care Act as clause (xi); and 

9 (2) by adding at the end the following new 

10 clause: 

11 ‘‘(xii) The provisions of subparagraph (L) of 

12 subsection (h)(4) shall apply under this subpara13 graph in the same manner as they apply under such 

14 subsection.’’. 

15 (c) EFFECTIVE DATE.—The amendments made by 

16 subsections (a) and (b) shall apply with respect to pay17 ments made to hospitals on or after the date that is one 

18 year after the date of the enactment of this Act. 

19 SEC. 704. FEDERAL REIMBURSEMENT FOR CULTURALLY 

20 AND LINGUISTICALLY APPROPRIATE SERV21 ICES UNDER THE MEDICARE, MEDICAID, AND 

22 STATE CHILDREN’S HEALTH INSURANCE 

23 PROGRAMS. 

24 (a) LANGUAGE ACCESS GRANTS FOR MEDICARE

25 PROVIDERS.— 


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1 (1) ESTABLISHMENT.— 

2 (A) IN GENERAL.—Not later than 6 

3 months after the date of the enactment of this 

4 Act, the Secretary of Health and Human Serv5 ices, acting through the Centers for Medicare & 

6 Medicaid Services and in consultation with the 

7 Center for Medicare and Medicaid Innovation 

8 (as referred to in section 1115A of the Social 

9 Security Act (42 U.S.C. 1315a)), shall establish 

10 a demonstration program under which the Sec11 retary shall award grants to eligible Medicare 

12 service providers to improve communication be13 tween such providers and Medicare beneficiaries 

14 who are limited English proficient, including 

15 beneficiaries who live in diverse and under16 served communities. 

17 (B) APPLICATION OF INNOVATION

18 RULES.—The demonstration project under sub19 paragraph (A) shall be conducted in a manner 

20 that is consistent with the applicable provisions 

21 of subsections (b), (c), and (d) of section 1115A 

22 of the Social Security Act (42 U.S.C. 1315a). 

23 (C) NUMBER OF GRANTS.—To the extent 

24 practicable, the Secretary shall award not less 

25 than 24 grants under this subsection. 


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1 (D) GRANT PERIOD.—Except as provided 

2 under paragraph (2)(D), each grant awarded 

3 under this subsection shall be for a 3-year pe4 riod. 

5 (2) ELIGIBILITY REQUIREMENTS.—To be eligi6 ble for a grant under this subsection, an entity must 

7 meet the following requirements: 

8 (A) MEDICARE PROVIDER.—The entity 

9 must be— 

10 (i) a provider of services under part A 

11 of title XVIII of the Social Security Act 

12 (42 U.S.C. 1395c et seq.); 

13 (ii) a provider of services under part 

14 B of such title (42 U.S.C. 1395j et seq.); 

15 (iii) a Medicare Advantage organiza16 tion offering a Medicare Advantage plan 

17 under part C of such title (42 U.S.C. 

18 1395w–21 et seq.); or 

19 (iv) a PDP sponsor offering a pre20 scription drug plan under part D of such 

21 title (42 U.S.C. 1395w–101 et seq.). 

22 (B) UNDERSERVED COMMUNITIES.—The 

23 entity must serve a community that, with re24 spect to necessary language services for improv25 ing access and utilization of health care among 


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1 English learners, is disproportionally under2 served. 

3 (C) APPLICATION.—The entity must pre4 pare and submit to the Secretary an applica5 tion, at such time, in such manner, and accom6 panied by such additional information as the 

7 Secretary may require. 

8 (D) REPORTING.—In the case of a grantee 

9 that received a grant under this subsection in 

10 a previous year, such grantee is only eligible for 

11 continued payments under a grant under this 

12 subsection if the grantee met the reporting re13 quirements under paragraph (9) for such year. 

14 If a grantee fails to meet the requirement of 

15 such paragraph for the first year of a grant, the 

16 Secretary may terminate the grant and solicit 

17 applications from new grantees to participate in 

18 the demonstration program. 

19 (3) DISTRIBUTION.—To the extent feasible, the 

20 Secretary shall award— 

21 (A) at least 6 grants to providers of serv22 ices described in paragraph (2)(A)(i); 

23 (B) at least 6 grants to service providers 

24 described in paragraph (2)(A)(ii); 


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1 (C) at least 6 grants to organizations de2 scribed in paragraph (2)(A)(iii); and 

3 (D) at least 6 grants to sponsors described 

4 in paragraph (2)(A)(iv). 

5 (4) CONSIDERATIONS IN AWARDING GRANTS.— 

6 (A) VARIATION IN GRANTEES.—In award7 ing grants under this subsection, the Secretary 

8 shall select grantees to ensure the following: 

9 (i) The grantees provide many dif10 ferent types of language services. 

11 (ii) The grantees serve Medicare bene12 ficiaries who speak different languages, 

13 and who, as a population, have differing 

14 needs for language services. 

15 (iii) The grantees serve Medicare 

16 beneficiaries in both urban and rural set17 tings. 

18 (iv) The grantees serve Medicare 

19 beneficiaries in at least two geographic re20 gions, as defined by the Secretary. 

21 (v) The grantees serve Medicare bene22 ficiaries in at least two large metropolitan 

23 statistical areas with racial, ethnic, sexual, 

24 gender, disability, and economically diverse 

25 populations. 


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1 (B) PRIORITY FOR PARTNERSHIPS WITH

2 COMMUNITY ORGANIZATIONS AND AGENCIES.— 

3 In awarding grants under this subsection, the 

4 Secretary shall give priority to eligible entities 

5 that have a partnership with— 

6 (i) a community organization; or 

7 (ii) a consortia of community organi8 zations, State agencies, and local agencies, 

9 that has experience in providing language serv10 ices. 

11 (5) USE OF FUNDS FOR COMPETENT LANGUAGE

12 SERVICES.— 

13 (A) IN GENERAL.—Subject to subpara14 graph (E), a grantee may only use grant funds 

15 received under this subsection to pay for the 

16 provision of competent language services to 

17 Medicare beneficiaries who are English learn18 ers. 

19 (B) COMPETENT LANGUAGE SERVICES DE20 FINED.—For purposes of this subsection, the 

21 term ‘‘competent language services’’ means— 

22 (i) interpreter and translation services 

23 that— 

24 (I) subject to the exceptions 

25 under subparagraph (C)— 


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1 (aa) if the grantee operates 

2 in a State that has statewide 

3 health care interpreter standards, 

4 meet the State standards cur5 rently in effect; or 

6 (bb) if the grantee operates 

7 in a State that does not have 

8 statewide health care interpreter 

9 standards, utilizes competent in10 terpreters who follow the Na11 tional Council on Interpreting in 

12 Health Care’s Code of Ethics and 

13 Standards of Practice and com14 ply with the requirements of sec15 tion 1557 of the Patient Protec16 tion and Affordable Care Act (42 

17 U.S.C. 18116) as published in 

18 the Federal Register on May 18, 

19 2016; and 

20 (II) that, in the case of inter21 preter services, are provided 

22 through— 

23 (aa) onsite interpretation; 

24 (bb) telephonic interpreta25 tion; or 


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1 (cc) video interpretation; 

2 and 

3 (ii) the direct provision of health care 

4 or health-care-related services by a com5 petent bilingual health care provider. 

6 (C) EXCEPTIONS.—The requirements of 

7 subparagraph (B)(i)(I) do not apply, with re8 spect to interpreter and translation services and 

9 a grantee— 

10 (i) in the case of a Medicare bene11 ficiary who is an English learner if— 

12 (I) such beneficiary has been in13 formed, in the beneficiary’s primary 

14 language, of the availability of free in15 terpreter and translation services and 

16 the beneficiary instead requests that a 

17 family member, friend, or other per18 son provide such services; and 

19 (II) the grantee documents such 

20 request in the beneficiary’s medical 

21 record; or 

22 (ii) in the case of a medical emergency 

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1 lation services would jeopardize the health 

2 of the patient. 

3 Clause (ii) shall not be construed to exempt 

4 emergency rooms or similar entities that regu5 larly provide health care services in medical 

6 emergencies to patients who are English learn7 ers from any applicable legal or regulatory re8 quirements related to providing competent in9 terpreter and translation services without undue 

10 delay. 

11 (D) MEDICARE ADVANTAGE ORGANIZA12 TIONS AND PDP SPONSORS.—If a grantee is a 

13 Medicare Advantage organization offering a 

14 Medicare Advantage plan under part C of title 

15 XVIII of the Social Security Act (42 U.S.C. 

16 1395w–21 et seq.) or a PDP sponsor offering 

17 a prescription drug plan under part D of such 

18 title (42 U.S.C. 1395w–101 et seq.), such entity 

19 must provide at least 50 percent of the grant 

20 funds that the entity receives under this sub21 section directly to the entity’s network providers 

22 (including all health providers and pharmacists) 

23 for the purpose of providing support for such 

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1 ices to Medicare beneficiaries who are English 

2 learners. 

3 (E) ADMINISTRATIVE AND REPORTING

4 COSTS.—A grantee may use up to 10 percent of 

5 the grant funds to pay for administrative costs 

6 associated with the provision of competent lan7 guage services and for reporting required under 

8 paragraph (9). 

9 (6) DETERMINATION OF AMOUNT OF GRANT

10 PAYMENTS.— 

11 (A) IN GENERAL.—Payments to grantees 

12 under this subsection shall be calculated based 

13 on the estimated numbers of Medicare bene14 ficiaries who are English learners in a grantee’s 

15 service area utilizing— 

16 (i) data on the numbers of English 

17 learners who speak English less than ‘‘very 

18 well’’ from the most recently available data 

19 from the Bureau of the Census or other 

20 State-based study the Secretary determines 

21 likely to yield accurate data regarding the 

22 number of such individuals in such service 

23 area; or 

24 (ii) data provided by the grantee, if 

25 the grantee routinely collects data on the 


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1 primary language of the Medicare bene2 ficiaries that the grantee serves and the 

3 Secretary determines that the data is accu4 rate and shows a greater number of 

5 English learners than would be estimated 

6 using the data under clause (i). 

7 (B) DISCRETION OF SECRETARY.—Subject 

8 to subparagraph (C), the amount of payment 

9 made to a grantee under this subsection may be 

10 modified annually at the discretion of the Sec11 retary, based on changes in the data under sub12 paragraph (A) with respect to the service area 

13 of a grantee for the year. 

14 (C) LIMITATION ON AMOUNT.—The 

15 amount of a grant made under this subsection 

16 to a grantee may not exceed $500,000 for the 

17 period under paragraph (1)(D). 

18 (7) ASSURANCES.—Grantees under this sub19 section shall, as a condition of receiving a grant 

20 under this subsection— 

21 (A) ensure that clinical and support staff 

22 receive appropriate ongoing education and 

23 training in linguistically appropriate service de24 livery; 


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1 (B) ensure the linguistic competence of bi2 lingual providers; 

3 (C) offer and provide appropriate language 

4 services at no additional charge to each patient 

5 who is an English learner for all points of con6 tact between the patient and the grantee, in a 

7 timely manner during all hours of operation; 

8 (D) notify Medicare beneficiaries of their 

9 right to receive language services in their pri10 mary language; 

11 (E) post signage in the primary languages 

12 commonly used by the patient population in the 

13 service area of the organization; and 

14 (F) ensure that— 

15 (i) primary language data are col16 lected for recipients of language services 

17 and such data are consistent with stand18 ards developed under title XXXIV of the 

19 Public Health Service Act, as added by 

20 section 202 of this Act, to the extent such 

21 standards are available upon the initiation 

22 of the demonstration program; and 

23 (ii) consistent with the privacy protec24 tions provided under the regulations pro25 mulgated pursuant to section 264(c) of the 


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1 Health Insurance Portability and Account2 ability Act of 1996 (42 U.S.C. 1320d–2 

3 note), if the recipient of language services 

4 is a minor or is incapacitated, primary lan5 guage data are collected on the parent or 

6 legal guardian of such recipient. 

7 (8) NO COST SHARING.—Medicare beneficiaries 

8 who are English learners shall not have to pay cost 

9 sharing or co-payments for competent language serv10 ices provided under this demonstration program. 

11 (9) REPORTING REQUIREMENTS FOR GRANT12 EES.—Not later than the end of each calendar year, 

13 a grantee that receives funds under this subsection 

14 in such year shall submit to the Secretary a report 

15 that includes the following information: 

16 (A) The number of Medicare beneficiaries 

17 to whom competent language services are pro18 vided. 

19 (B) The primary languages of those Medi20 care beneficiaries. 

21 (C) The types of language services pro22 vided to such beneficiaries. 

23 (D) Whether such language services were 

24 provided by employees of the grantee or 


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1 through a contract with external contractors or 

2 agencies. 

3 (E) The types of interpretation services 

4 provided to such beneficiaries, and the approxi5 mate length of time such service is provided to 

6 such beneficiaries. 

7 (F) The costs of providing competent lan8 guage services. 

9 (G) An account of the training or accredi10 tation of bilingual staff, interpreters, and trans11 lators providing services funded by the grant 

12 under this subsection. 

13 (10) EVALUATION AND REPORT TO CON14 GRESS.—Not later than 1 year after the completion 

15 of a 3-year grant under this subsection, the Sec16 retary shall conduct an evaluation of the demonstra17 tion program under this subsection and shall submit 

18 to the Congress a report that includes the following: 

19 (A) An analysis of the patient outcomes 

20 and the costs of furnishing care to the Medicare 

21 beneficiaries who are English learners partici22 pating in the project as compared to such out23 comes and costs for such Medicare beneficiaries 

24 not participating, based on the data provided 


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1 under paragraph (9) and any other information 

2 available to the Secretary. 

3 (B) The effect of delivering language serv4 ices on— 

5 (i) Medicare beneficiary access to care 

6 and utilization of services; 

7 (ii) the efficiency and cost effective8 ness of health care delivery; 

9 (iii) patient satisfaction; 

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) ENGLISH LEARNER DEFINED.—In this 

14 subsection, the term ‘‘English learner’’ has the 

15 meaning given such term in section 8101(20) of the 

16 Elementary and Secondary Education Act of 1965, 

17 except that subparagraphs (A), (B), and (D) of such 

18 section shall not apply. 

19 (b) LANGUAGE ASSISTANCE SERVICES UNDER THE

20 MEDICARE PROGRAM.— 

21 (1) INCLUSION AS RURAL HEALTH CLINIC

22 SERVICES.—Section 1861 of the Social Security Act 

23 (42 U.S.C. 1395x) is amended— 

24 (A) in subsection (aa)(1)— 


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1 (i) in subparagraph (B), by striking 

2 ‘‘and’’ at the end; 

3 (ii) by adding ‘‘and’’ at the end of 

4 subparagraph (C); and 

5 (iii) by inserting after subparagraph 

6 (C) the following new subparagraph: 

7 ‘‘(D) language assistance services as defined in 

8 subsection (jjj)(1),’’; and 

9 (B) by adding at the end the following new 

10 subsection: 

11 ‘‘Language Assistance Services and Related Terms 

12 ‘‘(kkk)(1) The term ‘language assistance services’ 

13 means ‘language access’ or ‘language assistance services’ 

14 (as those terms are defined in section 3400 of the Public 

15 Health Service Act) furnished by a ‘qualified interpreter 

16 for an individual with limited English proficiency’ or a 

17 ‘qualified translator’ (as those terms are defined in such 

18 section 3400) to an ‘individual with limited English pro19 ficiency’ (as defined in such section 3400) or an ‘English 

20 learner’ (as defined in paragraph (2)). 

21 ‘‘(2) The term ‘English learner’ has the meaning 

22 given that term in section 8101(20) of the Elementary and 

23 Secondary Education Act of 1965, except that subpara24 graphs (A), (B), and (D) of such section shall not apply.’’. 


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1 (2) COVERAGE.—Section 1832(a)(2) of the So2 cial Security Act (42 U.S.C. 1395k(a)(2)) is amend3 ed— 

4 (A) by striking ‘‘and’’ at the end of sub5 paragraph (I); 

6 (B) by striking the period at the end of 

7 subparagraph (J) and inserting ‘‘; and’’; and 

8 (C) by adding at the end the following new 

9 subparagraph: 

10 ‘‘(K) language assistance services (as de11 fined in section 1861(jjj)(1)).’’. 

12 (3) PAYMENT.—Section 1833(a) of the Social 

13 Security Act (42 U.S.C. 1395l(a)) is amended— 

14 (A) by striking ‘‘and’’ at the end of para15 graph (8); 

16 (B) by striking the period at the end of 

17 paragraph (9) and inserting ‘‘; and’’; and 

18 (C) by inserting after paragraph (9) the 

19 following new paragraph: 

20 ‘‘(10) in the case of language assistance serv21 ices (as defined in section 1861(jjj)(1)), 100 percent 

22 of the reasonable charges for such services, as deter23 mined in consultation with the Medicare Payment 

24 Advisory Commission.’’. 


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1 (4) WAIVER OF BUDGET NEUTRALITY.—For 

2 the 3-year period beginning on the date of enact3 ment of this section, the budget neutrality provision 

4 of section 1848(c)(2)(B)(ii) of the Social Security 

5 Act (42 U.S.C. 1395w–4(c)(2)(B)(ii)) shall not 

6 apply with respect to language assistance services 

7 (as defined in section 1861(kkk)(1) of such Act). 

8 (c) MEDICARE PARTS C AND D.— 

9 (1) IN GENERAL.—Medicare Advantage plans 

10 under part C of title XVIII of the Social Security 

11 Act (42 U.S.C. 1395w–21 et seq.) and prescription 

12 drug plans under part D of such title (42 U.S.C. 

13 1395q–101) shall comply with title VI of the Civil 

14 Rights Act of 1964 (42 U.S.C. 2000d et seq.) and 

15 section 1557 of the Patient Protection and Afford16 able Care Act (42 U.S.C. 18116) to provide effective 

17 language services to enrollees of such plans. 

18 (2) MEDICARE ADVANTAGE PLANS AND PRE19 SCRIPTION DRUG PLANS REPORTING REQUIRE20 MENT.—Section 1857(e) of the Social Security Act 

21 (42 U.S.C. 1395w–27(e)) is amended by adding at 

22 the end the following new paragraph: 

23 ‘‘(5) REPORTING REQUIREMENTS RELATING TO

24 EFFECTIVE LANGUAGE SERVICES.—A contract under 

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1 zation (and, through application of section 1860D– 

2 12(b)(3)(D), a contract under section 1860D–12 

3 shall require a PDP sponsor) to annually submit 

4 (for each year of the contract) a report that contains 

5 information on the internal policies and procedures 

6 of the organization (or sponsor) related to recruit7 ment and retention efforts directed to workforce di8 versity and linguistically and culturally appropriate 

9 provision of services in each of the following con10 texts: 

11 ‘‘(A) The collection of data in a manner 

12 that meets the requirements of title I of the 

13 Ending Health Disparities During COVID–19 

14 Act of 2020, regarding the enrollee population. 

15 ‘‘(B) Education of staff and contractors 

16 who have routine contact with enrollees regard17 ing the various needs of the diverse enrollee 

18 population. 

19 ‘‘(C) Evaluation of the language services 

20 programs and services offered by the organiza21 tion (or sponsor) with respect to the enrollee 

22 population, such as through analysis of com23 plaints or satisfaction survey results. 


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1 ‘‘(D) Methods by which the plan provides 

2 to the Secretary information regarding the eth3 nic diversity of the enrollee population. 

4 ‘‘(E) The periodic provision of educational 

5 information to plan enrollees on the language 

6 services and programs offered by the organiza7 tion (or sponsor).’’. 

8 (d) IMPROVING LANGUAGE SERVICES IN MEDICAID

9 AND CHIP.— 

10 (1) PAYMENTS TO STATES.—Section 

11 1903(a)(2)(E) of the Social Security Act (42 U.S.C. 

12 1396b(a)(2)(E)), as amended by section 203(g)(3), 

13 is further amended by— 

14 (A) striking ‘‘75’’ and inserting ‘‘95’’; 

15 (B) striking ‘‘translation or interpretation 

16 services’’ and inserting ‘‘language assistance 

17 services’’; and 

18 (C) striking ‘‘children of families’’ and in19 serting ‘‘individuals’’. 

20 (2) STATE PLAN REQUIREMENTS.—Section 

21 1902(a)(10)(A) of the Social Security Act (42 

22 U.S.C. 1396a(a)(10)(A)) is amended by striking 

23 ‘‘and (29)’’ and inserting ‘‘(29), and (30)’’. 


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1 (3) DEFINITION OF MEDICAL ASSISTANCE.— 

2 Section 1905(a) of the Social Security Act (42 

3 U.S.C. 1396d(a)) is amended by— 

4 (A) in paragraph (29), by striking ‘‘and’’ 

5 at the end; 

6 (B) by redesignating paragraph (30) as 

7 paragraph (31); and 

8 (C) by inserting after paragraph (29) the 

9 following new paragraph: 

10 ‘‘(30) language assistance services, as such 

11 term is defined in section 1861(kkk)(1), provided in 

12 a timely manner to individuals with limited English 

13 proficiency as defined in section 3400 of the Public 

14 Health Service Act; and’’. 

15 (4) USE OF DEDUCTIONS AND COST SHAR16 ING.—Section 1916(a)(2) of the Social Security Act 

17 (42 U.S.C. 1396o(a)(2)) is amended by— 

18 (A) by striking ‘‘or’’ at the end of subpara19 graph (D); 

20 (B) by striking ‘‘; and’’ at the end of sub21 paragraph (E) and inserting ‘‘, or’’; and 

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

23 subparagraph: 

24 ‘‘(F) language assistance services described 

25 in section 1905(a)(29); and’’. 


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1 (5) CHIP COVERAGE REQUIREMENTS.—Section 

2 2103 of the Social Security Act (42 U.S.C. 1397cc) 

3 is amended— 

4 (A) in subsection (a), in the matter before 

5 paragraph (1), by striking ‘‘and (7)’’ and in6 serting ‘‘(7), and (10)’’; and 

7 (B) in subsection (c), by adding at the end 

8 the following new paragraph: 

9 ‘‘(10) LANGUAGE ASSISTANCE SERVICES.—The 

10 child health assistance provided to a targeted low-in11 come child shall include coverage of language assist12 ance services, as such term is defined in section 

13 1861(jjj)(1), provided in a timely manner to individ14 uals with limited English proficiency (as defined in 

15 section 3400 of the Public Health Service Act).’’; 

16 and 

17 (C) in subsection (e)(2)— 

18 (i) in the heading, by striking ‘‘PRE19 VENTIVE’’ and inserting ‘‘CERTAIN’’; and 

20 (ii) by inserting ‘‘or subsection 

21 (c)(10)’’ after ‘‘subsection (c)(1)(D)’’. 

22 (6) DEFINITION OF CHILD HEALTH ASSIST23 ANCE.—Section 2110(a)(27) of the Social Security 

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1 ing ‘‘translation’’ and inserting ‘‘language assistance 

2 services as described in section 2103(c)(10)’’. 

3 (7) STATE DATA COLLECTION.—Pursuant to 

4 the reporting requirement described in section 

5 2107(b)(1) of the Social Security Act (42 U.S.C. 

6 1397gg(b)(1)), the Secretary of Health and Human 

7 Services shall require that States collect data on— 

8 (A) the primary language of individuals re9 ceiving child health assistance under title XXI 

10 of the Social Security Act (42 U.S.C. 1397aa et 

11 seq.); and 

12 (B) in the case of such individuals who are 

13 minors or incapacitated, the primary language 

14 of the individual’s parent or guardian. 

15 (8) CHIP PAYMENTS TO STATES.—Section 

16 2105 of the Social Security Act (42 U.S.C. 1397ee) 

17 is amended— 

18 (A) in subsection (a)(1), by striking ‘‘75’’ 

19 and inserting ‘‘90’’; and 

20 (B) in subsection (c)(2)(A), by inserting 

21 before the period at the end the following: ‘‘, 

22 except that expenditures pursuant to clause (iv) 

23 of subparagraph (D) of such paragraph shall 

24 not count towards this total’’. 


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1 (e) FUNDING LANGUAGE ASSISTANCE SERVICES

2 FURNISHED BY PROVIDERS OF HEALTH CARE AND

3 HEALTH-CARE-RELATED SERVICES THAT SERVE HIGH

4 RATES OF UNINSURED LEP INDIVIDUALS.— 

5 (1) PAYMENT OF COSTS.— 

6 (A) IN GENERAL.—Subject to subpara7 graph (B), the Secretary of Health and Human 

8 Services (referred to in this subsection as the 

9 ‘‘Secretary’’) shall make payments (on a quar10 terly basis) directly to eligible entities to sup11 port the provision of language assistance serv12 ices to English learners in an amount equal to 

13 an eligible entity’s eligible costs for providing 

14 such services for the quarter. 

15 (B) FUNDING.—Out of any funds in the 

16 Treasury not otherwise appropriated, there are 

17 appropriated to the Secretary of Health and 

18 Human Services such sums as may be nec19 essary for each of fiscal years 2021 through 

20 2025. 

21 (C) RELATION TO MEDICAID DSH.—Pay22 ments under this subsection shall not offset or 

23 reduce payments under section 1923 of the So24 cial Security Act (42 U.S.C. 1396r–4), nor 

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1 ered when determining uncompensated costs as2 sociated with the provision of language assist3 ance services for the purposes of this section. 

4 (2) METHODOLOGY FOR PAYMENT OF

5 CLAIMS.— 

6 (A) IN GENERAL.—The Secretary shall es7 tablish a methodology to determine the average 

8 per person cost of language assistance services. 

9 (B) DIFFERENT ENTITIES.—In estab10 lishing such methodology, the Secretary may es11 tablish different methodologies for different 

12 types of eligible entities. 

13 (C) NO INDIVIDUAL CLAIMS.—The Sec14 retary may not require eligible entities to sub15 mit individual claims for language assistance 

16 services for individual patients as a requirement 

17 for payment under this subsection. 

18 (3) DATA COLLECTION INSTRUMENT.—For pur19 poses of this subsection, the Secretary shall create a 

20 standard data collection instrument that is con21 sistent with any existing reporting requirements by 

22 the Secretary or relevant accrediting organizations 

23 regarding the number of individuals to whom lan24 guage access are provided. 


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1 (4) GUIDELINES.—Not later than 6 months 

2 after the date of enactment of this Act, the Sec3 retary shall establish and distribute guidelines con4 cerning the implementation of this subsection. 

5 (5) REPORTING REQUIREMENTS.— 

6 (A) REPORT TO SECRETARY.—Entities re7 ceiving payment under this subsection shall pro8 vide the Secretary with a quarterly report on 

9 how the entity used such funds. Such report 

10 shall contain aggregate (and may not contain 

11 individualized) data collected using the instru12 ment under paragraph (3) and shall otherwise 

13 be in a form and manner determined by the 

14 Secretary. 

15 (B) REPORT TO CONGRESS.—Not later 

16 than 2 years after the date of enactment of this 

17 Act, and every 2 years thereafter, the Secretary 

18 shall submit a report to Congress concerning 

19 the implementation of this subsection. 

20 (6) DEFINITIONS.—In this subsection: 

21 (A) ELIGIBLE COSTS.—The term ‘‘eligible 

22 costs’’ means, with respect to an eligible entity 

23 that provides language assistance services to 

24 English learners, the product of— 


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1 (i) the average per person cost of lan2 guage assistance services, determined ac3 cording to the methodology devised under 

4 paragraph (2); and 

5 (ii) the number of English learners 

6 who are provided language assistance serv7 ices by the entity and for whom no reim8 bursement is available for such services 

9 under the amendments made by sub10 sections (a), (b), (c), or (d) or by private 

11 health insurance. 

12 (B) ELIGIBLE ENTITY.—The term ‘‘eligible 

13 entity’’ means an entity that— 

14 (i) is a Medicaid provider that is— 

15 (I) a physician; 

16 (II) a hospital with a low-income 

17 utilization rate (as defined in section 

18 1923(b)(3) of the Social Security Act 

19 (42 U.S.C. 1396r–4(b)(3))) of greater 

20 than 25 percent; or 

21 (III) a Federally qualified health 

22 center (as defined in section 

23 1905(l)(2)(B) of the Social Security 

24 Act (42 U.S.C. 1396d(l)(2)(B))); 


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1 (ii) not later than 6 months after the 

2 date of the enactment of this Act, provides 

3 language assistance services to not less 

4 than 8 percent of the entity’s total number 

5 of patients; and 

6 (iii) prepares and submits an applica7 tion to the Secretary, at such time, in such 

8 manner, and accompanied by such infor9 mation as the Secretary may require, to 

10 ascertain the entity’s eligibility for funding 

11 under this subsection. 

12 (C) ENGLISH LEARNER.—The term 

13 ‘‘English learner’’ has the meaning given such 

14 term in section 8101(20) of the Elementary 

15 and Secondary Education Act of 1965 (20 

16 U.S.C. 7801(20)), except that subparagraphs 

17 (A), (B), and (D) of such section shall not 

18 apply. 

19 (D) LANGUAGE ASSISTANCE SERVICES.— 

20 The term ‘‘language assistance services’’ has 

21 the meaning given such term in section 

22 1861(kkk)(1) of the Social Security Act, as 

23 added by subsection (b). 

24 (f) APPLICATION OF CIVIL RIGHTS ACT OF 1964, 

25 SECTION 1557 OF THE AFFORDABLE CARE ACT, AND


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1 OTHER LAWS.—Nothing in this section shall be construed 

2 to limit otherwise existing obligations of recipients of Fed3 eral financial assistance under title VI of the Civil Rights 

4 Act of 1964 (42 U.S.C. 2000d et seq.), section 1557 of 

5 the Affordable Care Act, or other laws that protect the 

6 civil rights of individuals. 

7 (g) EFFECTIVE DATE.— 

8 (1) IN GENERAL.—Except as otherwise pro9 vided and subject to paragraph (2), the amendments 

10 made by this section shall take effect on January 1, 

11 2021. 

12 (2) EXCEPTION IF STATE LEGISLATION RE13 QUIRED.—In the case of a State plan for medical as14 sistance under title XIX of the Social Security Act 

15 (42 U.S.C. 1396 et seq.) which the Secretary of 

16 Health and Human Services determines requires 

17 State legislation (other than legislation appro18 priating funds) in order for the plan to meet the ad19 ditional requirement imposed by the amendments 

20 made by this section, the State plan shall not be re21 garded as failing to comply with the requirements of 

22 such title solely on the basis of its failure to meet 

23 this additional requirement before the first day of 

24 the first calendar quarter beginning after the close 

25 of the first regular session of the State legislature 


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1 that begins after the date of the enactment of this 

2 Act. For purposes of the previous sentence, in the 

3 case of a State that has a 2-year legislative session, 

4 each year of such session shall be deemed to be a 

5 separate regular session of the State legislature. 

6 SEC. 705. REQUIREMENTS FOR HEALTH PROGRAMS OR AC7 TIVITIES RECEIVING FEDERAL FUNDS. 

8 (a) COVERED ENTITY; COVERED PROGRAM OR AC9 TIVITY.—In this section— 

10 (1) the term ‘‘covered entity’’ has the meaning 

11 given such term in section 92.4 of title 42, Code of 

12 Federal Regulations, as in effect on May 16, 2016; 

13 and 

14 (2) the term ‘‘covered program or activity’’ has 

15 the meaning given such term in section 92.4 of title 

16 42, Code of Federal Regulations, as in effect on May 

17 16, 2016. 

18 (b) REQUIREMENTS.—A covered entity, in order to 

19 ensure the right of individuals with limited English pro20 ficiency to receive access to high-quality health care 

21 through the covered program or activity, shall— 

22 (1) ensure that appropriate clinical and support 

23 staff receive ongoing education and training in cul24 turally and linguistically appropriate service delivery; 


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1 (2) offer and provide appropriate language as2 sistance services at no additional charge to each pa3 tient that is an individual with limited English pro4 ficiency at all points of contact, in a timely manner 

5 during all hours of operation; 

6 (3) notify patients of their right to receive lan7 guage services in their primary language; and 

8 (4) utilize only qualified interpreters for an in9 dividual with limited English proficiency or qualified 

10 translators, except as provided in subsection (c). 

11 (c) EXEMPTIONS.—The requirements of subsection 

12 (b)(4) shall not apply as follows: 

13 (1) When a patient requests the use of family, 

14 friends, or other persons untrained in interpretation 

15 or translation if each of the following conditions are 

16 met: 

17 (A) The interpreter requested by the pa18 tient is over the age of 18. 

19 (B) The covered entity informs the patient 

20 in the primary language of the patient that he 

21 or she has the option of having the entity pro22 vide to the patient an interpreter and trans23 lation services without charge. 

24 (C) The covered entity informs the patient 

25 that the entity may not require an individual 


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1 with a limited English proficiency to use a fam2 ily member or friend as an interpreter. 

3 (D) The covered entity evaluates whether 

4 the person the patient wishes to use as an in5 terpreter is competent. If the covered entity has 

6 reason to believe that such person is not com7 petent as an interpreter, the entity provides its 

8 own interpreter to protect the covered entity 

9 from liability if the patient’s interpreter is later 

10 found not competent. 

11 (E) If the covered entity has reason to be12 lieve that there is a conflict of interest between 

13 the interpreter and patient, the covered entity 

14 may not use the patient’s interpreter. 

15 (F) The covered entity has the patient sign 

16 a waiver, witnessed by at least 1 individual not 

17 related to the patient, that includes the infor18 mation stated in subparagraphs (A) through 

19 (E) and is translated into the patient’s primary 

20 language. 

21 (2) When a medical emergency exists and the 

22 delay directly associated with obtaining competent 

23 interpreter or translation services would jeopardize 

24 the health of the patient, but only until a competent 

25 interpreter or translation service is available. 


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1 (d) RULE OF CONSTRUCTION.—Subsection (c)(2) 

2 shall not be construed to mean that emergency rooms or 

3 similar entities that regularly provide health care services 

4 in medical emergencies are exempt from legal or regu5 latory requirements related to competent interpreter serv6 ices. 

7 SEC. 706. REPORT ON FEDERAL EFFORTS TO PROVIDE CUL8 TURALLY AND LINGUISTICALLY APPRO9 PRIATE HEALTH CARE SERVICES. 

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

11 of enactment of this Act and annually thereafter, the Sec12 retary of Health and Human Services shall enter into a 

13 contract with the National Academy of Medicine for the 

14 preparation and publication of a report that describes 

15 Federal efforts to ensure that all individuals with limited 

16 English proficiency have meaningful access to health care 

17 services and health-care-related services that are culturally 

18 and linguistically appropriate. Such report shall include— 

19 (1) a description and evaluation of the activities 

20 carried out under this Act; 

21 (2) a description and analysis of best practices, 

22 model programs, guidelines, and other effective 

23 strategies for providing access to culturally and lin24 guistically appropriate health care services; 


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1 (3) recommendations on the development and 

2 implementation of policies and practices by providers 

3 of health care services and health-care-related serv4 ices for individuals with limited English proficiency, 

5 including people with cognitive, hearing, vision, or 

6 print impairments; 

7 (4) recommend guidelines or standards for 

8 health literacy and plain language, informed consent, 

9 discharge instructions, and written communications, 

10 and for improvement of health care access; 

11 (5) a description of the effect of providing lan12 guage services on quality of health care and access 

13 to care; and 

14 (6) a description of the costs associated with or 

15 savings related to the provision of language services. 

16 (b) AUTHORIZATION OF APPROPRIATIONS.—There 

17 are authorized to be appropriated to carry out this section 

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

19 2021 through 2025. 

20 SEC. 707. HEALTH PROFESSIONS COMPETENCIES TO AD21 DRESS RACIAL AND ETHNIC MENTAL HEALTH 

22 DISPARITIES. 

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 curricula or core 

5 competencies addressing mental health inequities 

6 among racial and ethnic minority groups for use in 

7 the training of students in the professions of social 

8 work, psychology, psychiatry, marriage and family 

9 therapy, mental health counseling, peer support, and 

10 substance abuse counseling; and 

11 (2) certifying community health workers and 

12 peer wellness specialists with respect to such cur13 ricula and core competencies and integrating and ex14 panding the use of such workers and specialists into 

15 health care and community-based settings to address 

16 mental health disparities among racial and ethnic 

17 minority groups. 

18 (b) CURRICULA; CORE COMPETENCIES.—Organiza19 tions receiving funds under subsection (a) may use the 

20 funds to engage in the following activities related to the 

21 development and dissemination of curricula or core com22 petencies described in subsection (a)(1): 

23 (1) Formation of committees or working groups 

24 comprised of experts from accredited health profes25 sions schools to identify core competencies relating 


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1 to mental health disparities among racial and ethnic 

2 minority groups. 

3 (2) Planning of workshops in national fora to 

4 allow for public input, including input from commu5 nities of color with lived experience, into the edu6 cational needs associated with mental health dispari7 ties among racial and ethnic minority groups. 

8 (3) Dissemination and promotion of the use of 

9 curricula or core competencies in undergraduate and 

10 graduate health professions training programs na11 tionwide. 

12 (4) Establishing external stakeholder advisory 

13 boards to provide meaningful input into policy and 

14 program development and best practices to reduce 

15 mental health inequities among racial and ethnic 

16 groups, including participation from communities of 

17 color with lived experience of the impacts of mental 

18 health disparities. 

19 (c) DEFINITIONS.—In this section: 

20 (1) QUALIFIED NATIONAL ORGANIZATION.—The 

21 term ‘‘qualified national organization’’ means a na22 tional organization that focuses on the education of 

23 students in programs of social work, occupational 

24 therapy, psychology, psychiatry, and marriage and 

25 family therapy. 


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1 (2) RACIAL AND ETHNIC MINORITY GROUP.— 

2 The term ‘‘racial and ethnic minority group’’ has the 

3 meaning given to such term in section 1707(g) of 

4 the Public Health Service Act (42 U.S.C. 300u– 

5 6(g)). 

6 (d) 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 2021 through 2025. 

10 SEC. 708. STUDY ON THE UNINSURED. 

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

12 Human Services (in this section referred to as the ‘‘Sec13 retary’’) shall— 

14 (1) conduct a study, in accordance with the 

15 standards under section 3101 of the Public Health 

16 Service Act (42 U.S.C. 300kk), on the demographic 

17 characteristics of the population of individuals who 

18 do not have health insurance coverage or oral health 

19 coverage; and 

20 (2) predict, based on such study, the demo21 graphic characteristics of the population of individ22 uals who would remain without health insurance cov23 erage after the end of any annual open enrollment 

24 or any special enrollment period or upon enactment 

25 and implementation of any legislative changes to the 


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1 Patient Protection and Affordable Care Act (Public 

2 Law 111–148) that affect the number of persons eli3 gible for coverage. 

4 (b) REPORTING REQUIREMENTS.— 

5 (1) IN GENERAL.—Not later than 12 months 

6 after the date of the enactment of this Act, the Sec7 retary shall submit to the Congress the results of 

8 the study under subsection (a)(1) and the prediction 

9 made under subsection (a)(2). 

10 (2) REPORTING OF DEMOGRAPHIC CHARACTER11 ISTICS.—The Secretary shall— 

12 (A) report the demographic characteristics 

13 under paragraphs (1) and (2) of subsection (a) 

14 on the basis of racial and ethnic group, and 

15 shall stratify the reporting on each racial and 

16 ethnic group by other demographic characteris17 tics that can impact access to health insurance 

18 coverage, such as sexual orientation, gender 

19 identity, primary language, disability status, 

20 sex, socioeconomic status, age group, and citi21 zenship and immigration status, in a manner 

22 consistent with title I of this Act, including the 

23 amendments made by such title; and 

24 (B) not use such report to engage in or an25 ticipate any deportation or immigration related 


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1 enforcement action by any entity, including the 

2 Department of Homeland Security. 

3 TITLE VIII—AID TO PROVIDERS 

4 SERVING MINORITY COMMU5 NITIES 

6 SEC. 801. TEMPORARY INCREASE IN MEDICAID DSH ALLOT7 MENTS. 

8 (a) IN GENERAL.—Section 1923(f)(3) of the Social 

9 Security Act (42 U.S.C. 1396r–4(f)(3)) is amended— 

10 (1) in subparagraph (A), by striking ‘‘and sub11 paragraph (E)’’ and inserting ‘‘and subparagraphs 

12 (E) and (F)’’; and 

13 (2) by adding at the end the following new sub14 paragraph: 

15 ‘‘(F) TEMPORARY INCREASE IN ALLOT16 MENTS DURING CERTAIN PUBLIC HEALTH

17 EMERGENCY.—The DSH allotment for any 

18 State for each of fiscal years 2020 and 2021 is 

19 equal to 102.5 percent of the DSH allotment 

20 that would be determined under this paragraph 

21 for the State for each respective fiscal year 

22 without application of this subparagraph, not23 withstanding subparagraphs (B) and (C). For 

24 each fiscal year after fiscal year 2021, the DSH 

25 allotment for a State for such fiscal year is 


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1 equal to the DSH allotment that would have 

2 been determined under this paragraph for such 

3 fiscal year if this subparagraph had not been 

4 enacted.’’. 

5 (b) DSH ALLOTMENT ADJUSTMENT FOR TEN6 NESSEE.—Section 1923(f)(6)(A)(vi) of the Social Security 

7 Act (42 U.S.C. 1396r–4(f)(6)(A)(vi)) is amended— 

8 (1) by striking ‘‘Notwithstanding any other pro9 vision of this subsection’’ and inserting the fol10 lowing: 

11 ‘‘(I) IN GENERAL.—Notwith12 standing any other provision of this 

13 subsection (except as provided in sub14 clause (II) of this clause)’’; and 

15 (2) by adding at the end the following: 

16 ‘‘(II) TEMPORARY INCREASE IN

17 ALLOTMENTS.—The DSH allotment 

18 for Tennessee for each of fiscal years 

19 2020 and 2021 shall be equal to 

20 $54,427,500.’’. 

21 (c) SENSE OF CONGRESS.—It is the sense of Con22 gress that a State should prioritize making payments 

23 under the State plan of the State under title XIX of the 

24 Social Security Act (42 U.S.C. 1396 et seq.) (or a waiver 

25 of such plan) to disproportionate share hospitals that have 


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1 a higher share of COVID–19 patients relative to other 

2 such hospitals in the State. 

3 SEC. 802. COVID–19-RELATED TEMPORARY INCREASE OF 

4 MEDICAID FMAP. 

5 (a) IN GENERAL.—Section 6008 of the Families 

6 First Coronavirus Response Act (42 U.S.C. 1396d note) 

7 is amended— 

8 (1) in subsection (a)— 

9 (A) by inserting ‘‘(or, if later, June 30, 

10 2021)’’ after ‘‘last day of such emergency pe11 riod occurs’’; and 

12 (B) by striking ‘‘6.2 percentage points.’’ 

13 and inserting ‘‘the percentage points specified 

14 in subsection (e). In no case may the applica15 tion of this section result in the Federal medical 

16 assistance percentage determined for a State 

17 being more than 95 percent.’’; and 

18 (2) by adding at the end the following new sub19 sections: 

20 ‘‘(e) SPECIFIED PERCENTAGE POINTS.—For pur21 poses of subsection (a), the percentage points specified in 

22 this subsection are— 

23 ‘‘(1) for each calendar quarter occurring during 

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1 tion 1135(g) of the Social Security Act (42 U.S.C. 

2 1320b–5(g)) and ending on June 30, 2020, 6.2 per3 centage points; 

4 ‘‘(2) for each calendar quarter occurring during 

5 the period beginning on July 1, 2020, and ending on 

6 June 30, 2021, 14 percentage points; and 

7 ‘‘(3) for each calendar quarter, if any, occurring 

8 during the period beginning on July 1, 2021, and 

9 ending on the last day of the calendar quarter in 

10 which the last day of such emergency period occurs, 

11 6.2 percentage points. 

12 ‘‘(f) CLARIFICATIONS.— 

13 ‘‘(1) In the case of a State that treats an indi14 vidual described in subsection (b)(3) as eligible for 

15 the benefits described in such subsection, for the pe16 riod described in subsection (a), expenditures for 

17 medical assistance and administrative costs attrib18 utable to such individual that would not otherwise be 

19 included as expenditures under section 1903 of the 

20 Social Security Act shall be regarded as expendi21 tures under the State plan approved under title XIX 

22 of the Social Security Act or for administration of 

23 such State plan. 

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1 curity Act (42 U.S.C. 1308) shall not apply to Fed2 eral payments made under section 1903(a)(1) of the 

3 Social Security Act (42 U.S.C. 1396b(a)(1)) attrib4 utable to the increase in the Federal medical assist5 ance percentage under this section. 

6 ‘‘(3) Expenditures attributable to the increased 

7 Federal medical assistance percentage under this 

8 section shall not be counted for purposes of the limi9 tations under section 2104(b)(4) of such Act (42 

10 U.S.C. 1397dd(b)(4)). 

11 ‘‘(4) Notwithstanding the first sentence of sec12 tion 2105(b) of the Social Security Act (42 U.S.C. 

13 1397ee(b)), the application of the increase under 

14 this section may result in the enhanced FMAP of a 

15 State for a fiscal year under such section exceeding 

16 85 percent, but in no case may the application of 

17 such increase before application of the second sen18 tence of such section result in the enhanced FMAP 

19 of the State exceeding 95 percent. 

20 ‘‘(g) SCOPE OF APPLICATION.—An increase in the 

21 Federal medical assistance percentage for a State under 

22 this section shall not be taken into account for purposes 

23 of payments under part D of title IV of the Social Security 

24 Act (42 U.S.C. 651 et seq.).’’. 


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1 (b) EFFECTIVE DATE.—The amendments made by 

2 subsection (a) shall take effect and apply as if included 

3 in the enactment of section 6008 of the Families First 

4 Coronavirus Response Act (Public Law 116–127). 

5 SEC. 803. APPROPRIATION FOR PRIMARY HEALTH CARE. 

6 For an additional amount for ‘‘Department of Health 

7 and Human Services—Health Resources and Services Ad8 ministration—Primary Health Care’’, $7,600,000,000, to 

9 remain available until September 30, 2025, for necessary 

10 expenses to prevent, prepare for, and respond to 

11 coronavirus, for grants and cooperative agreements under 

12 the Health Centers Program, as defined by section 330 

13 of the Public Health Service Act, and for grants to Feder14 ally qualified health centers, as defined in section 

15 1861(aa)(4)(B) of the Social Security Act, and for eligible 

16 entities under the Native Hawaiian Health Care Improve17 ment Act, including maintenance or expansion of health 

18 center and system capacity and staffing levels: Provided, 

19 That sections 330(r)(2)(B), 330(e)(6)(A)(iii), and 

20 330(e)(6)(B)(iii) shall not apply to funds provided under 

21 this heading in this section: Provided further, That funds 

22 provided under this heading in this section may be used 

23 to (1) purchase equipment and supplies to conduct mobile 

24 testing for SARS–CoV–2 or COVID–19; (2) purchase and 

25 maintain mobile vehicles and equipment to conduct such 


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1 testing; and (3) hire and train laboratory personnel and 

2 other staff to conduct such mobile testing: Provided fur3 ther, That such amount is designated by the Congress as 

4 being for an emergency requirement pursuant to section 

5 251(b)(2)(A)(i) of the Balanced Budget and Emergency 

6 Deficit Control Act of 1985. 

7 SEC. 804. AMENDMENT TO THE PUBLIC HEALTH SERVICE 

8 ACT. 

9 Title XXXIV of the Public Health Service Act, as 

10 amended by sections 104 and 702, is further amended by 

11 adding at the following: 

12 ‘‘Subtitle C—Reconstruction and 

13 Improvement Grants for Public 

14 Health Care Facilities Serving 

15 Pacific Islanders and the Insu16 lar Areas 

17 ‘‘SEC. 3407. GRANT SUPPORT FOR QUALITY IMPROVEMENT 

18 INITIATIVES. 

19 ‘‘(a) IN GENERAL.—The Secretary, in collaboration 

20 with the Administrator of the Health Resources and Serv21 ices Administration, the Director of the Agency for 

22 Healthcare Research and Quality, and the Administrator 

23 of the Centers for Medicare & Medicaid Services, shall 

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1 onstration projects to improve the quality of and access 

2 to health care. 

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

4 under subsection (a), an entity shall— 

5 ‘‘(1) be a health center, hospital, health plan, 

6 health system, community clinic, or other health en7 tity determined appropriate by the Secretary— 

8 ‘‘(A) that, by legal mandate or explicitly 

9 adopted mission, provides patients with access 

10 to services regardless of their ability to pay; 

11 ‘‘(B) that provides care or treatment for a 

12 substantial number of patients who are unin13 sured, are receiving assistance under a State 

14 plan under title XIX of the Social Security Act 

15 (or under a waiver of such plan), or are mem16 bers of vulnerable populations, as determined 

17 by the Secretary; and 

18 ‘‘(C)(i) with respect to which, not less than 

19 50 percent of the entity’s patient population is 

20 made up of racial and ethnic minority groups; 

21 or 

22 ‘‘(ii) that— 

23 ‘‘(I) serves a disproportionate percent24 age of local patients that are from a racial 

25 and ethnic minority group, or that has a 


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1 patient population, at least 50 percent of 

2 which is composed of individuals with lim3 ited English proficiency; and 

4 ‘‘(II) provides an assurance that 

5 amounts received under the grant will be 

6 used only to support quality improvement 

7 activities in the racial and ethnic minority 

8 population served; and 

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

10 application at such time, in such manner, and con11 taining such information as the Secretary may re12 quire. 

13 ‘‘(c) PRIORITY.—In awarding grants under sub14 section (a), the Secretary shall give priority to applicants 

15 under subsection (b)(2) that— 

16 ‘‘(1) demonstrate an intent to operate as part 

17 of a health care partnership, network, collaborative, 

18 coalition, or alliance where each member entity con19 tributes to the design, implementation, and evalua20 tion of the proposed intervention; or 

21 ‘‘(2) intend to use funds to carry out system22 wide changes with respect to health care quality im23 provement, including— 

24 ‘‘(A) improved systems for data collection 

25 and reporting; 


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1 ‘‘(B) innovative collaborative or similar 

2 processes; 

3 ‘‘(C) group programs with behavioral or 

4 self-management interventions; 

5 ‘‘(D) case management services; 

6 ‘‘(E) physician or patient reminder sys7 tems; 

8 ‘‘(F) educational interventions; or 

9 ‘‘(G) other activities determined appro10 priate by the Secretary. 

11 ‘‘(d) USE OF FUNDS.—An entity shall use amounts 

12 received under a grant under subsection (a) to support 

13 the implementation and evaluation of health care quality 

14 improvement activities or minority health and health care 

15 disparity reduction activities that include— 

16 ‘‘(1) with respect to health care systems, activi17 ties relating to improving— 

18 ‘‘(A) patient safety; 

19 ‘‘(B) timeliness of care; 

20 ‘‘(C) effectiveness of care; 

21 ‘‘(D) efficiency of care; 

22 ‘‘(E) patient centeredness; and 

23 ‘‘(F) health information technology; and 

24 ‘‘(2) with respect to patients, activities relating 

25 to— 


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1 ‘‘(A) staying healthy; 

2 ‘‘(B) getting well, mentally and physically; 

3 ‘‘(C) living effectively with illness or dis4 ability; 

5 ‘‘(D) coping with end-of-life issues; and 

6 ‘‘(E) shared decision making. 

7 ‘‘(e) COMMON DATA SYSTEMS.—The Secretary shall 

8 provide financial and other technical assistance to grant9 ees under this section for the development of common data 

10 systems. 

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 2021 through 2026. 

15 ‘‘SEC. 3408. CENTERS OF EXCELLENCE. 

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

17 the Administrator of the Health Resources and Services 

18 Administration, shall designate centers of excellence at 

19 public hospitals, and other health systems serving large 

20 numbers of minority patients, that— 

21 ‘‘(1) meet the requirements of section 

22 3451(b)(1); 

23 ‘‘(2) demonstrate excellence in providing care to 

24 minority populations; and 


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1 ‘‘(3) demonstrate excellence in reducing dispari2 ties in health and health care. 

3 ‘‘(b) REQUIREMENTS.—A hospital or health system 

4 that serves as a center of excellence under subsection (a) 

5 shall— 

6 ‘‘(1) design, implement, and evaluate programs 

7 and policies relating to the delivery of care in ra8 cially, ethnically, and linguistically diverse popu9 lations; 

10 ‘‘(2) provide training and technical assistance 

11 to other hospitals and health systems relating to the 

12 provision of quality health care to minority popu13 lations; and 

14 ‘‘(3) develop activities for graduate or con15 tinuing medical education that institutionalize a 

16 focus on cultural competence training for health care 

17 providers. 

18 ‘‘(c) 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 2021 through 2026. 


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1 ‘‘SEC. 3409. RECONSTRUCTION AND IMPROVEMENT GRANTS 

2 FOR PUBLIC HEALTH CARE FACILITIES SERV3 ING PACIFIC ISLANDERS AND THE INSULAR 

4 AREAS. 

5 ‘‘(a) IN GENERAL.—The Secretary shall provide di6 rect financial assistance to designated health care pro7 viders and community health centers in American Samoa, 

8 Guam, the Commonwealth of the Northern Mariana Is9 lands, the United States Virgin Islands, Puerto Rico, and 

10 Hawaii for the purposes of reconstructing and improving 

11 health care facilities and services in a culturally competent 

12 and sustainable manner. 

13 ‘‘(b) ELIGIBILITY.—To be eligible to receive direct fi14 nancial assistance under subsection (a), an entity shall be 

15 a public health facility or community health center located 

16 in American Samoa, Guam, the Commonwealth of the 

17 Northern Mariana Islands, the United States Virgin Is18 lands, Puerto Rico, or Hawaii that— 

19 ‘‘(1) is owned or operated by— 

20 ‘‘(A) the Government of American Samoa, 

21 Guam, the Commonwealth of the Northern 

22 Mariana Islands, the United States Virgin Is23 lands, Puerto Rico, or Hawaii or a unit of local 

24 government; or 

25 ‘‘(B) a nonprofit organization; and 


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1 ‘‘(2)(A) provides care or treatment for a sub2 stantial number of patients who are uninsured, re3 ceiving assistance under title XVIII of the Social Se4 curity Act, or a State plan under title XIX of such 

5 Act (or under a waiver of such plan), or who are 

6 members of a vulnerable population, as determined 

7 by the Secretary; or 

8 ‘‘(B) serves a disproportionate percentage of 

9 local patients that are from a racial and ethnic mi10 nority group. 

11 ‘‘(c) REPORT.—Not later than 180 days after the 

12 date of enactment of this title and annually thereafter, the 

13 Secretary shall submit to the Congress and the President 

14 a report that includes an assessment of health resources 

15 and facilities serving populations in American Samoa, 

16 Guam, the Commonwealth of the Northern Mariana Is17 lands, the United States Virgin Islands, Puerto Rico, and 

18 Hawaii. In preparing such report, the Secretary shall— 

19 ‘‘(1) consult with and obtain information on all 

20 health care facilities needs from the entities receiv21 ing direct financial assistance under subsection (a); 

22 ‘‘(2) include all amounts of Federal assistance 

23 received by each such entity in the preceding fiscal 

24 year; 


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1 ‘‘(3) review the total unmet needs of health care 

2 facilities serving American Samoa, Guam, the Com3 monwealth of the Northern Mariana Islands, the 

4 United States Virgin Islands, Puerto Rico, and Ha5 waii, including needs for renovation and expansion 

6 of existing facilities; 

7 ‘‘(4) include a strategic plan for addressing the 

8 needs of each such population identified in the re9 port; and 

10 ‘‘(5) evaluate the effectiveness of the care pro11 vided by measuring patient outcomes and cost meas12 ures. 

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

14 are authorized to be appropriated such sums as necessary 

15 to carry out this section.’’. 

16 SEC. 805. PANDEMIC PREMIUM PAY FOR ESSENTIAL WORK17 ERS. 

18 (a) IN GENERAL.— Beginning 3 days after an essen19 tial work employer receives a grant under section 806 

20 from the Secretary of the Treasury, the essential work em21 ployer shall— 

22 (1) be required to comply with subsections (b) 

23 through (h); and 

24 (2) be subject to the enforcement requirements 

25 of section 807. 


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1 (b) PANDEMIC PREMIUM PAY.— 

2 (1) IN GENERAL.—An essential work employer 

3 receiving a grant under section 806 shall, in accord4 ance with this subsection, provide each essential 

5 worker of the essential work employer with premium 

6 pay at a rate equal to $13 for each hour of work 

7 performed by the essential worker for the employer 

8 from January 27, 2020, until the date that is 60 

9 days after the last day of the COVID–19 Public 

10 Health Emergency. 

11 (2) MAXIMUM AMOUNTS.—The total amount of 

12 all premium pay under this subsection that an essen13 tial work employer is required to provide to an es14 sential worker, including through any retroactive 

15 payment under paragraph (3), shall not exceed— 

16 (A) for an essential worker who is not a 

17 highly-compensated essential worker, $10,000 

18 reduced by employer payroll taxes with respect 

19 to such premium pay; or 

20 (B) for a highly-compensated essential 

21 worker, $5,000 reduced by employer payroll 

22 taxes with respect to such premium pay. 

23 (3) RETROACTIVE PAYMENT.—For all work 

24 performed by an essential worker during the period 

25 from January 27, 2020, through the date on which 


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1 the essential work employer of the worker receives a 

2 grant under this title, the essential work employer 

3 shall use a portion of the amount of such grant to 

4 provide such worker with premium pay under this 

5 subsection for such work at the rate provided under 

6 paragraph (1). Such amount shall be provided to the 

7 essential worker as a lump sum in the next paycheck 

8 (or other payment form) that immediately follows 

9 the receipt of the grant by the essential work em10 ployer. In any case where it is impossible for the em11 ployer to arrange for payment of the amount due in 

12 such paycheck (or other payment form), such 

13 amounts shall be paid as soon as practicable, but in 

14 no event later than the second paycheck (or other 

15 payment form) following the receipt of the grant by 

16 the essential work employer. 

17 (4) NO EMPLOYER DISCRETION.—An essential 

18 work employer receiving a grant under section 806 

19 shall not have any discretion to determine which 

20 portions of work performed by an essential worker 

21 qualify for premium pay under this subsection, but 

22 shall pay such premium pay for any increment of 

23 time worked by the essential worker for the essential 

24 work employer up to the maximum amount applica25 ble to the essential worker under paragraph (2). 


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1 (c) PROHIBITION ON REDUCING COMPENSATION AND

2 DISPLACEMENT.— 

3 (1) IN GENERAL.—Any payments made to an 

4 essential worker as premium pay under subsection 

5 (b) shall be in addition to all other compensation, in6 cluding all wages, remuneration, or other pay and 

7 benefits, that the essential worker otherwise receives 

8 from the essential work employer. 

9 (2) REDUCTION OF COMPENSATION.—An essen10 tial work employer receiving a grant under section 

11 806 shall not, during the period beginning on the 

12 date of enactment of this Act and ending on the 

13 date that is 60 days after the last day of the 

14 COVID–19 Public Health Emergency, reduce or in 

15 any other way diminish, any other compensation, in16 cluding the wages, remuneration, or other pay or 

17 benefits, that the essential work employer provided 

18 to the essential worker on the day before the date 

19 of enactment of this Act. 

20 (3) DISPLACEMENT.—An essential work em21 ployer shall not take any action to displace an essen22 tial worker (including partial displacement such as a 

23 reduction in hours, wages, or employment benefits) 

24 for purposes of hiring an individual for an equivalent 

25 position at a rate of compensation that is less than 


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1 is required to be provided to an essential worker 

2 under paragraph (2). 

3 (d) DEMARCATION FROM OTHER COMPENSATION.— 

4 The amount of any premium pay paid under subsection 

5 (b) shall be clearly demarcated as a separate line item in 

6 each paystub or other document provided to an essential 

7 worker that details the remuneration the essential worker 

8 received from the essential work employer for a particular 

9 period of time. If any essential worker does not otherwise 

10 regularly receive any such paystub or other document from 

11 the employer, the essential work employer shall provide 

12 such paystub or other document to the essential worker 

13 for the duration of the period in which the essential work 

14 employer provides premium pay under subsection (b). 

15 (e) EXCLUSION FROM WAGE-BASED CALCULA16 TIONS.—Any premium pay under subsection (b) paid to 

17 an essential worker under this section by an essential work 

18 employer receiving a grant under section 806 shall be ex19 cluded from the amount of remuneration for work paid 

20 to the essential worker for purposes of— 

21 (1) calculating the essential worker’s eligibility 

22 for any wage-based benefits offered by the essential 

23 work employer; 

24 (2) computing the regular rate at which such 

25 essential worker is employed under section 7 of the 


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1 Fair Labor Standards Act of 1938 (29 U.S.C. 207); 

2 and 

3 (3) determining whether such essential worker 

4 is exempt from application of such section 7 under 

5 section 13(a)(1) of such Act (29 U.S.C. 213(a)(1)). 

6 (f) ESSENTIAL WORKER DEATH.— 

7 (1) IN GENERAL.—In any case in which an es8 sential worker of an essential work employer receiv9 ing a grant under section 806 exhibits symptoms of 

10 COVID–19 and dies, the essential work employer 

11 shall pay as a lump sum to the next of kin of the 

12 essential worker for premium pay under subsection 

13 (b)— 

14 (A) for an essential worker who is not a 

15 highly-compensated essential worker, the 

16 amount determined under subsection (b)(2)(A) 

17 minus the total amount of any premium pay the 

18 worker received under subsection (b) prior to 

19 the death; or 

20 (B) for a highly-compensated essential 

21 worker, the amount determined under sub22 section (b)(2)(B) minus the amount of any pre23 mium pay the worker received under subsection 

24 (b) prior to the death. 

25 (2) TREATMENT OF LUMP SUM PAYMENTS.— 


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1 (A) TREATMENT AS PREMIUM PAY.—For 

2 purposes of this title, any payment made under 

3 this subsection shall be treated as a premium 

4 pay under subsection (b). 

5 (B) TREATMENT FOR PURPOSES OF IN6 TERNAL REVENUE CODE OF 1986.—For pur7 poses of the Internal Revenue Code of 1986, 

8 any payment made under this subsection shall 

9 be treated as a payment for work performed by 

10 the essential worker. 

11 (g) APPLICATION TO SELF-DIRECTED CARE WORK12 ERS FUNDED THROUGH MEDICAID OR THE VETERAN-DI13 RECTED CARE PROGRAM.— 

14 (1) MEDICAID.—In the case of an essential 

15 work employer receiving a grant under section 806 

16 that is a covered employer described in paragraph 

17 (4) who, under a State Medicaid plan under title 

18 XIX of the Social Security Act (42 U.S.C. 1396 et 

19 seq.) or under a waiver of such plan, has opted to 

20 receive items or services using a self-directed service 

21 delivery model, the preceding requirements of this 

22 section, including the requirements to provide pre23 mium pay under subsection (b) (including a lump 

24 sum payment in the event of an essential worker 

25 death under subsection (f)) and the requirements of 


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1 sections 806 and 807, shall apply to the State Med2 icaid agency responsible for the administration of 

3 such plan or waiver with respect to self-directed care 

4 workers employed by that employer. In admin5 istering payments made under this title to such self6 directed care workers on behalf of such employers, 

7 a State Medicaid agency shall— 

8 (A) exclude and disregard any payments 

9 made under this title to such self-directed work10 ers from the individualized budget that applies 

11 to the items or services furnished to the indi12 vidual client employer under the State Medicaid 

13 plan or waiver; 

14 (B) to the extent practicable, administer 

15 and provide payments under this title directly 

16 to such self-directed workers through arrange17 ments with entities that provide financial man18 agement services in connection with the self-di19 rected service delivery models used under the 

20 State Medicaid plan or waiver; and 

21 (C) ensure that individual client employers 

22 of such self-directed workers are provided notice 

23 of, and comply with, the prohibition under sec24 tion 807(b)(1)(B). 


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1 (2) VETERAN-DIRECTED CARE PROGRAM.—In 

2 the case of an essential work employer that is a cov3 ered employer described in paragraph (4) who is a 

4 veteran participating in the Veteran Directed Care 

5 program administered by the VA Office of Geriatrics 

6 & Extended Care of the Veterans Health Adminis7 tration, the preceding requirements of this section 

8 and sections 806 and 807, shall apply to such VA 

9 Office of Geriatrics & Extended Care with respect to 

10 self-directed care workers employed by that em11 ployer. Paragraph (1) of this subsection shall apply 

12 to the administration by the VA Office of Geriatrics 

13 & Extended Care of payments made under this title 

14 to such self-directed care workers on behalf of such 

15 employers in the same manner as such requirements 

16 apply to State Medicaid agencies. 

17 (3) PENALTY ENFORCEMENT.—The Secretary 

18 of Labor shall consult with the Secretary of Health 

19 and Human Services and the Secretary of Veterans 

20 Affairs regarding the enforcement of penalties im21 posed under section 807(b)(2) with respect to viola22 tions of subparagraph (A) or (B) of section 

23 807(b)(1) that involve self-directed workers for 

24 which the requirements of this section and sections 

25 806 and 807 are applied to a State Medicaid agency 


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1 under paragraph (1) or the VA Office of Geriatrics 

2 & Extended Care under paragraph (2). 

3 (4) COVERED EMPLOYER DESCRIBED.—For 

4 purposes of paragraphs (1) and (2), a covered em5 ployer described in this paragraph means— 

6 (A) an entity or person that contracts di7 rectly with a State, locality, Tribal government, 

8 or the Federal Government, to provide care 

9 (which may include items and services) through 

10 employees of such entity or person to individ11 uals under the Medicare program under title 

12 XVIII of the Social Security Act (42 U.S.C. 

13 1395 et seq.), under a State Medicaid plan 

14 under title XIX of such Act (42 U.S.C. 1396 et 

15 seq.) or under a waiver of such plan, or under 

16 any other program established or administered 

17 by a State, locality, Tribal government, or the 

18 Federal Government; 

19 (B) a subcontractor of an entity or person 

20 described in subparagraph (A); 

21 (C) an individual client (or a representa22 tive on behalf of an individual client), an entity, 

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1 rected service delivery model through a program 

2 established or administered by a State, locality, 

3 Tribal government, or the Federal Government; 

4 or 

5 (D) an individual client (or a representa6 tive on behalf of an individual client) that, on 

7 their own accord, employs an individual to pro8 vide care (which may include items and serv9 ices) to the individual client using the individual 

10 client’s own finances. 

11 (h) INTERACTION WITH STAFFORD ACT.—Nothing 

12 in this section shall nullify, supersede, or otherwise change 

13 a State’s ability to seek reimbursement under section 403 

14 of the Robert T. Stafford Disaster Relief and Emergency 

15 Assistance Act (42 U.S.C. 5170b) for the costs of pre16 mium pay based on pre-disaster labor policies for eligible 

17 employees. 

18 (i) CALCULATION OF PAID LEAVE UNDER FFCRA 

19 AND FMLA.— 

20 (1) FAMILIES FIRST CORONAVIRUS RESPONSE

21 ACT.—Section 5110(5)(B) of the Families First 

22 Coronavirus Response Act (29 U.S.C. 2601 note) is 

23 amended by adding at the end the following: 

24 ‘‘(iii) PANDEMIC PREMIUM PAY.— 

25 Compensation received by an employee 


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1 under section 807(b) of the EHDC Act of 

2 2020 shall be included as remuneration for 

3 employment paid to the employee for pur4 poses of computing the regular rate at 

5 which such employee is employed.’’. 

6 (2) FAMILY AND MEDICAL LEAVE ACT OF

7 1993.—Section 110(b)(2)(B) of the Family and Med8 ical Leave Act of 1993 (29 U.S.C. 2620(b)(2)(B)) is 

9 amended by adding at the end the following: 

10 ‘‘(iii) PANDEMIC PREMIUM PAY.— 

11 Compensation received by an employee 

12 under section 807(b) of the EHDC Act of 

13 2020 shall be included as remuneration for 

14 employment paid to the employee for pur15 poses of computing the regular rate at 

16 which such employee is employed.’’. 

17 SEC. 806. COVID–19 HEROES FUND GRANTS. 

18 (a) GRANTS.— 

19 (1) FOR PANDEMIC PREMIUM PAY.—The Sec20 retary of the Treasury shall, subject to the avail21 ability of amounts provided in this title, award a 

22 grant to each essential work employer that applies 

23 for a grant, in accordance with this section, for the 

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1 ers under section 805(b), including amounts paid 

2 under section 805(f). 

3 (2) ELIGIBILITY.— 

4 (A) ELIGIBLE EMPLOYERS GENERALLY.— 

5 Any essential work employer shall be eligible for 

6 a grant under paragraph (1). 

7 (B) SELF-DIRECTED CARE WORKERS.—A 

8 self-directed care worker employed by an essen9 tial work employer other than an essential work 

10 employer described in section 805(g), shall be 

11 eligible to apply for a grant under paragraph 

12 (1) in the same manner as an essential work 

13 employer. Such a worker shall provide premium 

14 pay to himself or herself in accordance with this 

15 section, including the recordkeeping and refund 

16 requirements of this section. 

17 (b) AMOUNT OF GRANTS.— 

18 (1) IN GENERAL.—The maximum amount avail19 able for making a grant under subsection (a)(1) to 

20 an essential work employer shall be equal to the sum 

21 of— 

22 (A) the amount obtained by multiplying 

23 $10,000 by the number of essential workers the 

24 employer certifies, in the application submitted 

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1 viding remuneration to for services or labor, 

2 who are paid wages or remuneration by the em3 ployer at a rate that is less than the equivalent 

4 of $200,000 per year; and 

5 (B) the amount obtained by multiplying 

6 $5,000 by the number of highly-compensated 

7 essential workers the employer certifies, in the 

8 application submitted under subsection (c)(1), 

9 as employing, or providing remuneration to for 

10 services or labor, who are paid wages or remu11 neration by the employer at a rate that is equal 

12 to or greater than the equivalent of $200,000 

13 per year. 

14 (2) NO PARTIAL GRANTS.—The Secretary of 

15 the Treasury shall not award a grant under this sec16 tion in an amount less than the maximum described 

17 in paragraph (1). 

18 (c) GRANT APPLICATION AND DISBURSAL.— 

19 (1) APPLICATION.—Any essential work em20 ployer seeking a grant under subsection (a)(1) shall 

21 submit an application to the Secretary of the Treas22 ury at such time, in such manner, and complete with 

23 such information as the Secretary may require. 

24 (2) NOTICE AND CERTIFICATION.— 


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1 (A) IN GENERAL.—The Secretary of the 

2 Treasury shall, within 15 days after receiving a 

3 complete application from an essential work em4 ployer eligible for a grant under this section— 

5 (i) notify the employer of the Sec6 retary’s findings with respect to the re7 quirements for the grant; and 

8 (ii)(I) if the Secretary finds that the 

9 essential work employer meets the require10 ments under this section for a grant under 

11 subsection (a), provide a certification to 

12 the employer— 

13 (aa) that the employer has met 

14 such requirements; 

15 (bb) of the amount of the grant 

16 payment that the Secretary has deter17 mined the employer shall receive 

18 based on the requirements under this 

19 section; or 

20 (II) if the Secretary finds that the es21 sential work employer does not meet the 

22 requirements under this section for a grant 

23 under subsection (a), provide a notice of 

24 denial stating the reasons for the denial 

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1 tive review by not later than 10 days after 

2 the denial. 

3 (B) TRANSFER.—Not later than 7 days 

4 after making a certification under subpara5 graph (A)(ii) with respect to an essential work 

6 employer, the Secretary of the Treasury shall 

7 make the appropriate transfer to the employer 

8 of the amount of the grant. 

9 (d) USE OF FUNDS.— 

10 (1) IN GENERAL.—An essential work employer 

11 receiving a grant under this section shall use the 

12 amount of the grant solely for the following pur13 poses: 

14 (A) Providing premium pay under section 

15 805(b) to essential workers in accordance with 

16 the requirements for such payments under such 

17 section, including providing payments described 

18 in section 805(f) to the next of kin of essential 

19 workers in accordance with the requirements 

20 for such payments under such section. 

21 (B) Paying employer payroll taxes with re22 spect to premium pay amounts described in 

23 subparagraph (A), including such payments de24 scribed in section 805(f). 


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1 Each dollar of a grant received by an essential work 

2 employer under this title shall be used as provided 

3 in subparagraph (A) or (B) or returned to the Sec4 retary of the Treasury. 

5 (2) NO OTHER USES AUTHORIZED.—An essen6 tial work employer who uses any amount of a grant 

7 for a purpose not required under paragraph (1) shall 

8 be— 

9 (A) considered to have misused funds in 

10 violation of section 805; and 

11 (B) subject to the enforcement and rem12 edies provided under section 807. 

13 (3) REFUND.— 

14 (A) IN GENERAL.—If an essential work 

15 employer receives a grant under this section 

16 and, for any reason, does not provide every dol17 lar of such grant to essential workers in accord18 ance with the requirements of this title, then 

19 the employer shall refund any such dollars to 

20 the Secretary of the Treasury not later than 

21 June 30, 2021. Any amounts returned to the 

22 Secretary shall be deposited into the Fund and 

23 be available for any additional grants under this 

24 section. 


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1 (B) REQUIREMENT FOR NOT REDUCING

2 COMPENSATION.—An essential work employer 

3 who is required to refund any amount under 

4 this paragraph shall not reduce or otherwise di5 minish an eligible worker’s compensation or 

6 benefits in response to or otherwise due to such 

7 refund. 

8 (e) RECORDKEEPING.—An essential work employer 

9 that receives a grant under this section shall— 

10 (1) maintain records, including payroll records, 

11 demonstrating how each dollar of funds received 

12 through the grant were provided to essential work13 ers; and 

14 (2) provide such records to the Secretary of the 

15 Treasury or the Secretary of Labor upon the request 

16 of either such Secretary. 

17 (f) RECOUPMENT.—In addition to all other enforce18 ment and remedies available under this title or any other 

19 law, the Secretary of the Treasury shall establish a process 

20 under which the Secretary shall recoup the amount of any 

21 grant awarded under subsection (a)(1) if the Secretary de22 termines that the essential work employer receiving the 

23 grant— 

24 (1) did not provide all of the dollars of such 

25 grant to the essential workers of the employer; 


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1 (2) did not, in fact, have the number of essen2 tial workers certified by the employer in accordance 

3 with subparagraphs (A) and (B) of subsection 

4 (b)(1); 

5 (3) did not pay the essential workers for the 

6 number of hours the employer claimed to have paid; 

7 or 

8 (4) otherwise misused funds or violated this 

9 title. 

10 (g) SPECIAL RULE FOR CERTAIN EMPLOYEES OF

11 TRIBAL EMPLOYERS.—Essential workers of Tribal em12 ployers who receive funds under title II shall not be eligi13 ble to receive funds from grants under this section. 

14 (h) TAX TREATMENT.— 

15 (1) EXCLUSION FROM INCOME.—For purposes 

16 of the Internal Revenue Code of 1986, any grant re17 ceived by an essential work employer under this sec18 tion shall not be included in the gross income of 

19 such essential work employer. 

20 (2) DENIAL OF DOUBLE BENEFIT.— 

21 (A) IN GENERAL.—In the case of an essen22 tial work employer that receives a grant under 

23 this section— 

24 (i) amounts paid under subsections 

25 (b) or (f) of section 805 shall not be taken 


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1 into account as wages for purposes of sec2 tions 41, 45A, 51, or 1396 of the Internal 

3 Revenue Code of 1986 or section 2301 of 

4 the CARES Act (Public Law 116–136); 

5 and 

6 (ii) any deduction otherwise allowable 

7 under such Code for applicable payments 

8 during any taxable year shall be reduced 

9 (but not below zero) by the excess (if any) 

10 of— 

11 (I) the aggregate amounts of 

12 grants received under this section; 

13 over 

14 (II) the sum of any amount re15 funded under subsection (d) plus the 

16 aggregate amount of applicable pay17 ments made for all preceding taxable 

18 years. 

19 (B) APPLICABLE PAYMENTS.—For pur20 poses of this paragraph, the term ‘‘applicable 

21 payments’’ means amounts paid as premium 

22 pay under subsections (b) or (f) of section 805 

23 and amounts paid for employer payroll taxes 

24 with respect to such amounts. 


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1 (C) AGGREGATION RULE.—Rules similar 

2 to the rules of subsections (a) and (b) of section 

3 52 of the Internal Revenue Code of 1986 shall 

4 apply for purposes of this section. 

5 (3) INFORMATION REPORTING.—The Secretary 

6 of the Treasury shall submit to the Commissioner of 

7 Internal Revenue statements containing— 

8 (A) the name and tax identification num9 ber of each essential work employer receiving a 

10 grant under this section; 

11 (B) the amount of such grant; and 

12 (C) any amounts refunded under sub13 section (d)(3). 

14 (i) REPORTS.— 

15 (1) IN GENERAL.—Not later than 30 days after 

16 obligating the last dollar of the funds appropriated 

17 under this title, the Secretary of the Treasury shall 

18 submit a report, to the Committees of Congress de19 scribed in paragraph (2), that— 

20 (A) certifies that all funds appropriated 

21 under this title have been obligated; and 

22 (B) indicates the number of pending appli23 cations for grants under this section that will 

24 be rejected due to the lack of funds. 


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1 (2) COMMITTEES OF CONGRESS.—The Commit2 tees of Congress described in this paragraph are— 

3 (A) the Committee on Ways and Means of 

4 the House of Representatives; 

5 (B) the Committee on Education and 

6 Labor of the House of Representatives; 

7 (C) the Committee on Finance of the Sen8 ate; and 

9 (D) the Committee on Health, Education, 

10 Labor, and Pensions of the Senate. 

11 SEC. 807. ENFORCEMENT AND OUTREACH. 

12 (a) DUTIES OF SECRETARY OF LABOR.—The Sec13 retary of Labor shall— 

14 (1) have authority to enforce the requirements 

15 of section 805, in accordance with subsections (b) 

16 through (e); 

17 (2) conduct outreach as described in subsection 

18 (f); and 

19 (3) coordinate with the Secretary of the Treas20 ury as needed to carry out the Secretary of Labor’s 

21 responsibilities under this section. 

22 (b) PROHIBITED ACTS, PENALTIES, AND ENFORCE23 MENT.— 

24 (1) PROHIBITED ACTS.—It shall be unlawful for 

25 a person to— 


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1 (A) violate any provision of section 805 ap2 plicable to such person; or 

3 (B) discharge or in any other manner dis4 criminate against any essential worker because 

5 such essential worker has filed any complaint or 

6 instituted or caused to be instituted any pro7 ceeding under or related to this title, or has tes8 tified or is about to testify in any such pro9 ceeding. 

10 (2) ENFORCEMENT AND PENALTIES.— 

11 (A) PREMIUM PAY VIOLATIONS.—A viola12 tion described in paragraph (1)(A) shall be 

13 deemed a violation of section 7 of the Fair 

14 Labor Standards Act of 1938 (29 U.S.C. 207) 

15 and unpaid amounts required under this section 

16 shall be treated as unpaid overtime compensa17 tion under such section 7 for the purposes of 

18 sections 15 and 16 of such Act (29 U.S.C. 215 

19 and 216). 

20 (B) DISCHARGE OR DISCRIMINATION.—A 

21 violation of paragraph (1)(B) shall be deemed a 

22 violation of section 15(a)(3) of the Fair Labor 

23 Standards Act of 1938 (29 U.S.C. 215(a)(3)). 

24 (c) INVESTIGATION.— 


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1 (1) IN GENERAL.—To ensure compliance with 

2 the provisions of section 805, including any regula3 tion or order issued under that section, the Sec4 retary of Labor shall have the investigative authority 

5 provided under section 11(a) of the Fair Labor 

6 Standards Act of 1938 (29 U.S.C. 211(a)). For the 

7 purposes of any investigation provided for in this 

8 subsection, the Secretary of Labor shall have the 

9 subpoena authority provided for under section 9 of 

10 such Act (29 U.S.C. 209). 

11 (2) STATE AGENCIES.—The Secretary of Labor 

12 may, for the purpose of carrying out the functions 

13 and duties under this section, utilize the services of 

14 State and local agencies in accordance with section 

15 11(b) of the Fair Labor Standards Act of 1938 (29 

16 U.S.C. 211(b)). 

17 (d) ESSENTIAL WORKER ENFORCEMENT.— 

18 (1) RIGHT OF ACTION.—An action alleging a 

19 violation of paragraph (1) or (2) of subsection (b) 

20 may be maintained against an essential work em21 ployer receiving a grant under section 806 in any 

22 Federal or State court of competent jurisdiction by 

23 one or more essential workers or their representative 

24 for and on behalf of the essential workers, or the es25 sential workers and others similarly situated, in the 


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1 same manner, and subject to the same remedies (in2 cluding attorney’s fees and costs of the action), as 

3 an action brought by an employee alleging a viola4 tion of section 7 or 15(a)(3), respectively, of the 

5 Fair Labor Standards Act of 1938 (29 U.S.C. 207, 

6 215(a)(3)). 

7 (2) NO WAIVER.—In an action alleging a viola8 tion of paragraph (1) or (2) of subsection (b) 

9 brought by one or more essential workers or their 

10 representative for and on behalf of the persons as 

11 described in paragraph (1), to enforce the rights in 

12 section 805, no court of competent jurisdiction may 

13 grant the motion of an essential work employer re14 ceiving a grant under section 806 to compel arbitra15 tion, under chapter 1 of title 9, United States Code, 

16 or any analogous State arbitration statute, of the 

17 claims involved. An essential worker’s right to bring 

18 an action described in paragraph (1) or subsection 

19 (b)(2)(A) on behalf of similarly situated essential 

20 workers to enforce such rights may not be subject to 

21 any private agreement that purports to require the 

22 essential workers to pursue claims on an individual 

23 basis. 

24 (e) RECORDKEEPING.—An essential work employer 

25 receiving a grant under section 806 shall make, keep, and 


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1 preserve records pertaining to compliance with section 805 

2 in accordance with section 11(c) of the Fair Labor Stand3 ards Act of 1938 (29 U.S.C. 211(c)) and in accordance 

4 with regulations prescribed by the Secretary of Labor. 

5 (f) OUTREACH AND EDUCATION.—Out of amounts 

6 appropriated to the Secretary of the Treasury under sec7 tion 805 for a fiscal year, the Secretary of the Treasury 

8 shall transfer to the Secretary of Labor, $3,000,000, of 

9 which the Secretary of Labor shall use— 

10 (1) $2,500,000 for outreach to essential work 

11 employers and essential workers regarding the pre12 mium pay under section 805; and 

13 (2) $500,000 to implement an advertising cam14 paign encouraging large essential work employers to 

15 provide the same premium pay provided for by sec16 tion 805 using the large essential work employers’ 

17 own funds and without utilizing grants under this 

18 title. 

19 (g) CLARIFICATION OF ENFORCING OFFICIAL.— 

20 Nothing in the Government Employee Rights Act of 1991 

21 (42 U.S.C. 2000e–16a et seq.) or section 3(e)(2)(C) of the 

22 Fair Labor Standards Act of 1938 (29 U.S.C. 

23 203(e)(2)(C)) shall be construed to prevent the Secretary 

24 of Labor from carrying out the authority of the Secretary 

25 under this section in the case of State employees described 


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1 in section 304(a) of the Government Employee Rights Act 

2 of 1991 (42 U.S.C. 2000e–16c(a)). 

3 TITLE IX—HEALTH IT AND 

4 BRIDGING THE DIGITAL DI5 VIDE IN HEALTH CARE 

6 SEC. 901. HRSA ASSISTANCE TO HEALTH CENTERS FOR 

7 PROMOTION OF HEALTH IT. 

8 The Secretary of Health and Human Services, acting 

9 through the Administrator of the Health Resources and 

10 Services Administration, shall expand and intensify the 

11 programs and activities of the Administration (directly or 

12 through grants or contracts) to provide technical assist13 ance and resources to health centers (as defined in section 

14 330(a) of the Public Health Service Act (42 U.S.C. 

15 254b(a))) to adopt and meaningfully use certified EHR 

16 technology for the management of chronic diseases and 

17 health conditions and reduction of health disparities. 

18 SEC. 902. ASSESSMENT OF IMPACT OF HEALTH IT ON RA19 CIAL AND ETHNIC MINORITY COMMUNITIES; 

20 OUTREACH AND ADOPTION OF HEALTH IT IN 

21 SUCH COMMUNITIES. 

22 (a) NATIONAL COORDINATOR FOR HEALTH INFOR23 MATION TECHNOLOGY.—Not later than 18 months after 

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1 nator for Health Information Technology (referred to in 

2 this section as the ‘‘National Coordinator’’) shall— 

3 (1) conduct an evaluation of the level of inter4 operability, access, use, and accessibility of electronic 

5 health records in racial and ethnic minority commu6 nities, focusing on whether patients in such commu7 nities have providers who use electronic health 

8 records, and the degree to which patients in such 

9 communities can access, exchange, and use without 

10 special effort their health information in those elec11 tronic health records, and indicating whether such 

12 providers— 

13 (A) are participating in the Medicare pro14 gram under title XVIII of the Social Security 

15 Act (42 U.S.C. 1395 et seq.) or a State plan 

16 under title XIX of such Act (42 U.S.C. 1396 et 

17 seq.) (or a waiver of such plan); 

18 (B) have received incentive payments or in19 centive payment adjustments under Medicare 

20 and Medicaid Electronic Health Records Incen21 tive Programs (as defined in subsection (c)(2)); 

22 (C) are MIPS eligible professionals, as de23 fined in paragraph (1)(C) of section 1848(q) of 

24 the Social Security Act (42 U.S.C. 1395w– 


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1 4(q)), for purposes of the Merit-Based Incentive 

2 Payment System under such section; or 

3 (D) have been recruited by any of the 

4 Health Information Technology Regional Ex5 tension Centers established under section 3012 

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

7 300jj–32); 

8 (2) publish the results of such evaluation in9 cluding the race and ethnicity of such providers and 

10 the populations served by such providers; and 

11 (3) not later than 12 months after the enact12 ment of this Act, shall promulgate a certification cri13 terion and module of certified EHR technology that 

14 stratifies quality measures by disparity characteris15 tics, including race, ethnicity, language, gender, gen16 der identity, sexual orientation, socioeconomic sta17 tus, and disability status, as those characteristics 

18 are defined in certified EHR technology; and reports 

19 to Centers for Medicare & Medicaid Services the 

20 quality measures stratified by race and at least two 

21 other disparity characteristics. 

22 The term ‘‘quality measures’’ refers to the quality meas23 ures specified in MIPS. 

24 (b) NATIONAL CENTER FOR HEALTH STATISTICS.— 

25 As soon as practicable after the date of enactment of this 


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1 Act, the Director of the National Center for Health Statis2 tics shall provide to Congress a more detailed analysis of 

3 the data presented in National Center for Health Statis4 tics data brief entitled ‘‘Adoption of Certified Electronic 

5 Health Record Systems and Electronic Information Shar6 ing in Physician Offices: United States, 2013 and 2014’’ 

7 (NCHS Data Brief No. 236). 

8 (c) CENTERS FOR MEDICARE & MEDICAID SERV9 ICES.— 

10 (1) IN GENERAL.—As part of the process of 

11 collecting information, with respect to a provider, at 

12 registration and attestation for purposes of Medicare 

13 and Medicaid Electronic Health Records Incentive 

14 Programs (as defined in paragraph (2)) or the 

15 Merit-Based Incentive Payment System under sec16 tion 1848(q) of the Social Security Act (42 U.S.C. 

17 1395w–4(q)), the Secretary of Health and Human 

18 Services shall collect the race and ethnicity of such 

19 provider. 

20 (2) MEDICARE AND MEDICAID ELECTRONIC

21 HEALTH RECORDS INCENTIVE PROGRAMS DE22 FINED.—For purposes of paragraph (1), the term 

23 ‘‘Medicare and Medicaid Electronic Health Records 

24 Incentive Programs’’ means the incentive programs 

25 under section 1814(l)(3), subsections (a)(7) and (o) 


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1 of section 1848, subsections (l) and (m) of section 

2 1853, subsections (b)(3)(B)(ix)(I) and (n) of section 

3 1886, and subsections (a)(3)(F) and (t) of section 

4 1903 of the Social Security Act (42 U.S.C. 

5 1395f(l)(3), 1395w–4, 1395w–23, 1395ww, and 

6 1396b). 

7 (d) NATIONAL COORDINATOR’S ASSESSMENT OF IM8 PACT OF HIT.—Section 3001(c)(6)(C) of the Public 

9 Health Service Act (42 U.S.C. 300jj–11(c)(6)(C)) is 

10 amended— 

11 (1) in the heading by inserting ‘‘, RACIAL AND

12 ETHNIC MINORITY COMMUNITIES,’’ after ‘‘HEALTH

13 DISPARITIES’’; 

14 (2) by inserting ‘‘, in communities with a high 

15 proportion of individuals from racial and ethnic mi16 nority groups (as defined in section 1707(g)), in17 cluding people with disabilities in these groups,’’ 

18 after ‘‘communities with health disparities’’; 

19 (3) by striking ‘‘The National Coordinator’’ and 

20 inserting the following: 

21 ‘‘(i) IN GENERAL.—The National Co22 ordinator’’; and 

23 (4) by adding at the end the following: 

24 ‘‘(ii) CRITERIA.—In any publication 

25 under clause (i), the National Coordinator 


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1 shall include best practices for encouraging 

2 partnerships between the Federal Govern3 ment, States, and private entities to ex4 pand outreach for and the adoption of cer5 tified EHR technology in communities with 

6 a high proportion of individuals from racial 

7 and ethnic minority groups (as so defined), 

8 while also maintaining the accessibility re9 quirements of section 508 of the Rehabili10 tation Act of 1973 to encourage patient in11 volvement in patient health care. The Na12 tional Coordinator shall— 

13 ‘‘(I) not later than 6 months 

14 after the submission of the report re15 quired under section 822 of the End16 ing Health Disparities During 

17 COVID–19 Act of 2020, establish cri18 teria for evaluating the impact of 

19 health information technology on com20 munities with a high proportion of in21 dividuals from racial and ethnic mi22 nority groups (as so defined) taking 

23 into account the findings in such re24 port; and 


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1 ‘‘(II) not later than 1 year after 

2 the submission of such report, conduct 

3 and publish the results of an evalua4 tion of such impact.’’. 

5 SEC. 903. EXTENDING FUNDING TO STRENGTHEN THE 

6 HEALTH IT INFRASTRUCTURE IN RACIAL 

7 AND ETHNIC MINORITY COMMUNITIES. 

8 Section 3011 of the Public Health Service Act (42 

9 U.S.C. 300jj–31) is amended— 

10 (1) in subsection (a), in the matter preceding 

11 paragraph (1), by inserting ‘‘, including with respect 

12 to communities with a high proportion of individuals 

13 from racial and ethnic minority groups (as defined 

14 in section 1707(g))’’ before the colon; and 

15 (2) by adding at the end the following new sub16 section: 

17 ‘‘(e) ANNUAL REPORT ON EXPENDITURES.—The 

18 National Coordinator shall report annually to Congress on 

19 activities and expenditures under this section.’’. 


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1 SEC. 904. 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. 905. 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 2021 

16 through 2026’’. 

17 SEC. 906. DATA COLLECTION AND ASSESSMENTS CON18 DUCTED IN COORDINATION WITH MINORITY19 SERVING INSTITUTIONS. 

20 Section 3001(c)(6) of the Public Health Service Act 

21 (42 U.S.C. 300jj–11(c)(6)) is amended by adding at the 

22 end the following new subparagraph: 

23 ‘‘(F) DATA COLLECTION AND ASSESS24 MENTS CONDUCTED IN COORDINATION WITH

25 MINORITY-SERVING INSTITUTIONS.— 


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1 ‘‘(i) IN GENERAL.—In carrying out 

2 subparagraph (C) with respect to commu3 nities with a high proportion of individuals 

4 from racial and ethnic minority groups (as 

5 defined in section 1707(g)), the National 

6 Coordinator shall, to the greatest extent 

7 possible, coordinate with an entity de8 scribed in clause (ii). 

9 ‘‘(ii) MINORITY-SERVING INSTITU10 TIONS.—For purposes of clause (i), an en11 tity described in this clause is a Histori12 cally Black College or University, a His13 panic-serving institution, a tribal college or 

14 university, or an Asian-American-, Native 

15 American-, or Pacific Islander-serving in16 stitution with an accredited public health, 

17 health policy, or health services research 

18 program.’’. 

19 SEC. 907. STUDY OF HEALTH INFORMATION TECHNOLOGY 

20 IN MEDICALLY UNDERSERVED COMMU21 NITIES. 

22 (a) IN GENERAL.—Not later than 2 years after the 

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

24 Human Services shall— 


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1 (1) enter into an agreement with the National 

2 Academies of Sciences, Engineering, and Medicine to 

3 conduct a study on the development, implementa4 tion, and effectiveness of health information tech5 nology within medically underserved areas (as de6 scribed in subsection (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) identify barriers to successful implementa13 tion of health information technology in medically 

14 underserved areas; 

15 (2) survey a cross-section of individuals in 

16 medically underserved areas and report their opin17 ions about the various topics of study; 

18 (3) examine the degree of interoperability 

19 among health information technology and users of 

20 health information technology in medically under21 served areas, including patients, providers, and com22 munity services; 

23 (4) examine the impact of health information 

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1 ing the impact of such technology on improved 

2 health outcomes for individuals, including which 

3 technology worked for which population and how it 

4 improved health outcomes for that population; 

5 (5) examine the impact of health information 

6 technology on improving health care-related deci7 sions by both patients and providers in such areas; 

8 (6) identify specific best practices for using 

9 health information technology to foster the con10 sistent provision of physical accessibility and reason11 able policy accommodations in health care to individ12 uals with disabilities in such areas; 

13 (7) assess the feasibility and costs associated 

14 with the use of health information technology in 

15 such areas; 

16 (8) evaluate whether the adoption and use of 

17 qualified electronic health records (as defined in sec18 tion 3000 of the Public Health Service Act (42 

19 U.S.C. 300jj)) is effective in reducing health dispari20 ties, including analysis of clinical quality measures 

21 reported by providers who are participating in the 

22 Medicare program under title XVIII of the Social 

23 Security Act (42 U.S.C. 1395 et seq.) or a State 

24 plan under title XIX of such Act (42 U.S.C. 1396 

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1 grams to encourage the adoption and use of certified 

2 EHR technology; 

3 (9) identify providers in medically underserved 

4 areas that are not electing to adopt and use elec5 tronic health records and determine what barriers 

6 are preventing those providers from adopting and 

7 using such records; and 

8 (10) examine urban and rural community 

9 health systems and determine the impact that health 

10 information technology may have on the capacity of 

11 primary health providers in those systems. 

12 (c) MEDICALLY UNDERSERVED AREA.—The term 

13 ‘‘medically underserved area’’ means— 

14 (1) a population that has been designated as a 

15 medically underserved population under section 

16 330(b)(3) of the Public Health Service Act (42 

17 U.S.C. 254b(b)(3)); 

18 (2) an area that has been designated as a 

19 health professional shortage area under section 332 

20 of the Public Health Service Act (42 U.S.C. 254e); 

21 (3) an area or population that has been des22 ignated as a medically underserved community under 

23 section 799B of the Public Health Service Act (42 

24 U.S.C. 295p); or 

25 (4) another area or population that— 


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1 (A) experiences significant barriers to ac2 cessing quality health services; and 

3 (B) has a high prevalence of diseases or 

4 conditions described in title VII, with such dis5 eases or conditions having a disproportionate 

6 impact on racial and ethnic minority groups (as 

7 defined in section 1707(g) of the Public Health 

8 Service Act (42 U.S.C. 300u–6(g))) or a sub9 group of people with disabilities who have spe10 cific functional impairments. 

11 SEC. 908. STUDY ON THE EFFECTS OF CHANGES TO TELE12 HEALTH UNDER THE MEDICARE AND MED13 ICAID PROGRAMS DURING THE COVID-19 

14 EMERGENCY. 

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

16 end of the emergency period described in section 

17 1135(g)(1)(B) of the Social Security Act (42 U.S.C. 

18 1320b–5(g)(1)(B)), the Secretary of Health and Human 

19 Services (in this section referred to as the ‘‘Secretary’’) 

20 shall conduct a study and submit to the Committee on 

21 Energy and Commerce and the Committee on Ways and 

22 Means of the House of Representatives and the Committee 

23 on Finance of the Senate an interim report on any 

24 changes made to the provision or availability of telehealth 

25 services under part A or B of title XVIII of the Social 


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1 Security Act (42 U.S.C. 1395 et seq.) during such period. 

2 Such report shall include the following: 

3 (1) A summary of utilization of all health care 

4 services furnished under such part A or B during 

5 such period, including the number of— 

6 (A) in-person outpatient visits, inpatient 

7 admissions, and in-person emergency depart8 ment visits; and 

9 (B) telehealth visits, broken down by— 

10 (i) the number of such visits furnished 

11 via audio-visual technology compared to 

12 the number of such visits furnished via 

13 audio-only technology; 

14 (ii) the number of such visits fur15 nished by each type of provider of services 

16 or supplier (as defined in section 1861 of 

17 such Act (42 U.S.C. 1395x) and including 

18 a Federally qualified health center or rural 

19 health clinic (as so defined)), including a 

20 specification of the specialty of each such 

21 provider or supplier (if applicable); and 

22 (iii) the type of service provided, in23 cluding level of service and diagnoses asso24 ciated with the telehealth visit. 


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1 (2) A description of any changes in utilization 

2 patterns for the care settings described in paragraph 

3 (1) over the course of such period compared to such 

4 patterns prior to such period. 

5 (3) An analysis of utilization of telehealth serv6 ices under such part A or B during such period, bro7 ken down by age, sex (including sexual orientation 

8 and gender identity where possible), race and eth9 nicity, disability status, primary language, geo10 graphic region (including by rural health areas (as 

11 defined by the Health Resources & Services Admin12 istration), non-rural health areas, health professional 

13 shortage areas (as defined in section 332(a)(1) of 

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

15 254e(a)(1))), medically underserved communities (as 

16 defined in section 799B(6) of such Act (42 U.S.C. 

17 295p(6))), areas with medically underserved popu18 lations (as defined in section 330(b)(3) of such Act 

19 (42 U.S.C. 254b(b)(3))), and by State), and income 

20 level (as measured directly or indirectly, such as by 

21 patient’s zip code tabulation area median income as 

22 publicly reported by the United States Census Bu23 reau), and of any trends in such utilization during 

24 such period, so broken down. Such analysis shall in25 clude the number of telehealth visits performed by 


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1 providers of services or suppliers licensed in a State 

2 different from the State where the individual receiv3 ing such telehealth services is located at the time 

4 such services are furnished. Such analysis may not 

5 include any individually identifiable information or 

6 protected health information. 

7 (4) A description of expenditures and any sav8 ings under such part A or B attributable to use of 

9 such telehealth services during such period. 

10 (5) A description of any instances of fraud 

11 identified by the Secretary, acting through the Office 

12 of the Inspector General or other relevant agencies 

13 and departments, with respect to such telehealth 

14 services furnished under such part A or B during 

15 such period and a comparison of the number of such 

16 instances with the number of instances of fraud so 

17 identified with respect to in-person services so fur18 nished during such period. 

19 (6) A description of any privacy concerns with 

20 respect to the furnishing of such telehealth services 

21 (such as cybersecurity or ransomware concerns), in22 cluding a description of any actions taken by the 

23 Secretary, acting through the Health Sector 

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1 sist health care providers secure telecommunications 

2 systems. 

3 (7) An analysis of health care quality related to 

4 telehealth (which may include patient health out5 comes (such as morbidity, mortality, healthcare utili6 zation, and disease-specific management metrics), 

7 safety metrics, quality measures, health equity fo8 cused measures, patient satisfaction, provider satis9 faction, and other inputs and sources as determined 

10 by the Secretary). 

11 (8) An analysis of any other outcomes or 

12 metrics related to telehealth, as determined appro13 priate by the Secretary. 

14 (b) INPUT.—In conducting the study and submitting 

15 the report under subsection (a), the Secretary— 

16 (1)(A) consult with relevant stakeholders (such 

17 as patients, caregivers, patient advocacy groups, mi18 nority or tribal groups (including Urban Indian Or19 ganization (UIOs)), health care professionals (in20 cluding behavioral health professionals), hospitals, 

21 State medical boards, State nursing boards, the 

22 Federation of State Medical Boards, National Coun23 cil of State Boards of Nursing, medical professional 

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1 sional liability providers, public and private payers, 

2 and State leaders); and 

3 (B) solicit public comments on such report be4 fore the submission of such report; and 

5 (2) shall endeavor to include as many racially, 

6 ethnically, geographically, linguistically, and profes7 sionally diverse perspectives as possible. 

8 (c) FINAL REPORT.—Not later than December 31, 

9 2024, the Secretary shall— 

10 (1) update and finalize the interim report under 

11 subsection (a); and 

12 (2) submit such updated and finalized report to 

13 the committees specified in such subsection. 

14 (d) GRANTS FOR MEDICAID REPORTS.— 

15 (1) IN GENERAL.—Not later than 2 years after 

16 the end of the emergency period described in section 

17 1135(g)(1)(B) of the Social Security Act (42 U.S.C. 

18 1320b–5(g)(1)(B)), the Secretary shall award grants 

19 to States with a State plan (or waiver of such plan) 

20 in effect under title XIX of the Social Security Act 

21 (42 U.S.C. 1396r) that submit an application under 

22 this subsection for purposes of enabling such States 

23 to study and submit reports to the Secretary on any 

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1 health services under such plans (or such waivers) 

2 during such period. 

3 (2) ELIGIBILITY.—To be eligible to receive a 

4 grant under paragraph (1), a State shall— 

5 (A) provide benefits for telehealth services 

6 under the State plan (or waiver of such plan) 

7 in effect under title XIX of the Social Security 

8 Act (42 U.S.C. 1396r); 

9 (B) be able to differentiate telehealth from 

10 in-person visits within claims data submitted 

11 under such plan (or such waiver) during such 

12 period; and 

13 (C) submit to the Secretary an application 

14 at such time, in such manner, and containing 

15 such information (including the amount of the 

16 grant requested) as the Secretary may require. 

17 (3) USE OF FUNDS.—An State shall use 

18 amounts received under a grant under this sub19 section to conduct a study and report findings re20 garding the effects of changes to telehealth services 

21 offered under the State plan (or waiver of such plan) 

22 of such State under title XIX of the Social Security 

23 Act (42 U.S.C. 1396 et seq.) during such period in 

24 accordance with paragraph (4). 

25 (4) REPORTS.— 


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1 (A) INTERIM REPORT.—Not later 1 year 

2 after the date a State receives a grant under 

3 this subsection, the State shall submit to the 

4 Secretary an interim report that— 

5 (i) details any changes made to the 

6 provision or availability of telehealth bene7 fits (such as eligibility, coverage, or pay8 ment changes) under the State plan (or 

9 waiver of such plan) of the State under 

10 title XIX of the Social Security Act (42 

11 U.S.C. 1396 et seq.) during the emergency 

12 period described in paragraph (1); and 

13 (ii) contains— 

14 (I) a summary and description of 

15 the type described in paragraphs (1) 

16 and (2), respectively, of subsection 

17 (a); and 

18 (II) to the extent practicable, an 

19 analysis of the type described in para20 graph (3) of subsection (a), 

21 except that any reference in such sub22 section to ‘‘such part A or B’’ shall, for 

23 purposes of subclauses (I) and (II), be 

24 treated as a reference to such State plan 

25 (or waiver). 


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1 (B) FINAL REPORT.—Not later than 3 

2 years after the date a State receives a grant 

3 under this subsection, the State shall update 

4 and finalize the interim report and submit such 

5 final report to the Secretary. 

6 (C) REPORT BY SECRETARY.—Not later 

7 than the earlier of the date that is 1 year after 

8 the submission of all final reports under sub9 paragraph (B) and December 31, 2028, the 

10 Secretary shall submit to Congress a report on 

11 the grant program, including a summary of the 

12 reports received from States under this para13 graph. 

14 (5) MODIFICATION AUTHORITY.—The Secretary 

15 may modify any deadline described in paragraph (4) 

16 or any information required to be included in a re17 port made under this subsection to provide flexibility 

18 for States to modify the scope of the study and 

19 timeline for such reports. 

20 (6) TECHNICAL ASSISTANCE.—The Secretary 

21 shall provide such technical assistance as may be 

22 necessary to a State receiving a grant under this 

23 subsection in order to assist such state in conducting 

24 studies and submitting reports under this sub25 section. 


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1 (7) STATE.—For purposes of this subsection, 

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

3 the District of Columbia, and each territory of the 

4 United States. 

5 (e) AUTHORIZATION OF APPROPRIATIONS.— 

6 (1) MEDICARE.—For the purpose of carrying 

7 out subsections (a) through (c), there are authorized 

8 to be appropriated such sums as may be necessary 

9 for each of the fiscal years 2020 through 2024. 

10 (2) MEDICAID.—For the purpose of carrying 

11 out subsection (d), there are authorized to be appro12 priated such sums as may be necessary for each of 

13 the fiscal years 2022 through 2028. 

14 SEC. 909. COVID–19 DESIGNATION OF IMMEDIATE SPECIAL 

15 AUTHORITY OF SPECTRUM FOR TRIBES’ 

16 EMERGENCY RESPONSE IN INDIAN COUNTRY. 

17 (a) FINDINGS.—Congress finds the following: 

18 (1) The immediate grant of emergency special 

19 temporary authority of available spectrum that will 

20 efficiently support temporary wireless broadband 

21 networks and allow Indian Tribes to provide Tribal 

22 members with wireless broadband service over Tribal 

23 lands or Hawaiian Home Lands during the COVID– 

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1 communications and disproportionate impacts of the 

2 COVID–19 pandemic in Indian Country is essential. 

3 (2) Reservations are the most digitally discon4 nected areas in the United States that lack basic ac5 cess to broadband and wireless services at rates 

6 comparable to, and in some cases lower than, third7 world countries. 

8 (3) In 2018, the Government Accountability Of9 fice and the Federal Communications Commission 

10 reported that only 65 percent of American Indian 

11 and Alaska Natives (AI/ANs) living on Tribal lands 

12 had access to fixed broadband services, and only 68 

13 percent of AI/AN households on rural Tribal lands 

14 had telephone services. This is a stark comparison to 

15 only 8 percent of the national average that lacks ac16 cess to fixed broadband services. 

17 (4) Indian Tribes have previously encountered 

18 substantial barriers to accessing broadband and 

19 other communications services on Tribal lands to de20 ploy telecommunication services for the safety and 

21 well-being of Tribal members and to decrease the 

22 alarming rates of unnecessary loss of lives that AI/ 

23 ANs disproportionately experience, especially 

24 through the lack of access to health care services 

25 and emergency resources, as demonstrated during 


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1 the COVID–19 pandemic that continues to dis2 proportionately impact Indian Country. 

3 (5) Indian Tribes’ lack of access to broadband 

4 services on Tribal lands and Hawaiian Home Lands 

5 during the COVID–19 pandemic further highlights 

6 the digital divide in Indian Country. 

7 (6) The Government Accountability Office 

8 found that health information technology systems at 

9 the Indian Health Service rank as the Federal Gov10 ernment’s third-highest need for agency system mod11 ernization, since 50 percent of Indian Health Service 

12 facilities depend on outdated circuit connections 

13 based on one or two TI circuit lines (3 Mbps), cre14 ating slower response times than any other health 

15 facility system in the United States. 

16 (7) A 2018 Tribal health reform comment filed 

17 with the Federal Communications Commission has 

18 further stated that approximately 1.5 million people 

19 living on Tribal lands lack access to broadband and, 

20 of the 75 percent of rural Indian Health Service fa21 cilities, many still lack reliable broadband networks 

22 for American Indians and Alaska Natives (AI/ANs) 

23 to access telehealth or clinical health care services, 

24 which is a critical need in the most geographically 

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1 est poverty rates, and lack of access to reliable 

2 transportation. 

3 (8) The Bureau of Indian Education has stated 

4 that recent estimates from 142 out of 174 schools 

5 have indicated that approximately 15 to 95 percent 

6 of students do not have access to internet services 

7 at home depending on Bureau school location and 

8 limitations on data caps during the COVID–19 cri9 sis. 

10 (b) DEPLOYMENT OF WIRELESS BROADBAND SERV11 ICE ON TRIBAL LANDS AND HAWAIIAN HOME LANDS.— 

12 (1) FUNDING OF GRANTS FOR IMMEDIATE DE13 PLOYMENT OF WIRELESS BROADBAND SERVICE ON

14 TRIBAL LANDS AND HAWAIIAN HOME LANDS.—In 

15 addition to any other amounts made available, out of 

16 any money in the Treasury of the United States not 

17 otherwise appropriated, there are appropriated— 

18 (A) $297,500,000 for grants under the 

19 community facilities grant program under sec20 tion 306(a)(19) of the Consolidated Farm and 

21 Rural Development Act to Indian Tribes, quali22 fying Tribal entities, and the Director of the 

23 Department of Hawaiian Home Lands, for the 

24 immediate deployment of wireless broadband 

25 service on Tribal lands and Hawaiian Home 


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1 Lands, respectively, through the use of emer2 gency special temporary authority granted 

3 under paragraph (2) of this subsection, includ4 ing backhaul costs, repairs to damaged infra5 structure, the cost of the repairs to which would 

6 be less expensive than the cost of new infra7 structure and would support the emergency spe8 cial temporary use, and the Federal share appli9 cable to grants from such amount shall be 100 

10 percent, which amount shall remain available 

11 for one year from the enactment of this Act; 

12 and 

13 (B) $3,000,000 for grants under the com14 munity facilities technical assistance and train15 ing grant program under section 306(a)(26) of 

16 such Act, without regard to sections 

17 306(a)(26)(B) and 306(a)(26)(C) of such Act, 

18 to assist Indian Tribes, qualifying Tribal enti19 ties, and the Director of the Department of Ha20 waiian Home Lands in preparing applications 

21 for the grants referred to in subparagraph (B) 

22 of this paragraph, which amount shall remain 

23 available for one year from the enactment of 

24 this Act. 


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1 Grants referred to under subparagraph (B) shall be 

2 available to Indian Tribes, qualifying Tribal entities 

3 and shall also be available to inter-Tribal govern4 ment organizations, universities, and colleges with 

5 Tribal serving institutions for the purposes stated 

6 herein. 

7 (2) EMERGENCY SPECIAL TEMPORARY AUTHOR8 ITY TO USE AVAILABLE AND EFFICIENT SPECTRUM

9 ON TRIBAL LANDS AND HAWAIIAN HOME LANDS.— 

10 (A) GRANT OF AUTHORITY.—Not later 

11 than 10 days after receiving a request from an 

12 Indian Tribe, a qualifying Tribal entity, or the 

13 Director of the Department of Hawaiian Home 

14 Lands for emergency special temporary author15 ity to use electromagnetic spectrum described in 

16 subparagraph (C) for the provision of wireless 

17 broadband service over the Tribal lands over 

18 which the Indian Tribe or qualifying Tribal en19 tity has jurisdiction or (in the case of a request 

20 from the Director of the Department of Hawai21 ian Home Lands) over the Hawaiian Home 

22 Lands, allowing unlicensed radio transmitters 

23 to operate for such provision on such spectrum 

24 at locations on such Tribal lands or Hawaiian 

25 Home Lands where such spectrum is not being 


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1 used, the Commission shall grant such request 

2 on a secondary non-interference basis. 

3 (B) DURATION.—A grant of emergency 

4 special temporary authority under subpara5 graph (A) shall be for a period of operation to 

6 begin not later than 6 months after the date of 

7 the enactment of this Act and to remain in op8 eration for not longer than 6 months, absent 

9 extensions granted by the Commission pursuant 

10 to the procedures of the Commission relating to 

11 special temporary authority. 

12 (C) ELECTROMAGNETIC SPECTRUM DE13 SCRIBED.—The electromagnetic spectrum de14 scribed in this subparagraph for utilization on 

15 the temporary basis is any portion of the elec16 tromagnetic spectrum— 

17 (i) that is— 

18 (I) between the frequencies of 

19 2496 megahertz and 2690 megahertz, 

20 inclusive; 

21 (II) in the white spaces of the 

22 television broadcast spectrum between 

23 the frequencies of 470 megahertz and 

24 790 megahertz, inclusive, excluding 

25 those frequencies utilized for other 


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1 purposes under subpart H of part 15 

2 of title 47, Code of Federal Regula3 tions; 

4 (III) between the frequencies of 

5 5925 megahertz and 7125 megahertz, 

6 inclusive; or 

7 (IV) between frequencies of 3550 

8 megahertz and 3700 megahertz, inclu9 sive; and 

10 (ii) with respect to the Tribal lands or 

11 Hawaiian Home Lands over which author12 ity to use such spectrum is requested 

13 under subparagraph (A), is not assigned to 

14 any licensee. 

15 (3) DEFINITIONS.—In this subsection: 

16 (A) COMMISSION.—The term ‘‘Commis17 sion’’ means the Federal Communications Com18 mission. 

19 (B) HAWAIIAN HOME LANDS.—The term 

20 ‘‘Hawaiian Home Lands’’ means lands held in 

21 trust for Native Hawaiians by Hawaii pursuant 

22 to the Hawaiian Homes Commission Act, 1920. 

23 (C) INDIAN TRIBE.—The term ‘‘Indian 

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1 dian or Alaska Native Tribe, band, nation, 

2 pueblo, village, community, affiliated tribal 

3 group, or component reservation in the list pub4 lished pursuant to section 104(a) of the Feder5 ally Recognized Indian Tribe List Act of 1994 

6 (25 U.S.C. 5131(a)). 

7 (D) QUALIFYING TRIBAL ENTITY.—The 

8 term ‘‘qualifying Tribal entity’’ means an entity 

9 designated by the Indian Tribe with jurisdiction 

10 over particular Tribal lands for which the spec11 trum access is sought. The following may be 

12 designated as a qualifying Tribal entity: 

13 (i) Indian Tribes. 

14 (ii) Tribal consortia which consists of 

15 two or more Indian Tribes, or an Indian 

16 Tribe and an entity that is more than 50 

17 percent owned and controlled by one or 

18 more Indian Tribes. 

19 (iii) Federally chartered Tribal cor20 porations created under section 17 of the 

21 Indian Reorganization Act (25 U.S.C. 

22 5124), and created under section 4 of the 

23 Oklahoma Indian Welfare Act (25 U.S.C. 

24 5204). 


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1 (iv) Entities that are more than 50 

2 percent owned and controlled by an Indian 

3 Tribe or Indian Tribes. 

4 (E) ENTITY THAT IS MORE THAN 50 PER5 CENT OWNED AND CONTROLLED BY ONE OR

6 MORE INDIAN TRIBES.—The term ‘‘entity that 

7 is more than 50 percent owned and controlled 

8 by one or more Indian Tribes’’ means an entity 

9 over which one or more Indian Tribes have both 

10 de facto and de jure control of the entity. De 

11 jure control of the entity is evidenced by owner12 ship of greater than 50 percent of the voting 

13 stock of a corporation, or in the case of a part14 nership, general partnership interests. De facto 

15 control of an entity is determined on a case-by16 case basis. An Indian Tribe or Indian Tribes 

17 must demonstrate indicia of control to establish 

18 that such Indian Tribe or Indian Tribes retain 

19 de facto control of the applicant seeking eligi20 bility as a ‘‘qualifying Tribal entity’’, including 

21 the following: 

22 (i) The Indian Tribe or Indian Tribes 

23 constitute or appoint more than 50 percent 

24 of the board of directors or management 

25 committee of the entity. 


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1 (ii) The Indian Tribe or Indian Tribes 

2 have authority to appoint, promote, de3 mote, and fire senior executives who con4 trol the day-to-day activities of the entity. 

5 (iii) The Indian Tribe or Indian 

6 Tribes play an integral role in the manage7 ment decisions of the entity. 

8 (iv) The Indian Tribe or Indian 

9 Tribes have the authority to make deci10 sions or otherwise engage in practices or 

11 activities that determine or significantly in12 fluence— 

13 (I) the nature or types of services 

14 offered by such an entity; 

15 (II) the terms upon which such 

16 services are offered; or 

17 (III) the prices charged for such 

18 services. 

19 (F) TRIBAL LANDS.—The term ‘‘Tribal 

20 lands’’ has the meaning given that term in sec21 tion 73.7000 of title 47, Code of Federal Regu22 lations, as of April 16, 2020, and includes the 

23 definition ‘‘Indian Country’’ as defined in sec24 tion 1151 of title 18, United States Code, and 


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1 includes fee simple and restricted fee land held 

2 by an Indian Tribe. 

3 (G) WIRELESS BROADBAND SERVICE.— 

4 The term ‘‘wireless broadband service’’ means 

5 wireless broadband internet access service that 

6 is delivered— 

7 (i) with a download speed of not less 

8 than 25 megabits per second and an 

9 upload speed of not less than 3 megabits 

10 per second; and 

11 (ii) through— 

12 (I) mobile service; 

13 (II) fixed point-to-point 

14 multipoint service; 

15 (III) fixed point-to-point service; 

16 or 

17 (IV) broadcast service. 

18 SEC. 910. FACILITATING THE PROVISION OF TELEHEALTH 

19 SERVICES ACROSS STATE LINES. 

20 (a) IN GENERAL.—For purposes of expediting the 

21 provision of telehealth services, for which payment is made 

22 under the Medicare Program, across State lines, the Sec23 retary of Health and Human Services shall, in consulta24 tion with representatives of States, physicians, health care 

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1 tate the adoption of provisions allowing for multistate 

2 practitioner practice across State lines. 

3 (b) DEFINITIONS.—In subsection (a): 

4 (1) TELEHEALTH SERVICE.—The term ‘‘tele5 health service’’ has the meaning given that term in 

6 subparagraph (F) of section 1834(m)(4) of the So7 cial Security Act (42 U.S.C. 1395m(m)(4)). 

8 (2) PHYSICIAN, PRACTITIONER.—The terms 

9 ‘‘physician’’ and ‘‘practitioner’’ have the meaning 

10 given those terms in subparagraphs (D) and (E), re11 spectively, of such section. 

12 (3) MEDICARE PROGRAM.—The term ‘‘Medicare 

13 Program’’ means the program of health insurance 

14 administered by the Secretary of Health and Human 

15 Services under title XVIII of the Social Security Act 

16 (42 U.S.C. 1395 et seq.). 

17 TITLE X—PUBLIC AWARENESS 

18 SEC. 1001. AWARENESS CAMPAIGNS. 

19 The Secretary of Health and Human Services, acting 

20 through the Director of the Centers for Disease Control 

21 and Prevention and in coordination with other offices and 

22 agencies, as appropriate, shall award competitive grants 

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1 lingual and culturally appropriate awareness campaigns. 

2 Such campaigns shall— 

3 (1) be based on available scientific evidence; 

4 (2) increase awareness and knowledge of 

5 COVID–19, including countering stigma associated 

6 with COVID–19; 

7 (3) improve information on the availability of 

8 COVID–19 diagnostic testing; and 

9 (4) promote cooperation with contact tracing ef10 forts. 

11 SEC. 1002. INCREASING UNDERSTANDING OF AND IMPROV12 ING HEALTH LITERACY. 

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

14 Director of the Agency for Healthcare Research and Qual15 ity with respect to grants under subsection (c)(1) and 

16 through the Administrator of the Health Resources and 

17 Services Administration with respect to grants under sub18 section (c)(2), in consultation with the Director of the Na19 tional Institute on Minority Health and Health Disparities 

20 and the Deputy Assistant Secretary for Minority Health, 

21 shall award grants to eligible entities to improve health 

22 care for patient populations that have low functional 

23 health literacy. 

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

25 under subsection (a), an entity shall— 


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1 (1) be a hospital, health center or clinic, health 

2 plan, or other health entity (including a nonprofit 

3 minority health organization or association); and 

4 (2) prepare and submit to the Secretary an ap5 plication at such time, in such manner, and con6 taining such information as the Secretary may rea7 sonably require. 

8 (c) USE OF FUNDS.— 

9 (1) AGENCY FOR HEALTHCARE RESEARCH AND

10 QUALITY.—A grant awarded under subsection (a) 

11 through the Director of the Agency for Healthcare 

12 Research and Quality shall be used— 

13 (A) to define and increase the under14 standing of health literacy; 

15 (B) to investigate the correlation between 

16 low health literacy and health and health care; 

17 (C) to clarify which aspects of health lit18 eracy have an effect on health outcomes; and 

19 (D) for any other activity determined ap20 propriate by the Director. 

21 (2) HEALTH RESOURCES AND SERVICES ADMIN22 ISTRATION.—A grant awarded under subsection (a) 

23 through the Administrator of the Health Resources 

24 and Services Administration shall be used to conduct 


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1 demonstration projects for interventions for patients 

2 with low health literacy that may include— 

3 (A) the development of new disease man4 agement programs for patients with low health 

5 literacy; 

6 (B) the tailoring of disease management 

7 programs addressing mental, physical, oral, and 

8 behavioral health conditions for patients with 

9 low health literacy; 

10 (C) the translation of written health mate11 rials for patients with low health literacy; 

12 (D) the identification, implementation, and 

13 testing of low health literacy screening tools; 

14 (E) the conduct of educational campaigns 

15 for patients and providers about low health lit16 eracy; 

17 (F) the conduct of educational campaigns 

18 concerning health directed specifically at pa19 tients with mental disabilities, including those 

20 with cognitive and intellectual disabilities, de21 signed to reduce the incidence of low health lit22 eracy among these populations, which shall 

23 have instructional materials in the plain lan24 guage standards promulgated under the Plain 


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1 Writing Act of 2010 (5 U.S.C. 301 note) for 

2 Federal agencies; and 

3 (G) other activities determined appropriate 

4 by the Administrator. 

5 (d) DEFINITIONS.—In this section, the term ‘‘low 

6 health literacy’’ means the inability of an individual to ob7 tain, process, and understand basic health information 

8 and services needed to make appropriate health decisions. 

9 (e) AUTHORIZATION OF APPROPRIATIONS.—There 

10 are authorized to be appropriated to carry out this section, 

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

12 2021 through 2025. 

13 SEC. 1003. ENGLISH FOR SPEAKERS OF OTHER LAN14 GUAGES. 

15 (a) GRANTS AUTHORIZED.—The Secretary of Edu16 cation is authorized to provide grants to eligible entities 

17 for the provision of English as a second language (in this 

18 section referred to ‘‘ESL’’) instruction and shall deter19 mine, after consultation with appropriate stakeholders, the 

20 mechanism for administering and distributing such 

21 grants. 

22 (b) ELIGIBLE ENTITY DEFINED.—In this section, 

23 the term ‘‘eligible entity’’ means a State or community24 based organization that employs and serves minority popu25 lations. 


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1 (c) APPLICATION.—An eligible entity may apply for 

2 a grant under this section by submitting such information 

3 as the Secretary of Education may require and in such 

4 form and manner as the Secretary may require. 

5 (d) USE OF GRANT.—As a condition of receiving a 

6 grant under this section, an eligible entity shall— 

7 (1) develop and implement a plan for assuring 

8 the availability of ESL instruction that effectively 

9 integrates information about the nature of the 

10 United States health care system, how to access 

11 care, and any special language skills that may be re12 quired for individuals to access and regularly nego13 tiate the system effectively; 

14 (2) develop a plan, including, where appro15 priate, public-private partnerships, for making ESL 

16 instruction progressively available to all individuals 

17 seeking instruction; and 

18 (3) maintain current ESL instruction efforts by 

19 using funds available under this section to supple20 ment rather than supplant any funds expended for 

21 ESL instruction in the State as of January 1, 2020. 

22 (e) ADDITIONAL DUTIES OF THE SECRETARY.—The 

23 Secretary of Education shall— 


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1 (1) collect and publicize annual data on how 

2 much Federal, State, and local governments spend 

3 on ESL instruction; 

4 (2) collect data from State and local govern5 ments to identify the unmet needs of English lan6 guage learners for appropriate ESL instruction, in7 cluding— 

8 (A) the preferred written and spoken lan9 guage of such English language learners; 

10 (B) the extent of waiting lists for ESL in11 struction, including how many programs main12 tain waiting lists and, for programs that do not 

13 have waiting lists, the reasons why not; 

14 (C) the availability of programs to geo15 graphically isolated communities; 

16 (D) the impact of course enrollment poli17 cies, including open enrollment, on the avail18 ability of ESL instruction; 

19 (E) the number individuals in the State 

20 and each participating locality; 

21 (F) the effectiveness of the instruction in 

22 meeting the needs of individuals receiving in23 struction and those needing instruction; 

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1 struction, to assist individuals to obtain better 

2 jobs; and 

3 (H) the availability of ESL slots by State 

4 and locality; 

5 (3) determine the cost and most appropriate 

6 methods of making ESL instruction available to all 

7 English language learners seeking instruction; and 

8 (4) not later than 1 year after the date of en9 actment of this Act, issue a report to Congress that 

10 assesses the information collected in paragraphs (1), 

11 (2), and (3) and makes recommendations on steps 

12 that should be taken to progressively realize the goal 

13 of making ESL instruction available to all English 

14 language learners seeking instruction. 

15 (f) AUTHORIZATION OF APPROPRIATIONS.—There 

16 are authorized to be appropriated to the Secretary of Edu17 cation $250,000,000 for each of fiscal years 2021 through 

18 2024 to carry out this section. 

19 SEC. 1004. INFLUENZA, COVID–19, AND PNEUMONIA VAC20 CINATION CAMPAIGN. 

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

22 Human Services shall— 

23 (1) enhance the annual campaign by the De24 partment of Health and Human Services to increase 


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1 the number of people vaccinated each year for influ2 enza, pneumonia, and COVID–19; and 

3 (2) include in such campaign the use of written 

4 educational materials, public service announcements, 

5 physician education, and any other means which the 

6 Secretary deems effective. 

7 (b) MATERIALS AND ANNOUNCEMENTS.—In carrying 

8 out the annual campaign described in subsection (a), the 

9 Secretary of Health and Human Services shall ensure 

10 that— 

11 (1) educational materials and public service an12 nouncements are readily and widely available in 

13 communities experiencing disparities in the incidence 

14 and mortality rates of influenza, pneumonia, and 

15 COVID–19; and 

16 (2) the campaign uses targeted, culturally ap17 propriate messages and messengers to reach under18 served communities. 

19 (c) AUTHORIZATION OF APPROPRIATIONS.—There 

20 are authorized to be appropriated to carry out this section 

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

22 2021 through 2025. 


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1 TITLE XI—RESEARCH 

2 SEC. 1101. RESEARCH AND DEVELOPMENT. 

3 The Secretary of Health and Human Services, in co4 ordination with the Director of the Centers for Disease 

5 Control and Prevention and in collaboration with the Di6 rector of the National Institutes of Health, the Director 

7 of the Agency for Healthcare Research and Quality, the 

8 Commissioner of Food and Drugs, and the Administrator 

9 of the Centers for Medicare & Medicaid Services, shall 

10 support research and development on more efficient and 

11 effective strategies— 

12 (1) for the surveillance of SARS–CoV–2 and 

13 COVID–19; 

14 (2) for the testing and identification of individ15 uals infected with COVID–19; and 

16 (3) for the tracing of contacts of individuals in17 fected with COVID–19. 

18 SEC. 1102. CDC FIELD STUDIES PERTAINING TO SPECIFIC 

19 HEALTH INEQUITIES. 

20 (a) IN GENERAL.—Not later than 90 days after the 

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

22 Human Services (referred to in this section as the ‘‘Sec23 retary’’), acting through the Centers for Disease Control 

24 and Prevention, in collaboration with State, local, Tribal, 

25 and territorial health departments, shall complete (by the 


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1 reporting deadline in subsection (b)) field studies to better 

2 understand health inequities that are not currently 

3 tracked by the Secretary. Such studies shall include an 

4 analysis of— 

5 (1) the impact of socioeconomic status on 

6 health care access and disease outcomes, including 

7 COVID–19 outcomes; 

8 (2) the impact of disability status on health 

9 care access and disease outcomes, including COVID– 

10 19 outcomes; 

11 (3) the impact of language preference on health 

12 care access and disease outcomes, including COVID– 

13 19 outcomes; 

14 (4) factors contributing to disparities in health 

15 outcomes for the COVID–19 pandemic; and 

16 (5) other topics related to disparities in health 

17 outcomes for the COVID–19 pandemic, as deter18 mined by the Secretary. 

19 (b) REPORT.—Not later than December 31, 2021, 

20 the Secretary shall submit to the Committee on Energy 

21 and Commerce of the House of Representatives and the 

22 Committee on Health, Education, Labor, and Pensions of 

23 the Senate an initial report on the results of the field stud24 ies under this section. 


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1 (c) FINAL REPORT.—Not later than December 31, 

2 2023, the Secretary shall— 

3 (1) update and finalize the initial report under 

4 subsection (b); and 

5 (2) submit such final report to the committees 

6 specified in such subsection. 

7 (d) AUTHORIZATION OF APPROPRIATIONS.—There is 

8 authorized to be appropriated to carry out this section 

9 $25,000,000, to remain available until expended. 

10 SEC. 1103. EXPANDING CAPACITY FOR HEALTH OUTCOMES. 

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

12 Human Services (referred to in this section as the ‘‘Sec13 retary’’), acting through the Administrator of the Health 

14 Resources and Services Administration, shall award 

15 grants to eligible entities to develop and expand the use 

16 of technology-enabled collaborative learning and capacity 

17 building models to respond to ongoing and real-time learn18 ing, health care information sharing, and capacity building 

19 needs related to COVID–19. 

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

21 grant under this section, an entity shall have experience 

22 providing technology-enabled collaborative learning and 

23 capacity building health care services— 


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1 (1) in rural areas, frontier areas, health profes2 sional shortage areas, or medically underserved area; 

3 or 

4 (2) to medically underserved populations or In5 dian Tribes. 

6 (c) USE OF FUNDS.—An eligible entity receiving a 

7 grant under this section shall use funds received through 

8 the grant— 

9 (1) to advance quality of care in response to 

10 COVID–19, with particular emphasis on rural and 

11 underserved areas and populations; 

12 (2) to protect medical personnel and first re13 sponders through sharing real-time learning through 

14 virtual communities of practice; 

15 (3) to improve patient outcomes for conditions 

16 affected or exacerbated by COVID–19, including im17 provement of care for patients with complex chronic 

18 conditions; and 

19 (4) to support rapid uptake by health care pro20 fessionals of emerging best practices and treatment 

21 protocols around COVID–19. 

22 (d) OPTIONAL ADDITIONAL USES OF FUNDS.—An 

23 eligible entity receiving a grant under this section may use 

24 funds received through the grant for— 


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1 (1) equipment to support the use and expansion 

2 of technology-enabled collaborative learning and ca3 pacity building models, including hardware and soft4 ware that enables distance learning, health care pro5 vider support, and the secure exchange of electronic 

6 health information; 

7 (2) the participation of multidisciplinary expert 

8 team members to facilitate and lead technology-en9 abled collaborative learning sessions, and profes10 sionals and staff assisting in the development and 

11 execution of technology-enabled collaborative learn12 ing; 

13 (3) the development of instructional program14 ming and the training of health care providers and 

15 other professionals that provide or assist in the pro16 vision of services through technology-enabled collabo17 rative learning and capacity building models; and 

18 (4) other activities consistent with achieving the 

19 objectives of the grants awarded under this section. 

20 (e) TECHNOLOGY-ENABLED COLLABORATIVE

21 LEARNING AND CAPACITY BUILDING MODEL DEFINED.— 

22 In this section, the term ‘‘technology-enabled collaborative 

23 learning and capacity building model’’ has the meaning 

24 given that term in section 2(7) of the Expanding Capacity 


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1 for Health Outcomes Act (Public Law 114–270; 130 Stat. 

2 1395). 

3 (f) AUTHORIZATION OF APPROPRIATIONS.—There is 

4 authorized to be appropriated to carry out this section 

5 $20,000,000, to remain available until expended. 

6 SEC. 1104. DATA COLLECTION AND ANALYSIS GRANTS TO 

7 MINORITY-SERVING INSTITUTIONS. 

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

9 Human Services, acting through the Director of the Na10 tional Institute on Minority Health and Health Disparities 

11 and the Deputy Assistant Secretary for Minority Health, 

12 shall award grants to eligible entities to access and analyze 

13 racial and ethnic data on disparities in health and health 

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

15 and health care, to monitor and report on progress to re16 duce and eliminate disparities in health and health care. 

17 (b) ELIGIBLE ENTITY.—In this section, the term ‘‘el18 igible entity’’ means an entity that has an accredited pub19 lic health, health policy, or health services research pro20 gram and is any of the following: 

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

22 322 of the Higher Education Act of 1965 (20 

23 U.S.C. 1061). 

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

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


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

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

3 (4) An Asian American and Native American 

4 Pacific Islander-serving institution, as defined in 

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

6 (c) AUTHORIZATION OF APPROPRIATIONS.—To carry 

7 out this section, there are authorized to be appropriated 

8 such sums as may be necessary for fiscal years 2021 

9 through 2025. 

10 SEC. 1105. SAFETY AND EFFECTIVENESS OF DRUGS WITH 

11 RESPECT TO RACIAL AND ETHNIC BACK12 GROUND. 

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

14 Drug, and Cosmetic Act (21 U.S.C. 351 et seq.) is amend15 ed by adding after section 505F the following: 

16 ‘‘SEC. 505G. SAFETY AND EFFECTIVENESS OF DRUGS WITH 

17 RESPECT TO RACIAL AND ETHNIC BACK18 GROUND. 

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

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

21 ethnic background or other demographic characteristics 

22 (such as age, sex, gender) as to the safety or effectiveness 

23 of a drug or biological product or if such product address24 es a disease that disproportionately impacts certain racial 


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1 or ethnic groups or other demographic characteristics 

2 (such as age, sex, gender), then— 

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

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

5 adequate and well-controlled investigations of the 

6 disparity; or 

7 ‘‘(B) in the case of a biological product, the evi8 dence required under section 351(a) of the Public 

9 Health Service Act for approval of a biologics license 

10 application for the biological product shall include 

11 adequate and well-controlled investigations of the 

12 disparity; and 

13 ‘‘(2) if the investigations described in subpara14 graph (A) or (B) of paragraph (1) confirm that 

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

16 biological product shall include appropriate informa17 tion about the disparity. 

18 ‘‘(b) POSTMARKET STUDIES.— 

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

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

21 ethnic background or other demographic characteris22 tics (such as age, sex, gender) as to the safety or ef23 fectiveness of a drug for which there is an approved 

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1 cense under section 351 of the Public Health Service 

2 Act, the Secretary may by order require the holder 

3 of the approved application or license to conduct, by 

4 a date specified by the Secretary, postmarket studies 

5 to investigate the disparity. 

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

7 that the postmarket studies confirm that there is a 

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

9 the drug or biological product shall include appro10 priate information about the disparity. 

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

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

13 the design of the postmarket studies required under 

14 such paragraph for a drug or biological product, in15 cluding the number of studies and study partici16 pants, and the other demographic characteristics of 

17 the study participants. 

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

19 Secretary may, by order and as necessary, modify 

20 any aspect of the design of a postmarket study re21 quired in an order under paragraph (1) after issuing 

22 such order. 

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

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1 mitted to the Secretary as a supplement to the drug 

2 application or biologics license application. 

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

4 ‘‘(1) IN GENERAL.—A drug for which an appli5 cation has been submitted or approved under section 

6 505(j) shall not be considered ineligible for approval 

7 under that section or misbranded under section 502 

8 on the basis that the labeling of the drug omits in9 formation relating to a disparity on the basis of ra10 cial or ethnic background or other demographic 

11 characteristics (such as age, sex, gender) as to the 

12 safety or effectiveness of the drug as to the safety 

13 or effectiveness of the drug, whether derived from 

14 investigations or studies required under this section 

15 or derived from other sources, when the omitted in16 formation is protected by patent or by exclusivity 

17 under section 505(j)(5)(F). 

18 ‘‘(2) LABELING.—Notwithstanding paragraph 

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

20 a drug approved under section 505(j) that omits in21 formation relating to a disparity on the basis of ra22 cial or ethnic background (such as age, sex, gender) 

23 as to the safety or effectiveness of the drug include 

24 a statement of any appropriate contraindications, 


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1 warnings, or precautions related to the disparity 

2 that the Secretary considers necessary. 

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

4 may be a disparity on the basis of racial or ethnic back5 ground or other demographic characteristics (such as age, 

6 sex, gender) as to the safety or effectiveness’, with respect 

7 to a drug or biological product, includes— 

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

9 basis of racial or ethnic background or other demo10 graphic characteristics (such as age, sex, gender) as 

11 to safety or effectiveness of a drug or biological 

12 product in the same chemical class as the drug or 

13 biological product; 

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

15 basis of racial or ethnic background or other demo16 graphic characteristics (such as age, sex, gender) in 

17 the way the drug or biological product is metabo18 lized; 

19 ‘‘(3) other evidence as the Secretary may deter20 mine appropriate; and 

21 ‘‘(4) if such product addresses a disease/condi22 tion that evidence shows disproportionately impacts 

23 certain racial or ethnic groups or other demographic 

24 characteristics (such as age, sex, gender).’’. 


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

2 Food, Drug, and Cosmetic Act (21 U.S.C. 352) is amend3 ed by adding at the end the following: 

4 ‘‘(ee) If it is a drug and the holder of the approved 

5 application under section 505 or license under section 351 

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

7 to complete the investigations or studies, or comply with 

8 any other requirement, of section 505G.’’. 

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

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

11 379h(a)(1)(A)(ii)) is amended by inserting after ‘‘are not 

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

13 required under section 505G’’. 

14 SEC. 1106. GAO AND NIH REPORTS. 

15 (b) GAO REPORT ON NIH GRANT RACIAL AND ETH16 NIC DIVERSITY.— 

17 (1) IN GENERAL.—The Comptroller General of 

18 the United States shall conduct a study on the racial 

19 and ethnic diversity among the following groups: 

20 (A) All applicants for grants, contracts, 

21 and cooperative agreements awarded by the Na22 tional Institutes of Health during the period be23 ginning on January 1, 2009, and ending De24 cember 31, 2019. 


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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 the enactment of this Act, the Comp8 troller General shall complete the study under para9 graph (1) and submit to Congress a report con10 taining the results of such study. 

11 (c) GAO REPORT.—Not later than one year after the 

12 date of the enactment of this Act and biennially thereafter 

13 until 2024, the Comptroller General of the United States 

14 shall submit to Congress a report that identifies— 

15 (1) the racial and ethnic diversity of commu16 nity-based organizations that applied for Federal 

17 funding provided pursuant to Coronavirus Prepared18 ness and Response Supplemental Appropriations Act 

19 (Public Law 116–123), Families First Coronavirus 

20 Response Act (Public Law 116–127), Coronavirus 

21 Aid, Relief, and Economic Security Act (Public Law 

22 116–136), and Paycheck Protection Program and 

23 Health Care Enhancement Act (Public Law 116– 

24 139); 


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1 (2) the percentage of such organizations that 

2 were awarded such funding; and 

3 (3) the impact of such community-based organi4 zations’ efforts on reducing health disparities within 

5 racial and ethnic minority groups. 

6 (d) ANNUAL REPORT ON ACTIVITIES OF NATIONAL

7 INSTITUTE ON MINORITY HEALTH AND HEALTH DIS8 PARITIES.—The Director of the National Institute on Mi9 nority Health and Health Disparities shall prepare an an10 nual report on the activities carried out or to be carried 

11 out by such institute, and shall submit each such report 

12 to the Committee on Health, Education, Labor, and Pen13 sions of the Senate, the Committee on Energy and Com14 merce of the House of Representatives, the Secretary of 

15 Health and Human Services, and the Director of the Na16 tional Institutes of Health. With respect to the fiscal year 

17 involved, the report shall— 

18 (1) describe and evaluate the progress made in 

19 health disparities research conducted or supported 

20 by institutes and centers of the National Institutes 

21 of Health; 

22 (2) summarize and analyze expenditures made 

23 for activities with respect to health disparities re24 search conducted or supported by the National Insti25 tutes of Health; 


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1 (3) include a separate statement applying the 

2 requirements of paragraphs (1) and (2) specifically 

3 to minority health disparities research; and 

4 (4) contain such recommendations as the Direc5 tor of the Institute considers appropriate. 

6 SEC. 1107. HEALTH IMPACT ASSESSMENTS. 

7 (a) FINDINGS.—Congress makes the following find8 ings: 

9 (1) Health Impact Assessment is a tool to help 

10 planners, health officials, decision makers, and the 

11 public make more informed decisions about the po12 tential health effects of proposed plans, policies, pro13 grams, and projects in order to maximize health 

14 benefits and minimize harms. 

15 (2) Health Impact Assessments fosters commu16 nity leadership, ownership and participation in deci17 sion-making processes. 

18 (3) Health Impact Assessments can build com19 munity support and reduce opposition to a project or 

20 policy, thereby facilitating economic growth by aid21 ing the development of consensus regarding new de22 velopment proposals. 

23 (4) Health Impact Assessments facilitate col24 laboration across sectors. 

25 (b) PURPOSES.—It is the purpose of this section to— 


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1 (1) provide more information about the poten2 tial human health effects of policy decisions and the 

3 distribution of those effects; 

4 (2) improve how health is considered in plan5 ning and decisionmaking processes; and 

6 (3) build stronger, healthier communities 

7 through the use of Health Impact Assessment. 

8 (c) HEALTH IMPACT ASSESSMENTS.—Part P of title 

9 III of the Public Health Service Act (42 U.S.C. 280g et 

10 seq.), as amended by section 796A, is further amended 

11 by adding at the end the following: 

12 ‘‘SEC. 399V–12. HEALTH IMPACT ASSESSMENTS. 

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

14 ‘‘(1) ADMINISTRATOR.—The term ‘Adminis15 trator’ means the Administrator of the Environ16 mental Protection Agency. 

17 ‘‘(2) DIRECTOR.—The term ‘Director’ means 

18 the Director of the Centers for Disease Control and 

19 Prevention. 

20 ‘‘(3) HEALTH IMPACT ASSESSMENT.—The term 

21 ‘health impact assessment’ means a systematic proc22 ess that uses an array of data sources and analytic 

23 methods and considers input from stakeholders to 

24 determine the potential effects of a proposed policy, 

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1 lation and the distribution of those effects within the 

2 population. Such term includes identifying and rec3 ommending appropriate actions on monitoring and 

4 maximizing potential benefits and minimizing the 

5 potential harms. 

6 ‘‘(4) HEALTH DISPARITY.—The term ‘health 

7 disparity’ means a particular type of health dif8 ference that is closely linked with social, economic, 

9 or environmental disadvantage and that adversely 

10 affects groups of people who have systematically ex11 perienced greater obstacles to health based on their 

12 racial or ethnic group; religion; socioeconomic status; 

13 gender; age; mental health; cognitive, sensory, or 

14 physical disability; sexual orientation or gender iden15 tity; geographic location; citizenship status; or other 

16 characteristics historically linked to discrimination 

17 or exclusion. 

18 ‘‘(b) ESTABLISHMENT.—The Secretary, acting 

19 through the Director and in collaboration with the Admin20 istrator, shall— 

21 ‘‘(1) in consultation with the Director of the 

22 National Center for Chronic Disease Prevention and 

23 Health Promotion and relevant offices within the 

24 Department of Housing and Urban Development, 

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1 ment of Agriculture, establish a program at the Na2 tional Center for Environmental Health at the Cen3 ters for Disease Control and Prevention focused on 

4 advancing the field of health impact assessment that 

5 includes— 

6 ‘‘(A) collecting and disseminating best 

7 practices; 

8 ‘‘(B) administering capacity building 

9 grants to States to support grantees in initi10 ating health impact assessments, in accordance 

11 with subsection (d); 

12 ‘‘(C) providing technical assistance; 

13 ‘‘(D) developing training tools and pro14 viding training on conducting health impact as15 sessment and the implementation of built envi16 ronment and health indicators; 

17 ‘‘(E) making information available, as ap18 propriate, regarding the existence of other com19 munity healthy living tools, checklists, and indi20 ces that help connect public health to other sec21 tors, and tools to help examine the effect of the 

22 indoor built environment and building codes on 

23 population health; 

24 ‘‘(F) conducting research and evaluations 

25 of health impact assessments; and 


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1 ‘‘(G) awarding competitive extramural re2 search grants; 

3 ‘‘(2) develop guidance and guidelines to conduct 

4 health impact assessments in accordance with sub5 section (c); and 

6 ‘‘(3) establish a grant program to allow States 

7 to fund eligible entities to conduct health impact as8 sessments. 

9 ‘‘(c) GUIDANCE.— 

10 ‘‘(1) IN GENERAL.—Not later than 1 year after 

11 the date of enactment of the Ending Health Dispari12 ties during COVID-19 Act of 2020, the Secretary, 

13 acting through the Director, shall issue final guid14 ance for conducting the health impact assessments. 

15 In developing such guidance the Secretary shall— 

16 ‘‘(A) consult with the Director of the Na17 tional Center for Environmental Health and, 

18 the Director of the National Center for Chronic 

19 Disease Prevention and Health Promotion, and 

20 relevant offices within the Department of Hous21 ing and Urban Development, the Department of 

22 Transportation, and the Department of Agri23 culture; and 

24 ‘‘(B) consider available international health 

25 impact assessment guidance, North American 


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1 health impact assessment practice standards, 

2 and recommendations from the National Acad3 emy of Science. 

4 ‘‘(2) CONTENT.—The guidance under this sub5 section shall include— 

6 ‘‘(A) background on national and inter7 national efforts to bridge urban planning, cli8 mate forecasting, and public health institutions 

9 and disciplines, including a review of health im10 pact assessment best practices internationally; 

11 ‘‘(B) evidence-based direct and indirect 

12 pathways that link land-use planning, transpor13 tation, and housing policy and objectives to 

14 human health outcomes; 

15 ‘‘(C) data resources and quantitative and 

16 qualitative forecasting methods to evaluate both 

17 the status of health determinants and health ef18 fects, including identification of existing pro19 grams that can disseminate these resources; 

20 ‘‘(D) best practices for inclusive public in21 volvement in conducting health impact assess22 ments; and 

23 ‘‘(E) technical assistance for other agen24 cies seeking to develop their own guidelines and 

25 procedures for health impact assessment. 


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1 ‘‘(d) GRANT PROGRAM.— 

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

3 through the Director and in collaboration with the 

4 Administrator, shall— 

5 ‘‘(A) award grants to States to fund eligi6 ble entities for capacity building or to prepare 

7 health impact assessments; and 

8 ‘‘(B) ensure that States receiving a grant 

9 under this subsection further support training 

10 and technical assistance for grantees under the 

11 program by funding and overseeing appropriate 

12 local, State, Tribal, Federal, institution of high13 er education, or nonprofit health impact assess14 ment experts to provide such technical assist15 ance. 

16 ‘‘(2) APPLICATIONS.— 

17 ‘‘(A) IN GENERAL.—To be eligible to re18 ceive a grant under this section, an eligible enti19 ty shall— 

20 ‘‘(i) be a State, Indian tribe, or tribal 

21 organization that includes individuals or 

22 populations the health of which are, or will 

23 be, affected by an activity or a proposed 

24 activity; and 


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1 ‘‘(ii) submit to the Secretary an appli2 cation in accordance with this subsection, 

3 at such time, in such manner, and con4 taining such additional information as the 

5 Secretary may require. 

6 ‘‘(B) INCLUSION.—An application under 

7 this subsection shall include a list of proposed 

8 activities that require or would benefit from 

9 conducting a health impact assessment within 

10 six months of awarding funds. The list should 

11 be accompanied by supporting documentation, 

12 including letters of support, from potential con13 ductors of health impact assessments for the 

14 listed proposed activities. Each application 

15 should also include an assessment by the eligi16 ble entity of the health of the population of its 

17 jurisdiction and describe potential adverse or 

18 positive effects on health that the proposed ac19 tivities may create. 

20 ‘‘(C) PREFERENCE.—Preference in award21 ing funds under this section may be given to el22 igible entities that demonstrate the potential to 

23 significantly improve population health or lower 

24 health care costs as a result of potential health 

25 impact assessment work. 


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1 ‘‘(3) USE OF FUNDS.— 

2 ‘‘(A) IN GENERAL.—An entity receiving a 

3 grant under this section shall use such grant 

4 funds to conduct health impact assessment ca5 pacity building or to fund subgrantees in con6 ducting a health impact assessment for a pro7 posed activity in accordance with this sub8 section. 

9 ‘‘(B) PURPOSES.—The purposes of a 

10 health impact assessment under this subsection 

11 are— 

12 ‘‘(i) to facilitate the involvement of 

13 tribal, State, and local public health offi14 cials in community planning, transpor15 tation, housing, and land use decisions and 

16 other decisions affecting the built environ17 ment to identify any potential health con18 cern or health benefit relating to an activ19 ity or proposed activity; 

20 ‘‘(ii) to provide for an investigation of 

21 any health-related issue of concern raised 

22 in a planning process, an environmental 

23 impact assessment process, or policy ap24 praisal relating to a proposed activity; 


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1 ‘‘(iii) to describe and compare alter2 natives (including no-action alternatives) to 

3 a proposed activity to provide clarification 

4 with respect to the potential health out5 comes associated with the proposed activity 

6 and, where appropriate, to the related ben7 efit-cost or cost-effectiveness of the pro8 posed activity and alternatives; 

9 ‘‘(iv) to contribute, when applicable, 

10 to the findings of a planning process, pol11 icy appraisal, or an environmental impact 

12 statement with respect to the terms and 

13 conditions of implementing a proposed ac14 tivity or related mitigation recommenda15 tions, as necessary; 

16 ‘‘(v) to ensure that the dispropor17 tionate distribution of negative impacts 

18 among vulnerable populations is minimized 

19 as much as possible; 

20 ‘‘(vi) to engage affected community 

21 members and ensure adequate opportunity 

22 for public comment on all stages of the 

23 health impact assessment; 

24 ‘‘(vii) where appropriate, to consult 

25 with local and county health departments 


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1 and appropriate organizations, including 

2 planning, transportation, and housing or3 ganizations and providing them with infor4 mation and tools regarding how to conduct 

5 and integrate health impact assessment 

6 into their work; and 

7 ‘‘(viii) to inspect homes, water sys8 tems, and other elements that pose risks to 

9 lead exposure, with an emphasis on areas 

10 that pose a higher risk to children. 

11 ‘‘(4) ASSESSMENTS.—Health impact assess12 ments carried out using grant funds under this sec13 tion shall— 

14 ‘‘(A) take appropriate health factors into 

15 consideration as early as practicable during the 

16 planning, review, or decisionmaking processes; 

17 ‘‘(B) assess the effect on the health of in18 dividuals and populations of proposed policies, 

19 projects, or plans that result in modifications to 

20 the built environment; and 

21 ‘‘(C) assess the distribution of health ef22 fects across various factors, such as race, in23 come, ethnicity, age, disability status, gender, 

24 and geography. 

25 ‘‘(5) ELIGIBLE ACTIVITIES.— 


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1 ‘‘(A) IN GENERAL.—Eligible entities fund2 ed under this subsection shall conduct an eval3 uation of any proposed activity to determine 

4 whether it will have a significant adverse or 

5 positive effect on the health of the affected pop6 ulation in the jurisdiction of the eligible entity, 

7 based on the criteria described in subparagraph 

8 (B). 

9 ‘‘(B) CRITERIA.—The criteria described in 

10 this subparagraph include, as applicable to the 

11 proposed activity, the following: 

12 ‘‘(i) Any substantial adverse effect or 

13 significant health benefit on health out14 comes or factors known to influence health, 

15 including the following: 

16 ‘‘(I) Physical activity. 

17 ‘‘(II) Injury. 

18 ‘‘(III) Mental health. 

19 ‘‘(IV) Accessibility to health-pro20 moting goods and services. 

21 ‘‘(V) Respiratory health. 

22 ‘‘(VI) Chronic disease. 

23 ‘‘(VII) Nutrition. 


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1 ‘‘(VIII) Land use changes that 

2 promote local, sustainable food 

3 sources. 

4 ‘‘(IX) Infectious disease, includ5 ing COVID–19. 

6 ‘‘(X) Health disparities. 

7 ‘‘(XI) Existing air quality, 

8 ground or surface water quality or 

9 quantity, or noise levels. 

10 ‘‘(XII) Lead exposure. 

11 ‘‘(XIII) Drinking water quality 

12 and accessibility. 

13 ‘‘(ii) Other factors that may be con14 sidered, including— 

15 ‘‘(I) the potential for a proposed 

16 activity to result in systems failure 

17 that leads to a public health emer18 gency, pandemic, or other infectious 

19 or biochemical agent; 

20 ‘‘(II) the probability that the pro21 posed activity will result in a signifi22 cant increase in tourism, economic de23 velopment, or employment in the ju24 risdiction of the eligible entity; 


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1 ‘‘(III) any other significant po2 tential hazard or enhancement to 

3 human health, as determined by the 

4 eligible entity; or 

5 ‘‘(IV) whether the evaluation of a 

6 proposed activity would duplicate an7 other analysis or study being under8 taken in conjunction with the pro9 posed activity. 

10 ‘‘(C) FACTORS FOR CONSIDERATION.—In 

11 evaluating a proposed activity under subpara12 graph (A), an eligible entity may take into con13 sideration any reasonable, direct, indirect, or 

14 cumulative effect that can be clearly related to 

15 potential health effects and that is related to 

16 the proposed activity, including the effect of 

17 any action that is— 

18 ‘‘(i) included in the long-range plan 

19 relating to the proposed activity; 

20 ‘‘(ii) likely to be carried out in coordi21 nation with the proposed activity; 

22 ‘‘(iii) dependent on the occurrence of 

23 the proposed activity; or 


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1 ‘‘(iv) likely to have a disproportionate 

2 impact on high-risk or vulnerable popu3 lations. 

4 ‘‘(6) REQUIREMENTS.—A health impact assess5 ment prepared with funds awarded under this sub6 section shall incorporate the following, after con7 ducting the screening phase (identifying projects or 

8 policies for which a health impact assessment would 

9 be valuable and feasible) through the application 

10 process: 

11 ‘‘(A) SCOPING.—Identifying which health 

12 effects to consider and the research methods to 

13 be utilized. 

14 ‘‘(B) ASSESSING RISKS AND BENEFITS.— 

15 Assessing the baseline health status and factors 

16 known to influence the health status in the af17 fected community, which may include aggre18 gating and synthesizing existing health assess19 ment evidence and data from the community. 

20 ‘‘(C) DEVELOPING RECOMMENDATIONS.— 

21 Suggesting changes to proposals to promote 

22 positive or mitigate adverse health effects. 

23 ‘‘(D) REPORTING.—Synthesizing the as24 sessment and recommendations and commu25 nicating the results to decision makers. 


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1 ‘‘(E) MONITORING AND EVALUATING.— 

2 Tracking the decision and implementation effect 

3 on health determinants and health status. 

4 ‘‘(7) PLAN.—An eligible entity that is awarded 

5 a grant under this section shall develop and imple6 ment a plan, to be approved by the Director, for 

7 meaningful and inclusive stakeholder involvement in 

8 all phases of the health impact assessment. Stake9 holders may include community leaders, community10 based organizations, youth-serving organizations, 

11 planners, public health experts, State and local pub12 lic health departments and officials, health care ex13 perts or officials, housing experts or officials, and 

14 transportation experts or officials. 

15 ‘‘(8) SUBMISSION OF FINDINGS.—An eligible 

16 entity that is awarded a grant under this section 

17 shall submit the findings of any funded health im18 pact assessment activities to the Secretary and make 

19 these findings publicly available. 

20 ‘‘(9) ASSESSMENT OF IMPACTS.—An eligible en21 tity that is awarded a grant under this section shall 

22 ensure the assessment of the distribution of health 

23 impacts (related to the proposed activity) across 

24 race, ethnicity, income, age, gender, disability status, 

25 and geography. 


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1 ‘‘(10) CONDUCT OF ASSESSMENT.—To the 

2 greatest extent feasible, a health impact assessment 

3 shall be conducted under this section in a manner 

4 that respects the needs and timing of the decision5 making process it evaluates. 

6 ‘‘(11) METHODOLOGY.—In preparing a health 

7 impact assessment under this subsection, an eligible 

8 entity or partner shall follow the guidance published 

9 under subsection (c). 

10 ‘‘(e) HEALTH IMPACT ASSESSMENT DATABASE.— 

11 The Secretary, acting through the Director and in collabo12 ration with the Administrator, shall establish, maintain, 

13 and make publicly available a health impact assessment 

14 database, including— 

15 ‘‘(1) a catalog of health impact assessments re16 ceived under this section; 

17 ‘‘(2) an inventory of tools used by eligible enti18 ties to conduct health impact assessments; and 

19 ‘‘(3) guidance for eligible entities with respect 

20 to the selection of appropriate tools described in 

21 paragraph (2). 

22 ‘‘(f) EVALUATION OF GRANTEE ACTIVITIES.—The 

23 Secretary shall award competitive grants to Prevention 

24 Research Centers, or nonprofit organizations or academic 


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1 institutions with expertise in health impact assessments 

2 to— 

3 ‘‘(1) assist grantees with the provision of train4 ing and technical assistance in the conducting of 

5 health impact assessments; 

6 ‘‘(2) evaluate the activities carried out with 

7 grants under subsection (d); and 

8 ‘‘(3) assist the Secretary in disseminating evi9 dence, best practices, and lessons learned from 

10 grantees. 

11 ‘‘(g) REPORT TO CONGRESS.—Not later than 1 year 

12 after the date of enactment of the Ending Health Dispari13 ties During COVID–19 Act of 2020, the Secretary shall 

14 submit to Congress a report concerning the evaluation of 

15 the programs under this section, including recommenda16 tions as to how lessons learned from such programs can 

17 be incorporated into future guidance documents developed 

18 and provided by the Secretary and other Federal agencies, 

19 as appropriate. 

20 ‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—There 

21 are authorized to be appropriated to carry out this section 

22 such sums as may be necessary. 


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1 ‘‘SEC. 399V–13. 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; or transportation options; 

22 ‘‘(10) ability to reduce the spread of infectious 

23 diseases (such as COVID–19); and 

24 ‘‘(11) other factors, as the Secretary determines 

25 appropriate. 


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1 ‘‘(b) APPLICATIONS.—A public agency or private 

2 nonprofit institution desiring a grant under this section 

3 shall submit to the Secretary an application at such time, 

4 in such manner, and containing such agreements, assur5 ances, and information as the Secretary, in consultation 

6 with the Administrator, may require. 

7 ‘‘(c) RESEARCH.—The Secretary, in consultation 

8 with the Administrator, shall support, through grants 

9 awarded under this section, research that— 

10 ‘‘(1) uses evidence-based research to improve 

11 the built environment and human health; 

12 ‘‘(2) examines— 

13 ‘‘(A) the scope and intensity of the impact 

14 that the built environment (including the var15 ious characteristics of the built environment) 

16 has on the human health; or 

17 ‘‘(B) the distribution of such impacts by— 

18 ‘‘(i) location; and 

19 ‘‘(ii) population subgroup; 

20 ‘‘(3) is used to develop— 

21 ‘‘(A) measures and indicators to address 

22 health impacts and the connection of health to 

23 the built environment; 

24 ‘‘(B) efforts to link the measures to trans25 portation, land use, and health databases; and 


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1 ‘‘(C) efforts to enhance the collection of 

2 built environment surveillance data; 

3 ‘‘(4) distinguishes carefully between personal 

4 attitudes and choices and external influences on be5 havior to determine how much the association be6 tween the built environment and the health of resi7 dents, versus the lifestyle preferences of the people 

8 that choose to live in the neighborhood, reflects the 

9 physical characteristics of the neighborhood; and 

10 ‘‘(5)(A) identifies or develops effective interven11 tion strategies focusing on enhancements to the built 

12 environment that promote increased use physical ac13 tivity, access to nutritious foods, or other health-pro14 moting activities by residents; and 

15 ‘‘(B) in developing the intervention strategies 

16 under subparagraph (A), ensures that the interven17 tion strategies will reach out to high-risk or vulner18 able populations, including low-income urban and 

19 rural communities and aging populations, in addi20 tion to the general population. 

21 ‘‘(d) SURVEYS.—The Secretary may allow recipients 

22 of grants under this section to use such grant funds to 

23 support the expansion of national surveys and data track24 ing systems to provide more detailed information about 

25 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. 1108. TRIBAL FUNDING TO RESEARCH HEALTH IN16 EQUITIES INCLUDING COVID–19. 

17 (a) IN GENERAL.—Not later than 6 months after the 

18 date of enactment of this Act, the Director of the Indian 

19 Health Service, in coordination with Tribal Epidemiology 

20 Centers and other Federal agencies, as appropriate, shall 

21 conduct or support research and field studies for the pur22 poses of improved understanding of Tribal health inequi23 ties among American Indians and Alaska Natives, includ24 ing with respect to— 

25 (1) disparities related to COVID–19; 


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1 (2) public health surveillance and infrastructure 

2 regarding unmet needs in Indian country and Urban 

3 Indian communities; 

4 (3) population-based health disparities; 

5 (4) barriers to health care services; 

6 (5) the impact of socioeconomic status; and 

7 (6) factors contributing to Tribal health inequi8 ties. 

9 (b) CONSULTATION, CONFER, AND COORDINATION.— 

10 In carrying out this section, the Director of the Indian 

11 Health Service shall— 

12 (1) consult with Indian Tribes and Tribal orga13 nizations; 

14 (2) confer with Urban Indian organizations; 

15 (3) coordinate with the Director of the Centers 

16 for Disease Control and Prevention and the Director 

17 of the National Institutes of Health. 

18 (c) PROCESS.—Not later than 60 days after the date 

19 of enactment of this Act, the Director of the Indian Health 

20 Service shall establish a nationally representative panel to 

21 establish processes and procedures for the research and 

22 field studies conducted or supported under subsection (a). 

23 The Director shall ensure that, at a minimum, the panel 

24 consists of the following individuals: 

25 (1) Elected Tribal leaders or their designees. 


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1 (2) Tribal public health practitioners and ex2 perts from the national and regional levels. 

3 (d) DUTIES.—The panel established under subsection 

4 (c) shall, at a minimum— 

5 (1) advise the Director of the Indian Health 

6 Service on the processes and procedures regarding 

7 the design, implementation, and evaluation of, and 

8 reporting on, research and field studies conducted or 

9 supported under this section; 

10 (2) develop and share resources on Tribal pub11 lic health data surveillance and reporting, including 

12 best practices; and 

13 (3) carry out such other activities as may be 

14 appropriate to establish processes and procedures for 

15 the research and field studies conducted or sup16 ported under subsection (a). 

17 (e) REPORT.—Not later than 1 year after expending 

18 all funds made available to carry out this section, the Di19 rector of the Indian Health Service, in coordination with 

20 the panel established under subsection (c), shall submit 

21 an initial report on the results of the research and field 

22 studies under this section to— 

23 (1) the Committee on Energy and Commerce 

24 and the Committee on Natural Resources of the 

25 House of Representatives; and 


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1 (2) the Committee on Indian Affairs and the 

2 Committee on Health, Education, Labor, and Pen3 sions of the Senate. 

4 (f) TRIBAL DATA SOVEREIGNTY.—The Director of 

5 the Indian Health Service shall ensure that all research 

6 and field studies conducted or supported under this sec7 tion are tribally-directed and carried out in a manner 

8 which ensures Tribal-direction of all data collected under 

9 this section— 

10 (1) according to Tribal best practices regarding 

11 research design and implementation, including by 

12 ensuring the consent of the Tribes involved to public 

13 reporting of Tribal data; 

14 (2) according to all relevant and applicable 

15 Tribal, professional, institutional, and Federal 

16 standards for conducting research and governing re17 search ethics; 

18 (3) with the prior and informed consent of any 

19 Indian Tribe participating in the research or sharing 

20 data for use under this section; and 

21 (4) in a manner that respects the inherent sov22 ereignty of Indian Tribes, including Tribal govern23 ance of data and research. 

24 (g) FINAL REPORT.—Not later than December 31, 

25 2023, the Director of the Indian Health Service shall— 


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1 (1) update and finalize the initial report under 

2 subsection (e); and 

3 (2) submit such final report to the committees 

4 specified in such subsection. 

5 (h) DEFINITIONS.—In this section: 

6 (1) The terms ‘‘Indian Tribe’’ and ‘‘Tribal or7 ganization’’ have the meanings given to such terms 

8 in section 4 of the Indian Self-Determination and 

9 Education Assistance Act (25 U.S.C. 5304). 

10 (2) The term ‘‘Urban Indian organization’’ has 

11 the meaning given to such term in section 4 of the 

12 Indian Health Care Improvement Act (25 U.S.C. 

13 1603). 

14 (i) AUTHORIZATION OF APPROPRIATIONS.—There is 

15 authorized to be appropriated to carry out this section 

16 $25,000,000, to remain available until expended. 

17 SEC. 1109. RESEARCH ENDOWMENTS AT BOTH CURRENT 

18 AND FORMER CENTERS OF EXCELLENCE. 

19 Paragraph (1) of section 464z–3(h) of the Public 

20 Health Service Act (42 U.S.C. 285t(h)) is amended to 

21 read as follows: 

22 ‘‘(1) IN GENERAL.—The Director of the Insti23 tute may carry out a program to facilitate minority 

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1 ties research by providing for research endow2 ments— 

3 ‘‘(A) at current or former centers of excel4 lence under section 736; and 

5 ‘‘(B) at current or former centers of excel6 lence under section 464z–4.’’. 

7 TITLE XII—EDUCATION 

8 SEC. 1201. GRANTS FOR SCHOOLS OF MEDICINE IN DI9 VERSE AND UNDERSERVED AREAS. 

10 Subpart II of part C of title VII of the Public Health 

11 Service Act is amended by inserting after section 749B 

12 of such Act (42 U.S.C. 293m) the following: 

13 ‘‘SEC. 749C. SCHOOLS OF MEDICINE IN UNDERSERVED 

14 AREAS. 

15 ‘‘(a) GRANTS.—The Secretary, acting through the 

16 Administrator of the Health Resources and Services Ad17 ministration, may award grants to institutions of higher 

18 education (including multiple institutions of higher edu19 cation applying jointly) for the establishment, improve20 ment, and expansion of an allopathic or osteopathic school 

21 of medicine, or a branch campus of an allopathic or osteo22 pathic school of medicine. 

23 ‘‘(b) PRIORITY.—In selecting grant recipients under 

24 this section, the Secretary shall give priority to institutions 

25 of higher education that— 


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1 ‘‘(1) propose to use the grant for an allopathic 

2 or osteopathic school of medicine, or a branch cam3 pus of an allopathic or osteopathic school of medi4 cine, in a combined statistical area with fewer than 

5 200 actively practicing physicians per 100,000 resi6 dents according to the medical board (or boards) of 

7 the State (or States) involved; 

8 ‘‘(2) have a curriculum that emphasizes care for 

9 diverse and underserved populations; or 

10 ‘‘(3) are minority-serving institutions described 

11 in the list in section 371(a) of the Higher Education 

12 Act of 1965. 

13 ‘‘(c) USE OF FUNDS.—The activities for which a 

14 grant under this section may be used include— 

15 ‘‘(1) planning and constructing— 

16 ‘‘(A) a new allopathic or osteopathic school 

17 of medicine in an area in which no other school 

18 is based; or 

19 ‘‘(B) a branch campus of an allopathic or 

20 osteopathic school of medicine in an area in 

21 which no such school is based; 

22 ‘‘(2) accreditation and planning activities for an 

23 allopathic or osteopathic school of medicine or 

24 branch campus; 


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1 ‘‘(3) hiring faculty and other staff to serve at 

2 an allopathic or osteopathic school of medicine or 

3 branch campus; 

4 ‘‘(4) recruitment and enrollment of students at 

5 an allopathic or osteopathic school of medicine or 

6 branch campus; 

7 ‘‘(5) supporting educational programs at an 

8 allopathic or osteopathic school of medicine or 

9 branch campus; 

10 ‘‘(6) modernizing infrastructure or curriculum 

11 at an existing allopathic or osteopathic school of 

12 medicine or branch campus thereof; 

13 ‘‘(7) expanding infrastructure or curriculum at 

14 existing an allopathic or osteopathic school of medi15 cine or branch campus; and 

16 ‘‘(8) other activities that the Secretary deter17 mines further the development, improvement, and 

18 expansion of an allopathic or osteopathic school of 

19 medicine or branch campus thereof. 

20 ‘‘(d) DEFINITIONS.—In this section: 

21 ‘‘(1) The term ‘branch campus’ means a geo22 graphically separate site at least 100 miles from the 

23 main campus of a school of medicine where at least 

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1 dent’s training leading to a degree of doctor of medi2 cine. 

3 ‘‘(2) The term ‘institution of higher education’ 

4 has the meaning given to such term in section 

5 101(a) of the Higher Education Act of 1965. 

6 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—To 

7 carry out this section, there is authorized to be appro8 priated $1,000,000,000, to remain available until ex9 pended.’’. 

10 SEC. 1202. AMENDMENT TO THE PUBLIC HEALTH SERVICE 

11 ACT. 

12 Title XXXIV of the Public Health Service Act, as 

13 amended by as amended by sections 104, 702, and 806, 

14 is amended by adding at the end the following: 

15 ‘‘Subtitle D—Diversifying the 

16 Health Care Workplace 

17 ‘‘SEC. 3410. NATIONAL WORKING GROUP ON WORKFORCE 

18 DIVERSITY. 

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

20 the Bureau of Health Workforce of the Health Resources 

21 and Services Administration, shall award a grant to an 

22 entity determined appropriate by the Secretary for the es23 tablishment of a national working group on workforce di24 versity. 


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1 ‘‘(b) REPRESENTATION.—In establishing the national 

2 working group under subsection (a): 

3 ‘‘(1) The grantee shall ensure that the group 

4 has representatives of each of the following: 

5 ‘‘(A) The Health Resources and Services 

6 Administration. 

7 ‘‘(B) The Department of Health and 

8 Human Services Data Council. 

9 ‘‘(C) The Office of Minority Health of the 

10 Department of Health and Human Services. 

11 ‘‘(D) The Substance Abuse and Mental 

12 Health Services Administration. 

13 ‘‘(E) The Bureau of Labor Statistics of 

14 the Department of Labor. 

15 ‘‘(F) The National Institute on Minority 

16 Health and Health Disparities. 

17 ‘‘(G) The Agency for Healthcare Research 

18 and Quality. 

19 ‘‘(H) The Institute of Medicine Study 

20 Committee for the 2004 workforce diversity re21 port. 

22 ‘‘(I) The Indian Health Service. 

23 ‘‘(J) The Department of Education. 

24 ‘‘(K) Minority-serving academic institu25 tions. 


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1 ‘‘(L) Consumer organizations. 

2 ‘‘(M) Health professional associations, in3 cluding those that represent underrepresented 

4 minority populations. 

5 ‘‘(N) Researchers in the area of health 

6 workforce. 

7 ‘‘(O) Health workforce accreditation enti8 ties. 

9 ‘‘(P) Private (including nonprofit) founda10 tions that have sponsored workforce diversity 

11 initiatives. 

12 ‘‘(Q) Local and State health departments. 

13 ‘‘(R) Representatives of community mem14 bers to be included on admissions committees 

15 for health profession schools pursuant to sub16 section (c)(9). 

17 ‘‘(S) National community-based organiza18 tions that serve as a national intermediary to 

19 their urban affiliate members and have dem20 onstrated capacity to train health care profes21 sionals. 

22 ‘‘(T) The Veterans Health Administration. 

23 ‘‘(U) Other entities determined appropriate 

24 by the Secretary. 


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1 ‘‘(2) The grantee shall ensure that, in addition 

2 to the representatives under paragraph (1), the 

3 working group has not less than 5 health professions 

4 students representing various health profession fields 

5 and levels of training. 

6 ‘‘(c) ACTIVITIES.—The working group established 

7 under subsection (a) shall convene at least twice each year 

8 to complete the following activities: 

9 ‘‘(1) Review public and private health workforce 

10 diversity initiatives. 

11 ‘‘(2) Identify successful health workforce diver12 sity programs and practices. 

13 ‘‘(3) Examine challenges relating to the devel14 opment and implementation of health workforce di15 versity initiatives. 

16 ‘‘(4) Draft a national strategic work plan for 

17 health workforce diversity, including recommenda18 tions for public and private sector initiatives. 

19 ‘‘(5) Develop a framework and methods for the 

20 evaluation of current and future health workforce di21 versity initiatives. 

22 ‘‘(6) Develop recommended standards for work23 force diversity that could be applicable to all health 

24 professions programs and programs funded under 

25 this Act. 


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1 ‘‘(7) Develop guidelines to train health profes2 sionals to care for a diverse population. 

3 ‘‘(8) Develop a workforce data collection or 

4 tracking system to identify where racial and ethnic 

5 minority health professionals practice. 

6 ‘‘(9) Develop a strategy for the inclusion of 

7 community members on admissions committees for 

8 health profession schools. 

9 ‘‘(10) Help with monitoring and implementation 

10 of standards for diversity, equity, and inclusion. 

11 ‘‘(11) Other activities determined appropriate 

12 by the Secretary. 

13 ‘‘(d) ANNUAL REPORT.—Not later than 1 year after 

14 the establishment of the working group under subsection 

15 (a), and annually thereafter, the working group shall pre16 pare and make available to the general public for com17 ment, an annual report on the activities of the working 

18 group. Such report shall include the recommendations of 

19 the working group for improving health workforce diver20 sity. 

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

22 is authorized to be appropriated to carry out this section 

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

24 2021 through 2025. 


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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 under18 represented minority representation in health and al19 lied health professions and occupations. 

20 ‘‘(3) Model health workforce diversity practices 

21 and programs, including integrated models of care. 

22 ‘‘(4) Admissions policies that promote health 

23 workforce diversity and are in compliance with Fed24 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 minority health professional associations and 

13 minority sections of major health professional associations 

14 to ensure the adequacy and accuracy of information. 

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

16 is authorized to be appropriated to carry out this section 

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

18 2021 through 2025. 

19 ‘‘SEC. 3413. SUPPORT FOR INSTITUTIONS COMMITTED TO 

20 WORKFORCE DIVERSITY, EQUITY, AND IN21 CLUSION. 

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

23 the Administrator of the Health Resources and Services 

24 Administration and the Centers for Disease Control and 


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1 Prevention, shall award grants to eligible entities that 

2 demonstrate a commitment to health workforce diversity. 

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

4 under subsection (a), an entity shall— 

5 ‘‘(1) be an educational institution or entity that 

6 historically produces or trains meaningful numbers 

7 of underrepresented minority health professionals, 

8 including— 

9 ‘‘(A) part B institutions, as defined in sec10 tion 322 of the Higher Education Act of 1965; 

11 ‘‘(B) Hispanic-serving health professions 

12 schools; 

13 ‘‘(C) Hispanic-serving institutions, as de14 fined in section 502 of such Act; 

15 ‘‘(D) Tribal colleges or universities, as de16 fined in section 316 of such Act; 

17 ‘‘(E) Asian American and Native American 

18 Pacific Islander-serving institutions, as defined 

19 in section 371(c) of such Act; 

20 ‘‘(F) institutions that have programs to re21 cruit and retain underrepresented minority 

22 health professionals, in which a significant 

23 number of the enrolled participants are under24 represented minorities; 


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1 ‘‘(G) health professional associations, 

2 which may include underrepresented minority 

3 health professional associations; and 

4 ‘‘(H) institutions, including national and 

5 regional community-based organizations with 

6 demonstrated commitment to a diversified 

7 workforce— 

8 ‘‘(i) located in communities with pre9 dominantly underrepresented minority pop10 ulations; 

11 ‘‘(ii) with whom partnerships have 

12 been formed for the purpose of increasing 

13 workforce diversity; and 

14 ‘‘(iii) in which at least 20 percent of 

15 the enrolled participants are underrep16 resented minorities; and 

17 ‘‘(2) submit to the Secretary an application at 

18 such time, in such manner, and containing such in19 formation as the Secretary may require. 

20 ‘‘(c) USE OF FUNDS.—Amounts received under a 

21 grant under subsection (a) shall be used to expand existing 

22 workforce diversity programs, implement new workforce 

23 diversity programs, or evaluate existing or new workforce 

24 diversity programs, including with respect to mental 

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1 versity by considering minority status as part of an indi2 vidualized consideration of qualifications. Possible activi3 ties may include— 

4 ‘‘(1) educational outreach programs relating to 

5 opportunities in the health professions; 

6 ‘‘(2) scholarship, fellowship, grant, loan repay7 ment, and loan cancellation programs; 

8 ‘‘(3) postbaccalaureate programs; 

9 ‘‘(4) academic enrichment programs, particu10 larly targeting those who would not be competitive 

11 for health professions schools; 

12 ‘‘(5) supporting workforce diversity in kinder13 garten through 12th grade and other health pipeline 

14 programs; 

15 ‘‘(6) mentoring programs; 

16 ‘‘(7) internship or rotation programs involving 

17 hospitals, health systems, health plans, and other 

18 health entities; 

19 ‘‘(8) community partnership development for 

20 purposes relating to workforce diversity; or 

21 ‘‘(9) leadership training. 

22 ‘‘(d) REPORTS.—Not later than 1 year after receiving 

23 a grant under this section, and annually for the term of 

24 the grant, a grantee shall submit to the Secretary a report 


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1 that summarizes and evaluates all activities conducted 

2 under the grant. 

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

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

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

6 2021 through 2025. 

7 ‘‘SEC. 3414. CAREER DEVELOPMENT FOR SCIENTISTS AND 

8 RESEARCHERS. 

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

10 the Director of the National Institutes of Health, the Di11 rector of the Centers for Disease Control and Prevention, 

12 the Commissioner of Food and Drugs, the Director of the 

13 Agency for Healthcare Research and Quality, and the Ad14 ministrator of the Health Resources and Services Admin15 istration, shall award grants that expand existing opportu16 nities for scientists and researchers and promote the inclu17 sion of underrepresented minorities in the health profes18 sions. 

19 ‘‘(b) RESEARCH FUNDING.—The head of each agency 

20 listed in subsection (a) shall establish or expand existing 

21 programs to provide research funding to scientists and re22 searchers in training. Under such programs, the head of 

23 each such entity shall give priority in allocating research 

24 funding to support health research in traditionally under25 served communities, including underrepresented minority 


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1 communities, and research classified as community or 

2 participatory. 

3 ‘‘(c) DATA COLLECTION.—The head of each agency 

4 listed in subsection (a) shall collect data on the number 

5 (expressed as an absolute number and a percentage) of 

6 underrepresented minority and nonminority applicants 

7 who receive and are denied agency funding at every stage 

8 of review. Such data shall be reported annually to the Sec9 retary and the appropriate committees of Congress. 

10 ‘‘(d) STUDENT LOAN REIMBURSEMENT.—The Sec11 retary shall establish a student loan reimbursement pro12 gram to provide student loan reimbursement assistance to 

13 researchers who focus on racial and ethnic disparities in 

14 health. The Secretary shall promulgate regulations to de15 fine the scope and procedures for the program under this 

16 subsection. 

17 ‘‘(e) STUDENT LOAN CANCELLATION.—The Sec18 retary shall establish a student loan cancellation program 

19 to provide student loan cancellation assistance to research20 ers who focus on racial and ethnic disparities in health. 

21 Students participating in the program shall make a min22 imum 5-year commitment to work at an accredited health 

23 profession school. The Secretary shall promulgate addi24 tional regulations to define the scope and procedures for 

25 the program under this subsection. 


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

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

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

4 2021 through 2025. 

5 ‘‘SEC. 3415. CAREER SUPPORT FOR NONRESEARCH HEALTH 

6 PROFESSIONALS. 

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

8 the Director of the Centers for Disease Control and Pre9 vention, the Assistant Secretary for Mental Health and 

10 Substance Use, the Administrator of the Health Resources 

11 and Services Administration, and the Administrator of the 

12 Centers for Medicare & Medicaid Services, shall establish 

13 a program to award grants to eligible individuals for ca14 reer support in nonresearch-related health and wellness 

15 professions. 

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

17 under subsection (a), an individual shall— 

18 ‘‘(1) be a student in a health professions school, 

19 a graduate of such a school who is working in a 

20 health profession, an individual working in a health 

21 or wellness profession (including mental and behav22 ioral health), or a faculty member of such a school; 

23 and 


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1 ‘‘(2) 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.—An individual shall use 

5 amounts received under a grant under this section to— 

6 ‘‘(1) support the individual’s health activities or 

7 projects that involve underserved communities, in8 cluding racial and ethnic minority communities; 

9 ‘‘(2) support health-related career advancement 

10 activities; 

11 ‘‘(3) to pay, or as reimbursement for payments 

12 of, student loans or training or credentialing costs 

13 for individuals who are health professionals and are 

14 focused on health issues affecting underserved com15 munities, including racial and ethnic minority com16 munities; and 

17 ‘‘(4) to establish and promote leadership train18 ing programs to decrease health disparities and to 

19 increase cultural competence with the goal of in20 creasing diversity in leadership positions. 

21 ‘‘(d) DEFINITION.—In this section, the term ‘career 

22 in nonresearch-related health and wellness professions’ 

23 means employment or intended employment in the field 

24 of public health, health policy, health management, health 

25 administration, medicine, nursing, pharmacy, psychology, 


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1 social work, psychiatry, other mental and behavioral 

2 health, allied health, community health, social work, or 

3 other fields determined appropriate by the Secretary, 

4 other than in a position that involves research. 

5 ‘‘(e) 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 2021 through 2025. 

9 ‘‘SEC. 3416. RESEARCH ON THE EFFECT OF WORKFORCE DI10 VERSITY ON QUALITY. 

11 ‘‘(a) IN GENERAL.—The Director of the Agency for 

12 Healthcare Research and Quality, in collaboration with 

13 the Deputy Assistant Secretary for Minority Health and 

14 the Director of the National Institute on Minority Health 

15 and Health Disparities, shall award grants to eligible enti16 ties to expand research on the link between health work17 force diversity and quality health care. 

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

19 under subsection (a), an entity shall— 

20 ‘‘(1) be a clinical, public health, or health serv21 ices research entity or other entity determined ap22 propriate by the Director; and 

23 ‘‘(2) submit to the Secretary an application at 

24 such time, in such manner, and containing such in25 formation as the Secretary may require. 


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1 ‘‘(c) USE OF FUNDS.—Amounts received under a 

2 grant awarded under subsection (a) shall be used to sup3 port research that investigates the effect of health work4 force diversity on— 

5 ‘‘(1) language access; 

6 ‘‘(2) cultural competence; 

7 ‘‘(3) patient satisfaction; 

8 ‘‘(4) timeliness of care; 

9 ‘‘(5) safety of care; 

10 ‘‘(6) effectiveness of care; 

11 ‘‘(7) efficiency of care; 

12 ‘‘(8) patient outcomes; 

13 ‘‘(9) community engagement; 

14 ‘‘(10) resource allocation; 

15 ‘‘(11) organizational structure; 

16 ‘‘(12) compliance of care; or 

17 ‘‘(13) other topics determined appropriate by 

18 the Director. 

19 ‘‘(d) PRIORITY.—In awarding grants under sub20 section (a), the Director shall give individualized consider21 ation to all relevant aspects of the applicant’s background. 

22 Consideration of prior research experience involving the 

23 health of underserved communities shall be such a factor. 

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

25 is authorized to be appropriated to carry out this section 


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

2 2021 through 2025. 

3 ‘‘SEC. 3417. HEALTH DISPARITIES EDUCATION PROGRAM. 

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

5 through the Office of Minority Health, in collaboration 

6 with the National Institute on Minority Health and Health 

7 Disparities, the Office for Civil Rights, the Centers for 

8 Disease Control and Prevention, the Centers for Medicare 

9 & Medicaid Services, the Health Resources and Services 

10 Administration, and other appropriate public and private 

11 entities, shall establish and coordinate a health and health 

12 care disparities education program to support, develop, 

13 and implement educational initiatives and outreach strate14 gies that inform health care professionals and the public 

15 about the existence of and methods to reduce racial and 

16 ethnic disparities in health and health care. 

17 ‘‘(b) ACTIVITIES.—The Secretary, through the edu18 cation program established under subsection (a), shall, 

19 through the use of public awareness and outreach cam20 paigns targeting the general public and the medical com21 munity at large— 

22 ‘‘(1) disseminate scientific evidence for the ex23 istence and extent of racial and ethnic disparities in 

24 health care, including disparities that are not other25 wise attributable to known factors such as access to 


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1 care, patient preferences, or appropriateness of 

2 intervention, as described in the 2002 Institute of 

3 Medicine Report entitled ‘Unequal Treatment: Con4 fronting Racial and Ethnic Disparities in Health 

5 Care’, as well as the impact of disparities related to 

6 age, disability status, socioeconomic status, sex, gen7 der identity, and sexual orientation on racial and 

8 ethnic minorities; 

9 ‘‘(2) disseminate new research findings to 

10 health care providers and patients to assist them in 

11 understanding, reducing, and eliminating health and 

12 health care disparities; 

13 ‘‘(3) disseminate information about the impact 

14 of linguistic and cultural barriers on health care 

15 quality and the obligation of health providers who 

16 receive Federal financial assistance to ensure that 

17 individuals with limited English proficiency have ac18 cess to language access services; 

19 ‘‘(4) disseminate information about the impor20 tance and legality of racial, ethnic, disability status, 

21 socioeconomic status, sex, gender identity, and sex22 ual orientation, and primary language data collec23 tion, analysis, and reporting; 


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1 ‘‘(5) design and implement specific educational 

2 initiatives to health care providers relating to health 

3 and health care disparities; 

4 ‘‘(6) assess the impact of the programs estab5 lished under this section in raising awareness of 

6 health and health care disparities and providing in7 formation on available resources; and 

8 ‘‘(7) design and implement specific educational 

9 initiatives to educate the health care workforce relat10 ing to unconscious bias. 

11 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 

12 is authorized to be appropriated to carry out this section 

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

14 2021 through 2025.’’. 

15 SEC. 1203. HISPANIC-SERVING INSTITUTIONS, HISTORI16 CALLY BLACK COLLEGES AND UNIVERSITIES, 

17 ASIAN AMERICAN AND NATIVE AMERICAN PA18 CIFIC ISLANDER-SERVING INSTITUTIONS, 

19 TRIBAL COLLEGES, REGIONAL COMMUNITY20 BASED ORGANIZATIONS, AND NATIONAL MI21 NORITY MEDICAL ASSOCIATIONS. 

22 Part B of title VII of the Public Health Service Act 

23 (42 U.S.C. 293 et seq.) is amended by adding at the end 

24 the following: 


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1 ‘‘SEC. 742. HISPANIC-SERVING INSTITUTIONS, HISTORI2 CALLY BLACK COLLEGES AND UNIVERSITIES, 

3 ASIAN AMERICAN AND NATIVE AMERICAN PA4 CIFIC ISLANDER-SERVING INSTITUTIONS, 

5 AND TRIBAL COLLEGES. 

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

7 the Administrator of the Health Resources and Services 

8 Administration and in consultation with the Secretary of 

9 Education, shall award grants to Hispanic-serving institu10 tions, Historically Black Colleges and Universities, Asian 

11 American and Native American Pacific Islander-serving 

12 institutions, Tribal Colleges or Universities, regional com13 munity-based organizations, and national minority med14 ical associations, for counseling, mentoring and providing 

15 information on financial assistance to prepare underrep16 resented minority individuals to enroll in and graduate 

17 from health professional schools and to increase services 

18 for underrepresented minority students including— 

19 ‘‘(1) mentoring with underrepresented health 

20 professionals; and 

21 ‘‘(2) providing financial assistance information 

22 for continued education and applications to health 

23 professional schools. 

24 ‘‘(b) DEFINITIONS.—In this section: 

25 ‘‘(1) ASIAN AMERICAN AND NATIVE AMERICAN

26 PACIFIC ISLANDER-SERVING INSTITUTION.—The 


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1 term ‘Asian American and Native American Pacific 

2 Islander-serving institution’ has the meaning given 

3 such term in section 320(b) of the Higher Education 

4 Act of 1965. 

5 ‘‘(2) HISPANIC-SERVING INSTITUTION.—The 

6 term ‘Hispanic-serving institution’ means an entity 

7 that— 

8 ‘‘(A) is a school or program for which 

9 there is a definition under 799B; 

10 ‘‘(B) has an enrollment of full-time equiva11 lent students that is made up of at least 9 per12 cent Hispanic students; 

13 ‘‘(C) has been effective in carrying out pro14 grams to recruit Hispanic individuals to enroll 

15 in and graduate from the school; 

16 ‘‘(D) has been effective in recruiting and 

17 retaining Hispanic faculty members; 

18 ‘‘(E) has a significant number of graduates 

19 who are providing health services to medically 

20 underserved populations or to individuals in 

21 health professional shortage areas; and 

22 ‘‘(F) is a Hispanic Center of Excellence in 

23 Health Professions Education designated under 

24 section 736(d)(2) of the Public Health Service 

25 Act (42 U.S.C. 293(d)(2)). 


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1 ‘‘(3) HISTORICALLY BLACK COLLEGES AND

2 UNIVERSITY.—The term ‘historically black college 

3 and university’ has the meaning given the term ‘part 

4 B institution’ as defined in section 322 of the High5 er Education Act of 1965. 

6 ‘‘(4) TRIBAL COLLEGE OR UNIVERSITY.—The 

7 term ‘Tribal College or University’ has the meaning 

8 given such term in section 316(b) of the Higher 

9 Education Act of 1965. 

10 ‘‘(c) CERTAIN LOAN REPAYMENT PROGRAMS.—In 

11 carrying out the National Health Service Corps Loan Re12 payment Program established under subpart III of part 

13 D of title III and the loan repayment program under sec14 tion 317F, the Secretary shall ensure, notwithstanding 

15 such subpart or section, that loan repayments of not less 

16 than $50,000 per year per person are awarded for repay17 ment of loans incurred for enrollment or participation of 

18 underrepresented minority individuals in health profes19 sional schools and other health programs described in this 

20 section. 

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

22 is authorized to be appropriated to carry out this section 

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

24 2021 through 2026.’’. 


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1 SEC. 1204. LOAN REPAYMENT PROGRAM OF CENTERS FOR 

2 DISEASE CONTROL AND PREVENTION. 

3 Section 317F(c)(1) of the Public Health Service Act 

4 (42 U.S.C. 247b–7(c)(1)) is amended— 

5 (1) by striking ‘‘and’’ after ‘‘1994,’’; and 

6 (2) by inserting before the period at the end the 

7 following: ‘‘, $750,000 for fiscal year 2020, and such 

8 sums as may be necessary for each of the fiscal 

9 years 2021 through 2025’’. 

10 SEC. 1205. STUDY AND REPORT ON STRATEGIES FOR IN11 CREASING DIVERSITY. 

12 (a) STUDY.—The Comptroller General of the United 

13 States shall conduct a study on strategies for increasing 

14 the diversity of the health professional workforce. Such 

15 study shall include an analysis of strategies for increasing 

16 the number of health professionals from rural, lower in17 come, and underrepresented minority communities, includ18 ing which strategies are most effective for achieving such 

19 goal. 

20 (b) REPORT.—Not later than 2 years after the date 

21 of enactment of this Act, the Comptroller General shall 

22 submit to Congress a report on the study conducted under 

23 subsection (a), together with recommendations for such 

24 legislation and administrative action as the Comptroller 

25 General determines appropriate. 


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1 SEC. 1206. AMENDMENTS TO THE PANDEMIC EBT ACT. 

2 Section 1101 of the Families First Coronavirus Re3 sponse Act (Public Law 116–127) is amended— 

4 (1) in subsection (a)— 

5 (A) by striking ‘‘fiscal year 2020’’ and in6 serting ‘‘fiscal years 2020 and 2021’’; 

7 (B) by striking ‘‘during which the school 

8 would otherwise be in session’’; and 

9 (C) by inserting ‘‘until the school reopens’’ 

10 after ‘‘assistance’’; 

11 (2) in subsection (b)— 

12 (A) by inserting ‘‘and State agency plans 

13 for child care covered children in accordance 

14 with subsection (i)’’ after ‘‘with eligible chil15 dren’’; 

16 (B) by inserting ‘‘, a plan to enroll chil17 dren who become eligible children during a pub18 lic health emergency designation’’ before ‘‘, and 

19 issuances’’; 

20 (C) by striking ‘‘in an amount not less 

21 than the value of meals at the free rate over the 

22 course of 5 school days’’ and inserting ‘‘in ac23 cordance with subsection (h)(1)’’; and 

24 (D) by inserting ‘‘and for each child care 

25 covered child in the household’’ before the pe26 riod at the end; 


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1 (3) in subsection (c), by inserting ‘‘or child care 

2 center’’ after ‘‘school’’; 

3 (4) by amending subsection (e) to read as fol4 lows: 

5 ‘‘(e) RELEASE OF INFORMATION.—Notwithstanding 

6 any other provision of law, the Secretary of Agriculture 

7 may authorize— 

8 ‘‘(1) State educational agencies and school food 

9 authorities administering a school lunch program 

10 under the Richard B. Russell National School Lunch 

11 Act (42 U.S.C. 1751 et seq.) to release to appro12 priate officials administering the supplemental nutri13 tion assistance program such information as may be 

14 necessary to carry out this section with respect to el15 igible children; and 

16 ‘‘(2) State agencies administering a child and 

17 adult care food program under section 17 of the 

18 Richard B. Russell National School Lunch Act (42 

19 U.S.C. 1766) to release to appropriate officials ad20 ministering the supplemental nutrition assistance 

21 program such information as may be necessary to 

22 carry out this section with respect to child care cov23 ered children.’’; 

24 (5) by amending subsection (g) to read as fol25 lows: 


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1 ‘‘(g) AVAILABILITY OF COMMODITIES.— 

2 ‘‘(1) IN GENERAL.—Subject to paragraph (2), 

3 during fiscal year 2020, the Secretary of Agriculture 

4 may purchase commodities for emergency distribu5 tion in any area of the United States during a public 

6 health emergency designation. 

7 ‘‘(2) PURCHASES.—Funds made available to 

8 carry out this subsection on or after the date of the 

9 enactment of the Child Nutrition and Related Pro10 grams Recovery Act may only be used to purchase 

11 commodities for emergency distribution— 

12 ‘‘(A) under commodity distribution pro13 grams and child nutrition programs that were 

14 established and administered by the Food and 

15 Nutrition Service on or before the day before 

16 the date of the enactment of the Families First 

17 Coronavirus Response Act (Public Law 116– 

18 127); 

19 ‘‘(B) to Tribal organizations (as defined in 

20 section 3 of the Food and Nutrition Act of 

21 2008 (7 U.S.C. 2012)), that are not admin22 istering the food distribution program estab23 lished under section 4(b) of the Food and Nu24 trition Act of 2008 (7 U.S.C. 2013(b)); or 


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1 ‘‘(C) to emergency feeding organizations 

2 that are eligible recipient agencies (as such 

3 terms are defined in section 201A of the Emer4 gency Food Assistance Act of 1983 (7 U.S.C. 

5 7501)).’’; 

6 (6) by redesignating subsections (h) and (i) as 

7 subsections (l) and (m); 

8 (7) by inserting after subsection (g) the fol9 lowing: 

10 ‘‘(h) AMOUNT OF BENEFITS.— 

11 ‘‘(1) IN GENERAL.—A household shall receive 

12 benefits under this section in an amount equal to 1 

13 breakfast and 1 lunch at the free rate for each eligi14 ble child or child care covered child in such house15 hold for each day. 

16 ‘‘(2) TREATMENT OF NEWLY ELIGIBLE CHIL17 DREN.—In the case of a child who becomes an eligi18 ble child during a public health emergency designa19 tion, the Secretary and State agency shall— 

20 ‘‘(A) if such child becomes an eligible child 

21 during school year 2019–2020, treat such child 

22 as if such child was an eligible child as of the 

23 date the school in which the child is enrolled 

24 closed; and 


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1 ‘‘(B) if such child becomes an eligible child 

2 after school year 2019–2020, treat such child 

3 as an eligible child as of the first day of the 

4 month in which such child becomes so eligible. 

5 ‘‘(i) CHILD CARE COVERED CHILD ASSISTANCE.— 

6 ‘‘(1) IN GENERAL.—During fiscal years 2020 

7 and 2021, in any case in which a child care center 

8 is closed for at least 5 consecutive days during a 

9 public health emergency designation, each household 

10 containing at least 1 member who is a child care 

11 covered child attending the child care center shall be 

12 eligible until the schools in the State in which such 

13 child care center is located reopen, as determined by 

14 the Secretary, to receive assistance pursuant to— 

15 ‘‘(A) a State agency plan approved under 

16 subsection (b) that includes— 

17 ‘‘(i) an application by the State agen18 cy seeking to participate in the program 

19 under this subsection; and 

20 ‘‘(ii) a State agency plan for tem21 porary emergency standards of eligibility 

22 and levels of benefits under the Food and 

23 Nutrition Act of 2008 (7 U.S.C. 2011 et 

24 seq.) for households with child care covered 

25 children; or 


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1 ‘‘(B) an addendum application described in 

2 paragraph (2). 

3 ‘‘(2) ADDENDUM APPLICATION.—In the case of 

4 a State agency that submits a plan to the Secretary 

5 of Agriculture under subsection (b) that does not in6 clude an application or plan described in clauses (i) 

7 and (ii) of paragraph (1)(A), such State agency may 

8 apply to participate in the program under this sub9 section by submitting to the Secretary of Agriculture 

10 an addendum application for approval that includes 

11 a State agency plan described in such clause (ii). 

12 ‘‘(3) REQUIREMENTS FOR PARTICIPATION.—A 

13 State agency may not participate in the program 

14 under this subsection if— 

15 ‘‘(A) the State agency plan submitted by 

16 such State agency under subsection (b) with re17 spect to eligible children is not approved by the 

18 Secretary under such subsection; or 

19 ‘‘(B) the State agency plan submitted by 

20 such State agency under subsection (b) or this 

21 subsection with respect to child care covered 

22 children is not approved by the Secretary under 

23 either such subsection. 

24 ‘‘(4) AUTOMATIC ENROLLMENT.— 


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1 ‘‘(A) IN GENERAL.—Subject to subpara2 graph (B), the Secretary shall deem a child who 

3 is less than 6 years of age to be a child care 

4 covered child eligible to receive assistance under 

5 this subsection if— 

6 ‘‘(i) the household with such child at7 tests that such child is a child care covered 

8 child; 

9 ‘‘(ii) such child resides in a household 

10 that includes an eligible child; 

11 ‘‘(iii) such child receives cash assist12 ance benefits under the temporary assist13 ance for needy families program under 

14 part A of title IV of the Social Security 

15 Act (42 U.S.C. 601 et seq.); 

16 ‘‘(iv) such child receives assistance 

17 under the Child Care and Development 

18 Block Grant Act of 1990 (42 U.S.C. 9857 

19 et seq.); 

20 ‘‘(v) such child is— 

21 ‘‘(I) enrolled as a participant in a 

22 Head Start program authorized under 

23 the Head Start Act (42 U.S.C. 9831 

24 et seq.); 


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1 ‘‘(II) a foster child whose care 

2 and placement is the responsibility of 

3 an agency that administers a State 

4 plan under part B or E of title IV of 

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

6 621 et seq.); 

7 ‘‘(III) a foster child who a court 

8 has placed with a caretaker house9 hold; or 

10 ‘‘(IV) a homeless child or youth 

11 (as defined in section 725(2) of the 

12 McKinney-Vento Homeless Assistance 

13 Act (42 U.S.C. 11434a(2))); 

14 ‘‘(vi) such child participates in the 

15 special supplemental nutrition program for 

16 women, infants, and children under section 

17 17 of the Child Nutrition Act of 1966 (42 

18 U.S.C. 1786); 

19 ‘‘(vii) through the use of information 

20 obtained by the State agency for the pur21 pose of participating in the supplemental 

22 nutrition assistance program under the 

23 Food and Nutrition Act of 2008 (7 U.S.C. 

24 2011 et seq.), the State agency elects to 

25 treat as a child care covered child each 


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1 child less than 6 years of age who is a 

2 member of a household that receives sup3 plemental nutrition assistance program 

4 benefits under such Act; or 

5 ‘‘(viii) the State in which such child 

6 resides determines that such child is a 

7 child care covered child, using State data 

8 approved by the Secretary. 

9 ‘‘(B) ACCEPTANCE OF ANY FORM OF

10 AUTOMATIC ENROLLMENT.— 

11 ‘‘(i) ONE CATEGORY.—For purposes 

12 of deeming a child to be a child care cov13 ered child under subparagraph (A), a State 

14 agency may not be required to show that 

15 a child meets more than one requirement 

16 specified in clauses (i) through (viii) of 

17 such subparagraph. 

18 ‘‘(ii) DEEMING REQUIREMENT.—If a 

19 State agency submits to the Secretary in20 formation that a child meets any one of 

21 the requirements specified in clauses (i) 

22 through (viii) of subparagraph (A), the 

23 Secretary shall deem such child a child 

24 care covered child under such subpara25 graph. 


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1 ‘‘(j) EXCLUSIONS.—The provisions of section 16 of 

2 the Food and Nutrition Act of 2008 (7 U.S.C. 2025) re3 lating to quality control shall not apply with respect to 

4 assistance provided under this section. 

5 ‘‘(k) FEASIBILITY ANALYSIS.— 

6 ‘‘(1) IN GENERAL.—Not later than 30 days 

7 after the date of the enactment of the Child Nutri8 tion and Related Programs Recovery Act, the Sec9 retary shall submit to the Education and Labor 

10 Committee and the Agriculture Committee of the 

11 House of Representatives and the Committee on Ag12 riculture, Nutrition, and Forestry of the Senate a 

13 report on— 

14 ‘‘(A) the feasibility of implementing the 

15 program for eligible children under this section 

16 using an EBT system in Puerto Rico, the Com17 monwealth of the Northern Mariana Islands, 

18 and American Samoa similar to the manner in 

19 which the supplemental nutrition assistance 

20 program under the Food and Nutrition Act of 

21 2008 is operated in the States, including an 

22 analysis of— 

23 ‘‘(i) the current nutrition assistance 

24 program issuance infrastructure; 

25 ‘‘(ii) the availability of— 


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1 ‘‘(I) an EBT system, including 

2 the ability for authorized retailers to 

3 accept EBT cards; and 

4 ‘‘(II) EBT cards; 

5 ‘‘(iii) the ability to limit purchases 

6 using nutrition assistance program benefits 

7 to food for home consumption; and 

8 ‘‘(iv) the availability of reliable data 

9 necessary for the implementation of such 

10 program under this section for eligible chil11 dren and child care covered children, in12 cluding the names of such children and the 

13 mailing addresses of their households; and 

14 ‘‘(B) the feasibility of implementing the 

15 program for child care covered children under 

16 subsection (i) in Puerto Rico, the Common17 wealth of the Northern Mariana Islands, and 

18 American Samoa, including with respect to such 

19 program each analysis specified in clauses (i) 

20 through (iv) of subparagraph (A). 

21 ‘‘(2) CONTINGENT AVAILABILITY OF PARTICIPA22 TION.—Beginning 30 days after the date of the en23 actment of the Child Nutrition and Related Pro24 grams Recovery Act, Puerto Rico, the CommonVerDate Sep 11 2014 00:31 Nov 13, 2020 Jkt 019200 PO 00000 Frm 00522 Fmt 6652 Sfmt 6201 E:\BILLS\H8200.IH H8200

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1 wealth of the Northern Mariana Islands, and Amer2 ican Samoa may each— 

3 ‘‘(A) submit a plan under subsection (b), 

4 unless the Secretary makes a finding, based on 

5 the analysis provided under paragraph (1)(A), 

6 that the implementation of the program for eli7 gible children under this section is not feasible 

8 in such territories; and 

9 ‘‘(B) submit a plan under subsection (i), 

10 unless the Secretary makes a finding, based on 

11 the analysis provided under paragraph (1)(B), 

12 that the implementation of the program for 

13 child care covered children under subsection (i) 

14 is not feasible in such territories. 

15 ‘‘(3) TREATMENT OF PLANS SUBMITTED BY

16 TERRITORIES.—Notwithstanding any other provision 

17 of law, with respect to a plan submitted pursuant to 

18 this subsection by Puerto Rico, the Commonwealth 

19 of the Northern Mariana Islands, or American 

20 Samoa under subsection (b) or subsection (i), the 

21 Secretary shall treat such plan in the same manner 

22 as a plan submitted by a State agency under such 

23 subsection, including with respect to the terms of 

24 funding provided under subsection (m).’’; 


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1 (8) in subsection (l), as redesigned by para2 graph (7)— 

3 (A) by redesignating paragraph (1) as 

4 paragraph (3); 

5 (B) by redesignating paragraphs (2) and 

6 (3) as paragraphs (5) and (6), respectively; 

7 (C) by inserting before paragraph (3) (as 

8 so redesignated) the following: 

9 ‘‘(1) The term ‘child care center’ means an or10 ganization described in subparagraph (A) or (B) of 

11 section 17(a)(2) of the Richard B. Russell National 

12 School Lunch Act (42 U.S.C. 1766(a)(2)) and a 

13 family or group day care home. 

14 ‘‘(2) The term ‘child care covered child’ means 

15 a child served under section 17 of the Richard B. 

16 Russell National School Lunch Act (42 U.S.C. 

17 1766) who, if not for the closure of the child care 

18 center attended by the child during a public health 

19 emergency designation and due to concerns about a 

20 COVID–19 outbreak, would receive meals under 

21 such section at the child care center.’’; and 

22 (D) by inserting after paragraph (3) (as so 

23 redesignated) the following: 

24 ‘‘(4) The term ‘free rate’ means— 


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1 ‘‘(A) with respect to a breakfast, the rate 

2 of a free breakfast under the school breakfast 

3 program under section 4 of the Child Nutrition 

4 Act of 1966 (42 U.S.C. 1773); and 

5 ‘‘(B) with respect to a lunch, the rate of 

6 a free lunch under the school lunch program 

7 under the Richard B. Russell National School 

8 Lunch Act (42 U.S.C. 1771 et seq.).’’; and 

9 (9) in subsection (m), as redesignated by para10 graph (7), by inserting ‘‘(including all administrative 

11 expenses)’’ after ‘‘this section’’. 

12 TITLE XIII—PUBLIC HEALTH 

13 ASSISTANCE TO TRIBES 

14 SEC. 1301. APPROPRIATIONS FOR THE INDIAN HEALTH 

15 SERVICE. 

16 HEROES Act Division A, Title V—Department of 

17 Health & Human Services—Indian Health Service—The 

18 $2.1 billion in COVID–19 response funding for the Indian 

19 Health Service. 

20 SEC. 1302. IMPROVING STATE, LOCAL, AND TRIBAL PUBLIC 

21 HEALTH SECURITY. 

22 Section 319C–1 of the Public Health Service Act (42 

23 U.S.C. 247d–3a) is amended— 

24 (1) in the section heading, by striking ‘‘AND

25 LOCAL’’ and inserting ‘‘, LOCAL, AND TRIBAL’’; 


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1 (2) in subsection (b)— 

2 (A) in paragraph (1)— 

3 (i) in subparagraph (B), by striking 

4 ‘‘or’’ at the end; 

5 (ii) in subparagraph (C), by striking 

6 ‘‘and’’ at the end and inserting ‘‘or’’; and 

7 (iii) by adding at the end the fol8 lowing: 

9 ‘‘(D) be an Indian Tribe, Tribal organiza10 tion, or a consortium of Indian Tribes or Tribal 

11 organizations; and’’; and 

12 (B) in paragraph (2)— 

13 (i) in the matter preceding subpara14 graph (A), by inserting ‘‘, as applicable’’ 

15 after ‘‘including’’; 

16 (ii) in subparagraph (A)(viii)— 

17 (I) by inserting ‘‘and Tribal’’ 

18 after ‘‘with State’’; 

19 (II) by striking ‘‘(as defined in 

20 section 8101 of the Elementary and 

21 Secondary Education Act of 1965)’’ 

22 and inserting ‘‘and Tribal educational 

23 agencies (as defined in sections 8101 

24 and 6132, respectively, of the ElemenVerDate Sep 11 2014 00:31 Nov 13, 2020 Jkt 019200 PO 00000 Frm 00526 Fmt 6652 Sfmt 6201 E:\BILLS\H8200.IH H8200

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1 tary and Secondary Education Act of 

2 1965)’’; and 

3 (III) by inserting ‘‘and Tribal’’ 

4 after ‘‘and State’’; 

5 (iii) in subparagraph (G), by striking 

6 ‘‘and tribal’’ and inserting ‘‘Tribal, and 

7 urban Indian organization’’; and 

8 (iv) in subparagraph (H), by inserting 

9 ‘‘, Indian Tribes, and urban Indian organi10 zations’’ after ‘‘public health’’; 

11 (3) in subsection (e), by inserting ‘‘Indian 

12 Tribes, Tribal organizations, urban Indian organiza13 tions,’’ after ‘‘local emergency plans,’’; 

14 (4) in subsection (g)(1), by striking ‘‘tribal offi15 cials’’ and inserting ‘‘Tribal officials’’; 

16 (5) in subsection (h)— 

17 (A) in paragraph (1)(A)— 

18 (i) by striking ‘‘through 2023’’ and 

19 inserting ‘‘and 2020’’; and 

20 (ii) by inserting before the period ‘‘; 

21 and $690,000,000 for each of fiscal years 

22 2021 through 2023 for awards pursuant to 

23 paragraph (3) (subject to the authority of 

24 the Secretary to make awards pursuant to 

25 paragraphs (4) and (5)) and paragraph 


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1 (8), of which not less than $5,000,000 

2 shall be reserved each fiscal year for 

3 awards under paragraph (8)’’; 

4 (B) in subsection (h)(2)(B), by striking 

5 ‘‘tribal public’’ and inserting ‘‘Tribal public’’; 

6 (C) in the heading of paragraph (3), by in7 serting ‘‘FOR STATES’’ after ‘‘AMOUNT’’; and 

8 (D) by adding at the end the following: 

9 ‘‘(8) TRIBAL ELIGIBLE ENTITIES.— 

10 ‘‘(A) DETERMINATION OF FUNDING

11 AMOUNT.— 

12 ‘‘(i) IN GENERAL.—The Secretary 

13 shall award at least 10 cooperative agree14 ments under this section, in amounts not 

15 less than the minimum amount determined 

16 under clause (ii), to eligible entities de17 scribed in subsection (b)(1)(D) that sub18 mits to the Secretary an application that 

19 meets the criteria of the Secretary for the 

20 receipt of such an award and that meets 

21 other reasonable implementation conditions 

22 established by the Secretary, in consulta23 tion with Indian Tribes, for such awards. 

24 If the Secretary receives more than 10 ap25 plications under this section from eligible 


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1 entities described in subsection (b)(1)(D) 

2 that meet the criteria and conditions de3 scribed in the previous sentence, the Sec4 retary, in consultation with Indian Tribes, 

5 may make additional awards under this 

6 section to such entities. 

7 ‘‘(ii) MINIMUM AMOUNT.—In deter8 mining the minimum amount of an award 

9 pursuant to clause (i), the Secretary, in 

10 consultation with Indian Tribes, shall first 

11 determine an amount the Secretary con12 siders appropriate for the eligible entity. 

13 ‘‘(B) AVAILABLE UNTIL EXPENDED.— 

14 Amounts provided to a Tribal eligible entity 

15 under a cooperative agreement under this sec16 tion for a fiscal year and remaining unobligated 

17 at the end of such year shall remain available 

18 to such entity during the entirety of the per19 formance period, for the purposes for which 

20 said funds were provided. 

21 ‘‘(C) NO MATCHING REQUIREMENT.—Sub22 paragraphs (B), (C), and (D) of paragraph (1) 

23 shall not apply with respect to cooperative 

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1 ble entities described in subsection (b)(1)(D).’’; 

2 and 

3 (6) by adding at the end the following: 

4 ‘‘(l) SPECIAL RULES RELATED TO TRIBAL ELIGIBLE

5 ENTITIES.— 

6 ‘‘(1) MODIFICATIONS.—After consultation with 

7 Indian Tribes, the Secretary may make necessary 

8 and appropriate modifications to the program under 

9 this section to facilitate the use of the cooperative 

10 agreement program by eligible entities described in 

11 subsection (b)(1)(D). 

12 ‘‘(2) WAIVERS.— 

13 ‘‘(A) IN GENERAL.—Except as provided in 

14 subparagraph (B), the Secretary may waive or 

15 specify alternative requirements for any provi16 sion of this section (including regulations) that 

17 the Secretary administers in connection with 

18 this section if the Secretary finds that the waiv19 er or alternative requirement is necessary for 

20 the effective delivery and administration of this 

21 program with respect to eligible entities de22 scribed in subsection (b)(1)(D). 

23 ‘‘(B) EXCEPTION.—The Secretary may not 

24 waive or specify alternative requirements under 


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1 subparagraph (A) relating to labor standards or 

2 the environment. 

3 ‘‘(3) CONSULTATION.—The Secretary shall con4 sult with Indian Tribes and Tribal organizations on 

5 the design of this program with respect to such 

6 Tribes and organizations to ensure the effectiveness 

7 of the program in enhancing the security of Indian 

8 Tribes with respect to public health emergencies. 

9 ‘‘(4) REPORTING.— 

10 ‘‘(A) IN GENERAL.—Not later than 2 years 

11 after the date of enactment of this subsection, 

12 and as an addendum to the biennial evaluations 

13 required under subsection (k), the Secretary, in 

14 coordination with the Director of the Indian 

15 Health Service, shall— 

16 ‘‘(i) conduct a review of the implemen17 tation of this section with respect to eligi18 ble entities described in subsection 

19 (b)(1)(D), including any factors that may 

20 have limited its success; and 

21 ‘‘(ii) submit a report describing the 

22 results of the review described in clause (i) 

23 to— 

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1 cation, Labor, and Pensions, and the 

2 Committee on Appropriations of the 

3 Senate; and 

4 ‘‘(II) the Subcommittee for In5 digenous Peoples of the United States 

6 of the Committee on Natural Re7 sources, the Committee on Energy 

8 and Commerce, and the Committee on 

9 Appropriations of the House of Rep10 resentatives. 

11 ‘‘(B) ANALYSIS OF TRIBAL PUBLIC

12 HEALTH EMERGENCY INFRASTRUCTURE LIMI13 TATION.—The Secretary shall include in the 

14 initial report submitted under subparagraph (A) 

15 a description of any public health emergency in16 frastructure limitation encountered by eligible 

17 entities described in subsection (b)(1)(D).’’. 

18 SEC. 1303. PROVISION OF ITEMS TO INDIAN PROGRAMS 

19 AND FACILITIES. 

20 (a) STRATEGIC NATIONAL STOCKPILE.—Section 

21 319F–2(a)(3)(G) of the Public Health Service Act (42 

22 U.S.C. 247d–6b(a)(3)(G)) is amended by inserting ‘‘, and, 

23 in the case that the Secretary deploys the stockpile under 

24 this subparagraph, ensure, in coordination with the appli25 cable States and programs and facilities, that appropriate 


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1 drugs, vaccines and other biological products, medical de2 vices, and other supplies are deployed by the Secretary di3 rectly to health programs or facilities operated by the In4 dian Health Service, an Indian Tribe, a Tribal organiza5 tion (as those terms are defined in section 4 of the Indian 

6 Self-Determination and Education Assistance Act (25 

7 U.S.C. 5304)), or an inter-Tribal consortium (as defined 

8 in section 501 of the Indian Self-Determination and Edu9 cation Assistance Act (25 U.S.C. 5381)) or through an 

10 urban Indian organization (as defined in section 4 of the 

11 Indian Health Care Improvement Act), while avoiding du12 plicative distributions to such programs or facilities’’ be13 fore the semicolon. 

14 (b) DISTRIBUTION OF QUALIFIED PANDEMIC OR EPI15 DEMIC PRODUCTS TO IHS FACILITIES.—Title III of the 

16 Public Health Service Act (42 U.S.C. 241 et seq.) is 

17 amended by inserting after section 319F–4 the following: 

18 ‘‘SEC. 319F–5. DISTRIBUTION OF QUALIFIED PANDEMIC OR 

19 EPIDEMIC PRODUCTS TO INDIAN PROGRAMS 

20 AND FACILITIES. 

21 ‘‘In the case that the Secretary distributes qualified 

22 pandemic or epidemic products (as defined in section 

23 319F–3(i)(7)) to States or other entities, the Secretary 

24 shall ensure, in coordination with the applicable States 

25 and programs and facilities, that, as appropriate, such 


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1 products are distributed directly to health programs or fa2 cilities operated by the Indian Health Service, an Indian 

3 Tribe, a Tribal organization (as those terms are defined 

4 in section 4 of the Indian Self-Determination and Edu5 cation Assistance Act (25 U.S.C. 5304)), or an inter-Trib6 al consortium (as defined in section 501 of the Indian 

7 Self-Determination and Education Assistance Act (25 

8 U.S.C. 5381)) or through an urban Indian organization 

9 (as defined in section 4 of the Indian Health Care Im10 provement Act), while avoiding duplicative distributions to 

11 such programs or facilities.’’. 

12 SEC. 1304. HEALTH CARE ACCESS FOR URBAN NATIVE VET13 ERANS. 

14 Section 405 of the Indian Health Care Improvement 

15 Act (25 U.S.C. 1645) is amended— 

16 (1) in subsection (a)(1), by inserting ‘‘urban In17 dian organizations,’’ before ‘‘and tribal organiza18 tions’’; and 

19 (2) in subsection (c)— 

20 (A) by inserting ‘‘urban Indian organiza21 tion,’’ before ‘‘or tribal organization’’; and 

22 (B) by inserting ‘‘an urban Indian organi23 zation,’’ before ‘‘or a tribal organization’’. 


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1 SEC. 1305. PROPER AND REIMBURSED CARE FOR NATIVE 

2 VETERANS. 

3 Section 405(c) of the Indian Health Care Improve4 ment Act (25 U.S.C. 1645(c)) is amended by inserting be5 fore the period at the end the following: ‘‘, regardless of 

6 whether such services are provided directly by the Service, 

7 an Indian tribe, or tribal organization, through contract 

8 health services, or through a contract for travel described 

9 in section 213(b)’’. 

Æ 


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