I

103D CONGRESS

1ST SESSION H. R. 3230

To amend the Public Health Service Act with respect to the health of

individuals who are members of racial or ethnic minority groups.

IN THE HOUSE OF REPRESENTATIVES

OCTOBER 6, 1993

Mr. SERRANO (for himself, Mr. RICHARDSON, Mr. GUTIERREZ, Ms. ROYBALALLARD, Mr. PASTOR, Mr. TORRES, Mr. BECERRA, Ms. VELA ́ZQUEZ, Mr.

ROMERO-BARCELO ́, Mr. DE LUGO, Mr. ORTIZ, Mr. MENENDEZ, Mr.

DIAZ-BALART, and Mr. UNDERWOOD) introduced the following bill; which

was referred to the Committee on Energy and Commerce

A BILL

To amend the Public Health Service Act with respect to

the health of individuals who are members of racial or

ethnic minority groups.

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

3 SECTION 1. SHORT TITLE.

4 This Act may be cited as the ‘‘Minority Health Op5 portunity Enhancement Act of 1993’’.
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1 SEC. 2. MODIFICATIONS REGARDING SECRETARY’S OFFICE

2 OF MINORITY HEALTH.

3 (a) DUTIES.—Section 1707(b) of the Public Health

4 Service Act (42 U.S.C. 300u-6(b)) is amended—

5 (1) in paragraph (1), by striking ‘‘that relate’’

6 and all that follows and inserting the following:

7 ‘‘that relate to programs regarding the prevention of

8 diseases; the promotion of health; the delivery of

9 health services; research; the health professions; and

10 training and technical assistance regarding such pro11 grams;’’; and

12 (2)(A) in paragraph (7), by striking ‘‘and’’

13 after the semicolon at the end;

14 (B) in paragraph (8), by striking the period at

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

16 (C) by adding at the end the following para17 graph:

18 ‘‘(9)(A) establish by contract a center for the

19 purpose of carrying out programs to improve access

20 to health care services for individuals who have the

21 limitation of lacking proficiency in speaking the

22 English language, which programs carry out such

23 purpose by facilitating the removal of barriers to the

24 receipt of health care that result from such limita25 tion; and
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1 ‘‘(B) in carrying out subparagraph (A), ensure

2 that the center under such subparagraph conducts

3 research, develops and evaluates model projects, and

4 provides technical assistance to health care provid5 ers.’’.

6 (b) DEFINITIONS.—Section 1707 of the Public

7 Health Service Act (42 U.S.C. 300u-6) is amended—

8 (1) by redesignating subsection (f) as sub9 section (h); and

10 (2) by inserting before subsection (h) (as so re11 designated) the following subsection:

12 ‘‘(g) DEFINITION OF RACIAL OR ETHNIC MINORITY

13 GROUP.—The term ‘racial or ethnic minority group’

14 means Hispanics, African Americans, Asian Americans,

15 Pacific Islanders, Native Americans, Eskimos, and Aleuts.

16 For purposes of the preceding sentence, the term ‘His17 panic’ means individuals whose origin is Mexican, Puerto

18 Rican, Cuban, Central or South American, or any other

19 Spanish-speaking country, including Spain or the Carib20 bean Islands; and individuals indentifying themselves as

21 Hispanic, Latino, Spanish, or Spanish-American.’’.

22 (c) REPORTS.—Section 1707(e) of the Public Health

23 Service Act (42 U.S.C. 300u-6(e)) is amended by striking

24 ‘‘to the Congress’’ and inserting the following: ‘‘to the

25 Committee on Energy and Commerce and the Committee
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1 on Appropriations of the House of Representatives, and

2 to the Committee on Labor and Human Resources and

3 the Committee on Appropriations of the Senate,’’.

4 (d) CONFORMING AMENDMENT.—Section 1707(b) of

5 the Public Health Service Act (42 U.S.C. 300u-6(b)) is

6 amended in the matter preceding paragraph (1) by strik7 ing ‘‘racial and ethnic minorities’’ and inserting ‘‘racial

8 and ethnic minority groups’’.

9 SEC. 3. ESTABLISHMENT OF INDIVIDUAL OFFICES OF MI10 NORITY HEALTH WITHIN AGENCIES OF PUB11 LIC HEALTH SERVICE.

12 Title XVII of the Public Health Service Act (42

13 U.S.C. 300u et seq.), as amended by section 302 of Public

14 Law 102–531 (106 Stat. 3483), is amended by inserting

15 after section 1707 the following section:

16 ‘‘INDIVIDUAL OFFICES OF MINORITY HEALTH WITHIN

17 PUBLIC HEALTH SERVICE

18 ‘‘SEC. 1707A. (a) IN GENERAL.—The head of each

19 agency specified in subsection (b)(1) shall establish within

20 the agency an office to be known as the Office of Minority

21 Health. Each such Office shall be headed by a director,

22 who shall be appointed by the head of the agency within

23 which the Office is established and who shall report di24 rectly to the head of the agency. The head of such agency

25 shall carry out this section (as this section relates to the

26 agency) acting through such Director.
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1 ‘‘(b) SPECIFIED AGENCIES.—

2 ‘‘(1) IN GENERAL.—The agencies referred to in

3 subsection (a) are the following:

4 ‘‘(A) The Centers for Disease Control and

5 Prevention.

6 ‘‘(B) The Agency for Health Care Policy

7 and Research.

8 ‘‘(C) The Health Resources and Services

9 Administration.

10 ‘‘(D) The Substance Abuse and Mental

11 Health Services Administration.

12 ‘‘(2) NATIONAL INSTITUTES OF HEALTH.—For

13 purposes of subsection (c) and the subsequent provi14 sions of this section, the term ‘minority health of15 fice’’ includes the Office of Research on Minority

16 Health established within the National Institutes of

17 Health. The Director of the National Institutes of

18 Health shall carry out this section (as this section

19 relates to the agency) acting through the Director of

20 such Office.

21 ‘‘(c) COMPOSITION.—The head of each specified

22 agency shall ensure that the officers and employees of the

23 minority health office of the agency are, collectively, expe24 rienced in carrying out community-based health programs

25 for each of the various racial and ethnic minority groups
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1 and subgroups that are present in significant numbers in

2 the United States. The head of such agency shall ensure

3 that, of such officers and employees who are members of

4 racial and ethnic minority groups, no such group is dis5 proportionately represented.

6 ‘‘(d) COLLABORATION WITH SECRETARY’S OFFICE

7 OF MINORITY HEALTH.—In carrying out section 1707 re8 garding a specified agency, the Secretary shall collaborate

9 with the Director of the minority health office of the agen10 cy. With respect to the health concerns of individuals who

11 are members of racial or ethnic minority groups, the ac12 tivities with respect to which such Director collaborates

13 under the preceding sentence shall be—

14 ‘‘(1) establishing short-range and long-range

15 goals and objectives;

16 ‘‘(2) coordinating all other activities within the

17 agency that relate to programs regarding the pre18 vention of diseases; the promotion of health; the de19 livery of health services; research; the health profes20 sions; and training and technical assistance regard21 ing such programs; and

22 ‘‘(3) all other activities carried out under sec23 tion 1707.
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1 ‘‘(e) MONITORING OF AGENCY PROGRAMS.—Each

2 Director of a minority health office shall monitor the pro3 grams of the specified agency of such office in order to—

4 ‘‘(1) determine the extent to which the purposes

5 of the programs are being carried out with respect

6 to racial and ethnic minority groups;

7 ‘‘(2) determine the extent to which members of

8 such groups are represented among the Federal offi9 cers and employees who administer the programs;

10 and

11 ‘‘(3) make recommendations to the head of

12 such agency on carrying out the programs with re13 spect to such groups.

14 ‘‘(f) REPORTS.—The head of each specified agency

15 shall submit to the Secretary a biennial report describ16 ing—

17 ‘‘(1) the extent to which the minority health of18 fice of the agency employs individuals who are mem19 bers of racial and ethnic minority groups, including

20 a specification by racial and ethnic minority group

21 of the number of such individuals employed by such

22 office; and

23 ‘‘(2) the extent to which the agency has com24 plied with Public Law 94–311 (relating to data on

25 Americans of Spanish origin or descent).
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1 ‘‘(g) DEFINITIONS.—For purposes of this section:

2 ‘‘(1) The term ‘‘minority health office’’ means

3 an office established under subsection (a), subject to

4 subsection (b)(2).

5 ‘‘(2) The term ‘racial or ethnic minority group’

6 has the meaning given such term in section 1707(g).

7 ‘‘(3) The term ‘specified agency’ means—

8 ‘‘(A) an agency specified in subsection

9 (b)(1); and

10 ‘‘(B) the National Institutes of Health.

11 ‘‘(h) AUTHORIZATIONS OF APPROPRIATIONS.—

12 ‘‘(1) INDIVIDUAL AUTHORIZATIONS.—For the

13 purpose of carrying out activities under this section

14 through the minority health offices of the specified

15 agencies, there is authorized to be appropriated for

16 each such office for each of the fiscal years 1994

17 through 1996 an amount equal to 5 percent of the

18 amount appropriated for the preceding fiscal year

19 for the specified agency of such office, or

20 $3,000,000, whichever is greater.

21 ‘‘(2) AVAILABILITY OF FUNDS FOR STAFF22 ING.—The purposes for which amounts appropriated

23 under paragraph (1) may be expended by a minority

24 health office include the costs of employing staff for

25 such office.’’.
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1 SEC. 4. EQUITABLE ALLOCATIONS REGARDING CERTAIN

2 PROGRAMS.

3 (a) GENERALLY APPLICABLE PROVISIONS.—

4 (1) INCREASE IN AUTHORIZATIONS OF APPRO5 PRIATIONS.—

6 (A) For the purpose of carrying out the

7 programs specified in subparagraph (B), there

8 is authorized to be appropriated for each such

9 program for each of the fiscal years 1994

10 through 1996 an amount to 10 percent of the

11 amount appropriated for the program for fiscal

12 year 1993. The authorization established in the

13 preceding sentence for such a program for a fis14 cal year is in addition to any other authoriza15 tion of appropriations that is available for such

16 purpose.

17 (B) The programs referred to in subpara18 graph (A) are the following sections of the Pub19 lic Health Service Act: Section 340A, section

20 724, section 737, section 738(a), 738(b), and

21 740.

22 (2) PEER REVIEW.—

23 (A) In carrying out the designated pro24 grams, the Secretary shall ensure that each ap25 plication for any grant, cooperative agreement,

26 or contract authorized for the program is sub-
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1 mitted to a peer review group for an evaluation

2 of the merits of the proposals made in the ap3 plication. The Secretary may not approve such

4 an application unless a peer review group has

5 recommended the application for approval.

6 (B) Each peer review group under sub7 paragraph (A) shall be composed principally of

8 individuals who are not officers or employees of

9 the Federal Government. Each such group shall

10 be composed of individuals who are experienced

11 in carrying out community-based health pro12 grams for each of the various racial and ethnic

13 minority groups and subgroups that are present

14 in significant numbers in the United States.

15 The Secretary shall ensure that, of individuals

16 comprising the peer review groups who are

17 members of racial and ethnic minority groups,

18 no racial or ethnic minority group is dispropor19 tionately represented.

20 (3) OUTREACH.—With respect to awards of

21 grants and contracts that are available under the

22 designated programs, the Secretary shall carry out a

23 program—

24 (A) to inform entities, as appropriate, that

25 the entities may be eligible for the awards;
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1 (B) to provide technical assistance to such

2 entities in the process of preparing and submit3 ting applications for the awards in accordance

4 with the policies of the Secretary regarding

5 such applications; and

6 (C) to inform populations, as appropriate,

7 that members of the populations may be eligible

8 to receive services or otherwise participate in

9 the activities carried out with such awards.

10 (4) DEFINITIONS.—For purposes of this sub11 section:

12 (A) The term ‘racial or ethnic minority

13 group’ has the meaning given such term in sec14 tion 1707(g) of the Public Health Service Act.

15 (B) The term ‘‘designated program’’

16 means a program specified in paragraph (1)(B).

17 (C) The term ‘‘Secretary’’ means the Sec18 retary of Health and Human Services.

19 (b) EQUITABLE ALLOCATIONS REGARDING RACIAL

20 AND ETHNIC GROUPS.—Section 1707 of the Public

21 Health Service Act, as amended by section 2 of this Act,

22 is amended—

23 (1) by redesignating subsections (c) through (e)

24 as subsections (d) through (f), respectively;

25 (2) in subsection (d) (as so redesignated)—
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1 (A) by striking paragraph (1); and

2 (B) by redesignating paragraphs (2) and

3 (3) as paragraphs (1) and (2), respectively; and

4 (3) by inserting after subsection (b) the follow5 ing subsection:

6 ‘‘(c) EQUITABLE ALLOCATIONS.—

7 ‘‘(1) APPLICABILITY TO DESIGNATED PRO8 GRAMS.—

9 ‘‘(A) This subsection applies—

10 ‘‘(i) to activities carried out under any

11 program established under this section;

12 and

13 ‘‘(ii) to activities carried out under

14 any program of this Act that specifies that

15 this subsection is applicable to the pro16 gram (subject to such limitations as may

17 be established for the program involved).

18 ‘‘(B) With respect to a designated pro19 gram, this subsection shall be carried out by the

20 Secretary, acting through the head of the agen21 cy that carries out the program.

22 ‘‘(2) EQUITABLE ALLOCATIONS.—In carrying

23 out activities under a designated program on behalf

24 of members of racial or ethnic minority groups, the

25 Secretary shall ensure that the activities are equi-
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1 tably allocated among the various groups. In carry2 ing out the preceding sentence, the Secretary shall,

3 in the case of such a group, consider the following

4 factors:

5 ‘‘(A) The extent to which the group has a

6 disproportionate incidence or prevalence of any

7 health condition relative to the incidence and

8 prevalence of the condition in the general popu9 lation.

10 ‘‘(B) The extent to which there is evidence

11 that there has been discrimination against the

12 group on the basis of race or national origin.

13 ‘‘(C) The percentage constituted by the

14 ratio of the number of individuals who are

15 members of the group to the number of individ16 uals in the general population.

17 ‘‘(3) REPORTS.—

18 ‘‘(A) Subject to subparagraph (C), not

19 later than February 1 of fiscal year 1995 and

20 of each subsequent fiscal year, the Secretary

21 shall submit to the Committee on Energy and

22 Commerce and the Committee on Appropria23 tions of the House of Representatives, and to

24 the Committee on Labor and Human Resources

25 and the Committee on Appropriations of the
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1 Senate, a report describing the allocations that,

2 under paragraph (2), were made for the preced3 ing fiscal year under each designated program.

4 ‘‘(B) A report under subparagraph (A)

5 shall specify the methodology that was used to

6 make the allocations involved, the total amount

7 that was expended on behalf of each of the ra8 cial and ethnic minority groups involved, and

9 the total amount that was expended to employ

10 staff to make the allocations.

11 ‘‘(C) With respect to reports under sub12 paragraph (A), in any case in which a des13 ignated program is otherwise subject to a re14 quirement that annual reports concerning the

15 program be submitted to the Committees speci16 fied in such subparagraph, the reports under

17 such subparagraph may be incorporated into

18 such other reports.

19 ‘‘(4) DEFINITIONS.—For purposes of this sub20 section:

21 ‘‘(A) The term ‘designated program’

22 means a program to which this subsection ap23 plies, as indicated pursuant to paragraph (1).
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1 ‘‘(B) The term ‘racial or ethnic minority

2 group’ has the meaning given such term in sub3 section (g).’’.

4 (c) DESIGNATED PROGRAMS.—

5 (1) HEALTH CARE FOR RESIDENTS OF PUBLIC

6 HOUSING.—Section 340A of the Public Health Serv7 ice Act (42 U.S.C. 256a), as amended by section

8 309(d) of Public Law 102–531 (106 Stat. 3502), is

9 amended—

10 (A) by redesignating subsections (o)

11 through (q) as subsections (p) through (r), re12 spectively; and

13 (B) by inserting after subsection (n) the

14 following subsection:

15 ‘‘(o) EQUITABLE ALLOCATIONS.—The awarding of

16 grants under subsection (a) is subject to section

17 1707(c).’’.

18 (2) FEDERALLY-SUPPORTED LOAN FUNDS RE19 GARDING HEALTH PROFESSIONS SCHOOLS.—

20 (1) IN GENERAL.—Section 724(f) of the Public

21 Health Service Act (42 U.S.C. 292t(f)), as added by

22 section 102 of Public Law 102–408 (106 Stat.

23 1994), is amended by adding at the end the follow24 ing paragraph:
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1 ‘‘(3) EQUITABLE ALLOCATIONS.—The awarding

2 of Federal capital contributions for purposes of sub3 section (a) is subject to section 1707(c).’’.

4 (d) GRANTS FOR SCHOLARSHIPS AND OTHER PUR5 POSES REGARDING HEALTH PROFESSIONS SCHOOLS.—

6 (1) IN GENERAL.—Section 737 of the Public

7 Health Service Act (42 U.S.C. 293a), as added by

8 section 102 of Public Law 102–408 (106 Stat.

9 1994), is amended—

10 (A) by redesignating subsections (g) and

11 (h) as subsections (h) and (i), respectively; and

12 (B) by inserting after subsection (f) the

13 following subsection:

14 ‘‘(g) EQUITABLE ALLOCATIONS.—The awarding of

15 grants under subsection (a) is subject to section

16 1707(c).’’.

17 (e) LOAN REPAYMENTS AND FELLOWSHIPS REGARD18 ING FACULTY POSITIONS AT HEALTH PROFESSIONS

19 SCHOOLS.—Section 738 of the Public Health Service Act

20 (42 U.S.C. 293b), as added by section 102 of Public Law

21 102–408 (106 Stat. 1994), is amended by adding at the

22 end the following subsection:

23 ‘‘(c) EQUITABLE ALLOCATIONS.—The awarding of

24 contracts under subsection (a), and the awarding of grants

25 under subsection (b), are subject to section 1707(c).’’.
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1 (f) EDUCATIONAL ASSISTANCE REGARDING UNDER2 GRADUATES.—

3 (1) IN GENERAL.—Section 740(c) of the Public

4 Health Service Act (42 U.S.C. 293d(c)), as added by

5 section 102 of Public Law 102–408 (106 Stat.

6 1994), is amended to read as follows:

7 ‘‘(c) EQUITABLE ALLOCATIONS.—The awarding of

8 grants and contracts under subsection (a) is subject to

9 section 1707(c).’’.

10 SEC. 5. MEDICALLY UNDERSERVED POPULATIONS; HEALTH

11 PROFESSIONAL SHORTAGE AREAS.

12 (a) MEDICALLY UNDERSERVED POPULATIONS.—

13 (1) FACTORS IN DESIGNATING POPULATIONS.—

14 Section 330(b)(4)(B) of the Public Health Service

15 Act (42 U.S.C. 245c(b)(4)(B)) is amended to read

16 as follows:

17 ‘‘(B) include the following factors regarding the

18 population involved:

19 ‘‘(i) Factors indicating the health status of

20 the population, including the following (which

21 the Secretary shall consider to be of equal im22 portance): The rate of infant mortality and

23 morbidity; and the extent to which there is a

24 substantial rate of morbidity resulting from

25 complications in infectious, communicable, or
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1 chronic diseases that have progressed to a criti2 cal condition (as indicated by data provided

3 pursuant to discharging patients from hospitals

4 and pursuant to admissions to the emergency

5 facilities of hospitals).

6 ‘‘(ii) The ability to pay for health services,

7 including the rate of poverty and including the

8 percentage of the population constituted by in9 dividuals and families that do not have health

10 insurance.

11 ‘‘(iii) The percentage of the population

12 constituted by members of racial or ethnic mi13 nority groups.

14 ‘‘(iv) With respect to community-based

15 physicians who provide primary health services

16 and who are accepting additional patients

17 whose means of payment is through the pro18 gram established in title XVIII or XIX of the

19 Social Security Act, the following: The ratio of

20 the number of such physicians to the number of

21 individuals in the population.

22 ‘‘(v) The extent to which the individuals

23 lack access to primary health services, taking

24 into consideration barriers resulting from a lack

25 of proficiency in speaking the English language
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1 or from other cultural factors; the distance to

2 sites providing primary health services and the

3 lack of transportation to such sites; and any

4 other barriers encountered by the population.’’.

5 (2) CERTAIN DEFINITIONS.—Section 330(b) of

6 the Public Health Service Act (42 U.S.C. 245c(b))

7 is amended by adding at the end the following para8 graph:

9 ‘‘(7) For purposes of paragraph (4), the terms ‘popu10 lation’ and ‘population group’ include Hispanics, African

11 Americans, Native Americans, Asian Americans; Pacific

12 Islanders, and subgroups of such racial or ethnic minority

13 groups; individuals who lack proficiency in speaking the

14 English language; tribes and tribal organizations; seasonal

15 or migrant agricultural workers; homeless individuals; el16 derly individuals; and individuals with a disability.’’.

17 (3) USE OF FACTORS IN MAKING GRANTS.—

18 Section 330(b) of the Public Health Service Act, as

19 amended by paragraph (2) of this subsection, is

20 amended by adding at the end the following para21 graph:

22 ‘‘(8) In considering applications for grants under sub23 sections (c) and (d), the Secretary shall consider the ex24 tent to which the population involved has a shortage of
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1 personal health services, as indicated by the factors speci2 fied in paragraph (1) of this subsection.’’.

3 (4) DEFINITION.—Section 330(b) of the Public

4 Health Service Act, as amended by paragraph (3) of

5 this subsection, is amended by adding at the end the

6 following paragraph:

7 ‘‘(9) The term ‘racial or ethnic minority group’ has

8 the meaning given such term in section 1707(g).’’.

9 (b) HEALTH PROFESSIONAL SHORTAGE AREAS.—

10 (1) FACTORS IN DESIGNATING SHORTAGE

11 AREAS.—

12 (A) Section 332(b) of the Public Health

13 Service Act (42 U.S.C. 254e(b)) is amended—

14 (i) by redesignating paragraph (3) as

15 paragraph (6); and

16 (ii) by striking paragraphs (1) and (2)

17 and inserting the following:

18 ‘‘(1) Factors indicating the health status of the

19 population, including the following (which the Sec20 retary shall consider to be of equal importance): The

21 rate of infant mortality and morbidity; and the ex22 tent to which there is a substantial rate of morbidity

23 resulting from complications in infectious, commu24 nicable, or chronic diseases that have progressed to

25 a critical condition (as indicated by data provided
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1 pursuant to discharging patients from hospitals and

2 pursuant to admissions to the emergency facilities of

3 hospitals).

4 ‘‘(2) The ability to pay for health services, in5 cluding the rate of poverty and including the per6 centage of the population constituted by individuals

7 and families that do not have health insurance.

8 ‘‘(3) The percentage of the population con9 stituted by members of racial or ethnic minority

10 groups.

11 ‘‘(4) With respect to community-based physi12 cians who provide primary health services and who

13 are accepting additional patients whose means of

14 payment is through the program established in title

15 XVIII or XIX, the following: The ratio of the num16 ber of such physicians to the number of individuals

17 in the population.

18 ‘‘(5) The extent to which the individuals lack

19 access to primary health services, taking into consid20 eration barriers resulting from a lack of proficiency

21 in speaking the English language or from other cul22 tural factors; the distance to sites providing primary

23 health services and the lack of transportation to

24 such sites; and any other barriers encountered by

25 the population.’’.
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1 (B) Section 332(a)(3) of the Public Health

2 Service Act (42 U.S.C. 254e(a)(3)) is amended

3 to read as follows:

4 ‘‘(3) With respect to the consideration by the Sec5 retary under paragraph (1) of the population of an area,

6 the population served by a facility, or a population group,

7 the terms ‘population’ and ‘population group’ include His8 panics, African Americans, Native Americans, Asian

9 Americans; Pacific Islanders, and subgroups of such racial

10 or ethnic minority groups; individuals who lack proficiency

11 in speaking the English language; tribes and tribal organi12 zations; seasonal or migrant agricultural workers; home13 less individuals; elderly individuals; and individuals with

14 a disability.’’.

15 (2) PRIORITIES IN ASSIGNMENT OF CORPS PER16 SONNEL.—Section 333A(b) of the Public Health

17 Service Act (42 U.S.C. 254f–1(b)) is amended by

18 striking paragraphs (1) and (2) and inserting the

19 following:

20 ‘‘(1) Factors indicating the health status of the

21 population, including the following (which the Sec22 retary shall consider to be of equal importance): The

23 rate of infant mortality and morbidity; and the ex24 tent to which there is a substantial rate of morbidity

25 resulting from complications in infectious, commu-
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1 nicable, or chronic diseases that have progressed to

2 a critical condition (as indicated by data provided

3 pursuant to discharging patients from hospitals and

4 pursuant to admissions to the emergency facilities of

5 hospitals).

6 ‘‘(2) The ability to pay for health services, in7 cluding the rate of poverty and including the per8 centage of the population constituted by individuals

9 and families that do not have health insurance.

10 ‘‘(3) The percentage of the population con11 stituted by members of racial or ethnic minority

12 groups.

13 ‘‘(4) With respect to community-based physi14 cians who provide primary health services and who

15 are accepting additional patients whose means of

16 payment is through the program established in title

17 XVIII or XIX, the following: The ratio of the num18 ber of such physicians to the number of individuals

19 in the population.

20 ‘‘(5) The extent to which the individuals lack

21 access to primary health services, taking into consid22 eration barriers resulting from a lack of proficiency

23 in speaking the English language or from other cul24 tural factors; the distance to sites providing primary

25 health services and the lack of transportation to
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1 such sites; and any other barriers encountered by

2 the population.’’.

3 (4) DEFINITION.—Section 331(a)(3) of the

4 Public Health Service Act (42 U.S.C. 254d(a)(3)) is

5 amended by adding at the end the following sub6 paragraph:

7 ‘‘(E) The term ‘racial or ethnic minority group’

8 has the meaning given such term in section

9 1707(g).’’.

10 SEC. 6. LACK OF ENGLISH PROFICIENCY AS BARRIER TO

11 OBTAINING HEALTH CARE.

12 (a) CONTINUATION OF CERTAIN INITIATIVES FOR

13 REMOVAL OF BARRIERS.—

14 (1) MIGRANT HEALTH CENTERS.—Section

15 329(h) of the Public Health Service Act (42 U.S.C.

16 254b(h)) is amended by adding at the end the fol17 lowing paragraph:

18 ‘‘(4)(A) For the purpose of carrying out subpara19 graph (B), there are authorized to be appropriated

20 $3,000,000 for each of the fiscal years 1994 through

21 1996.

22 ‘‘(B) The Secretary may make grants to migrant

23 health centers for programs to reduce the extent to which

24 a lack of proficiency in speaking the English language (or
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1 other cultural factors) constitute a significant barrier to

2 obtaining health services.’’.

3 (2) COMMUNITY HEALTH CENTERS.—Section

4 330(g) of the Public Health Service Act (42 U.S.C.

5 254c(g)) is amended by adding at the end the fol6 lowing paragraph:

7 ‘‘(4)(A) For the purpose of carrying out subpara8 graph (B), there are authorized to be appropriated

9 $3,000,000 for each of the fiscal years 1994 through

10 1996.

11 ‘‘(B) The Secretary may make grants to community

12 health centers for programs to reduce the extent to which

13 a lack of proficiency in speaking the English language (or

14 other cultural factors) constitute a significant barrier to

15 obtaining health services.’’.

16 (b) ISSUANCE OF REGULATIONS.—

17 (1) PROPOSED RULE.—Not later than the expi18 ration of the 90-day period beginning on the date of

19 the enactment of this Act, the Secretary of Health

20 and Human Services (in this section referred to as

21 the ‘‘Secretary’’) shall issue a proposed rule to es22 tablish regulations for policies to reduce the extent

23 to which a lack of proficiency in speaking the Eng24 lish language constitutes a significant barrier to in25 dividuals in establishing the eligibility of the individ-
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1 uals for participation in health programs under the

2 Public Health Service Act or title XIX of the Social

3 Security Act, or in receiving services under such pro4 grams.

5 (2) FINAL RULE.—

6 (A) IN GENERAL.—Not later than the ex7 piration of the 1-year period beginning the date

8 of the enactment of this Act, the Secretary shall

9 issue a final rule to establish the regulations de10 scribed in paragraph (1).

11 (B) FAILURE TO ISSUE BY DATE CER12 TAIN.—If the Secretary fails to issue a final

13 rule under subparagraph (A) before the expira14 tion of the period specified in such subpara15 graph, the proposed rule issued under para16 graph (1) is upon such expiration deemed to be

17 the final rule under subparagraph (A) (and

18 shall remain in effect until the Secretary issues

19 a final rule under such subparagraph).

20 SEC. 7. CENTERS OF EXCELLENCE IN HEALTH PROFES21 SIONS EDUCATION.

22 (a) USE OF FUNDS.—Section 739(b) of the Public

23 Health Service Act (42 U.S.C. 293c(b)), as added by sec24 tion 102 of Public Law 102–408 (106 Stat. 1994), is

25 amended to read as follows:
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1 ‘‘(b) USE OF FUNDS.—

2 ‘‘(1) REQUIRED USES.—The Secretary may not

3 make a grant under subsection (a) unless the health

4 professions school involved agrees to expend the

5 grant for each of the following purposes:

6 ‘‘(A) To colloborate with public and non7 profit private entities to carry out community8 based programs to recruit minority students of

9 secondary schools and institutions of higher

10 education and to prepare the students academi11 cally for attendance at the health professions

12 school.

13 ‘‘(B) To improve the capacity of such

14 school to train, recruit, and retain minority fac15 ulty.

16 ‘‘(C) With respect to minority health is17 sues, to carry out activities to improve the in18 formation resources and curricula of the school

19 and clinical education at the school.

20 ‘‘(D) To facilitate faculty and student re21 search on health issues particularly affecting

22 minority groups.

23 ‘‘(2) RELATIONSHIP WITH OTHER ENTITIES.—

24 In expending a grant under subsection (a), a health

25 professions school may permit public and nonprofit
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1 private entities to participate in the programs and

2 activities that the school carries out under such sub3 section. The preceding sentence applies without re4 gard to whether such entities have been designated

5 under subsection (d) as centers of excellence.’’.

6 (b) DEFINITION.—Section 739(h) of the Public

7 Health Service Act (42 U.S.C. 293c(h)) is amended by

8 adding at the end the following paragraph:

9 ‘‘(4) The term ‘minority’’, with respect to an in10 dividual, means an individual who is a member of a

11 racial or ethnic minority group, as defined in section

12 1707(g).’’.

13 (c) FUNDING.—Section 739(i) of the Public Health

14 Service Act (42 U.S.C. 293c(i)), as added by section 102

15 of Public Law 102–408 (106 Stat. 1994), is amended—

16 (1) in paragraph (1), by inserting before the pe17 riod the following: ‘‘, and $27,000,000 for each of

18 the fiscal years 1994 through 1996’’; and

19 (2) in paragraph (2)—

20 (A) in subparagraph (B), by striking ‘‘60

21 percent’’ and inserting ‘‘80 percent’’; and

22 (B) in subparagraph (C), by striking ‘‘40

23 percent’’ and inserting ‘‘20 percent’’.
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1 SEC. 8. FUNDING FOR ACTIVITIES OF AGENCY FOR HEALTH

2 CARE POLICY AND RESEARCH.

3 Section 926(a) of the Public Health Service Act (42

4 U.S.C. 299c-5(a)) is amended by adding at the end the

5 following sentences: ‘‘Of the amounts appropriated under

6 the preceding sentence for a fiscal year, the Administrator

7 shall reserve not less than 8 percent for carrying out sec8 tion 902(b)(2). The activities carried out by the Secretary

9 with the amounts so reserved shall include activities re10 garding Hispanic individuals (as defined in section

11 1707(g)).’’.

12 SEC. 9. FUNDING FOR CERTAIN ACTIVITIES OF NATIONAL

13 CENTER FOR HEALTH STATISTICS.

14 Section 306(o) of the Public Health Service Act (42

15 U.S.C. 242k(o)) is amended—

16 (1) in paragraph (1)—

17 (A) by striking ‘‘subsections (a) through

18 (m)’’ and inserting ‘‘this section’’; and

19 (B) by striking ‘‘1993.’’ and inserting

20 ‘‘1993, $65,000,000 for fiscal year 1994, and

21 such sums as may be necessary for each of the

22 fiscal years 1995 and 1996.’’; and

23 (2) by amending paragraph (2) to read as fol24 lows:

25 ‘‘(2) Of the amounts appropriated under paragraph

26 (1) for a fiscal year, the Secretary shall obligate not less
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1 than an aggregate $10,000,000 for carrying out sub2 sections (h), (m), and (n), except that not more than

3 $100,000 may be expended in the aggregate for the ad4 ministration of activities under subsection (n) and for ac5 tivities described in paragraph (2) of such subsection.’’.

6 SEC. 10. DEMONSTRATION PROJECTS REGARDING DIABE7 TES-RELATED EYE DISORDERS.

8 (a) IN GENERAL.—The Secretary may make grants

9 to public and nonprofit private entities for the purpose of

10 carrying out demonstration projects that, for Hispanics,

11 African Americans, and any other populations that are at

12 significant risk of contracting diabetes mellitus—

13 (1) provide screenings for eye disorders for

14 which diabetes mellitus is a significant causal factor;

15 (2) provide appropriate referrals for services for

16 individuals who are screened pursuant to paragraph

17 (1) and ensure, to the extent practicable, the provi18 sion of appropriate follow-up services;

19 (3) develop and disseminate public information

20 and education programs for the detection and con21 trol of such eye disorders; and

22 (4) improve the education, training, and skills

23 of health professionals (including allied health pro24 fessionals) in the detection and control of such eye

25 disorders.
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1 (b) PRIORITY REGARDING DIABETIC RETINOP2 ATHY.—The Secretary may make a grant under sub3 section (a) only if the applicant involved agrees to give

4 priority to carrying out paragraphs (1) through (4) of

5 such subsection with respect to the eye disorder known

6 as diabetic retinopathy.

7 (c) APPLICATION FOR GRANT.—The Secretary may

8 make a grant under subsection (a) only if an application

9 for the grant is submitted to the Secretary and the appli10 cation is in such form, is made in such manner, and con11 tains such agreements, assurances, and information as the

12 Secretary determines to be necessary to carry out this sec13 tion.

14 (d) DEFINITIONS.—For purposes of this section, the

15 term ‘‘Secretary’’ means the Secretary of Health and

16 Human Services.

17 (e) AUTHORIZATION OF APPROPRIATIONS.—For the

18 purpose of carrying out this section, there are authorized

19 to be appropriated $100,000 for fiscal year 1994, and

20 such sums as may be necessary for each of the fiscal years

21 1995 and 1996.

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