I 

114TH CONGRESS 

1ST SESSION H. R. 3285 

To provide for a study by the Institute of Medicine on health disparities, 

to direct the Secretary of Health and Human Services to develop guidelines on reducing health disparities, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 29, 2015 

Mr. PASCRELL (for himself, Mr. COHEN, Mr. CAPUANO, Ms. LINDA T. 

SA ́NCHEZ of California, Mr. LARSON of Connecticut, Mr. DANNY K. 

DAVIS of Illinois, Mr. GRIJALVA, Ms. BROWN of Florida, Ms. MICHELLE

LUJAN GRISHAM of New Mexico, Mr. BISHOP of Georgia, Mr. DAVID

SCOTT of Georgia, Mr. HONDA, Mr. PAYNE, Ms. JUDY CHU of California, 

Mr. TAKAI, Mr. RANGEL, Mr. POCAN, Ms. LEE, Mr. GUTIE ́RREZ, Mr. 

ELLISON, and Mr. THOMPSON of California) introduced the following bill; 

which was referred to the Committee on Energy and Commerce, and in 

addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such 

provisions as fall within the jurisdiction of the committee concerned 

A BILL 

To provide for a study by the Institute of Medicine on 

health disparities, to direct the Secretary of Health and 

Human Services to develop guidelines on reducing health 

disparities, 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 ‘‘Reducing Disparities 

3 Using Care Models and Education Act of 2015’’. 

4 SEC. 2. FINDINGS. 

5 The Congress finds as follows: 

6 (1) The infant death rate among African-Amer7 icans is more than double that of Whites. 

8 (2) The death rate for all cancers is 30-percent 

9 higher for African-Americans than for Whites; for 

10 prostate cancer, it is more than double that for 

11 Whites. 

12 (3) Black women have a higher death rate from 

13 breast cancer despite having a mammography 

14 screening rate that is nearly the same as the rate for 

15 White women. 

16 (4) In 2013, Asian-Americans and Pacific Is17 landers were the only racial group where cancer was 

18 the number one cause of death. Asian-Americans 

19 have the lowest screening rates for breast (64.1 per20 cent), cervical (75.4 percent), and colorectal (46.9 

21 percent) cancer, compared to all other racial groups; 

22 the cervical cancer rate for Vietnamese-American 

23 women is five times higher than for non-Hispanic 

24 Whites. 

25 (5) Diabetes incidence is highest among Native 

26 Americans, at 15.9 percent, followed by 13.2 percent 


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1 for African-Americans, 12.8 percent for Hispanics, 

2 9.0 percent for Asians, and 7.6 percent for Whites. 

3 In 2012, the percentage of Native Hawaiians and 

4 Pacific Islanders with diabetes was nearly two times 

5 higher than that of Whites. 

6 (6) New cases of hepatitis and tuberculosis are 

7 higher in Asians and Pacific Islanders living in the 

8 United States than in Whites. Half of all persons 

9 living with hepatitis B in the United States are 

10 Asian-American. 

11 (7) Individuals in same-sex couples were more 

12 likely than individuals in different-sex couples to re13 port a delay in getting necessary prescriptions. 

14 (8) Infants born to Black women are 1.5 to 3 

15 times more likely to die than those born to women 

16 of other races or ethnicities, and American Indian 

17 and Alaska Native infants die from sudden infant 

18 death syndrome (SIDS) at nearly 2.5 times the rate 

19 of White infants. 

20 (9) Low-income children have higher rates of 

21 mortality (even with the same condition), have high22 er rates of disability, and are more likely to have 

23 multiple conditions. 


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1 (10) White children are half as likely as Black 

2 and Latino children not to be in excellent or very 

3 good health. 

4 (11) As of 2012, 38.9 percent of United States 

5 adults were obese, with the highest rate among Afri6 can-Americans at 47.9 percent, followed by His7 panics at 42.5 percent, Whites at 32.6 percent, and 

8 Asians at 10.8 percent. Native Hawaiians and Pa9 cific Islanders are 30-percent more likely to be obese 

10 than non-Hispanic Whites. Lack of disaggregated 

11 data among Asians can mask differences in the bur12 den of obesity among ethnic groups. 

13 (12) The risk of stroke is twice as high for Af14 rican-Americans as for Whites, and African-Ameri15 cans are more likely to die of stroke. Other ethnic 

16 minorities also have higher risk than Whites. Over17 all, strokes are most prevalent in the Southeast 

18 United States, and less so in the Northeast. 

19 (13) African-Americans accounted for 44 per20 cent of all those infected with HIV, despite being 

21 only 12 percent of the United States population. 

22 (14) Black men who have sex with men (MSM) 

23 ages 13 to 24 had the most new infections among 

24 youth. 


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1 (15) Asian-Americans have the lowest rate of 

2 testing for HIV, with only four in 10 having ever 

3 been tested; Asian-American and Pacific Islander 

4 women have the lowest proportion (17.2 percent) of 

5 having ever been tested for HIV compared to other 

6 races. 

7 (16) Globally, transgender women are 49 times 

8 more likely to acquire HIV than the general popu9 lation; in the United States, transgender women are 

10 34 times more likely than the general population. 

11 (17) One study found that among heterosexuals 

12 living in the same urban community, those below the 

13 poverty line were twice as likely to contract human 

14 immunodeficiency virus (HIV). 

15 (18) Persons with less than a high school di16 ploma (6.7 percent) and high school graduates (4.0 

17 percent) were more likely to report major depression 

18 than those with at least some college education (2.5 

19 percent). 

20 (19) Only about 10 percent of physicians prac21 tice in rural America despite the fact that nearly 

22 one-fourth of the population lives in these areas. 

23 (20) Rural residents are less likely to have em24 ployer-provided health care coverage or prescription 

25 drug coverage, and the rural poor are less likely to 


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1 be covered by Medicaid benefits than their urban 

2 counterparts. 

3 (21) Twenty percent of nonmetropolitan coun4 ties lack mental health services versus 5 percent of 

5 metropolitan counties. 

6 (22) Forty-one percent of transgender people 

7 have reported attempting suicide compared to 1.6 

8 percent of the general population. 

9 (23) Fifteen percent of persons with disabilities 

10 report not seeing a doctor due to cost in comparison 

11 to 6 percent of the general population. 

12 (24) Nineteen percent of transgender people 

13 have been refused medical care because of their gen14 der identity. Twenty-eight percent have been har15 assed in a doctor’s office. 

16 (25) More than 20 percent of the United States 

17 population speaks a language other than English at 

18 home. Among Asian-Americans, 32 percent are lim19 ited English proficient, meaning they speak English 

20 less than very well or not at all. Lack of linguis21 tically accessible care presents health access chal22 lenges and can contribute to disparities for limited 

23 English speakers. 


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1 SEC. 3. INSTITUTE OF MEDICINE STUDY. 

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

3 date of the enactment of this Act, the Secretary shall enter 

4 into an arrangement with the Institute of Medicine under 

5 which the Institute agrees to study— 

6 (1) the extent of health disparities in the type 

7 and quality of preventive interventions, health serv8 ices, and outcomes in all populations, including chil9 dren, in the United States; 

10 (2) the factors that may contribute to inequities 

11 in such disparities; 

12 (3) existing programs and policies intended to 

13 reduce such disparities; 

14 (4) best practices and successful strategies in 

15 programs that aim to reduce such disparities; 

16 (5) priorities for successful intervention pro17 grams targeting such disparities; and 

18 (6) potential opportunities for expanding or 

19 replicating such programs. 

20 (b) REPORT.—The arrangement under subsection (a) 

21 shall provide for submission by the Institute of Medicine 

22 to the Secretary and Congress, not later than 20 months 

23 after the date of enactment of this Act, of a report on 

24 the results of the study. 


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1 SEC. 4. GUIDELINES FOR DEVELOPMENT AND IMPLEMEN2 TATION OF HEALTH DISPARITIES REDUC3 TION PROGRAMS AND ACTIVITIES. 

4 (a) GUIDELINES.—Not later than 90 days after the 

5 submission of the report described in section 3(b), and 

6 taking such report into consideration, the Secretary shall 

7 develop guidelines for entities to develop and implement 

8 programs and activities to reduce health disparities in all 

9 populations, including children. 

10 (b) USE BY HHS.—The Secretary shall, where ap11 propriate, incorporate the use of the guidelines developed 

12 under subsection (a) into the programs and activities of 

13 the Department of Health and Human Services. 

14 (c) GRANTS FOR DISPARITIES REDUCTION ACTIVI15 TIES.— 

16 (1) IN GENERAL.—The Secretary may award 

17 grants to entities for the development and implemen18 tation of programs and activities to reduce health 

19 disparities in all populations, including children, in 

20 accordance with the guidelines described in sub21 section (a). 

22 (2) APPLICATIONS.—To seek a grant under this 

23 subsection, an entity shall submit an application to 

24 the Secretary at such time, in such manner, and 

25 containing such information as the Secretary may 

26 require. 


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1 (3) MINIMUM CONTENTS.—The Secretary shall 

2 require that an application for a grant under this 

3 subsection contains at a minimum— 

4 (A) a description of the population and 

5 public health concern the program will target 

6 and an outreach plan to ensure that the most 

7 in need populations will benefit; 

8 (B) a description of the strategies the enti9 ty will use— 

10 (i) to develop and implement its pro11 grams and activities in accordance with the 

12 guidelines developed under subsection (a); 

13 and 

14 (ii) to make the interventions sustain15 able; and 

16 (C) an agreement by the entities to peri17 odically provide data with respect to— 

18 (i) the population served; 

19 (ii) improvements in reducing health 

20 disparities; and 

21 (iii) effectiveness of the interventions 

22 used. 

23 (d) APPROPRIATIONS.—To carry out this section, 

24 there are authorized to be appropriated $5,000,000 for fisVerDate Sep 11 2014 23:44 Aug 03, 2015 Jkt 049200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H3285.IH H3285

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1 cal year 2017 and such sums as may be necessary for each 

2 of fiscal years 2018 through 2021. 

3 SEC. 5. TESTING ALTERNATIVE PAYMENT AND DELIVERY 

4 MODELS TO REDUCE HEALTH DISPARITIES. 

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

6 Centers for Medicare and Medicaid Innovation under sec7 tion 1115A of the Social Security Act (42 U.S.C. 1315a) 

8 shall provide for the testing of a payment and service de9 livery model that includes incentives for reducing health 

10 disparities in all populations, including children, consistent 

11 with the cost and quality criteria otherwise applicable to 

12 the testing of models under such section. 

13 (b) DOCUMENTATION REQUIREMENT FOR MODEL

14 TESTING.—In carrying out subsection (a), the Secretary 

15 shall require that an application to conduct such testing 

16 of such a model include at least— 

17 (1) documentation of at least one health dis18 parity targeted for reduction; 

19 (2) a root-cause analysis of the health disparity 

20 targeted for reduction; 

21 (3) identification and selection of performance 

22 targets for such reduction; 

23 (4) a proposal to make payments in some way 

24 contingent on a reduction in health disparities; and 


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1 (5) a reliable method for monitoring progress in 

2 achieving such a reduction. 

3 SEC. 6. DEFINITIONS. 

4 In this Act: 

5 (1) The term ‘‘health disparity’’ means signifi6 cant disparity in the overall rate of disease inci7 dence, prevalence, morbidity, mortality, or survival 

8 rates in a population as compared to the health sta9 tus of the general population. 

10 (2) The term ‘‘intervention’’ means an activity 

11 taken by an entity on behalf of individuals or popu12 lations to reduce health disparities. 

13 (3) The term ‘‘Secretary’’ means the Secretary 

14 of Health and Human Services. 

Æ 


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