I 

115TH CONGRESS 

1ST SESSION H. R. 2048 

To amend title XIX of the Social Security Act to incentivize the development 

of community-based interventions to reduce health disparities among 

certain populations, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

APRIL 6, 2017 

Mr. BEN RAY LUJA ́N of New Mexico introduced the following bill; which was 

referred to the Committee on Energy and Commerce 

A BILL 

To amend title XIX of the Social Security Act to incentivize 

the development of community-based interventions to reduce health disparities among certain populations, and 

for other purposes. 

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

3 SECTION 1. SHORT TITLE. 

4 This Act may be referred to as the ‘‘Eliminating 

5 Health Disparities Act of 2017’’. 


rfrederick on DSKBCBPHB2PROD with BILLS
2 

•HR 2048 IH

1 SEC. 2. HEALTH DISPARITIES ELIMINATION STATE PLAN 

2 OPTION. 

3 Title XIX of the Social Security Act (42 U.S.C. 1396 

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

5 ‘‘SEC. 1947. HEALTH DISPARITIES ELIMINATION PROGRAM 

6 STATE PLAN OPTION. 

7 ‘‘(a) IN GENERAL.—Notwithstanding section 

8 1902(a)(1) (relating to statewideness), section 

9 1902(a)(10)(B) (relating to comparability), and any other 

10 provision of this title that the Secretary determines is nec11 essary to waive in order to implement this section, begin12 ning fiscal year 2018, a State, at its option as a State 

13 plan amendment, may establish a Health Disparities 

14 Elimination Program for purposes of reducing health dis15 parities among targeted populations in communities 

16 served by qualified community health systems under which 

17 the State provides incentive payments to qualified commu18 nity health systems for initiatives approved under sub19 section (c), if the State meets the requirements specified 

20 in subsection (c). 

21 ‘‘(b) STATE PLAN AMENDMENT.—Each State seek22 ing a State plan amendment under this section shall sub23 mit such amendment to the Secretary for approval. The 

24 Secretary shall approve any such amendment that meets 

25 the requirements of subsection (c) and includes— 


rfrederick on DSKBCBPHB2PROD with BILLS
3 

•HR 2048 IH

1 ‘‘(1) State goals for reducing health disparities 

2 through the Health Disparities Elimination Program 

3 to be established by the State; 

4 ‘‘(2) any requirements for the development and 

5 approval of action plans described in subsection 

6 (c)(1); 

7 ‘‘(3) eligibility criteria for any qualified commu8 nity health system seeking to establish a health dis9 parities elimination initiative (in this section referred 

10 to as an ‘initiative’) pursuant to this section; 

11 ‘‘(4) the methodology for determining the 

12 amount of incentive payments to be made to a quali13 fied community health system through an initiative, 

14 based on the size of the target population to be 

15 served through the initiative and the potential of the 

16 initiative for reducing health disparities; and 

17 ‘‘(5) the period during which initiatives may be 

18 implemented, in accordance with subsection (c)(3). 

19 ‘‘(c) STATE REQUIREMENTS.—The requirements 

20 specified in this subsection with respect to a State are the 

21 following: 

22 ‘‘(1) HEALTH SYSTEM ACTION PLAN.—The 

23 State shall require that a qualified community 

24 health system submit an action plan for an initiative 

25 to the State agency with responsibility for adminVerDate Sep 11 2014 02:58 Apr 14, 2017 Jkt 069200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H2048.IH H2048

rfrederick on DSKBCBPHB2PROD with BILLS
4 

•HR 2048 IH

1 istering the State plan under this title for approval 

2 that identifies— 

3 ‘‘(A) the target population or populations 

4 to be served by the initiative; 

5 ‘‘(B) specific, evidence-based projects that 

6 the system will undertake through the initiative 

7 to reduce health disparities for such population 

8 or populations; 

9 ‘‘(C) targets and benchmarks associated 

10 with such projects that must be met in order to 

11 receive incentive payments pursuant to this sec12 tion; 

13 ‘‘(D) measures for evaluating the effective14 ness of the initiative in reducing health dispari15 ties with respect to the goals established by the 

16 State pursuant to subsection (b)(1); and 

17 ‘‘(E) the amount of any proposed initial in18 centive payments to be made pursuant to this 

19 section to support startup costs of the initiative. 

20 ‘‘(2) PRIORITY IN SELECTION OF HEALTH SYS21 TEMS FOR PARTICIPATION.—In selecting qualified 

22 community health systems to establish an initiative 

23 under a State plan amendment approved under this 

24 section, the State shall give priority to health sys25 tems— 


rfrederick on DSKBCBPHB2PROD with BILLS
5 

•HR 2048 IH

1 ‘‘(A) that have submitted action plans 

2 (under paragraph (1)) that include the use of 

3 evidence-based interventions shown to reduce or 

4 eliminate health disparities; 

5 ‘‘(B) that demonstrate the potential to 

6 have a high impact in the elimination of health 

7 disparities, improved health care access, im8 proved health outcomes, or health care savings 

9 compared to the total incentive funding re10 quested; 

11 ‘‘(C) that have prior experience working on 

12 projects with the goal of reducing health dis13 parities; 

14 ‘‘(D) that demonstrate long-term commit15 ment to providing health services to the target 

16 population or populations; and 

17 ‘‘(E) with a demonstrated need for addi18 tional financial resources in order to strengthen 

19 and advance existing efforts of the health sys20 tem to reduce health disparities. 

21 ‘‘(3) DURATION OF ACTION PLAN.— 

22 ‘‘(A) IN GENERAL.—The State may not 

23 approve an action plan submitted under para24 graph (1) for a period exceeding 5 years. 


rfrederick on DSKBCBPHB2PROD with BILLS
6 

•HR 2048 IH

1 ‘‘(B) REPORT.—At the end of any such pe2 riod, the State shall require each participating 

3 qualified community health system to submit a 

4 report to the State describing the effectiveness 

5 of its initiative using the measures described in 

6 paragraph (1)(D). 

7 ‘‘(C) EXTENSION.—A State may extend 

8 the initiative of such health system upon ap9 proval of a new action plan to extend, improve, 

10 or expand the initiative, if the State determines 

11 that the initiative has proved effective, taking 

12 into account the report submitted under sub13 paragraph (B). 

14 ‘‘(d) STATE REPORT AND EVALUATION.— 

15 ‘‘(1) IN GENERAL.—A State with a State plan 

16 amendment approved under this section shall submit 

17 to the Secretary, in a time and manner to be speci18 fied by the Secretary— 

19 ‘‘(A) an annual report on the progress of 

20 the Health Disparities Elimination Program of 

21 the State towards meeting the goals of the 

22 State described under subsection (b)(1); and 

23 ‘‘(B) not less than once every 5 years, an 

24 evaluation of the effectiveness of the Health 

25 Disparities Elimination Program of the State. 


rfrederick on DSKBCBPHB2PROD with BILLS
7 

•HR 2048 IH

1 ‘‘(2) CONTENTS.—The evaluation described in 

2 paragraph (1)(B) shall include— 

3 ‘‘(A) an assessment of the effectiveness of 

4 initiatives receiving incentive payments pursu5 ant to this section during the period covered by 

6 the report in meeting the goals of the State de7 scribed under subsection (b)(1); and 

8 ‘‘(B) a description of the activities of such 

9 initiatives. 

10 ‘‘(3) PUBLICATION.—The Secretary shall pub11 lish on the public Web site of the Centers for Medi12 care & Medicaid Services each evaluation submitted 

13 under paragraph (1)(B). 

14 ‘‘(e) FUNDING.— 

15 ‘‘(1) STATE FUNDING.— 

16 ‘‘(A) IN GENERAL.—For the purpose of 

17 making allocations to States under subpara18 graph (C), there is appropriated for fiscal year 

19 2018 and each subsequent fiscal year, out of 

20 any money in the Treasury not otherwise ap21 propriated, an amount equal to one half of one 

22 percent of the total of the Federal share of ex23 penditures with respect to all State plans under 

24 this title in the most recent fiscal year for 

25 which complete expenditure data is available. 


rfrederick on DSKBCBPHB2PROD with BILLS
8 

•HR 2048 IH

1 ‘‘(B) INCENTIVE PAYMENT FUND.—The 

2 Secretary shall deposit all funds appropriated 

3 under subparagraph (A) into an incentive pay4 ment fund. Such funds shall remain available 

5 until expended. 

6 ‘‘(C) ALLOCATION AMONG STATES.—Of 

7 the total amount appropriated for this section 

8 for a fiscal year, the Secretary shall, except as 

9 provided in subparagraph (D), allocate for such 

10 fiscal year to each State an amount in propor11 tion to the ratio of— 

12 ‘‘(i) the State’s total expenditures 

13 under the State plan under this title in the 

14 most recent fiscal year for which complete 

15 expenditure data is available; to 

16 ‘‘(ii) the sum of all States’ total ex17 penditures under all State plans under this 

18 title in the fiscal year described in clause 

19 (i). 

20 ‘‘(D) FUNDS NOT USED BY THE STATE.— 

21 If the Secretary determines, on the basis of in22 formation available on the first day of a fiscal 

23 year, that any allocation under subparagraph 

24 (C) to a State for such fiscal year will not be 

25 required because a State does not have a State 


rfrederick on DSKBCBPHB2PROD with BILLS
9 

•HR 2048 IH

1 plan amendment approved under subsection (b) 

2 for such fiscal year, then such State’s allocation 

3 shall be treated as an unused allocation for 

4 such fiscal year and re-allocated in accordance 

5 with subparagraph (E)(i). 

6 ‘‘(E) QUALIFYING STATES.— 

7 ‘‘(i) RE-ALLOCATION TO QUALIFYING

8 STATES.—In addition to the allocation 

9 available to a State under subparagraph 

10 (C), the Secretary shall allocate to each 

11 qualifying State for a fiscal year, out of 

12 the sum of unused allocations, as described 

13 in subparagraph (D), for such fiscal year, 

14 an amount in proportion to the ratio of— 

15 ‘‘(I) each such State’s total ex16 penditures under the State plan under 

17 this title in the most recent fiscal year 

18 for which complete expenditure data is 

19 available; to 

20 ‘‘(II) the sum of all such States’ 

21 total expenditures under all State 

22 plans of such States under this title in 

23 the fiscal year described in subclause 

24 (I). 


rfrederick on DSKBCBPHB2PROD with BILLS
10 

•HR 2048 IH

1 ‘‘(ii) AVAILABILITY OF FUNDS.—Allo2 cations made to a qualifying State under 

3 clause (i) and subparagraph (C) shall re4 main available until expended. 

5 ‘‘(iii) DEFINITIONS.—In this section, 

6 the term ‘qualifying State’ means a State 

7 with a State plan amendment approved 

8 under this section that— 

9 ‘‘(I) has in effect an agreement 

10 with one or more qualified community 

11 health system initiatives; and 

12 ‘‘(II) in any fiscal year other 

13 than the first fiscal year for which 

14 such State receives an allocation 

15 under subparagraph (C) that is not 

16 re-allocated under subparagraph (D), 

17 has a Health Disparities Elimination 

18 Program established under this sec19 tion that, as determined by the Sec20 retary, has made measurable progress 

21 towards meeting the State’s goals, as 

22 described under subsection (b)(1), 

23 based on reports and evaluations sub24 mitted under subsection (d). 

25 ‘‘(2) PAYMENTS.— 


rfrederick on DSKBCBPHB2PROD with BILLS
11 

•HR 2048 IH

1 ‘‘(A) IN GENERAL.—Subject to the provi2 sions of this section, the Secretary shall pay to 

3 each State with a State plan amendment ap4 proved under this section, from its allocation 

5 under paragraph (1)(C) and, in the case of a 

6 qualifying State, from its allocation under para7 graph (1)(E)(i), an amount for each quarter 

8 equal to 90 percent of the sum expended by the 

9 State in such quarter for incentive payments 

10 made to qualified community health systems for 

11 initiatives approved pursuant to this section. 

12 ‘‘(B) STATUS OF INCENTIVE PAYMENTS.— 

13 Incentive payments made under a State plan 

14 amendment approved under this section shall 

15 not be considered payment for health care items 

16 or services and shall not count towards any 

17 limit with respect to the maximum amount of 

18 payments that may be made to a provider 

19 under the State plan under this title (or under 

20 a waiver of such plan). 

21 ‘‘(f) DEFINITIONS.—In this section: 

22 ‘‘(1) The term ‘health disparity’ means a dis23 parity in care provided to a health disparity popu24 lation, as defined in section 903(d) of the Public 

25 Health Service Act (42 U.S.C. 299a–1(d)). 


rfrederick on DSKBCBPHB2PROD with BILLS
12 

•HR 2048 IH

1 ‘‘(2) The term ‘qualified community health sys2 tem’ means— 

3 ‘‘(A) a hospital described in a report sub4 mitted under section 1900(b)(6)(B)(ii)(III); or 

5 ‘‘(B) an affiliated group of health care pro6 viders anchored by such hospital. 

7 ‘‘(3) The term ‘State’ means each of the several 

8 States and the District of Columbia. 

9 ‘‘(4) The term ‘target population’ means a pop10 ulation of individuals that has empirically experi11 enced disparities in health care access and quality 

12 and shall not be limited by source of coverage or 

13 lack thereof.’’. 

Æ 


rfrederick on DSKBCBPHB2PROD with BILLS