II 

114TH CONGRESS 

1ST SESSION S. 1903 

To provide for a study by the National Academy 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 SENATE OF THE UNITED STATES 

JULY 30, 2015 

Mr. BOOKER (for himself and Mr. BROWN) introduced the following bill; which 

was read twice and referred to the Committee on Health, Education, 

Labor, and Pensions 

A BILL 

To provide for a study by the National Academy 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, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Reducing Disparities 

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

6 SEC. 2. FINDINGS. 

7 The Congress finds as follows: 


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1 (1) The infant death rate among African-Amer2 icans is more than double that of Whites. 

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

4 higher for African-Americans than for Whites; for 

5 prostate cancer, it is more than double that for 

6 Whites. 

7 (3) African-American women have a higher 

8 death rate from breast cancer despite having a 

9 mammography screening rate that is nearly the 

10 same as the rate for White women. 

11 (4) Diabetes incidence is highest among Native 

12 Americans, at 15.9 percent, followed by 13.2 percent 

13 for African-Americans, 12.8 percent for Hispanics, 

14 9.0 percent for Asians, and 7.6 percent for Whites. 

15 (5) New cases of hepatitis and tuberculosis are 

16 higher in Asians and Pacific Islanders living in the 

17 United States than in Whites. 

18 (6) Individuals in same-sex couples were more 

19 likely than individuals in different-sex couples to re20 port a delay in getting necessary prescriptions. 

21 (7) Infants born to African-American women 

22 are 1.5 to 3 times more likely to die in infancy than 

23 those born to women of other races or ethnicities, 

24 and American Indian and Alaska Native infants die 


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1 from sudden infant death syndrome (SIDS) at near2 ly 2.5 times the rate of White infants. 

3 (8) Low-income children have higher rates of 

4 mortality (even with the same condition), have high5 er rates of disability, and are more likely to have 

6 multiple conditions. 

7 (9) White children are half as likely as African8 American and Latino children not to be in excellent 

9 or very good health. 

10 (10) As of 2012, 38.9 percent of United States 

11 adults were obese, with the highest rate among Afri12 can-Americans at 47.9 percent, followed by His13 panics at 42.5 percent, Whites at 32.6 percent, and 

14 Asians at 10.8 percent. 

15 (11) The risk of stroke is twice as high for Af16 rican-Americans as for Whites, and African-Ameri17 cans are more likely to die of stroke. Other ethnic 

18 minorities also have higher risk than Whites. Over19 all, strokes are most prevalent in the Southeast 

20 United States, and less so in the Northeast. 

21 (12) African-Americans accounted for 44 per22 cent of all those infected with human immuno23 deficiency virus (HIV), despite being only 12 percent 

24 of the United States population. 


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1 (13) African-American men who have sex with 

2 men ages 13 to 24 had the most new infections 

3 among youth. 

4 (14) One study found that among heterosexuals 

5 living in the same urban community, those below the 

6 poverty line were twice as likely to contract HIV. 

7 (15) Individuals with less than a high school di8 ploma (6.7 percent) and high school graduates (4.0 

9 percent) were more likely to report major depression 

10 than those with at least some college education (2.5 

11 percent). 

12 (16) Globally, transgender women are 49 times 

13 more likely to acquire HIV than the general popu14 lation; in the United States, they are 34 times more 

15 likely to acquire HIV than the general population. 

16 (17) Only about 10 percent of physicians prac17 tice in rural areas of the United States despite the 

18 fact that nearly one-fourth of the population lives in 

19 those areas. 

20 (18) Rural residents are less likely to have em21 ployer-provided health care coverage or prescription 

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

23 be covered by benefits under the Medicaid program 

24 under title XIX of the Social Security Act (42 

25 U.S.C. 1396 et seq.) than their urban counterparts. 


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1 (19) Twenty percent of nonmetropolitan coun2 ties lack mental health services, versus 5 percent of 

3 metropolitan counties. 

4 (20) Fifteen percent of persons with disabilities 

5 report not seeing a doctor due to cost, in comparison 

6 to 6 percent of the general population. 

7 (21) Forty-one percent of transgender people 

8 have reported attempting suicide, compared to 1.6 

9 percent of the general population. 

10 (22) Nineteen percent of transgender people 

11 have been refused medical care because of their gen12 der identity, and 28 percent have been harassed in 

13 a doctor’s office. 

14 SEC. 3. NATIONAL ACADEMY OF MEDICINE STUDY. 

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

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

17 into an arrangement with the National Academy of Medi18 cine under which the National Academy agrees to study— 

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

20 and quality of preventive interventions, health serv21 ices, and outcomes in all populations, including chil22 dren, in the United States; 

23 (2) the factors that may contribute to inequities 

24 in such disparities in all populations, including chil25 dren; 


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1 (3) existing programs and policies intended to 

2 reduce such disparities in all populations, including 

3 children; 

4 (4) best practices and successful strategies in 

5 programs that aim to reduce such disparities in all 

6 populations, including children; 

7 (5) priorities for successful intervention pro8 grams targeting such disparities; and 

9 (6) potential opportunities for expanding or 

10 replicating such programs. 

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

12 shall provide for submission by the National Academy of 

13 Medicine to the Secretary and Congress, not later than 

14 20 months after the date of enactment of this Act, of a 

15 report on the results of the study. 

16 SEC. 4. GUIDELINES FOR DEVELOPMENT AND IMPLEMEN17 TATION OF HEALTH DISPARITIES REDUC18 TION PROGRAMS AND ACTIVITIES. 

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

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

21 taking such report into consideration, the Secretary shall 

22 develop guidelines for entities to develop and implement 

23 programs and activities to reduce health disparities. 

24 (b) USE BY HHS.—The Secretary shall, where ap25 propriate, incorporate the use of the guidelines developed 


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

2 the Department of Health and Human Services. 

3 (c) GRANTS FOR DISPARITIES REDUCTION ACTIVI4 TIES.— 

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

6 grants to entities for the development and implemen7 tation of programs and activities to reduce health 

8 disparities in accordance with the guidelines de9 scribed in subparagraph (a). 

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

11 subsection, an entity shall submit an application to 

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

13 containing such information as the Secretary may 

14 require. 

15 (3) MINIMUM CONTENTS.—The Secretary shall 

16 require that an application for a grant under this 

17 subsection contains at a minimum— 

18 (A) a description of the population and 

19 public health concern the program will target 

20 and an outreach plan to ensure that the most 

21 in need populations will benefit; 

22 (B) a description of the strategies the enti23 ty will use— 

24 (i) to develop and implement its pro25 grams and activities in accordance with the 


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1 guidelines developed under subsection (a); 

2 and 

3 (ii) to make the interventions sustain4 able; and 

5 (C) an agreement by the entities to peri6 odically provide data with respect to— 

7 (i) the population served; 

8 (ii) improvements in reducing health 

9 disparities; and 

10 (iii) effectiveness of the interventions 

11 used. 

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

13 there are authorized to be appropriated $5,000,000 for fis14 cal year 2016 and such sums as may be necessary for each 

15 of fiscal years 2017 through 2020. 

16 SEC. 5. TESTING ALTERNATIVE PAYMENT AND DELIVERY 

17 MODELS TO REDUCE HEALTH DISPARITIES. 

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

19 Centers for Medicare and Medicaid Innovation under sec20 tion 1115A of the Social Security Act (42 U.S.C. 1315a) 

21 shall provide for the testing of a payment and service de22 livery model that includes incentives for reducing health 

23 disparities consistent with the cost and quality criteria 

24 otherwise applicable to the testing of models under such 

25 section. 


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1 (b) DOCUMENTATION REQUIREMENT FOR MODEL

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

3 shall require that an application to conduct such testing 

4 of such a model include at least— 

5 (1) documentation of at least one health dis6 parity targeted for reduction; 

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

8 targeted for reduction; 

9 (3) identification and selection of performance 

10 targets for such reduction; 

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

12 contingent on a reduction in health disparities; and 

13 (5) a reliable method for monitoring progress in 

14 achieving such a reduction. 

15 SEC. 6. DEFINITIONS. 

16 In this Act: 

17 (1) The term ‘‘health disparity’’ means signifi18 cant disparity in the overall rate of disease inci19 dence, prevalence, morbidity, mortality, or survival 

20 rates in a population as compared to the health sta21 tus of the general population. 

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

23 taken by an entity on behalf of individuals or popu24 lations to reduce health disparities. 


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

2 of Health and Human Services. 

Æ 


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