I 

114TH CONGRESS 

2D SESSION H. R. 5475 

To improve the health of minority individuals, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JUNE 14, 2016 

Ms. KELLY of Illinois (for herself, Ms. MICHELLE LUJAN GRISHAM of New 

Mexico, Ms. LINDA T. SA ́NCHEZ of California, Ms. LEE, Ms. JUDY CHU

of California, Mr. PAYNE, and Mr. BUTTERFIELD) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Agriculture, Education and the Workforce, the Budget, the Judiciary, Veterans’ Affairs, Armed Services, and Natural Resources, 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, 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 ‘‘Health Equity and 

5 Accountability Act of 2016’’. 

6 SEC. 2. TABLE OF CONTENTS. 

7 The table of contents of this Act is as follows: 


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Sec. 1. Short title. 

Sec. 2. Table of contents. 

Sec. 3. Findings. 

TITLE I—DATA COLLECTION AND REPORTING 

Sec. 101. Amendment to the Public Health Service Act. 

Sec. 102. Elimination of prerequisite of direct appropriations for data collection 

and analysis. 

Sec. 103. Collection of race and ethnicity data by the Social Security Administration. 

Sec. 104. Revision of HIPAA claims standards. 

Sec. 105. National Center for Health Statistics. 

Sec. 106. Oversampling of Asian-Americans, Native Hawaiians, or Pacific Islanders and other underrepresented groups in Federal health 

surveys. 

Sec. 107. Geo-access study. 

Sec. 108. Racial, ethnic, and primary language data collected by the Federal 

Government. 

Sec. 109. Data collection and analysis grants to minority-serving institutions. 

Sec. 110. Standards for measuring sexual orientation and gender identity in 

collection of health data. 

Sec. 111. Standards for measuring socioeconomic status in collection of health 

data. 

Sec. 112. Safety and effectiveness of drugs with respect to racial and ethnic 

background. 

Sec. 113. Improving health data regarding Native Hawaiians and other Pacific 

Islanders. 

Sec. 114. Clarification of simplified administrative reporting requirement. 

TITLE II—CULTURALLY AND LINGUISTICALLY APPROPRIATE 

HEALTH CARE 

Sec. 201. Definitions. 

Sec. 202. Amendment to the Public Health Service Act. 

Sec. 203. Pilot program for improvement and development of State medical interpreting services. 

Sec. 204. Training tomorrow’s doctors for culturally and linguistically appropriate care: graduate medical education. 

Sec. 205. Federal reimbursement for culturally and linguistically appropriate 

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

Health Insurance Programs. 

Sec. 206. Increasing understanding of and improving health literacy. 

Sec. 207. Assurances for receiving Federal funds. 

Sec. 208. Report on Federal efforts to provide culturally and linguistically appropriate health care services. 

Sec. 209. English for speakers of other languages. 

Sec. 210. Implementation. 

Sec. 211. Language access services. 

TITLE III—HEALTH WORKFORCE DIVERSITY 

Sec. 301. Amendment to the Public Health Service Act. 

Sec. 302. Hispanic-serving health professions schools. 

Sec. 303. Loan repayment program of Centers for Disease Control and Prevention. 


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Sec. 304. Cooperative agreements for online degree programs at schools of public health and schools of allied health. 

Sec. 305. Sense of Congress on the mission of the National Health Care Workforce Commission. 

Sec. 306. Scholarship and fellowship programs. 

Sec. 307. McNair Postbaccalaureate Achievement Program. 

Sec. 308. Rules for determination of full-time equivalent residents for cost-reporting periods. 

Sec. 309. Developing and implementing strategies for local health equity. 

Sec. 310. Loan forgiveness for mental and behavioral health social workers. 

Sec. 311. Health Professions Workforce Fund. 

Sec. 312. Findings; sense of Congress relating to graduate medical education. 

Sec. 313. Career support for skilled, internationally educated health professionals. 

TITLE IV—IMPROVEMENT OF HEALTH CARE SERVICES 

Subtitle A—Health Empowerment Zones 

Sec. 401. Short title. 

Sec. 402. Findings. 

Sec. 403. Designation of health empowerment zones. 

Sec. 404. Assistance to those seeking designation. 

Sec. 405. Benefits of designation. 

Sec. 406. Definition. 

Sec. 407. Authorization of appropriations. 

Subtitle B—Other Improvements of Health Care Services 

CHAPTER 1—EXPANSION OF COVERAGE

Sec. 411. Amendment to the Public Health Service Act. 

Sec. 412. Removing citizenship and immigration barriers to access to affordable 

health care under the ACA. 

Sec. 413. Study on the uninsured. 

Sec. 414. Medicaid payment parity for the territories. 

Sec. 415. Extension of Medicare secondary payer. 

Sec. 416. Border health grants. 

Sec. 417. Removing Medicare barrier to health care. 

Sec. 418. 100 percent FMAP for medical assistance provided by urban Indian 

health centers. 

Sec. 419. 100 percent FMAP for medical assistance provided to a Native Hawaiian through a federally qualified health center or a Native 

Hawaiian health care system under the Medicaid program. 

CHAPTER 2—EXPANSION OF ACCESS

Sec. 431. Grants for racial and ethnic approaches to community health. 

Sec. 432. Critical access hospital improvements. 

Sec. 433. Establishment of Rural Community Hospital (RCH) Program. 

Sec. 434. Medicare remote monitoring pilot projects. 

Sec. 435. Rural health quality advisory commission and demonstration projects. 

Sec. 436. Rural health care services. 

Sec. 437. Community health center collaborative access expansion. 

Sec. 438. Facilitating the provision of telehealth services across State lines. 

Sec. 439. Scoring of preventive health savings. 

Sec. 440. Sense of Congress. 


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Sec. 441. Repeal of requirement for documentation evidencing citizenship or 

nationality under the Medicaid program. 

Sec. 442. Office of Minority Health in Veterans Health Administration of Department of Veterans Affairs. 

Sec. 443. Indian defined in PPACA. 

Sec. 444. Study of DSH payments to ensure hospital access for low-income patients. 

Sec. 445. Assistant Secretary of the Indian Health Service. 

Sec. 446. Reauthorization of the Native Hawaiian Health Care Improvement 

Act. 

Sec. 447. Availability of non-English language speaking providers. 

Sec. 448. Access to essential community providers. 

Sec. 449. Provider network adequacy in communities of color. 

Sec. 450. Improving access to dental care. 

TITLE V—IMPROVING HEALTH OUTCOMES FOR WOMEN, 

CHILDREN, AND FAMILIES 

Sec. 501. Grants to promote positive health outcomes for women and children. 

Sec. 502. Removing barriers to health care and nutrition assistance for children, pregnant women, and lawfully present individuals. 

Sec. 503. Repeal of denial of benefits. 

Sec. 504. Birth defects prevention, risk reduction, and awareness. 

Sec. 505. Uniform State maternal mortality review committees on pregnancyrelated deaths. 

Sec. 506. Eliminating disparities in maternity health outcomes. 

Sec. 507. Decreasing the risk factors for sudden unexpected infant death and 

sudden unexplained death in childhood. 

Sec. 508. Reducing unintended teenage pregnancies. 

Sec. 509. Gestational diabetes. 

Sec. 510. Emergency contraception education and information programs. 

Sec. 511. Supporting healthy adolescent development. 

Sec. 512. Compassionate assistance for rape emergencies. 

Sec. 513. Access to birth control duties of pharmacies to ensure provision of 

FDA-approved contraception. 

Sec. 514. Additional focus area for the Office on Women’s Health. 

Sec. 515. Interagency coordinating committee on the promotion of optimal maternity outcomes. 

Sec. 516. Consumer education campaign. 

Sec. 517. Bibliographic database of systematic reviews for care of childbearing 

women and newborns. 

Sec. 518. Maternity care health professional shortage areas. 

Sec. 519. Expansion of CDC prevention research centers program to include 

centers on optimal maternity outcomes. 

Sec. 520. Expanding models allowed to be tested by Center for Medicare and 

Medicaid Innovation to include maternity care models. 

Sec. 521. Development of interprofessional maternity care educational models 

and tools. 

Sec. 522. Including within inpatient hospital services under Medicare services 

furnished by certain students, interns, and residents supervised 

by certified nurse midwives. 

Sec. 523. Grants to professional organizations to increase diversity in maternity 

care professionals. 

TITLE VI—MENTAL HEALTH 


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Sec. 601. Coverage of marriage and family therapist services, mental health 

counselor services, and substance abuse counselor services 

under part B of the Medicare program. 

Sec. 602. Minority Fellowship Program. 

Sec. 603. Integrated Health Care Demonstration Program. 

Sec. 604. Addressing racial and ethnic minority mental health disparities research gaps. 

Sec. 605. Health professions competencies to address racial and ethnic minority 

mental health disparities. 

TITLE VII—ADDRESSING HIGH IMPACT MINORITY DISEASES 

Subtitle A—Cancer 

Sec. 701. Lung cancer mortality reduction. 

Sec. 702. Expanding prostate cancer research, outreach, screening, testing, access, and treatment effectiveness. 

Sec. 703. Improved Medicaid coverage for certain breast and cervical cancer patients in the territories. 

Sec. 704. Cancer prevention and treatment demonstration for ethnic and racial 

minorities. 

Sec. 705. Reducing cancer disparities within Medicare. 

Subtitle B—Viral Hepatitis and Liver Cancer Control and Prevention 

Sec. 711. Viral hepatitis and liver cancer control and prevention. 

Subtitle C—Acquired Bone Marrow Failure Diseases 

Sec. 721. Acquired bone marrow failure diseases. 

Subtitle D—Cardiovascular Disease, Chronic Disease, and Other Disease 

Issues 

Sec. 731. Guidelines for disease screening for minority patients. 

Sec. 732. CDC Wisewoman Screening Program. 

Sec. 733. Report on cardiovascular care for women and minorities. 

Sec. 734. Coverage of comprehensive tobacco cessation services in Medicaid and 

in ACA essential health benefits . 

Sec. 735. Clinical research funding for oral health. 

Sec. 736. Participation by Medicaid beneficiaries in approved clinical trials. 

Subtitle E—HIV/AIDS 

Sec. 741. Statement of policy. 

Sec. 742. Findings. 

Sec. 743. Additional funding for AIDS drug assistance program treatments. 

Sec. 744. Enhancing the national HIV surveillance system. 

Sec. 745. Evidence-based strategies for improving linkage to and retention in 

appropriate care. 

Sec. 746. Improving entry into and retention in care and antiretroviral adherence for persons with HIV. 

Sec. 747. Services to reduce HIV/AIDS in racial and ethnic minority communities. 

Sec. 748. Minority AIDS initiative. 

Sec. 749. Health care professionals treating individuals with HIV/AIDS. 

Sec. 750. HIV/AIDS provider loan repayment program. 

Sec. 751. Dental education loan repayment program. 


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Sec. 752. Reducing new HIV infections among injecting drug users. 

Sec. 753. Support for expansion of comprehensive sexual health and education 

programs. 

Sec. 754. Report on impact of HIV/AIDS in vulnerable populations. 

Sec. 755. National HIV/AIDS observance days. 

Sec. 756. Review of all Federal and State laws, policies, and regulations regarding the criminal prosecution of individuals for HIV-related offenses. 

Sec. 757. Repeal of limitation against use of funds for education or information 

designed to promote or encourage, directly, homosexual or heterosexual activity or intravenous substance abuse. 

Sec. 758. Expanding support for condoms in prisons. 

Sec. 759. Automatic reinstatement or enrollment in Medicaid for people who 

test positive for HIV before reentering communities. 

Sec. 760. Stop AIDS in prison. 

Sec. 761. Support data system review and indicators for monitoring HIV care. 

Sec. 762. Transfer of funds for implementation of national HIV/AIDS strategy. 

Sec. 763. HIV integrated services delivery model demonstration. 

Sec. 764. Report on the implementation of goal 4 (improved coordination) of 

the national HIV/AIDS strategy. 

Subtitle F—Diabetes 

Sec. 771. Research, treatment, and education. 

Sec. 772. Research, education, and other activities. 

Sec. 773. Research, education, and other activities. 

Sec. 774. Research, education, and other activities. 

Sec. 775. Updated report on health disparities. 

Subtitle G—Lung Disease 

Sec. 776. Expansion of the National Asthma Education and Prevention Program. 

Sec. 777. Asthma-related activities of the Centers for Disease Control and Prevention. 

Sec. 778. Influenza and pneumonia vaccination campaign. 

Sec. 779. Chronic obstructive pulmonary disease action plan. 

Subtitle H—Osteoarthritis and Musculoskeletal Diseases 

Sec. 781. Findings. 

Sec. 782. Osteoarthritis and other musculoskeletal health-related activities of 

the Centers for Disease Control and Prevention. 

Sec. 783. Grants for comprehensive osteoarthritis and musculoskeletal disease 

health education within health professions schools. 

Subtitle I—Sleep and Circadian Rhythm Disorders 

Sec. 791. Short title; findings. 

Sec. 792. Sleep and circadian rhythm disorders research activities of the National Institutes of Health. 

Sec. 793. Sleep and circadian rhythm health disparities-related activities of the 

Centers for Disease Control and Prevention. 

Sec. 794. Grants for comprehensive sleep and circadian health education within 

health professions schools. 

Sec. 795. Report on impact of sleep and circadian health disorders in vulnerable & racial/ethnic populations. 


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TITLE VIII—HEALTH INFORMATION TECHNOLOGY 

Sec. 800. Definitions. 

Subtitle A—Reducing Health Disparities Through Health IT 

Sec. 801. HRSA assistance to health centers for promotion of Health IT. 

Sec. 802. Assessment of impact of Health IT on racial and ethnic minority 

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

Subtitle B—Modifications To Achieve Parity in Existing Programs 

Sec. 811. Extending funding to strengthen the Health IT infrastructure in racial and ethnic minority communities. 

Sec. 812. Prioritizing regional extension center assistance to racial and ethnic 

minority groups. 

Sec. 813. 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. 814. Authorization of appropriations. 

Subtitle C—Additional Research and Studies 

Sec. 831. Data collection and assessments conducted in coordination with minority-serving institutions. 

Sec. 832. Study of health information technology in medically underserved communities. 

Subtitle D—Closing Gaps in Funding To Adopt Certified EHRs 

Sec. 841. Extending Medicaid EHR incentive payments to rehabilitation facilities, long-term care facilities, and home health agencies. 

Sec. 842. Extending physician assistant eligibility for Medicaid electronic health 

record incentive payments. 

TITLE IX—ACCOUNTABILITY AND EVALUATION 

Sec. 901. Prohibition on discrimination in Federal assisted health care services 

and research programs on the basis of sex, race, color, national 

origin, marital status, familial status, sexual orientation, gender identity, or disability status. 

Sec. 902. Treatment of Medicare payments under title VI of the Civil Rights 

Act of 1964. 

Sec. 903. Accountability and transparency within the Department of Health 

and Human Services. 

Sec. 904. United States Commission on Civil Rights. 

Sec. 905. Sense of Congress concerning full funding of activities to eliminate 

racial and ethnic health disparities. 

Sec. 906. GAO and NIH reports. 

TITLE X—ADDRESSING SOCIAL DETERMINANTS AND IMPROVING 

ENVIRONMENTAL JUSTICE 

Sec. 1001. Definitions. 

Sec. 1002. Findings. 

Sec. 1003. Health impact assessments. 


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Sec. 1004. Implementation of recommendations by Environmental Protection 

Agency. 

Sec. 1005. Grant program to conduct environmental health improvement activities and to improve social determinants of health. 

Sec. 1006. Additional research on the relationship between the built environment and the health of community residents. 

Sec. 1007. Environment and public health restoration. 

Sec. 1008. GAO report on health effects of Deepwater Horizon oil rig explosion 

in the Gulf Coast. 

1 SEC. 3. FINDINGS. 

2 The Congress finds as follows: 

3 (1) The population of racial and ethnic minori4 ties is expected to increase over the next few dec5 ades, yet racial and ethnic minorities have the poor6 est health status and face substantial cultural, so7 cial, and economic barriers to obtaining quality 

8 health care. 

9 (2) Health disparities are a function of not only 

10 access to health care, but also the social deter11 minants of health—including the environment, the 

12 physical structure of communities, nutrition and 

13 food options, educational attainment, employment, 

14 race, ethnicity, sex, geography, language preference, 

15 immigrant or citizenship status, sexual orientation, 

16 gender identity, socioeconomic status, or disability 

17 status—that directly and indirectly affect the health, 

18 health care, and wellness of individuals and commu19 nities. 

20 (3) By 2020, the Nation will face a shortage of 

21 health care providers and allied health workers and 


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1 this shortage disproportionately affects health pro2 fessional shortage areas where many racial and eth3 nic minority populations reside. 

4 (4) All efforts to reduce health disparities and 

5 barriers to quality health services require better and 

6 more consistent data. 

7 (5) A full range of culturally and linguistically 

8 appropriate health care and public health services 

9 must be available and accessible in every community. 

10 (6) Racial and ethnic minorities and under11 served populations must be included early and equi12 tably in health reform innovations. 

13 (7) Efforts to improve minority health have 

14 been limited by inadequate resources in funding, 

15 staffing, stewardship, and accountability. Targeted 

16 investments that are focused on disparities elimi17 nation must be made in providing care and services 

18 that are community-based, including prevention and 

19 policies addressing social determinants of health. 

20 (8) In 2011, the Department of Health and 

21 Human Services developed the HHS Action Plan to 

22 Reduce Racial and Ethnic Health Disparities and 

23 the National Stakeholder Strategy for Achieving 

24 Health Equity, two strategic plans that represent 

25 the country’s first coordinated roadmap to reducing 


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1 health disparities. Along with the National Preven2 tion Strategy, Healthy People 2020, and the Na3 tional Health Care Quality Strategy, as well as crit4 ical resources such as the 2012 National Healthcare 

5 Quality and Disparities Reports, these comprehen6 sive plans will work to increase the number of Amer7 icans who are healthy at every stage of life. 

8 (9) The Department of Health and Human 

9 Services has also reviewed and advanced updated 

10 clinical guidelines and developed other strategic 

11 planning documents— 

12 (A) to combat health disparities with a 

13 high impact on minority populations including 

14 the National HIV/AIDS Strategy, the Action 

15 Plan for the Prevention, Care, and Treatment 

16 of Viral Hepatitis; and 

17 (B) to provide high-quality family planning 

18 services including recommendations of the Cen19 ters for Disease Control and Prevention and the 

20 Office of Population Affairs. 

21 (10) The Patient Protection and Affordable 

22 Care Act, as amended by the Health Care and Edu23 cation Reconciliation Act, represents the biggest ad24 vancement for minority health in the last 40 years. 


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1 TITLE I—DATA COLLECTION 

2 AND REPORTING 

3 SEC. 101. AMENDMENT TO THE PUBLIC HEALTH SERVICE 

4 ACT. 

5 (a) PURPOSE.—It is the purpose of this section to 

6 promote data collection, analysis, and reporting by race, 

7 ethnicity, sex, primary language, sexual orientation, dis8 ability status, gender identity, and socioeconomic status 

9 among federally supported health programs. 

10 (b) AMENDMENT.—Title XXXIV of the Public 

11 Health Service Act, as amended by titles II and III of 

12 this Act, is further amended by inserting after subtitle A 

13 the following: 

14 ‘‘Subtitle B—Strengthening Data 

15 Collection, Improving Data 

16 Analysis, and Expanding Data 

17 Reporting 

18 ‘‘SEC. 3431. HEALTH DISPARITY DATA. 

19 ‘‘(a) REQUIREMENTS.— 

20 ‘‘(1) IN GENERAL.—Each health-related pro21 gram operated by or that receives funding or reim22 bursement, in whole or in part, either directly or in23 directly from the Department of Health and Human 

24 Services shall— 


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

2 or program involved, of data on the race, eth3 nicity, sex, primary language, sexual orienta4 tion, disability status, gender identity, and so5 cioeconomic status of each applicant for and re6 cipient of health-related assistance under such 

7 program— 

8 ‘‘(i) using, at a minimum, the stand9 ards for data collection on race, ethnicity, 

10 sex, primary language, sexual orientation, 

11 disability status, gender identity, and so12 cioeconomic status developed under section 

13 3101; 

14 ‘‘(ii) collecting data for additional 

15 population groups if such groups can be 

16 aggregated into the race and ethnicity cat17 egories outlined by the standards developed 

18 under section 3101; 

19 ‘‘(iii) additionally referring, where 

20 practicable, to the standards developed by 

21 the Institute of Medicine in ‘Race, Eth22 nicity, and Language Data: Standardiza23 tion for Health Care Quality Improve24 ment’; and 


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1 ‘‘(iv) where practicable, through self2 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, and socioeconomic status 

21 in health and health care, and report the results 

22 of such analysis to the Secretary, the Director 

23 of the Office for Civil Rights, each agency listed 

24 in section 3101(c)(1), the Committee on 

25 Health, Education, Labor, and Pensions and 


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1 the Committee on Finance of the Senate, and 

2 the Committee on Energy and Commerce and 

3 the Committee on Ways and Means of the 

4 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, 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 existing or future require21 ments on health care providers to collect data. 

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

23 This title does not authorize any health care pro24 vider, Federal official, or other entity to compel the 

25 disclosure of any data collected under this title. The 


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1 disclosure of any such data by an individual pursu2 ant to this title shall be strictly voluntary. 

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

4 ensure (through the promulgation of regulations or other5 wise) that all data collected pursuant to subsection (a) are 

6 protected— 

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

8 Secretary applies to other health data under the reg9 ulations promulgated under section 264(c) of the 

10 Health Insurance Portability and Accountability Act 

11 of 1996 (Public Law 104–191; 110 Stat. 2033) re12 lating to the privacy of individually identifiable 

13 health information and other protections; and 

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

15 entity that collects, stores, or receives the data, in16 cluding use of such data in determinations of eligi17 bility (or continued eligibility) in health plans, and 

18 from other inappropriate uses, as defined by the 

19 Secretary. 

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

21 Secretary shall develop and implement a national plan to 

22 ensure the collection of data in a culturally appropriate 

23 and competent manner, to improve the collection, analysis, 

24 and reporting of racial, ethnic, sex, primary language, sex25 ual orientation, disability status, gender identity, and soVerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00015 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475

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1 cioeconomic status data at the Federal, State, territorial, 

2 tribal, and local levels, including data to be collected under 

3 subsection (a), and to ensure that data collection activities 

4 carried out under this section are in compliance with the 

5 standards developed under section 3101. The Data Coun6 cil of the Department of Health and Human Services, in 

7 consultation with the National Committee on Vital Health 

8 Statistics, the Office of Minority Health, Office on Wom9 en’s Health, and other appropriate public and private enti10 ties, shall make recommendations to the Secretary con11 cerning the development, implementation, and revision of 

12 the national plan. Such plan shall include recommenda13 tions on how to— 

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

15 the cost and administrative burdens of data collec16 tion and reporting; 

17 ‘‘(2) expand awareness among Federal agencies, 

18 States, territories, Indian tribes, health providers, 

19 health plans, health insurance issuers, and the gen20 eral public that data collection, analysis, and report21 ing by race, ethnicity, primary language, sexual ori22 entation, disability status, gender identity, and socio23 economic status is legal and necessary to assure eq24 uity and nondiscrimination in the quality of health 

25 care services; 


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

2 have data code sets for racial, ethnic, primary lan3 guage, sexual orientation, disability status, gender 

4 identity, and socioeconomic status identifiers and 

5 that such identifiers can be retrieved from clinical 

6 records, including records transmitted electronically; 

7 ‘‘(4) improve health and health care data collec8 tion and analysis for more population groups if such 

9 groups can be aggregated into the minimum race 

10 and ethnicity categories, including exploring the fea11 sibility of enhancing collection efforts in States for 

12 racial and ethnic groups that comprise a significant 

13 proportion of the population of the State; 

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

15 racial, ethnic, primary language, sexual orientation, 

16 disability status, gender identity, and socioeconomic 

17 status data, subject to privacy and confidentiality 

18 regulations; and 

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

20 collected under subsection (a). 

21 ‘‘(d) COMPLIANCE WITH STANDARDS.—Data col22 lected under subsection (a) shall be obtained, maintained, 

23 and presented (including for reporting purposes) in ac24 cordance with the standards developed under section 

25 3101. 


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1 ‘‘(e) TECHNICAL ASSISTANCE FOR THE COLLECTION

2 AND REPORTING OF DATA.— 

3 ‘‘(1) IN GENERAL.—The Secretary may, either 

4 directly or through grant or contract, provide tech5 nical assistance to enable a health care program or 

6 an entity operating under such program to comply 

7 with the requirements of this section. 

8 ‘‘(2) TYPES OF ASSISTANCE.—Assistance pro9 vided under this subsection may include assistance 

10 to— 

11 ‘‘(A) enhance or upgrade computer tech12 nology that will facilitate racial, ethnic, primary 

13 language, sexual orientation, disability status, 

14 gender identity, and socioeconomic status data 

15 collection and analysis; 

16 ‘‘(B) improve methods for health data col17 lection and analysis, including additional popu18 lation groups if such groups can be aggregated 

19 into the race and ethnicity categories outlined 

20 by the standards developed under section 3101; 

21 ‘‘(C) develop mechanisms for submitting 

22 collected data subject to existing privacy and 

23 confidentiality regulations; and 

24 ‘‘(D) develop educational programs to in25 form health insurance issuers, health plans, 


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1 health providers, health-related agencies, and 

2 the general public that data collection and re3 porting by race, ethnicity, primary language, 

4 sexual orientation, disability status, gender 

5 identity, and socioeconomic status are legal and 

6 essential for eliminating health and health care 

7 disparities. 

8 ‘‘(f) ANALYSIS OF HEALTH DISPARITY DATA.—The 

9 Secretary, acting through the Director of the Agency for 

10 Healthcare Research and Quality and in coordination with 

11 the Administrator of the Centers for Medicare & Medicaid 

12 Services, shall provide technical assistance to agencies of 

13 the Department of Health and Human Services in meeting 

14 Federal standards for health disparity data collection and 

15 for analysis of racial and ethnic disparities in health and 

16 health care in public programs by— 

17 ‘‘(1) identifying appropriate quality assurance 

18 mechanisms to monitor for health disparities; 

19 ‘‘(2) specifying the clinical, diagnostic, or thera20 peutic measures which should be monitored; 

21 ‘‘(3) developing new quality measures relating 

22 to racial and ethnic disparities and their overlap 

23 with other disparity factors in health and health 

24 care; 


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

2 should be conducted; and 

3 ‘‘(5) sharing data with external organizations 

4 for research and quality improvement purposes. 

5 ‘‘(g) PRIMARY LANGUAGE.—References in this sec6 tion— 

7 ‘‘(1) to primary language data, include spoken 

8 and written primary language data; and 

9 ‘‘(2) to primary language data collection activi10 ties, include identifying, collecting, storing, tracking, 

11 and analyzing primary language data and informa12 tion on the methods used to meet the language ac13 cess needs of limited-English-proficient individuals. 

14 ‘‘(h) DEFINITION.—In this section, the term ‘health15 related program’ mean a program— 

16 ‘‘(1) under the Social Security Act (42 U.S.C. 

17 301 et seq.) that pays for health care and services; 

18 and 

19 ‘‘(2) under this Act that provides Federal finan20 cial assistance for health care, biomedical research, 

21 or health services research and or is designed to im22 prove the public’s health. 

23 ‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—There 

24 are 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 2017 through 2022. 

3 ‘‘SEC. 3432. PROVISIONS RELATING TO NATIVE AMERICANS. 

4 ‘‘(a) ESTABLISHMENT OF EPIDEMIOLOGY CEN5 TERS.—The Secretary shall establish an epidemiology cen6 ter in each service area to carry out the functions de7 scribed in subsection (b). Any new center established after 

8 the date of the enactment of the Health Equity and Ac9 countability Act of 2016 may be operated under a grant 

10 authorized by subsection (d), but funding under such a 

11 grant shall not be divisible. 

12 ‘‘(b) FUNCTIONS OF CENTERS.—In consultation with 

13 and upon the request of Indian tribes, tribal organizations, 

14 and urban Indian organizations, each service area epide15 miology center established under this subsection shall, 

16 with respect to such service area— 

17 ‘‘(1) collect data relating to, and monitor 

18 progress made toward meeting, each of the health 

19 status objectives of the service, the Indian tribes, 

20 tribal organizations, and urban Indian organizations 

21 in the service area; 

22 ‘‘(2) evaluate existing delivery systems, data 

23 systems, and other systems that impact the improve24 ment of Indian health; 


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1 ‘‘(3) assist Indian tribes, tribal organizations, 

2 and urban Indian organizations in identifying their 

3 highest priority health status objectives and the 

4 services needed to achieve such objectives, based on 

5 epidemiological data; 

6 ‘‘(4) make recommendations for the targeting 

7 of services needed by the populations served; 

8 ‘‘(5) make recommendations to improve health 

9 care delivery systems for Indians and urban Indians; 

10 ‘‘(6) provide requested technical assistance to 

11 Indian tribes, tribal organizations, and urban Indian 

12 organizations in the development of local health 

13 service priorities and incidence and prevalence rates 

14 of disease and other illness in the community; and 

15 ‘‘(7) provide disease surveillance and assist In16 dian tribes, tribal organizations, and urban Indian 

17 organizations to promote public health. 

18 ‘‘(c) TECHNICAL ASSISTANCE.—The Director of the 

19 Centers for Disease Control and Prevention shall provide 

20 technical assistance to the centers in carrying out the re21 quirements of this subsection. 

22 ‘‘(d) GRANTS FOR STUDIES.— 

23 ‘‘(1) IN GENERAL.—The Secretary may make 

24 grants to Indian tribes, tribal organizations, urban 

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1 sortia to conduct epidemiological studies of Indian 

2 communities. 

3 ‘‘(2) ELIGIBLE INTERTRIBAL CONSORTIA.—An 

4 intertribal consortium is eligible to receive a grant 

5 under this subsection if— 

6 ‘‘(A) the intertribal consortium is incor7 porated for the primary purpose of improving 

8 Indian health; and 

9 ‘‘(B) the intertribal consortium is rep10 resentative of the Indian tribes or urban Indian 

11 communities in which the intertribal consortium 

12 is located. 

13 ‘‘(3) APPLICATIONS.—An application for a 

14 grant under this subsection shall be submitted in 

15 such manner and at such time as the Secretary shall 

16 prescribe. 

17 ‘‘(4) REQUIREMENTS.—An applicant for a 

18 grant under this subsection shall— 

19 ‘‘(A) demonstrate the technical, adminis20 trative, and financial expertise necessary to 

21 carry out the functions described in paragraph 

22 (5); 

23 ‘‘(B) consult and cooperate with providers 

24 of related health and social services in order to 

25 avoid duplication of existing services; and 


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1 ‘‘(C) demonstrate cooperation from Indian 

2 tribes or urban Indian organizations in the area 

3 to be served. 

4 ‘‘(5) USE OF FUNDS.—A grant awarded under 

5 paragraph (1) may be used— 

6 ‘‘(A) to carry out the functions described 

7 in subsection (b); 

8 ‘‘(B) to provide information to and consult 

9 with tribal leaders, urban Indian community 

10 leaders, and related health staff on health care 

11 and health service management issues; and 

12 ‘‘(C) in collaboration with Indian tribes, 

13 tribal organizations, and urban Indian commu14 nities, to provide the service with information 

15 regarding ways to improve the health status of 

16 Indians. 

17 ‘‘(e) ACCESS TO INFORMATION.—An epidemiology 

18 center operated by a grantee pursuant to a grant awarded 

19 under subsection (d) shall be treated as a public health 

20 authority for purposes of the Health Insurance Portability 

21 and Accountability Act of 1996 (Public Law 104–191; 110 

22 Stat. 2033), as such entities are defined in part 164.501 

23 of title 45, Code of Federal Regulations (or a successor 

24 regulation). The Secretary shall grant such grantees ac25 cess to and use of data, data sets, monitoring systems, 


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1 delivery systems, and other protected health information 

2 in the possession of the Secretary.’’. 

3 SEC. 102. ELIMINATION OF PREREQUISITE OF DIRECT AP4 PROPRIATIONS FOR DATA COLLECTION AND 

5 ANALYSIS. 

6 Section 3101 of the Public Health Service Act (42 

7 U.S.C. 300kk) is amended— 

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

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

10 (h). 

11 SEC. 103. COLLECTION OF RACE AND ETHNICITY DATA BY 

12 THE SOCIAL SECURITY ADMINISTRATION. 

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

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

15 the following: 

16 ‘‘COLLECTION OF RACE AND ETHNICITY DATA BY THE

17 SOCIAL SECURITY ADMINISTRATION

18 ‘‘SEC. 1150C. (a) REQUIREMENT.—The Commis19 sioner of Social Security, in consultation with the Admin20 istrator of the Centers for Medicare & Medicaid Services, 

21 shall— 

22 ‘‘(1) require the collection of data on the race, 

23 ethnicity, primary language, and disability status of 

24 all applicants for Social Security account numbers or 

25 benefits under title II or part A of title XVIII and 

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1 sioner maintains records of wages and self-employ2 ment income in accordance with reports received by 

3 the Commissioner or the Secretary of the Treas4 ury— 

5 ‘‘(A) using, at a minimum, the standards 

6 for data collection on race, ethnicity, primary 

7 language, and disability status developed under 

8 section 3101 of the Public Health Service Act; 

9 ‘‘(B) where practicable, collecting data for 

10 additional population groups if such groups can 

11 be aggregated into the race and ethnicity cat12 egories outlined by the standards developed 

13 under section 3101 of the Public Health Service 

14 Act; and 

15 ‘‘(C) additionally referring, where prac16 ticable, to the standards developed by the Insti17 tute of Medicine in ‘Race, Ethnicity, and Lan18 guage Data: Standardization for Health Care 

19 Quality Improvement’ (released August 31, 

20 2009); 

21 ‘‘(2) with respect to the collection of the data 

22 described in paragraph (1) for applicants who are 

23 under 18 years of age or otherwise legally incapaci24 tated, 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; 

6 ‘‘(3) require that such data be uniformly ana7 lyzed and reported at least annually to the Commis8 sioner of Social Security; 

9 ‘‘(4) be responsible for storing the data re10 ported under paragraph (3); 

11 ‘‘(5) ensure transmission to the Centers for 

12 Medicare & Medicaid Services and other Federal 

13 health agencies; 

14 ‘‘(6) provide such data to the Secretary on at 

15 least an annual basis; and 

16 ‘‘(7) ensure that the provision of assistance to 

17 an applicant is not denied or otherwise adversely af18 fected because of the failure of the applicant to pro19 vide race, ethnicity, primary language, and disability 

20 status data. 

21 ‘‘(b) PROTECTION OF DATA.—The Commissioner of 

22 Social Security shall ensure (through the promulgation of 

23 regulations or otherwise) that all data collected pursuant 

24 to subsection (a) are protected— 


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

2 Secretary applies to health data under the regula3 tions promulgated under section 264(c) of the 

4 Health Insurance Portability and Accountability Act 

5 of 1996 (Public Law 104–191; 110 Stat. 2033) re6 lating to the privacy of individually identifiable 

7 health information and other protections; and 

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

9 entity that collects, stores, or receives the data, in10 cluding use of such data in determinations of eligi11 bility (or continued eligibility) in health plans, and 

12 from other inappropriate uses, as defined by the 

13 Secretary. 

14 ‘‘(c) RULE OF CONSTRUCTION.—Nothing in this sec15 tion shall be construed to permit the use of information 

16 collected under this section in a manner that would ad17 versely affect any individual providing any such informa18 tion. 

19 ‘‘(d) TECHNICAL ASSISTANCE.—The Secretary may, 

20 either directly or by grant or contract, provide technical 

21 assistance to enable any health entity to comply with the 

22 requirements of this section. 

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

24 are 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 2017 through 2022.’’. 

3 SEC. 104. REVISION OF HIPAA CLAIMS STANDARDS. 

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

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

6 Human Services shall revise the regulations promulgated 

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

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

9 on race, ethnicity, and primary language in a health-re10 lated transaction, to require— 

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

12 data collection on race, ethnicity, primary language, 

13 disability, and sex developed under section 3101 of 

14 the Public Health Service Act (42 U.S.C. 300kk); 

15 and 

16 (2) the designation of the racial, ethnic, pri17 mary language, disability, and sex code sets as re18 quired for claims and enrollment data. 

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

20 Human Services shall disseminate the new standards de21 veloped under subsection (a) to all health entities that are 

22 subject to the regulations described in such subsection and 

23 provide technical assistance with respect to the collection 

24 of the data involved. 


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

2 Human Services shall require that health entities comply 

3 with the new standards developed under subsection (a) not 

4 later than 2 years after the final promulgation of such 

5 standards. 

6 SEC. 105. NATIONAL CENTER FOR HEALTH STATISTICS. 

7 Section 306(n) of the Public Health Service Act (42 

8 U.S.C. 242k(n)) is amended— 

9 (1) in paragraph (1), by striking ‘‘2003’’ and 

10 inserting ‘‘2022’’; 

11 (2) in paragraph (2), in the first sentence, by 

12 striking ‘‘2003’’ and inserting ‘‘2022’’; and 

13 (3) in paragraph (3), by striking ‘‘2002’’ and 

14 inserting ‘‘2022’’. 

15 SEC. 106. OVERSAMPLING OF ASIAN-AMERICANS, NATIVE 

16 HAWAIIANS, OR PACIFIC ISLANDERS AND 

17 OTHER UNDERREPRESENTED GROUPS IN 

18 FEDERAL HEALTH SURVEYS. 

19 Part B of title III of the Public Health Service Act 

20 (42 U.S.C. 243 et seq.) is amended by inserting after sec21 tion 317T the following: 


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1 ‘‘SEC. 317U. OVERSAMPLING OF ASIAN-AMERICANS, NATIVE 

2 HAWAIIANS, OR PACIFIC ISLANDERS AND 

3 OTHER UNDERREPRESENTED GROUPS IN 

4 FEDERAL HEALTH SURVEYS. 

5 ‘‘(a) NATIONAL STRATEGY.— 

6 ‘‘(1) IN GENERAL.—The Secretary of Health 

7 and Human Services, acting through the Director of 

8 the National Center for Health Statistics (referred 

9 to in this section as ‘NCHS’) of the Centers for Dis10 ease Control and Prevention, and other agencies 

11 within the Department of Health and Human Serv12 ices as the Secretary determines appropriate, shall 

13 develop and implement an ongoing and sustainable 

14 national strategy for oversampling Asian-Americans, 

15 Native Hawaiians, or Pacific Islanders, and other 

16 underrepresented populations as determined appro17 priate by the Secretary in Federal health surveys. 

18 ‘‘(2) CONSULTATION.—In developing and imple19 menting a national strategy, as described in para20 graph (1), not later than 180 days after the date of 

21 the enactment of the this section, the Secretary— 

22 ‘‘(A) shall consult with representatives of 

23 community groups, nonprofit organizations, 

24 nongovernmental organizations, and govern25 ment agencies working with Asian-Americans, 


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1 Native Hawaiians, or Pacific Islanders, and 

2 other underrepresented populations; and 

3 ‘‘(B) may solicit the participation of rep4 resentatives from other Federal departments 

5 and agencies. 

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

7 after the date of the enactment of this section, the Sec8 retary shall submit to the Congress a progress report, 

9 which shall include the national strategy described in sub10 section (a)(1). 

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

12 carry out this section, there are authorized to be appro13 priated such sums as may be necessary for fiscal years 

14 2017 through 2022.’’. 

15 SEC. 107. GEO-ACCESS STUDY. 

16 The Administrator of the Substance Abuse and Men17 tal Health Services Administration shall— 

18 (1) conduct a study to— 

19 (A) determine which geographic areas of 

20 the United States have shortages of specialty 

21 mental health providers; and 

22 (B) assess the preparedness of speciality 

23 mental health providers to deliver culturally and 

24 linguistically appropriate, affordable, and acces25 sible services; and 


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1 (2) submit a report to the Congress on the re2 sults of such study. 

3 SEC. 108. RACIAL, ETHNIC, AND PRIMARY LANGUAGE DATA 

4 COLLECTED BY THE FEDERAL GOVERNMENT. 

5 (a) COLLECTION; SUBMISSION.—Not later than 90 

6 days after the date of the enactment of this Act, and Jan7 uary 31 of each year thereafter, each department, agency, 

8 and office of the Federal Government that has collected 

9 racial, ethnic, or primary language data during the pre10 ceding calendar year shall submit such data to the Sec11 retary of Health and Human Services. 

12 (b) ANALYSIS; PUBLIC AVAILABILITY; REPORTING.— 

13 Not later than April 30, 2017, and each April 30 there14 after, the Secretary of Health and Human Services, acting 

15 through the Director of the National Institute on Minority 

16 Health and Health Disparities and the Deputy Assistant 

17 Secretary for Minority Health, shall— 

18 (1) collect and analyze the racial, ethnic, and 

19 primary language data submitted under subsection 

20 (a) for the preceding calendar year; 

21 (2) make publicly available such data and the 

22 results of such analysis; and 

23 (3) submit a report to the Congress on such 

24 data and analysis. 


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1 SEC. 109. DATA COLLECTION AND ANALYSIS GRANTS TO MI2 NORITY-SERVING INSTITUTIONS. 

3 (a) AUTHORITY.—The Secretary of Health and 

4 Human Services, acting through the National Institute on 

5 Minority Health and Health Disparities and the Office of 

6 Minority Health, may award grants to access and analyze 

7 racial and ethnic, and where possible other health dis8 parity data, to monitor and report on progress to reduce 

9 and eliminate disparities in health and health care. 

10 (b) ELIGIBLE ENTITY.—In this section, the term ‘‘el11 igible entity’’ means a historically Black college or univer12 sity, an Hispanic-serving institution, a tribal college or 

13 university, or an Asian-American, Native American, or Pa14 cific Islander-serving institution with an accredited public 

15 health, health policy, or health services research program. 

16 SEC. 110. STANDARDS FOR MEASURING SEXUAL ORIENTA17 TION AND GENDER IDENTITY IN COLLECTION 

18 OF HEALTH DATA. 

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

20 U.S.C. 300kk(a)) is amended— 

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

22 orientation, gender identity,’’ before ‘‘and disability 

23 status’’; 

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

25 orientation, gender identity,’’ before ‘‘and disability 

26 status’’; and 


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

2 orientation, gender identity,’’ before ‘‘and disability 

3 status’’. 

4 SEC. 111. STANDARDS FOR MEASURING SOCIOECONOMIC 

5 STATUS IN COLLECTION OF HEALTH DATA. 

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

7 U.S.C. 300kk(a)), as amended, is amended— 

8 (1) in paragraph (1)(A), by inserting ‘‘socio9 economic status,’’ before ‘‘and disability status’’; 

10 (2) in paragraph (1)(C), by inserting ‘‘socio11 economic status,’’ before ‘‘and disability status’’; and 

12 (3) in paragraph (2)(B), by inserting ‘‘socio13 economic status,’’ before ‘‘and disability status’’. 

14 SEC. 112. SAFETY AND EFFECTIVENESS OF DRUGS WITH 

15 RESPECT TO RACIAL AND ETHNIC BACK16 GROUND. 

17 (a) IN GENERAL.—Chapter V of the Federal Food, 

18 Drug, and Cosmetic Act (21 U.S.C. 351 et seq.) is amend19 ed by adding after section 505E the following: 

20 ‘‘SEC. 505F. SAFETY AND EFFECTIVENESS OF DRUGS WITH 

21 RESPECT TO RACIAL AND ETHNIC BACK22 GROUND. 

23 ‘‘(a) PREAPPROVAL STUDIES.—If there is evidence 

24 that there may be a disparity on the basis of racial or 


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1 ethnic background as to the safety or effectiveness of a 

2 drug, then— 

3 ‘‘(1)(A) the investigations required under sec4 tion 505(b)(1)(A) shall include adequate and well5 controlled investigations of the disparity; or 

6 ‘‘(B) the evidence required under section 351(a) 

7 of the Public Health Service Act for approval of a 

8 biologics license application for the drug shall in9 clude adequate and well-controlled investigations of 

10 the disparity; and 

11 ‘‘(2) if the investigations confirm that there is 

12 a disparity, the labeling of the drug shall include ap13 propriate information about the disparity. 

14 ‘‘(b) POSTMARKET STUDIES.— 

15 ‘‘(1) IN GENERAL.—If there is evidence that 

16 there may be a disparity on the basis of racial or 

17 ethnic background as to the safety or effectiveness 

18 of a drug for which there is an approved application 

19 under section 505 or a license under section 351 of 

20 the Public Health Service Act, the Secretary may by 

21 order require the holder of the approved application 

22 or license to conduct, by a date specified by the Sec23 retary, postmarketing studies to investigate the dis24 parity. 


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1 ‘‘(2) LABELING.—If the Secretary determines 

2 that the postmarket studies confirm that there is a 

3 disparity described in paragraph (1), the labeling of 

4 the drug shall include appropriate information about 

5 the disparity. 

6 ‘‘(3) STUDY DESIGN.—The Secretary may 

7 specify all aspects of study design, including the 

8 number of studies and study participants, and the 

9 other demographic characteristics of study partici10 pants included, in the order requiring postmarket 

11 studies of the drug. 

12 ‘‘(4) MODIFICATIONS OF STUDY DESIGN.—The 

13 Secretary may by order modify any aspect of the 

14 study design as necessary after issuing an order 

15 under paragraph (1). 

16 ‘‘(5) STUDY RESULTS.—The results from stud17 ies required under paragraph (1) shall be submitted 

18 to the Secretary as supplements to the drug applica19 tion or biological license application. 

20 ‘‘(c) DISPARITY.—The term ‘evidence that there may 

21 be a disparity on the basis of racial or ethnic background 

22 for adult and pediatric populations as to the safety or ef23 fectiveness of a drug’ includes— 

24 ‘‘(1) evidence that there is a disparity on the 

25 basis of racial or ethnic background as to safety or 


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1 effectiveness of a drug in the same chemical class as 

2 the drug; 

3 ‘‘(2) evidence that there is a disparity on the 

4 basis of racial or ethnic background in the way the 

5 drug is metabolized; and 

6 ‘‘(3) other evidence as the Secretary may deter7 mine. 

8 ‘‘(d) APPLICATIONS UNDER SECTIONS 505(b)(2) 

9 AND 505(j).— 

10 ‘‘(1) IN GENERAL.—A drug for which an appli11 cation has been submitted or approved under section 

12 505(j) shall not be considered ineligible for approval 

13 under that section or misbranded under section 502 

14 on the basis that the labeling of the drug omits in15 formation relating to a disparity on the basis of ra16 cial or ethnic background as to the safety or effec17 tiveness of the drug, whether derived from investiga18 tions or studies required under this section or de19 rived from other sources, when the omitted informa20 tion is protected by patent or by exclusivity under 

21 clause (iii) or (iv) of section 505(j)(5)(B). 

22 ‘‘(2) LABELING.—Notwithstanding clauses (iii) 

23 and (iv) of section 505(j)(5)(B), the Secretary may 

24 require that the labeling of a drug approved under 

25 section 505(j) that omits information relating to a 


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1 disparity on the basis of racial or ethnic background 

2 as to the safety or effectiveness of the drug include 

3 a statement of any appropriate contraindications, 

4 warnings, or precautions related to the disparity 

5 that the Secretary considers necessary.’’. 

6 (b) ENFORCEMENT.—Section 502 of the Federal 

7 Food, Drug, and Cosmetic Act (21 U.S.C. 352) is amend8 ed by adding at the end the following: 

9 ‘‘(dd) If it is a drug and the holder of the approved 

10 application under section 505 or license under section 351 

11 of the Public Health Service Act for the drug has failed 

12 to complete the investigations or studies, or comply with 

13 any other requirement, of section 505F.’’. 

14 (c) DRUG FEES.—Section 736(a)(1)(A)(ii) of the 

15 Federal Food, Drug, and Cosmetic Act (21 U.S.C. 379h) 

16 is amended by adding after ‘‘are required’’ the following: 

17 ‘‘, including supplements required under section 505F’’. 

18 SEC. 113. IMPROVING HEALTH DATA REGARDING NATIVE 

19 HAWAIIANS AND OTHER PACIFIC ISLANDERS. 

20 Part B of title III of the Public Health Service Act 

21 (42 U.S.C. 243 et seq.) is amended by inserting after sec22 tion 317U, as added, the following: 

23 ‘‘SEC. 317V. NATIVE HAWAIIAN AND OTHER PACIFIC IS24 LANDER HEALTH DATA. 

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


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1 ‘‘(1) COMMUNITY GROUP.—The term ‘commu2 nity group’ means a group of NHOPI who are orga3 nized at the community level, and may include a 

4 church group, social service group, national advocacy 

5 organization, or cultural group. 

6 ‘‘(2) NONPROFIT, NONGOVERNMENTAL ORGANI7 ZATION.—The term ‘nonprofit, nongovernmental or8 ganization’ means a group of NHOPI with a dem9 onstrated history of addressing NHOPI issues, in10 cluding a NHOPI coalition. 

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

12 ‘designated organization’ means an entity estab13 lished to represent NHOPI populations and which 

14 has statutory responsibilities to provide, or has com15 munity support for providing, health care. 

16 ‘‘(4) GOVERNMENT REPRESENTATIVES.—The 

17 term ‘government representatives’ means representa18 tives from Hawaii, American Samoa, the Common19 wealth of the Northern Mariana Islands, the Fed20 erated States of Micronesia, Guam, the Republic of 

21 Palau, and the Republic of the Marshall Islands. 

22 ‘‘(5) NATIVE HAWAIIANS AND OTHER PACIFIC

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

24 and Other Pacific Islanders’ or ‘NHOPI’ means peo25 ple having origins in any of the original peoples of 


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1 American Samoa, the Commonwealth of the North2 ern Mariana Islands, the Federated States of Micro3 nesia, Guam, Hawaii, the Republic of the Marshall 

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

5 island. 

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

7 means Guam, the Commonwealth of Northern Mar8 iana Islands, American Samoa, the United States 

9 Virgin Islands, the Federated States of Micronesia, 

10 the Republic of Palau, or the Republic of the Mar11 shall Islands. 

12 ‘‘(b) NATIONAL STRATEGY.— 

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

14 through the Director of the National Center for 

15 Health Statistics (referred to in this section as 

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

17 Prevention, and other agencies within the Depart18 ment of Health and Human Services as the Sec19 retary determines appropriate, shall develop and im20 plement an ongoing and sustainable national strat21 egy for identifying and evaluating the health status 

22 and health care needs of NHOPI populations living 

23 in the continental United States, Hawaii, American 

24 Samoa, the Commonwealth of the Northern Mariana 

25 Islands, the Federated States of Micronesia, Guam, 


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1 the Republic of Palau, and the Republic of the Mar2 shall Islands. 

3 ‘‘(2) CONSULTATION.—In developing and imple4 menting a national strategy, as described in para5 graph (1), not later than 180 days after the date of 

6 enactment of the Health Equity and Accountability 

7 Act of 2016, the Secretary— 

8 ‘‘(A) shall consult with representatives of 

9 community groups, designated organizations, 

10 and nonprofit, nongovernmental organizations 

11 and with government representatives of NHOPI 

12 populations; and 

13 ‘‘(B) may solicit the participation of rep14 resentatives from other Federal departments. 

15 ‘‘(c) PRELIMINARY HEALTH SURVEY.— 

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

17 through the Director of NCHS, shall conduct a pre18 liminary health survey in order to identify the major 

19 areas and regions in the continental United States, 

20 Hawaii, American Samoa, the Commonwealth of the 

21 Northern Mariana Islands, the Federated States of 

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

23 Republic of the Marshall Islands in which NHOPI 

24 people reside. 


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

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

3 other data the Secretary determines to be— 

4 ‘‘(A) useful in determining health status 

5 and health care needs; or 

6 ‘‘(B) required for developing or imple7 menting a national strategy. 

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

9 health survey described in paragraph (1), including 

10 plans for designing questions, implementation, sam11 pling, and analysis, shall be developed in consulta12 tion with community groups, designated organiza13 tions, nonprofit, nongovernmental organizations, and 

14 government representatives of NHOPI populations, 

15 as determined by the Secretary. 

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

17 this subsection shall be completed not later than 18 

18 months after the date of enactment of the Health 

19 Equity and Accountability Act of 2016. 

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

21 after the date of enactment of the Health Equity and Ac22 countability Act of 2016, the Secretary shall submit to 

23 Congress a progress report, which shall include the na24 tional strategy described in subsection (b)(1). 

25 ‘‘(e) STUDY AND REPORT BY THE IOM.— 


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

2 into an agreement with the Institute of Medicine to 

3 conduct a study, with input from stakeholders in in4 sular areas, on the following: 

5 ‘‘(A) The standards and definitions of 

6 health care applied to health care systems in in7 sular areas and the appropriateness of such 

8 standards and definitions. 

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

10 care systems in insular areas, evaluated based 

11 upon standards and definitions, as the Sec12 retary determines. 

13 ‘‘(C) The effectiveness of donor aid in ad14 dressing health care needs and priorities in in15 sular areas. 

16 ‘‘(D) The progress toward implementation 

17 of recommendations of the Committee on 

18 Health Care Services in the United States—As19 sociated Pacific Basin of the Institute of Medi20 cine that are set forth in the 1998 report, ‘Pa21 cific Partnerships for Health: Charting a New 

22 Course for the 21st Century’. 

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

24 paragraph (1) shall require the Institute of Medicine 

25 to submit to the Secretary and to Congress, not 


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1 later than 2 years after the date of the enactment 

2 of the Health Equity and Accountability Act of 

3 2016, a report containing a description of the results 

4 of the study conducted under paragraph (1), includ5 ing the conclusions and recommendations of the In6 stitute of Medicine for each of the items described 

7 in subparagraphs (A) through (D) of such para8 graph. 

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

10 carry out this section, there are authorized to be appro11 priated such sums as may be necessary for fiscal years 

12 2017 through 2022.’’. 

13 SEC. 114. CLARIFICATION OF SIMPLIFIED ADMINISTRATIVE 

14 REPORTING REQUIREMENT. 

15 Section 11(a) of the Food and Nutrition Act of 2008 

16 (7 U.S.C. 2020(a)) is amended by adding at the end the 

17 following: 

18 ‘‘(5) SIMPLIFIED ADMINISTRATIVE REPORTING

19 REQUIREMENT.—The administrative notification re20 quirement under section 421(e)(2) of the Personal 

21 Responsibility and Work Opportunity Reconciliation 

22 Act of 1996 (8 U.S.C. 1631(e)(2)) shall be satisfied 

23 by the submission by an agency of a report on the 

24 aggregate number of exceptions granted under such 

25 section by such agency in each year.’’. 


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1 TITLE II—CULTURALLY AND LIN2 GUISTICALLY APPROPRIATE 

3 HEALTH CARE 

4 SEC. 201. DEFINITIONS. 

5 In this title, the definitions contained in section 3400 

6 of the Public Health Service Act, as added by section 202, 

7 shall apply. 

8 SEC. 202. AMENDMENT TO THE PUBLIC HEALTH SERVICE 

9 ACT. 

10 (a) FINDINGS.—Congress finds the following: 

11 (1) Effective communication is essential to 

12 meaningful access to quality physical and mental 

13 health care. 

14 (2) Research indicates that the lack of appro15 priate language services creates language barriers 

16 that result in increased risk of misdiagnosis, ineffec17 tive treatment plans and poor health outcomes for 

18 limited-English-proficient individuals and individuals 

19 with communication disabilities such as hearing, vi20 sion, or print impairments. 

21 (3) The number of limited-English-speaking 

22 residents in the United States who speak English 

23 less than very well and, therefore, cannot effectively 

24 communicate with health and social service providers 

25 continues to increase significantly. 


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1 (4) The responsibility to fund language services 

2 in the provision of health care and health-care-re3 lated services to limited-English-proficient individ4 uals and individuals with communication disabilities 

5 such as hearing, vision, or print impairments is a so6 cietal one that cannot fairly be visited solely upon 

7 the health care, public health, or social services com8 munity. 

9 (5) Title VI of the Civil Rights Act of 1964 

10 prohibits discrimination based on the grounds of 

11 race, color, or national origin by any entity receiving 

12 Federal financial assistance. In order to avoid dis13 crimination on the grounds of national origin, all 

14 programs or activities administered by the Depart15 ment must take adequate steps to ensure that their 

16 policies and procedures do not deny or have the ef17 fect of denying limited-English-proficient individuals 

18 with equal access to benefits and services for which 

19 such persons qualify. 

20 (6) Linguistic diversity in the health care and 

21 health-care-related-services workforce is important 

22 for providing all patients the environment most con23 ducive to positive health outcomes. 

24 (7) All members of the health care and health25 care-related-services community should continue to 


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1 educate their staff and constituents about limited2 English-proficient and disability communication 

3 issues and help them identify resources to improve 

4 access to quality care for limited-English-proficient 

5 individuals and individuals with communication dis6 abilities such as hearing, vision, or print impair7 ments. 

8 (8) Access to English as a second language and 

9 sign language instructions is an important mecha10 nism for ensuring effective communication and elimi11 nating the language barriers that impede access to 

12 health care. 

13 (9) Competent language services in health care 

14 settings should be available as a matter of course. 

15 (b) AMENDMENT.—The Public Health Service Act 

16 (42 U.S.C. 201 et seq.) is amended by adding at the end 

17 the following: 

18 ‘‘TITLE XXXIV—CULTURALLY 

19 AND LINGUISTICALLY APPRO20 PRIATE HEALTH CARE 

21 ‘‘SEC. 3400. DEFINITIONS. 

22 ‘‘In this title: 

23 ‘‘(1) BILINGUAL.—The term ‘bilingual’ with re24 spect to an individual means a person who has suffi25 cient degree of proficiency in two languages. 


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1 ‘‘(2) COMMUNITY HEALTH WORKER.—The term 

2 ‘community health worker’ includes a community 

3 health advocate, a lay health educator, a community 

4 health representative, a peer health promoter, a 

5 community health outreach worker, and in Spanish, 

6 promotores de salud. 

7 ‘‘(3) COMPETENT INTERPRETER SERVICES.— 

8 The term ‘competent interpreter services’ means a 

9 translanguage rendition of a spoken or signed mes10 sage in which the interpreter— 

11 ‘‘(A) comprehends the source language and 

12 can communicate comprehensively in the target 

13 language to convey the meaning intended in the 

14 source language; and 

15 ‘‘(B) knows health and health-related ter16 minology and provides accurate interpretations 

17 by choosing equivalent expressions that convey 

18 the best matching and meaning to the source 

19 language and capture, to the greatest possible 

20 extent, all nuances intended in the source mes21 sage. 

22 ‘‘(4) COMPETENT TRANSLATION SERVICES.— 

23 The term ‘competent translation services’ means a 

24 translanguage rendition of a written document in 

25 which the translator— 


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1 ‘‘(A) comprehends the source language and 

2 can write or sign comprehensively in the target 

3 language to convey the meaning intended in the 

4 source language; and 

5 ‘‘(B) knows health and health-related ter6 minology and provides accurate translations by 

7 choosing equivalent expressions that convey the 

8 best matching and meaning to the source lan9 guage and capture, to the greatest possible ex10 tent, all nuances intended in the source docu11 ment. 

12 ‘‘(5) CULTURAL COMPETENCE.—The term ‘cul13 tural competence’ means a set of congruent behav14 iors, attitudes, and policies that come together in a 

15 system, agency, or among professionals that enables 

16 effective work in cross-cultural situations. In the 

17 preceding sentence— 

18 ‘‘(A) the term ‘cultural’ refers to inte19 grated patterns of human behavior that include 

20 the language, thoughts, communications, ac21 tions, customs, beliefs, values, and institutions 

22 of racial, ethnic, religious, or social groups, in23 cluding lesbian, gay, bisexual, transgender, 

24 queer, and questioning individuals, and individ25 uals with physical and mental disabilities; and 


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1 ‘‘(B) the term ‘competence’ implies having 

2 the capacity to function effectively as an indi3 vidual and an organization within the context of 

4 the cultural beliefs, behaviors, and needs pre5 sented by consumers and their communities. 

6 ‘‘(6) EFFECTIVE COMMUNICATION.—The term 

7 ‘effective communication’ means an exchange of in8 formation between the provider of health care or 

9 health-care-related services and the recipient of such 

10 services who is limited in English proficiency, or has 

11 a communication impairment such as a hearing, vi12 sion, speaking, or learning impairment, that enables 

13 access, understanding, and benefit from health care 

14 or health-care-related services, and full participation 

15 in the development of their treatment plan. 

16 ‘‘(7) GRIEVANCE RESOLUTION PROCESS.—The 

17 term ‘grievance resolution process’ means all aspects 

18 of dispute resolution including filing complaints, 

19 grievance and appeal procedures, and court action. 

20 ‘‘(8) HEALTH CARE GROUP.—The term ‘health 

21 care group’ means a group of physicians organized, 

22 at least in part, for the purposes of providing physi23 cians’ services under the Medicaid, SCHIP, or Medi24 care programs and may include a hospital and any 

25 other individual or entity furnishing services covered 


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1 under the Medicaid, SCHIP, or Medicare programs 

2 that is affiliated with the health care group. 

3 ‘‘(9) HEALTHCARE 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 ‘‘(10) 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 ‘‘(11) INDIAN TRIBE.—The term ‘Indian tribe’ 

12 means any Indian tribe, band, nation, or other orga13 nized group or community, including any Alaska Na14 tive village or group or regional or village corpora15 tion as defined in or established pursuant to the 

16 Alaska Native Claims Settlement Act (85 Stat. 688) 

17 (43 U.S.C. 1601 et seq.), which is recognized as eli18 gible for the special programs and services provided 

19 by the United States to Indians because of their sta20 tus as Indians. 

21 ‘‘(12) INTEGRATED HEALTH CARE DELIVERY

22 SYSTEM.—The term ‘integrated health care delivery 

23 system’ means an interdisciplinary system that 

24 brings together providers from the primary health, 

25 mental health, substance use and related disciplines 


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1 to improve the health outcomes of an individual. 

2 Providers may include but are not limited to hos3 pitals, health, mental health or substance use clinics 

4 and providers, home health agencies, ambulatory 

5 surgery centers, skilled nursing facilities, rehabilita6 tion centers, and employed, independent, or con7 tracted physicians. 

8 ‘‘(13) INTERPRETING/INTERPRETATION.—The 

9 terms ‘interpreting’ and ‘interpretation’ mean the 

10 transmission of a spoken, written, or signed message 

11 from one language or format into another, faithfully, 

12 accurately, and objectively. 

13 ‘‘(14) LANGUAGE ACCESS.—The term ‘language 

14 access’ means the provision of language services to 

15 an LEP individual or individual with communication 

16 disabilities designed to enhance that individual’s ac17 cess to, understanding of, or benefit from health 

18 care or health-care-related services. 

19 ‘‘(15) LANGUAGE OR LANGUAGE ACCESS SERV20 ICES.—The term ‘language or language access serv21 ices’ means provision of health care services directly 

22 in a non-English language, interpretation, trans23 lation, signage, video recording, and English or non24 English alternative formats. 


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1 ‘‘(16) LEP.—The term ‘LEP’ means limited2 English-proficient. 

3 ‘‘(17) MEDICARE, MEDICAID, AND SCHIP.—The 

4 terms ‘Medicare’, ‘Medicaid’, and ‘SCHIP’ mean the 

5 respective programs under titles XVIII, XIX, and 

6 XXI of the Social Security Act. 

7 ‘‘(18) MINORITY.— 

8 ‘‘(A) IN GENERAL.—The terms ‘minority’ 

9 and ‘minorities’ refer to individuals from a mi10 nority group. 

11 ‘‘(B) POPULATIONS.—The term ‘minority’, 

12 with respect to populations, refers to racial and 

13 ethnic minority groups. 

14 ‘‘(19) MINORITY GROUP.—The term ‘minority 

15 group’ has the meaning given the term ‘racial and 

16 ethnic minority group’. 

17 ‘‘(20) RACIAL AND ETHNIC MINORITY GROUP.— 

18 The term ‘racial and ethnic minority group’ means 

19 American Indians and Alaska Natives, African20 Americans (including Caribbean Blacks, Africans, 

21 and other Blacks), Asian-Americans, Hispanics (in22 cluding Latinos), and Native Hawaiians and other 

23 Pacific Islanders. 

24 ‘‘(21) ONSITE INTERPRETATION.—The term 

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1 preting or interpretation for which the interpreter is 

2 in the physical presence of the provider of health 

3 care or health-care-related services and the recipient 

4 of such services who is limited in English proficiency 

5 or has a communication impairment such as hear6 ing, vision, or learning. 

7 ‘‘(22) SECRETARY.—The term ‘Secretary’ 

8 means the Secretary of Health and Human Services. 

9 ‘‘(23) SIGHT TRANSLATION.—The term ‘sight 

10 translation’ means the transmission of a written 

11 message in one language into a spoken or signed 

12 message in another language, or an alternative for13 mat in English or another language. 

14 ‘‘(24) STATE.—The term ‘State’ means each of 

15 the several States, the District of Columbia, the 

16 Commonwealth of Puerto Rico, the Indian tribes, 

17 the United States Virgin Islands, Guam, American 

18 Samoa, and the Commonwealth of the Northern 

19 Mariana Islands. 

20 ‘‘(25) TELEPHONIC INTERPRETATION.—The 

21 term ‘telephonic interpretation’ (also known as over 

22 the phone interpretation or OPI) means a method of 

23 interpreting/interpretation for which the interpreter 

24 is not in the physical presence of the provider of 

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1 English-proficient recipient of such services but is 

2 connected via telephone. 

3 ‘‘(26) TRANSLATION.—The term ‘translation’ 

4 means the transmission of a written message in one 

5 language into a written or signed message in an6 other language, and includes translation into an7 other language or alternative format, such as large 

8 print font, Braille, audio recording, or CD. 

9 ‘‘(27) VIDEO INTERPRETATION.—The term 

10 ‘video interpretation’ means a method of inter11 preting/interpretation for which the interpreter is 

12 not in the physical presence of the provider of health 

13 care or related services and the limited-English-pro14 ficient recipient of such services but is connected via 

15 a video hook-up that includes both audio and video 

16 transmission. 

17 ‘‘(28) VITAL DOCUMENT.—The term ‘vital doc18 ument’ includes but is not limited to applications for 

19 government programs that provide health care serv20 ices, medical or financial consent forms, financial as21 sistance documents, letters containing important in22 formation regarding patient instructions (such as 

23 prescriptions, referrals to other providers, and dis24 charge plans) and participation in a program (such 

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1 taining to the reduction, denial, or termination of 

2 services or benefits, notices of the right to appeal 

3 such actions, and notices advising limited-English4 proficient individuals and individuals with commu5 nication disabilities of the availability of free lan6 guage services, alternative formats, and other out7 reach materials. 

8 ‘‘SEC. 3401. IMPROVING ACCESS TO SERVICES FOR INDIVID9 UALS WITH LIMITED ENGLISH PROFICIENCY. 

10 ‘‘(a) PURPOSE.—As provided in Executive Order 

11 13166, it is the purpose of this section— 

12 ‘‘(1) to improve Federal agency performance re13 garding access to federally conducted and federally 

14 assisted programs and activities for individuals who 

15 are limited in their English proficiency; 

16 ‘‘(2) to require each Federal agency to examine 

17 the services it provides and develop and implement 

18 a system by which limited-English-proficient individ19 uals can obtain cultural competence and meaningful 

20 access to those services consistent with, and without 

21 substantially burdening, the fundamental mission of 

22 the agency; 

23 ‘‘(3) to require each Federal agency to ensure 

24 that recipients of Federal financial assistance pro25 vide cultural competence and meaningful access to 


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1 their limited-English-proficient applicants and bene2 ficiaries; 

3 ‘‘(4) to ensure that recipients of Federal finan4 cial assistance take reasonable steps, consistent with 

5 the guidelines set forth in the Limited English Pro6 ficient Guidance of the Department of Justice (as 

7 issued on June 12, 2002), to ensure cultural com8 petence and meaningful access to their programs 

9 and activities by limited-English-proficient individ10 uals; and 

11 ‘‘(5) to ensure compliance with title VI of the 

12 Civil Rights Act of 1964 and that health care pro13 viders and organizations do not discriminate in the 

14 provision of services. 

15 ‘‘(b) FEDERALLY CONDUCTED PROGRAMS AND AC16 TIVITIES.— 

17 ‘‘(1) IN GENERAL.—Not later than 120 days 

18 after the date of enactment of this title, each Fed19 eral agency that carries out health-care-related ac20 tivities shall prepare a plan to improve access cul21 tural competence to the federally conducted, health22 care-related programs and activities of the agency by 

23 limited-English-proficient individuals. Not later than 

24 one year after the date of enactment of this title, 


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1 each such Federal agency shall ensure that such 

2 plan is fully implemented. 

3 ‘‘(2) PLAN REQUIREMENT.—Each plan under 

4 paragraph (1) shall include— 

5 ‘‘(A) the steps the agency will take to en6 sure that limited-English-proficient individuals 

7 have access to the agency’s federally conducted 

8 health care and health-care-related programs 

9 and activities; 

10 ‘‘(B) the policies and procedures for identi11 fying, assessing, and meeting the language 

12 needs and cultural competence needs of its lim13 ited-English-proficient beneficiaries served by 

14 federally conducted programs and activities; 

15 ‘‘(C) the steps the agency will take for its 

16 federally conducted programs and activities to 

17 improve cultural competence to provide a range 

18 of language assistance options, notice to lim19 ited-English-proficient individuals of the right 

20 to competent language services, periodic train21 ing of staff, monitoring and quality assessment 

22 of the language services and, in appropriate cir23 cumstances, the translation of written mate24 rials; 


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1 ‘‘(D) the steps the agency will take to en2 sure that applications, forms, and other rel3 evant documents for its federally conducted pro4 grams and activities are competently translated 

5 into the primary language of a limited-English6 proficient client where such materials are need7 ed to improve access to federally conducted and 

8 federally assisted programs and activities for 

9 such a limited-English-proficient individual; 

10 ‘‘(E) the resources the agency will provide 

11 to improve cultural competence to assist recipi12 ents of Federal funds to improve access to 

13 health care or health-care-related programs and 

14 activities for limited-English-proficient individ15 uals; 

16 ‘‘(F) the resources the agency will provide 

17 to ensure that competent language assistance is 

18 provided to limited-English-proficient patients 

19 by interpreters or trained bilingual staff; and 

20 ‘‘(G) the resources the agency will provide 

21 to ensure that family, particularly minor chil22 dren, and friends are not used to provide inter23 pretation services, except— 

24 ‘‘(i) in the case of a medical emer25 gency where delay directly associated with 


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1 obtaining a competent interpreter would 

2 jeopardize the health of the patient; or 

3 ‘‘(ii) on request of the patient, who 

4 has been informed in his or her preferred 

5 language of the availability of free inter6 pretation services, if the health care serv7 ices provider has determined that the fam8 ily or friend can provide competent inter9 preter services as defined in section 3400. 

10 ‘‘(3) SUBMISSION OF PLAN TO DOJ.—Each 

11 agency that is required to prepare a plan under 

12 paragraph (1) shall send a copy of such plan to the 

13 Department of Justice, which shall serve as the cen14 tral repository of such plans. 

15 ‘‘(4) RULE OF CONSTRUCTION.—Paragraph 

16 (2)(G)(i) shall not be construed to mean that emer17 gency rooms or similar entities that regularly pro18 vide health care services in medical emergencies are 

19 exempt from legal or regulatory requirements related 

20 to competent interpreter services. 

21 ‘‘(c) FEDERALLY ASSISTED PROGRAMS AND ACTIVI22 TIES.— 

23 ‘‘(1) IN GENERAL.—Not later than 120 days 

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1 nancial assistance shall ensure that the guidance for 

2 recipients of Federal financial assistance developed 

3 by the agency to ensure compliance with title VI of 

4 the Civil Rights Act of 1964 (42 U.S.C. 2000d et 

5 seq.) is specifically tailored to the recipients of such 

6 assistance. Each agency shall send a copy of such 

7 guidance to the Department of Justice which shall 

8 serve as the central repository of the agency’s plans. 

9 After approval by the Department of Justice, each 

10 agency shall publish its guidance document in the 

11 Federal Register for public comment. 

12 ‘‘(2) REQUIREMENTS.—The agency-specific 

13 guidance developed under paragraph (1) shall take 

14 into account the types of health care services pro15 vided by the recipients, the individuals served by the 

16 recipients, and other factors set out in such stand17 ards. 

18 ‘‘(3) EXISTING GUIDANCES.—A Federal agency 

19 that has developed a guidance for purposes of title 

20 VI of the Civil Rights Act of 1964 shall examine 

21 such existing guidance, as well as the programs and 

22 activities to which such guidance applies, to deter23 mine if modification of such guidance is necessary to 

24 comply with this subsection. 


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1 ‘‘(4) CONSULTATION.—Each Federal agency 

2 shall consult with the Department of Justice in es3 tablishing the guidances under this subsection. 

4 ‘‘(d) CONSULTATIONS.— 

5 ‘‘(1) IN GENERAL.—In carrying out this sec6 tion, each Federal agency that carriers out health 

7 care and health-care-related activities shall ensure 

8 that stakeholders, such as limited-English-proficient 

9 individuals and their representative organizations, 

10 recipients of Federal assistance, and other appro11 priate individuals or entities, have an adequate op12 portunity to provide input with respect to the actions 

13 of the agency. 

14 ‘‘(2) EVALUATION.—Each Federal agency de15 scribed in paragraph (1) shall evaluate the— 

16 ‘‘(A) particular needs of the limited17 English-proficient individuals served by the 

18 agency; 

19 ‘‘(B) particular needs of the limited20 English-proficient individuals served by the 

21 agency’s recipients of Federal financial assist22 ance; and 

23 ‘‘(C) burdens of compliance with the agen24 cy guidance and this section for the agency and 

25 its recipients. 


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1 ‘‘SEC. 3402. NATIONAL STANDARDS FOR CULTURALLY AND 

2 LINGUISTICALLY APPROPRIATE SERVICES IN 

3 HEALTH CARE. 

4 ‘‘(a) APPLICABILITY.—This section applies to any 

5 health program or activity, any part of which is receiving 

6 Federal financial assistance, including credits, subsidies, 

7 or contracts of insurance, or any program or activity that 

8 is administered by an executive agency or any entity estab9 lished under title I of the Patient Protection and Afford10 able Care Act (or amendments made thereby), as such 

11 programs, activities, agencies, and entities are described 

12 in section 1557(a) of the Patient Protection and Afford13 able Care Act. 

14 ‘‘(b) STANDARDS.—The programs, activities, agen15 cies, and entities described in subsection (a) shall— 

16 ‘‘(1) implement strategies to recruit, retain, and 

17 promote individuals at all levels to maintain a di18 verse staff and leadership that can provide culturally 

19 and linguistically appropriate health care to patient 

20 populations of the service area of the programs, ac21 tivities, agencies, and entities; 

22 ‘‘(2) educate and train governance, leadership, 

23 and workforce at all levels and across all disciplines 

24 of the programs, activities, agencies, and entities in 

25 culturally and linguistically appropriate policies and 

26 practices on an ongoing basis; 


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1 ‘‘(3) offer and provide language assistance, in2 cluding trained bilingual staff and interpreter serv3 ices, to individuals who have limited-English pro4 ficiency or other communication needs, at no cost to 

5 them at all points of contact, and during all hours 

6 of operation, to facilitate timely access to all health 

7 care and services; 

8 ‘‘(4) notify patients, in a culturally appropriate 

9 manner, of their right to receive language assistance 

10 services in their primary language, verbally and in 

11 writing; 

12 ‘‘(5) ensure the competence of language assist13 ance provided to limited-English-proficient patients 

14 by interpreters and bilingual staff, and ensure that 

15 family, particularly minor children, and friends are 

16 not used to provide interpretation services— 

17 ‘‘(A) except in case of emergency; or 

18 ‘‘(B) except on request of the patient, who 

19 has been informed in his or her preferred lan20 guage of the availability of free interpretation 

21 services if the health care services provider has 

22 determined that the family or friend can pro23 vide competent interpreter services as defined in 

24 section 3400; 


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1 ‘‘(6) for each eligible LEP language group that 

2 constitutes 5 percent or 500 individuals, whichever 

3 is less, of the population of persons eligible to be 

4 served or likely to be affected or encountered in the 

5 service area of the organization, make available— 

6 ‘‘(A) easily understood patient-related ma7 terials, including print and multimedia mate8 rials; 

9 ‘‘(B) information or notices about termi10 nation of benefits; and 

11 ‘‘(C) signage; 

12 ‘‘(7) develop and implement clear goals, poli13 cies, operational plans, and management, account14 ability, and oversight mechanisms to provide cul15 turally and linguistically appropriate services and in16 fuse them throughout the organization’s planning 

17 and operations; 

18 ‘‘(8) conduct initial and ongoing organizational 

19 assessments of culturally and linguistically appro20 priate services-related activities and integrate valid 

21 linguistic, competence-related National Standards 

22 for Culturally and Linguistically Appropriate Serv23 ices (CLAS) measures into the internal audits, per24 formance improvement programs, patient satisfac25 tion assessments, continuous quality improvement 


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1 activities, and outcomes-based evaluations of the or2 ganization and develop ways to standardize the as3 sessments; 

4 ‘‘(9) ensure that, consistent with the privacy 

5 protections provided for under the regulations pro6 mulgated under section 264(c) of the Health Insur7 ance Portability and Accountability Act of 1996, 

8 data on an individual required to be collected pursu9 ant to section 3101, including the individual’s alter10 native format preferences and policy modification 

11 needs, are— 

12 ‘‘(A) collected in health records; 

13 ‘‘(B) integrated into the organization’s 

14 management information systems; and 

15 ‘‘(C) periodically updated; 

16 ‘‘(10) maintain a current demographic, cultural, 

17 and epidemiological profile of the community, con18 duct regular assessments of community health assets 

19 and needs, and use the results to accurately plan for 

20 and implement services that respond to the cultural 

21 and linguistic characteristics of the service area of 

22 the organization; 

23 ‘‘(11) develop participatory, collaborative part24 nerships with communities and utilize a variety of 

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1 munity and patient involvement in designing, imple2 menting, and evaluating policies and practices to en3 sure culturally and linguistically appropriate service4 related activities; 

5 ‘‘(12) ensure that conflict and grievance resolu6 tion processes are culturally and linguistically sen7 sitive and capable of identifying, preventing, and re8 solving cross-cultural conflicts or complaints by pa9 tients; 

10 ‘‘(13) regularly make available to the public in11 formation about their progress and successful inno12 vations in implementing the standards under this 

13 section and provide public notice in their commu14 nities about the availability of this information; and 

15 ‘‘(14) if requested, regularly make available to 

16 the head of each Federal entity from which Federal 

17 funds are received, information about their progress 

18 and successful innovations in implementing the 

19 standards under this section as required by the head 

20 of such entity. 

21 ‘‘SEC. 3403. ROBERT T. MATSUI CENTER FOR CULTURAL 

22 AND LINGUISTIC COMPETENCE IN HEALTH 

23 CARE. 

24 ‘‘(a) ESTABLISHMENT.—The Secretary, acting 

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1 search and Quality, shall establish and support a center 

2 to be known as the ‘Robert T. Matsui Center for Cultural 

3 and Linguistic Competence in Health Care’ (referred to 

4 in this section as the ‘Center’) to carry out the following 

5 activities: 

6 ‘‘(1) INTERPRETATION SERVICES.—The Center 

7 shall provide resources via the Internet to identify 

8 and link health care providers to competent inter9 preter and translation services. 

10 ‘‘(2) TRANSLATION OF WRITTEN MATERIAL.— 

11 ‘‘(A) The Center shall provide, directly or 

12 through contract, vital documents from com13 petent translation services for providers of 

14 health care and health-care-related services at 

15 no cost to such providers. Materials may be 

16 submitted for translation into non-English lan17 guages. Translation services shall be provided 

18 in a timely and reasonable manner. The quality 

19 of such translation services shall be monitored 

20 and reported publicly. 

21 ‘‘(B) For each form developed or revised 

22 by the Secretary that will be used by LEP indi23 viduals in health care or health-care-related set24 tings, the Center shall translate the form, at a 

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1 guages in the United States according to the 

2 most recent data from the American Commu3 nity Survey or its replacement. The translation 

4 must be completed within 45 days of the Sec5 retary receiving final approval of the form from 

6 the Office of Management and Budget. 

7 ‘‘(3) TOLL-FREE CUSTOMER SERVICE TELE8 PHONE NUMBER.—The Center shall provide, 

9 through a toll-free number, a customer service line 

10 for LEP individuals— 

11 ‘‘(A) to obtain information about federally 

12 conducted or funded health programs, including 

13 Medicare, Medicaid, and SCHIP; 

14 ‘‘(B) to obtain assistance with applying for 

15 or accessing these programs and understanding 

16 Federal notices written in English; and 

17 ‘‘(C) to learn how to access language serv18 ices. 

19 ‘‘(4) HEALTH INFORMATION CLEARING20 HOUSE.— 

21 ‘‘(A) IN GENERAL.—The Center shall de22 velop and maintain an information clearing23 house to facilitate the provision of language 

24 services by providers of health care and health25 care-related services to reduce medical errors, 


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1 improve medical outcomes, to improve cultural 

2 competence, reduce health care costs caused by 

3 miscommunication with individuals with lim4 ited-English proficiency, and reduce or elimi5 nate the duplication of effort to translate mate6 rials. The clearinghouse shall make such infor7 mation available on the Internet and in print. 

8 Such information shall include the information 

9 described in the succeeding provisions of this 

10 paragraph. 

11 ‘‘(B) DOCUMENT TEMPLATES.—The Cen12 ter shall collect and evaluate for accuracy, de13 velop, and make available templates for stand14 ard documents that are necessary for patients 

15 and consumers to access and make educated de16 cisions about their health care, including the 

17 following: 

18 ‘‘(i) Administrative and legal docu19 ments, including— 

20 ‘‘(I) intake forms; 

21 ‘‘(II) Medicare, Medicaid, and 

22 SCHIP forms, including eligibility in23 formation; 

24 ‘‘(III) forms informing patient of 

25 HIPAA compliance and consent; and 


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1 ‘‘(IV) documents concerning in2 formed consent, advanced directives, 

3 and waivers of rights. 

4 ‘‘(ii) Clinical information, such as how 

5 to take medications, how to prevent trans6 mission of a contagious disease, and other 

7 prevention and treatment instructions. 

8 ‘‘(iii) Public health, patient education, 

9 and outreach materials, such as immuniza10 tion notices, health warnings, or screening 

11 notices. 

12 ‘‘(iv) Additional health or health-care13 related materials as determined appro14 priate by the Director of the Center. 

15 ‘‘(C) STRUCTURE OF FORMS.—In oper16 ating the clearinghouse, the Center shall— 

17 ‘‘(i) ensure that the documents posted 

18 in English and non-English languages are 

19 culturally appropriate; 

20 ‘‘(ii) allow public review of the docu21 ments before dissemination in order to en22 sure that the documents are understand23 able and culturally appropriate for the tar24 get populations; 


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1 ‘‘(iii) allow health care providers to 

2 customize the documents for their use; 

3 ‘‘(iv) facilitate access to these docu4 ments; 

5 ‘‘(v) provide technical assistance with 

6 respect to the access and use of such infor7 mation; and 

8 ‘‘(vi) carry out any other activities the 

9 Secretary determines to be useful to fulfill 

10 the purposes of the clearinghouse. 

11 ‘‘(D) LANGUAGE ASSISTANCE PRO12 GRAMS.—The Center shall provide for the col13 lection and dissemination of information on cur14 rent examples of language assistance programs 

15 and strategies to improve language services for 

16 LEP individuals, including case studies using 

17 de-identified patient information, program sum18 maries, and program evaluations. 

19 ‘‘(E) CULTURAL AND LINGUISTIC COM20 PETENCE MATERIALS.—The Center shall pro21 vide information relating to culturally and lin22 guistically competent health care for minority 

23 populations residing in the United States to all 

24 health care providers and health-care-related 


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1 services at no cost. Such information shall in2 clude— 

3 ‘‘(i) tenets of culturally and linguis4 tically competent care; 

5 ‘‘(ii) cultural and linguistic com6 petence self-assessment tools; 

7 ‘‘(iii) cultural and linguistic com8 petence training tools; 

9 ‘‘(iv) strategic plans to increase cul10 tural and linguistic competence in different 

11 types of providers of health care and 

12 health-care-related services, including re13 gional collaborations among health care or14 ganizations; and 

15 ‘‘(v) cultural and linguistic com16 petence information for educators, practi17 tioners, and researchers. 

18 ‘‘(F) INFORMATION ABOUT PROGRESS.— 

19 The Center shall regularly collect and make 

20 publicly available information about the 

21 progress of entities receiving grants under sec22 tion 3404 regarding successful innovations in 

23 implementing the obligations under this sub24 section and provide public notice in the entities’ 


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1 communities about the availability of this infor2 mation. 

3 ‘‘(b) DIRECTOR.—The Center shall be headed by a 

4 Director who shall be appointed by, and who shall report 

5 to, the Director of the Agency for Healthcare Research 

6 and Quality. 

7 ‘‘(c) AVAILABILITY OF LANGUAGE ACCESS.—The Di8 rector shall collaborate with the Deputy Assistant Sec9 retary for Minority Health, the Administrator of the Cen10 ters for Medicare & Medicaid Services, and the Adminis11 trator of the Health Resources and Services Administra12 tion to notify health care providers and health care organi13 zations about the availability of language access services 

14 by the Center. 

15 ‘‘(d) EDUCATION.—The Secretary, directly or 

16 through contract, shall undertake a national education 

17 campaign to inform providers, LEP individuals, health 

18 professionals, graduate schools, and community health 

19 centers about— 

20 ‘‘(1) Federal and State laws and guidelines gov21 erning access to language services; 

22 ‘‘(2) the value of using trained interpreters and 

23 the risks associated with using family members, 

24 friends, minors, and untrained bilingual staff; 


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1 ‘‘(3) funding sources for developing and imple2 menting language services; and 

3 ‘‘(4) promising practices to effectively provide 

4 language services. 

5 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—In ad6 dition to the amounts authorized under subsection 

7 (e)(8)(F), there are authorized to be appropriated to carry 

8 out this section such sums as may be necessary for each 

9 of fiscal years 2017 through 2021. 

10 ‘‘SEC. 3404. INNOVATIONS IN CULTURAL AND LINGUISTIC 

11 COMPETENCE GRANTS. 

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

13 the Director of the Agency for Healthcare Research and 

14 Quality, shall award grants to eligible entities to enable 

15 such entities to design, implement, and evaluate innova16 tive, cost-effective programs to improve cultural com17 petence and language access in health care for individuals 

18 with limited-English proficiency. The Director of the 

19 Agency for Healthcare Research and Quality shall coordi20 nate with, and ensure the participation of, other agencies 

21 including the Health Resources and Services Administra22 tion, the Center on Minority Health and Health Dispari23 ties at the National Institutes of Health, and the Office 

24 of Minority Health, regarding the design and evaluation 

25 of the grants program. 


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1 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 

2 under subsection (a) an entity shall— 

3 ‘‘(1) be— 

4 ‘‘(A) a city, county, Indian tribe, State, 

5 territory, or subdivision thereof; 

6 ‘‘(B) an organization described in section 

7 501(c)(3) of the Internal Revenue Code of 1986 

8 and exempt from tax under section 501(a) of 

9 such Code; 

10 ‘‘(C) a community health, mental health, 

11 or substance use center or clinic; 

12 ‘‘(D) a solo or group physician practice; 

13 ‘‘(E) an integrated health care delivery 

14 system; 

15 ‘‘(F) a public hospital; 

16 ‘‘(G) a health care group, university, or 

17 college; or 

18 ‘‘(H) other entity designated by the Sec19 retary; and 

20 ‘‘(2) prepare and submit to the Secretary an 

21 application, at such time, in such manner, and ac22 companied by such additional information as the 

23 Secretary may require. 

24 ‘‘(c) USE OF FUNDS.—An entity shall use funds re25 ceived under a grant under this section to— 


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1 ‘‘(1) develop, implement, and evaluate models of 

2 providing competent interpretation services through 

3 onsite interpretation, telephonic interpretation, or 

4 video interpretation; 

5 ‘‘(2) implement strategies to recruit, retain, and 

6 promote individuals at all levels of the organization 

7 to maintain a diverse staff and leadership that can 

8 promote and provide language services to patient 

9 populations of the service area of the organization; 

10 ‘‘(3) develop and maintain a needs assessment 

11 that identifies the current demographic, cultural, 

12 and epidemiological profile of the community to ac13 curately plan for and implement language services 

14 needed in service area of the organization; 

15 ‘‘(4) develop a strategic plan to implement lan16 guage services; 

17 ‘‘(5) develop participatory, collaborative part18 nerships with communities encompassing the LEP 

19 patient populations being served to gain input in de20 signing and implementing language services; 

21 ‘‘(6) develop and implement grievance resolu22 tion processes that are culturally and linguistically 

23 sensitive and capable of identifying, preventing, and 

24 resolving complaints by LEP individuals; 


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1 ‘‘(7) develop short-term medical mental health 

2 interpretation training courses and incentives for bi3 lingual health care staff who are asked to interpret 

4 in the workplace; 

5 ‘‘(8) develop formal training programs, includ6 ing continued professional development and edu7 cation programs as well as supervision, for individ8 uals interested in becoming dedicated health care in9 terpreters and culturally competent providers; 

10 ‘‘(9) provide staff language training instruction, 

11 which shall include information on the practical limi12 tations of such instruction for non-native speakers; 

13 ‘‘(10) develop policies that address compensa14 tion in salary for staff who receive training to be15 come either a staff interpreter or bilingual provider; 

16 ‘‘(11) develop other language assistance services 

17 as determined appropriate by the Secretary; 

18 ‘‘(12) develop, implement, and evaluate models 

19 of improving cultural competence, including cultural 

20 competence programs for community health workers; 

21 and 

22 ‘‘(13) ensure that, consistent with the privacy 

23 protections provided for under the regulations pro24 mulgated under section 264(c) of the Health Insur25 ance Portability and Accountability Act of 1996 (42 


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1 U.S.C. 1320d–2 note) and any applicable State pri2 vacy laws, data on the individual patient or recipi3 ent’s race, ethnicity, and primary language are col4 lected (and periodically updated) in health records 

5 and integrated into the organization’s information 

6 management systems or any similar system used to 

7 store and retrieve data. 

8 ‘‘(d) PRIORITY.—In awarding grants under this sec9 tion, the Secretary shall give priority to entities that pri10 marily engage in providing direct care and that have devel11 oped partnerships with community organizations or with 

12 agencies with experience in improving language access. 

13 ‘‘(e) EVALUATION.— 

14 ‘‘(1) BY GRANTEES.—An entity that receives a 

15 grant under this section shall submit to the Sec16 retary an evaluation that describes, in the manner 

17 and to the extent required by the Secretary, the ac18 tivities carried out with funds received under the 

19 grant, and how such activities improved access to 

20 health and health-care-related services and the qual21 ity of health care for individuals with limited-English 

22 proficiency. Such evaluation shall be collected and 

23 disseminated through the Robert T. Matsui Center 

24 for Cultural and Linguistic Competence in Health 

25 Care established under section 3403. The Director 


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1 of the Agency for Healthcare Research and Quality 

2 shall notify grantees of the availability of technical 

3 assistance for the evaluation and provide such assist4 ance upon request. 

5 ‘‘(2) BY SECRETARY.—The Director of the 

6 Agency for Healthcare Research and Quality shall 

7 evaluate or arrange with other individuals or organi8 zations to evaluate projects funded under this sec9 tion. 

10 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 

11 is authorized to be appropriated to carry out this section, 

12 $5,000,000 for each of fiscal years 2017 through 2021. 

13 ‘‘SEC. 3405. RESEARCH ON CULTURAL AND LANGUAGE COM14 PETENCE. 

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

16 the Director of the Agency for Healthcare Research and 

17 Quality, shall expand research concerning language access 

18 in the provision of health care. 

19 ‘‘(b) ELIGIBILITY.—The Director of the Agency for 

20 Healthcare Research and Quality may conduct the re21 search described in subsection (a) or enter into contracts 

22 with other individuals or organizations to do so. 

23 ‘‘(c) USE OF FUNDS.—Research under this section 

24 shall be designed to do one or more of the following: 


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1 ‘‘(1) To identify the barriers to mental and be2 havioral services that are faced by LEP individuals. 

3 ‘‘(2) To identify health care providers’ and 

4 health administrators’ attitudes, knowledge, and 

5 awareness of the barriers to quality health care serv6 ices that are faced by LEP individuals. 

7 ‘‘(3) To identify optimal approaches for deliv8 ering language access. 

9 ‘‘(4) To identify best practices for data collec10 tion, including— 

11 ‘‘(A) the collection by providers of health 

12 care and health-care-related services of data on 

13 the race, ethnicity, and primary language of re14 cipients of such services, taking into account ex15 isting research conducted by the Government or 

16 private sector; 

17 ‘‘(B) the development and implementation 

18 of data collection and reporting systems; and 

19 ‘‘(C) effective privacy safeguards for col20 lected data. 

21 ‘‘(5) To develop a minimum data collection set 

22 for primary language. 

23 ‘‘(6) To evaluate the most effective ways in 

24 which the Department can create or coordinate, and 

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1 tation providers for health care providers, taking 

2 into consideration, among other factors, the flexi3 bility necessary for such a system to accommodate 

4 variations in— 

5 ‘‘(A) provider type; 

6 ‘‘(B) languages needed and their frequency 

7 of use; 

8 ‘‘(C) type of encounter; 

9 ‘‘(D) time of encounter, including regular 

10 business hours and after hours; and 

11 ‘‘(E) location of encounter. 

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

13 are authorized to be appropriated to carry out this section 

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

15 2017 through 2021.’’. 

16 SEC. 203. PILOT PROGRAM FOR IMPROVEMENT AND DE17 VELOPMENT OF STATE MEDICAL INTER18 PRETING SERVICES. 

19 (a) GRANTS AUTHORIZED.—The Secretary shall 

20 award one grant in accordance with this section to each 

21 of three States to assist each such State in designing, im22 plementing, and evaluating a statewide program to provide 

23 onsite interpreter services under Medicaid. 


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1 (b) GRANT PERIOD.—A grant awarded under this 

2 section is authorized for a period of three fiscal years be3 ginning on October 1, 2016. 

4 (c) PREFERENCE.—In awarding a grant under this 

5 section, the Secretary shall give preference to a State— 

6 (1) that has a high proportion of qualified LEP 

7 enrollees, as determined by the Secretary; 

8 (2) that has a large number of qualified LEP 

9 enrollees, as determined by the Secretary; 

10 (3) that has a high growth rate of the popu11 lation of LEP individuals, as determined by the Sec12 retary; and 

13 (4) that has a population of qualified LEP en14 rollees that is linguistically diverse, requiring inter15 preter services in at least 200 non-English lan16 guages. 

17 (d) USE OF FUNDS.—A State receiving a grant under 

18 this section shall use the grant funds to— 

19 (1) ensure that all health care providers in the 

20 State participating in the State plan under Medicaid 

21 have access to onsite interpreter services, for the 

22 purpose of enabling effective communication between 

23 such providers and qualified LEP enrollees during 

24 the furnishing of items and services and administra25 tive interactions; 


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1 (2) establish, expand, procure, or contract for— 

2 (A) a statewide health care information 

3 technology system that is designed to achieve 

4 efficiencies and economies of scale with respect 

5 to onsite interpreter services provided to health 

6 care providers in the State participating in the 

7 State plan under Medicaid; and 

8 (B) an entity to administer such system, 

9 the duties of which shall include— 

10 (i) procuring and scheduling inter11 preter services for qualified LEP enrollees; 

12 (ii) procuring and scheduling inter13 preter services for LEP individuals seeking 

14 to enroll in the State plan under Medicaid; 

15 (iii) ensuring that interpreters receive 

16 payment for interpreter services rendered 

17 under the system; and 

18 (iv) consulting regularly with organi19 zations representing consumers, inter20 preters, and health care providers; and 

21 (3) develop mechanisms to establish, improve, 

22 and strengthen the competency of the medical inter23 pretation workforce that serves qualified LEP enroll24 ees in the State, including a national certification 

25 process that is valid, credible, and vendor-neutral. 


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1 (e) APPLICATION.—To receive a grant under this sec2 tion, a State shall submit an application at such time and 

3 containing such information as the Secretary may require, 

4 which shall include the following: 

5 (1) A description of the language access needs 

6 of individuals in the State enrolled in the State plan 

7 under Medicaid. 

8 (2) A description of the extent to which the 

9 program will— 

10 (A) use the grant funds for the purposes 

11 described in subsection (d); 

12 (B) meet the health care needs of rural 

13 populations of the State; and 

14 (C) collect information that accurately 

15 tracks the language services requested by con16 sumers as compared to the language services 

17 provided by health care providers in the State 

18 participating in the State plan under Medicaid. 

19 (3) A description of how the program will be 

20 evaluated, including a proposal for collaboration with 

21 organizations representing interpreters, consumers, 

22 and LEP individuals. 

23 (f) DEFINITIONS.—In this section: 

24 (1) QUALIFIED LEP ENROLLEE.—The term 

25 ‘‘qualified LEP enrollee’’ means an individual— 


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1 (A) who is limited-English-proficient; and 

2 (B) who is enrolled in a State plan under 

3 Medicaid. 

4 (2) STATE.—The term ‘‘State’’ has the mean5 ing given the term in section 1101(a)(1) of the So6 cial Security Act (42 U.S.C. 1301(a)(1)), for pur7 poses of title XIX of such Act. 

8 (3) UNITED STATES.—The term ‘‘United 

9 States’’ has the meaning given the term in section 

10 1101(a)(2) of the Social Security Act (42 U.S.C. 

11 1301(a)(2)), for purposes of title XIX of such Act. 

12 (g) FUNDING.— 

13 (1) AUTHORIZATION OF APPROPRIATIONS.— 

14 There is authorized to be appropriated $5,000,000 

15 to carry out this section. 

16 (2) AVAILABILITY OF FUNDS.—The funds au17 thorized by paragraph (1) shall be available without 

18 fiscal year limitation. 

19 (3) INCREASED FEDERAL FINANCIAL PARTICI20 PATION.—Section 1903(a)(2)(E) of the Social Secu21 rity Act (42 U.S.C. 1396b(a)(2)(E)), as amended by 

22 section 205(d)(1) of this Act, is further amended by 

23 inserting ‘‘(or, in the case of a State receiving a 

24 grant under section 203 of the Health Equity and 

25 Accountability Act of 2016, 100 percent for each 


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1 quarter occurring during the grant period)’’ after 

2 ‘‘90 percent’’. 

3 (h) LIMITATION.—No Federal funds under this sec4 tion may be used to provide interpreter services from a 

5 location outside the United States. 

6 SEC. 204. TRAINING TOMORROW’S DOCTORS FOR CUL7 TURALLY AND LINGUISTICALLY APPRO8 PRIATE CARE: GRADUATE MEDICAL EDU9 CATION. 

10 (a) DIRECT GRADUATE MEDICAL EDUCATION.—Sec11 tion 1886(h)(4) of the Social Security Act (42 U.S.C. 

12 1395ww(h)(4)) is amended by adding at the end the fol13 lowing new subparagraph: 

14 ‘‘(L) TREATMENT OF CULTURALLY COM15 PETENCY TRAINING.—In determining a hos16 pital’s number of full-time equivalent residents 

17 for purposes of this subsection, all the time that 

18 is spent by an intern or resident in an approved 

19 medical residency training program for edu20 cation and training in cultural competency and 

21 linguistically appropriate service delivery shall 

22 be counted toward the determination of full23 time equivalency.’’. 


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1 (b) INDIRECT MEDICAL EDUCATION.—Section 

2 1886(d)(5)(B) of the Social Security Act (42 U.S.C. 

3 1395ww(d)(5)(B)) is amended— 

4 (1) by redesignating the clause (x) added by 

5 section 5505(b) of the Patient Protection and Af6 fordable Care Act as clause (xi); and 

7 (2) by adding at the end the following new 

8 clause: 

9 ‘‘(xii) The provisions of subparagraph (L) of 

10 subsection (h)(4) shall apply under this subpara11 graph in the same manner as they apply under such 

12 subsection.’’. 

13 (c) EFFECTIVE DATE.—The amendments made by 

14 subsections (a) and (b) shall apply with respect to pay15 ments made to hospitals on or after the date that is one 

16 year after the date of the enactment of this Act. 

17 SEC. 205. FEDERAL REIMBURSEMENT FOR CULTURALLY 

18 AND LINGUISTICALLY APPROPRIATE SERV19 ICES UNDER THE MEDICARE, MEDICAID, AND 

20 STATE CHILDREN’S HEALTH INSURANCE 

21 PROGRAMS. 

22 (a) LANGUAGE ACCESS GRANTS FOR MEDICARE

23 PROVIDERS.— 

24 (1) ESTABLISHMENT.— 


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1 (A) IN GENERAL.—Not later than 6 

2 months after the date of the enactment of this 

3 Act, the Secretary of Health and Human Serv4 ices, acting through the Centers for Medicare & 

5 Medicaid Services and in consultation with the 

6 Center for Medicare and Medicaid Innovation, 

7 shall establish a demonstration program under 

8 which the Secretary shall award grants to eligi9 ble Medicare service providers to improve com10 munication between such providers and Medi11 care beneficiaries who are English learners, in12 cluding beneficiaries who live in diverse and un13 derserved communities. 

14 (B) APPLICATION OF INNOVATION

15 RULES.—The demonstration project under sub16 paragraph (A) shall be conducted in a manner 

17 that is consistent with the applicable provisions 

18 of subsections (b), (c), and (d) of section 1115A 

19 of the Social Security Act (42 U.S.C. 1315a). 

20 (C) NUMBER OF GRANTS.—To the extent 

21 practicable, the Secretary shall award not less 

22 than 24 grants under this subsection. 

23 (D) GRANT PERIOD.—Except as provided 

24 under paragraph (2)(D), each grant awarded 


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1 under this subsection shall be for a 3-year pe2 riod. 

3 (2) ELIGIBILITY REQUIREMENTS.—To be eligi4 ble for a grant under this subsection, an entity must 

5 meet the following requirements: 

6 (A) MEDICARE PROVIDER.—The entity 

7 must be— 

8 (i) a provider of services under part A 

9 of title XVIII of the Social Security Act; 

10 (ii) a provider of services under part 

11 B of such title; 

12 (iii) a Medicare Advantage organiza13 tion offering a Medicare Advantage plan 

14 under part C of such title; or 

15 (iv) a PDP sponsor offering a pre16 scription drug plan under part D of such 

17 title. 

18 (B) UNDERSERVED COMMUNITIES.—The 

19 entity must serve a community that, with re20 spect to necessary language services for improv21 ing access and utilization of health care among 

22 English learners, is disproportionally under23 served. 

24 (C) APPLICATION.—The entity must pre25 pare and submit to the Secretary an applicaVerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00091 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475

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1 tion, at such time, in such manner, and accom2 panied by such additional information as the 

3 Secretary may require. 

4 (D) REPORTING.—In the case of a grantee 

5 that received a grant under this subsection in 

6 a previous year, such grantee is only eligible for 

7 continued payments under a grant under this 

8 subsection if the grantee met the reporting re9 quirements under paragraph (9) for such year. 

10 If a grantee fails to meet the requirement of 

11 such paragraph for the first year of a grant, the 

12 Secretary may terminate the grant and solicit 

13 applications from new grantees to participate in 

14 the demonstration program. 

15 (3) DISTRIBUTION.—To the extent feasible, the 

16 Secretary shall award— 

17 (A) at least 6 grants to providers of serv18 ices described in paragraph (2)(A)(i); 

19 (B) at least 6 grants to service providers 

20 described in paragraph (2)(A)(ii); 

21 (C) at least 6 grants to organizations de22 scribed in paragraph (2)(A)(iii); and 

23 (D) at least 6 grants to sponsors described 

24 in paragraph (2)(A)(iv). 

25 (4) CONSIDERATIONS IN AWARDING GRANTS.— 


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1 (A) VARIATION IN GRANTEES.—In award2 ing grants under this subsection, the Secretary 

3 shall select grantees to ensure the following: 

4 (i) The grantees provide many dif5 ferent types of language services. 

6 (ii) The grantees serve Medicare bene7 ficiaries who speak different languages, 

8 and who, as a population, have differing 

9 needs for language services. 

10 (iii) The grantees serve Medicare 

11 beneficiaries in both urban and rural set12 tings. 

13 (iv) The grantees serve Medicare 

14 beneficiaries in at least two geographic re15 gions, as defined by the Secretary. 

16 (v) The grantees serve Medicare bene17 ficiaries in at least two large metropolitan 

18 statistical areas with racial, ethnic, and 

19 economically diverse populations. 

20 (B) PRIORITY FOR PARTNERSHIPS WITH

21 COMMUNITY ORGANIZATIONS AND AGENCIES.— 

22 In awarding grants under this subsection, the 

23 Secretary shall give priority to eligible entities 

24 that have a partnership with— 

25 (i) a community organization; or 


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1 (ii) a consortia of community organi2 zations, State agencies, and local agencies, 

3 that has experience in providing language serv4 ices. 

5 (5) USE OF FUNDS FOR COMPETENT LANGUAGE

6 SERVICES.— 

7 (A) IN GENERAL.—Subject to subpara8 graph (E), a grantee may only use grant funds 

9 received under this subsection to pay for the 

10 provision of competent language services to 

11 Medicare beneficiaries who are English learn12 ers. 

13 (B) COMPETENT LANGUAGE SERVICES DE14 FINED.—For purposes of this subsection, the 

15 term ‘‘competent language services’’ means— 

16 (i) interpreter and translation services 

17 that— 

18 (I) subject to the exceptions 

19 under subparagraph (C)— 

20 (aa) if the grantee operates 

21 in a State that has statewide 

22 health care interpreter standards, 

23 meet the State standards cur24 rently in effect; or 


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1 (bb) if the grantee operates 

2 in a State that does not have 

3 statewide health care interpreter 

4 standards, utilizes competent in5 terpreters who follow the Na6 tional Council on Interpreting in 

7 Health Care’s Code of Ethics and 

8 Standards of Practice; and 

9 (II) that, in the case of inter10 preter services, are provided 

11 through— 

12 (aa) onsite interpretation; 

13 (bb) telephonic interpreta14 tion; or 

15 (cc) video interpretation; 

16 and 

17 (ii) the direct provision of health care 

18 or health-care-related services by a com19 petent bilingual health care provider. 

20 (C) EXCEPTIONS.—The requirements of 

21 subparagraph (B)(i)(I) do not apply, with re22 spect to interpreter and translation services and 

23 a grantee— 

24 (i) in the case of a Medicare bene25 ficiary who is an English learner if— 


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1 (I) such beneficiary has been in2 formed, in the beneficiary’s primary 

3 language, of the availability of free in4 terpreter and translation services and 

5 the beneficiary instead requests that a 

6 family member, friend, or other per7 son provide such services; and 

8 (II) the grantee documents such 

9 request in the beneficiary’s medical 

10 record; or 

11 (ii) in the case of a medical emergency 

12 where the delay directly associated with ob13 taining a competent interpreter or trans14 lation services would jeopardize the health 

15 of the patient. 

16 Clause (ii) shall not be construed to exempt 

17 emergency rooms or similar entities that regu18 larly provide health care services in medical 

19 emergencies to patients who are English learn20 ers from any applicable legal or regulatory re21 quirements related to providing competent in22 terpreter and translation services without undue 

23 delay. 

24 (D) MEDICARE ADVANTAGE ORGANIZA25 TIONS AND PDP SPONSORS.—If a grantee is a 


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1 Medicare Advantage organization offering a 

2 Medicare Advantage plan under part C of title 

3 XVIII of the Social Security Act or a PDP 

4 sponsor offering a prescription drug plan under 

5 part D of such title, such entity must provide 

6 at least 50 percent of the grant funds that the 

7 entity receives under this subsection directly to 

8 the entity’s network providers (including all 

9 health providers and pharmacists) for the pur10 pose of providing support for such providers to 

11 provide competent language services to Medi12 care beneficiaries who are English learners. 

13 (E) ADMINISTRATIVE AND REPORTING

14 COSTS.—A grantee may use up to 10 percent of 

15 the grant funds to pay for administrative costs 

16 associated with the provision of competent lan17 guage services and for reporting required under 

18 paragraph (9). 

19 (6) DETERMINATION OF AMOUNT OF GRANT

20 PAYMENTS.— 

21 (A) IN GENERAL.—Payments to grantees 

22 under this subsection shall be calculated based 

23 on the estimated numbers of Medicare bene24 ficiaries who are English learners in a grantee’s 

25 service area utilizing— 


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1 (i) data on the numbers of English 

2 learners who speak English less than ‘‘very 

3 well’’ from the most recently available data 

4 from the Bureau of the Census or other 

5 State-based study the Secretary determines 

6 likely to yield accurate data regarding the 

7 number of such individuals in such service 

8 area; or 

9 (ii) data provided by the grantee, if 

10 the grantee routinely collects data on the 

11 primary language of the Medicare bene12 ficiaries that the grantee serves and the 

13 Secretary determines that the data is accu14 rate and shows a greater number of 

15 English learners than would be estimated 

16 using the data under clause (i). 

17 (B) DISCRETION OF SECRETARY.—Subject 

18 to subparagraph (C), the amount of payment 

19 made to a grantee under this subsection may be 

20 modified annually at the discretion of the Sec21 retary, based on changes in the data under sub22 paragraph (A) with respect to the service area 

23 of a grantee for the year. 

24 (C) LIMITATION ON AMOUNT.—The 

25 amount of a grant made under this subsection 


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1 to a grantee may not exceed $500,000 for the 

2 period under paragraph (1)(D). 

3 (7) ASSURANCES.—Grantees under this sub4 section shall, as a condition of receiving a grant 

5 under this subsection— 

6 (A) ensure that clinical and support staff 

7 receive appropriate ongoing education and 

8 training in linguistically appropriate service de9 livery; 

10 (B) ensure the linguistic competence of bi11 lingual providers; 

12 (C) offer and provide appropriate language 

13 services at no additional charge to each patient 

14 who is an English learner for all points of con15 tact between the patient and the grantee, in a 

16 timely manner during all hours of operation; 

17 (D) notify Medicare beneficiaries of their 

18 right to receive language services in their pri19 mary language; 

20 (E) post signage in the primary languages 

21 commonly used by the patient population in the 

22 service area of the organization; and 

23 (F) ensure that— 

24 (i) primary language data are col25 lected for recipients of language services 


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1 and such data are consistent with stand2 ards developed under title XXXIV of the 

3 Public Health Service Act, as added by 

4 section 202 of this Act, to the extent such 

5 standards are available upon the initiation 

6 of the demonstration program; and 

7 (ii) consistent with the privacy protec8 tions provided under the regulations pro9 mulgated pursuant to section 264(c) of the 

10 Health Insurance Portability and Account11 ability Act of 1996 (42 U.S.C. 1320d–2 

12 note), if the recipient of language services 

13 is a minor or is incapacitated, primary lan14 guage data are collected on the parent or 

15 legal guardian of such recipient. 

16 (8) NO COST-SHARING.—Medicare beneficiaries 

17 who are English learners shall not have to pay cost18 sharing or co-payments for competent language serv19 ices provided under this demonstration program. 

20 (9) REPORTING REQUIREMENTS FOR GRANT21 EES.—Not later than the end of each calendar year, 

22 a grantee that receives funds under this subsection 

23 in such year shall submit to the Secretary a report 

24 that includes the following information: 


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1 (A) The number of Medicare beneficiaries 

2 to whom competent language services are pro3 vided. 

4 (B) The primary languages of those Medi5 care beneficiaries. 

6 (C) The types of language services pro7 vided to such beneficiaries. 

8 (D) Whether such language services were 

9 provided by employees of the grantee or 

10 through a contract with external contractors or 

11 agencies. 

12 (E) The types of interpretation services 

13 provided to such beneficiaries, and the approxi14 mate length of time such service is provided to 

15 such beneficiaries. 

16 (F) The costs of providing competent lan17 guage services. 

18 (G) An account of the training or accredi19 tation of bilingual staff, interpreters, and trans20 lators providing services funded by the grant 

21 under this subsection. 

22 (10) EVALUATION AND REPORT TO CON23 GRESS.—Not later than 1 year after the completion 

24 of a 3-year grant under this subsection, the Sec25 retary shall conduct an evaluation of the demonstraVerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00101 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475

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1 tion program under this subsection and shall submit 

2 to the Congress a report that includes the following: 

3 (A) An analysis of the patient outcomes 

4 and the costs of furnishing care to the Medicare 

5 beneficiaries who are English learners partici6 pating in the project as compared to such out7 comes and costs for such Medicare beneficiaries 

8 not participating, based on the data provided 

9 under paragraph (9) and any other information 

10 available to the Secretary. 

11 (B) The effect of delivering language serv12 ices on— 

13 (i) Medicare beneficiary access to care 

14 and utilization of services; 

15 (ii) the efficiency and cost effective16 ness of health care delivery; 

17 (iii) patient satisfaction; 

18 (iv) health outcomes; and 

19 (v) the provision of culturally appro20 priate services provided to such bene21 ficiaries. 

22 (C) The extent to which bilingual staff, in23 terpreters, and translators providing services 

24 under such demonstration were trained or ac25 credited and the nature of accreditation or 


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1 training needed by type of provider, service, or 

2 other category as determined by the Secretary 

3 to ensure the provision of high-quality interpre4 tation, translation, or other language services to 

5 Medicare beneficiaries if such services are ex6 panded pursuant to subsection (c) of section 

7 1907 of this Act. 

8 (D) Recommendations, if any, regarding 

9 the extension of such project to the entire Medi10 care program, subject to the provisions of sec11 tion 1115A(c) of the Social Security Act (42 

12 U.S.C. 1315a(c)). 

13 (11) APPROPRIATIONS.—There is appropriated 

14 to carry out this subsection, in equal parts from the 

15 Federal Hospital Insurance Trust Fund under sec16 tion 1817 of the Social Security Act (42 U.S.C. 

17 1395i) and the Federal Supplementary Medical In18 surance Trust Fund under section 1841 of such Act 

19 (42 U.S.C. 1395t), $16,000,000 for each fiscal year 

20 of the demonstration program. 

21 (12) ENGLISH LEARNER DEFINED.—In this 

22 subsection, the term ‘‘English learner’’ has the 

23 meaning given such term in section 8101(20) of the 

24 Elementary and Secondary Education Act of 1965, 


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1 except that subparagraphs (A), (B), and (D) of such 

2 section shall not apply. 

3 (b) LANGUAGE SERVICES UNDER THE MEDICARE

4 PROGRAM.— 

5 (1) INCLUSION AS RURAL HEALTH CLINIC

6 SERVICES.—Section 1861 of the Social Security Act 

7 (42 U.S.C. 1395x) is amended— 

8 (A) in subsection (aa)(1)— 

9 (i) in subparagraph (B), by striking 

10 the ‘‘and’’ at the end; 

11 (ii) by adding ‘‘and’’ at the end of 

12 subparagraph (C); and 

13 (iii) by inserting after subparagraph 

14 (C) the following new subparagraph: 

15 ‘‘(D) language services as defined in subsection 

16 (iii)(1),’’; and 

17 (B) by adding at the end the following new 

18 subsection: 

19 ‘‘Language Services and Related Terms 

20 ‘‘(iii) 

21 ‘‘(1) The term ‘language services’ has the same 

22 meaning given the term ‘language or language ac23 cess services’ in section 3400 of the Public Health 

24 Service Act. 


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1 ‘‘(2) The term ‘interpreter services’ has the meaning 

2 given the term ‘competent interpreter services’ in section 

3 3400(3) of the Public Health Service Act. 

4 ‘‘(3) The term ‘interpreter’— 

5 ‘‘(A) means an individual— 

6 ‘‘(i) who faithfully, accurately, and objec7 tively transmits a spoken message from one lan8 guage into another language; and 

9 ‘‘(ii) who knows health and health-related 

10 terminology in both languages; and 

11 ‘‘(B) includes individuals who provide in-person, 

12 telephonic, and video interpretation. 

13 ‘‘(4) The term ‘translation’ means the transmission 

14 of a written message in one language into a written mes15 sage in another language that retains the intended mean16 ing of the original message. 

17 ‘‘(5) The term ‘English learner’ has the meaning 

18 given such term in section 8101(20) of the Elementary 

19 and Secondary Education Act of 1965, except that sub20 paragraphs (A), (B), and (D) of such section shall not 

21 apply.’’. 

22 (2) COVERAGE.—Section 1832(a)(2) of the So23 cial Security Act (42 U.S.C. 1395k(a)(2)) is amend24 ed— 


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1 (A) by striking ‘‘and’’ at the end of sub2 paragraph (I); 

3 (B) by striking the period at the end of 

4 subparagraph (J) and inserting ‘‘; and’’; and 

5 (C) by adding at the end the following new 

6 subparagraph: 

7 ‘‘(K) language services (as defined in para8 graph (1) of section 1861(iii)) furnished by an 

9 interpreter (as defined in paragraph (3) of such 

10 section) or translator.’’. 

11 (3) PAYMENT.—Section 1833(a) of the Social 

12 Security Act (42 U.S.C. 1395l(a)) is amended— 

13 (A) by striking ‘‘and’’ at the end of para14 graph (8); 

15 (B) by striking the period at the end of 

16 paragraph (9) and inserting ‘‘; and’’; and 

17 (C) by inserting after paragraph (9) the 

18 following new paragraph: 

19 ‘‘(10) in the case of language services described 

20 in section 1861(iii)(1), 100 percent of the reasonable 

21 charges for such services, as determined in consulta22 tion with the Medicare Payment Advisory Commis23 sion; and’’. 

24 (4) WAIVER OF BUDGET NEUTRALITY.—For 

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1 ment of this section, the budget neutrality provision 

2 of section 1848(c)(2)(B)(ii) of the Social Security 

3 Act (42 U.S.C. 1395w–4(c)(2)(B)(ii)) shall not 

4 apply with respect to language services (as such 

5 term is defined in section 1861(iii)(1) of such Act). 

6 (c) MEDICARE PARTS C AND D.— 

7 (1) IN GENERAL.—Medicare Advantage plans 

8 under part C of the Social Security Act and pre9 scription drug plans under part D of such Act shall 

10 comply with title VI of the Civil Rights Act of 1964 

11 and section 1557 of the Patient Protection and Af12 fordable Care Act (42 U.S.C. 18116) to provide ef13 fective language services to enrollees of such plans. 

14 (2) MEDICARE ADVANTAGE PLANS AND PRE15 SCRIPTION DRUG PLANS REPORTING REQUIRE16 MENT.—Section 1857(e) of the Social Security Act 

17 (42 U.S.C. 1395w–27(e)) is amended by adding at 

18 the end the following new paragraph: 

19 ‘‘(5) REPORTING REQUIREMENTS RELATING TO

20 EFFECTIVE LANGUAGE SERVICES.—A contract under 

21 this part shall require a Medicare Advantage organi22 zation (and, through application of section 1860D– 

23 12(b)(3)(D), a contract under section 1860D–12 

24 shall require a PDP sponsor) to annually submit 

25 (for each year of the contract) a report that contains 


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1 information on the plan’s internal policies and proce2 dures related to recruitment and retention efforts di3 rected to workforce diversity and linguistically and 

4 culturally appropriate provision of services in each of 

5 the following contexts: 

6 ‘‘(A) The collection of data in a manner 

7 that meets the requirements of title I of the 

8 Health Equity and Accountability Act of 2016, 

9 regarding the enrollee population. 

10 ‘‘(B) Education of staff and contractors 

11 who have routine contact with enrollees regard12 ing the various needs of the diverse enrollee 

13 population. 

14 ‘‘(C) Evaluation of the health plan’s lan15 guage services programs and services with re16 spect to the plan’s enrollee population, such as 

17 through analysis of complaints or satisfaction 

18 survey results. 

19 ‘‘(D) Methods by which the plan provides 

20 to the Secretary information regarding the eth21 nic diversity of the plan’s enrollee population. 

22 ‘‘(E) The periodic provision of educational 

23 information to plan enrollees on the plan’s lan24 guage services and programs.’’. 


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1 (d) IMPROVING LANGUAGE SERVICES IN MEDICAID

2 AND CHIP.— 

3 (1) PAYMENTS TO STATES.—Section 

4 1903(a)(2)(E) of the Social Security Act (42 U.S.C. 

5 1396b(a)(2)(E)) is amended by— 

6 (A) striking ‘‘75’’ and inserting ‘‘90’’; 

7 (B) striking ‘‘translation or interpretation 

8 services’’ and inserting ‘‘language services’’; 

9 and 

10 (C) striking ‘‘children of families’’ and in11 serting ‘‘individuals’’. 

12 (2) STATE PLAN REQUIREMENTS.—Section 

13 1902(a)(10)(A) of the Social Security Act (42 

14 U.S.C. 1396a(a)(10)(A)) is amended by striking 

15 ‘‘and (28)’’ and inserting ‘‘(28), and (29)’’. 

16 (3) DEFINITION OF MEDICAL ASSISTANCE.— 

17 Section 1905(a) of the Social Security Act (42 

18 U.S.C. 1396d(a)) is amended by— 

19 (A) in paragraph (28), by striking ‘‘and’’ 

20 at the end; 

21 (B) by redesignating paragraph (29) as 

22 paragraph (30); and 

23 (C) by inserting after paragraph (28) the 

24 following new paragraph: 


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1 ‘‘(29) language services, as such term is defined 

2 in section 1861(iii)(1), provided in a timely manner 

3 to English learners (as defined in section 

4 1861(iii)(5)) who need such services; and’’. 

5 (4) USE OF DEDUCTIONS AND COST SHAR6 ING.—Section 1916(a)(2) of the Social Security Act 

7 (42 U.S.C. 1396o(2)) is amended by— 

8 (A) by striking ‘‘or’’ at the end of subpara9 graph (D); 

10 (B) by striking ‘‘; and’’ at the end of sub11 paragraph (E) and inserting ‘‘, or’’; and 

12 (C) by adding at the end the following new 

13 subparagraph: 

14 ‘‘(F) language services described in section 

15 1905(a)(29); and’’. 

16 (5) CHIP COVERAGE REQUIREMENTS.—Section 

17 2103 of the Social Security Act (42 U.S.C. 1397cc) 

18 is amended— 

19 (A) in subsection (a), in the matter before 

20 paragraph (1), by striking ‘‘and (7)’’ and in21 serting ‘‘(7), and (9)’’; and 

22 (B) in subsection (c), by adding at the end 

23 the following new paragraph: 

24 ‘‘(9) LANGUAGE SERVICES.—The child health 

25 assistance provided to a targeted low-income child 


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1 shall include coverage of language services, as such 

2 term is defined in section 1861(iii)(1), provided in a 

3 timely manner to English learners (as defined in 

4 section 1861(iii)(5)) who need such services.’’; and 

5 (C) in subsection (e)(2)— 

6 (i) in the heading, by striking ‘‘PRE7 VENTIVE’’ and inserting ‘‘CERTAIN’’; and 

8 (ii) by inserting ‘‘or subsection (c)(9)’’ 

9 after ‘‘subsection (c)(1)(D)’’. 

10 (6) DEFINITION OF CHILD HEALTH ASSIST11 ANCE.—Section 2110(a)(27) of the Social Security 

12 Act (42 U.S.C. 1397jj) is amended by striking 

13 ‘‘translation’’ and inserting ‘‘language services as 

14 described in section 2103(c)(9)’’. 

15 (7) STATE DATA COLLECTION.—Pursuant to 

16 the reporting requirement described in section 

17 2107(b)(1) of the Social Security Act (42 U.S.C. 

18 1397gg(b)(1)), the Secretary of Health and Human 

19 Services shall require that States collect data on— 

20 (A) the primary language of individuals re21 ceiving child health assistance under title XXI 

22 of the Social Security Act; and 

23 (B) in the case of such individuals who are 

24 minors or incapacitated, the primary language 

25 of the individual’s parent or guardian. 


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1 (8) CHIP PAYMENTS TO STATES.—Section 

2 2105 of the Social Security Act (42 U.S.C. 

3 1397ee(c)) is amended— 

4 (A) in subsection (a)(1), by striking ‘‘75’’ 

5 and inserting ‘‘90’’; and 

6 (B) in subsection (c)(2)(A), by inserting 

7 before the period at the end the following: ‘‘, 

8 except that expenditures pursuant to clause (iv) 

9 of subparagraph (D) of such paragraph shall 

10 not count towards this total’’. 

11 (e) FUNDING LANGUAGE SERVICES FURNISHED BY

12 PROVIDERS OF HEALTH CARE AND HEALTH-CARE-RE13 LATED SERVICES THAT SERVE HIGH RATES OF UNIN14 SURED LEP INDIVIDUALS.— 

15 (1) PAYMENT OF COSTS.— 

16 (A) IN GENERAL.—Subject to subpara17 graph (B), the Secretary of Health and Human 

18 Services shall make payments (on a quarterly 

19 basis) directly to eligible entities to support the 

20 provision of language services to English learn21 ers in an amount equal to an eligible entity’s el22 igible costs for such services for the quarter. 

23 (B) FUNDING.—Out of any funds in the 

24 Treasury not otherwise appropriated, there are 

25 appropriated to the Secretary of Health and 


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1 Human Services such sums as may be nec2 essary for each of fiscal years 2017 through 

3 2021. 

4 (C) RELATION TO MEDICAID DSH.—Pay5 ments under this subsection shall not offset or 

6 reduce payments under section 1923 of the So7 cial Security Act, nor shall payments under 

8 such section be considered when determining 

9 uncompensated costs associated with the provi10 sion of language services. 

11 (2) METHODOLOGY FOR PAYMENT OF

12 CLAIMS.— 

13 (A) IN GENERAL.—The Secretary shall es14 tablish a methodology to determine the average 

15 per person cost of language services. 

16 (B) DIFFERENT ENTITIES.—In estab17 lishing such methodology, the Secretary may es18 tablish different methodologies for different 

19 types of eligible entities. 

20 (C) NO INDIVIDUAL CLAIMS.—The Sec21 retary may not require eligible entities to sub22 mit individual claims for language services for 

23 individual patients as a requirement for pay24 ment under this subsection. 


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1 (3) DATA COLLECTION INSTRUMENT.—For pur2 poses of this subsection, the Secretary shall create a 

3 standard data collection instrument that is con4 sistent with any existing reporting requirements by 

5 the Secretary or relevant accrediting organizations 

6 regarding the number of individuals to whom lan7 guage access are provided. 

8 (4) GUIDELINES.—Not later than 6 months 

9 after the date of enactment of this Act, the Sec10 retary of Health and Human Services shall establish 

11 and distribute guidelines concerning the implementa12 tion of this subsection. 

13 (5) REPORTING REQUIREMENTS.— 

14 (A) REPORT TO SECRETARY.—Entities re15 ceiving payment under this subsection shall pro16 vide the Secretary with a quarterly report on 

17 how the entity used such funds. Such report 

18 shall contain aggregate (and may not contain 

19 individualized) data collected using the instru20 ment under paragraph (3) and shall otherwise 

21 be in a form and manner determined by the 

22 Secretary. 

23 (B) REPORT TO CONGRESS.—Not later 

24 than 2 years after the date of enactment of this 

25 Act, and every 2 years thereafter, the Secretary 


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1 shall submit a report to Congress concerning 

2 the implementation of this subsection. 

3 (6) DEFINITIONS.—In this subsection: 

4 (A) ELIGIBLE COSTS.—The term ‘‘eligible 

5 costs’’ means, with respect to an eligible entity 

6 that provides language services to English 

7 learners, the product of— 

8 (i) the average per person cost of lan9 guage services, determined according to 

10 the methodology devised under paragraph 

11 (2); and 

12 (ii) the number of English learners 

13 who are provided language services by the 

14 entity and for whom no reimbursement is 

15 available for such services under the 

16 amendments made by subsections (a), (b), 

17 (c), or (d) or by private health insurance. 

18 (B) ELIGIBLE ENTITY.—The term ‘‘eligible 

19 entity’’ means an entity that— 

20 (i) is a Medicaid provider that is— 

21 (I) a physician; 

22 (II) a hospital with a low-income 

23 utilization rate (as defined in section 

24 1923(b)(3) of the Social Security Act 


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1 (42 U.S.C. 1396r–4(b)(3))) of greater 

2 than 25 percent; or 

3 (III) a federally qualified health 

4 center (as defined in section 

5 1905(l)(2)(B) of the Social Security 

6 Act (42 U.S.C. 1396d(l)(2)(B))); 

7 (ii) provide language services to at 

8 least 8 percent of the entity’s total number 

9 of patients, not later than 6 months after 

10 the date of the enactment of the Act; and 

11 (iii) prepare and submit an applica12 tion to the Secretary, at such time, in such 

13 manner, and accompanied by such infor14 mation as the Secretary may require to as15 certain the entity’s eligibility for funding 

16 under this subsection. 

17 (C) ENGLISH LEARNER.—The term 

18 ‘‘English learner’’ has the meaning given such 

19 term in section 8101(20) of the Elementary 

20 and Secondary Education Act of 1965, except 

21 that subparagraphs (A), (B), and (D) of such 

22 section shall not apply. 

23 (D) LANGUAGE SERVICES.—The term 

24 ‘‘language services’’ has the meaning given such 


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1 term in section 1861(iii)(1) of the Social Secu2 rity Act. 

3 (f) APPLICATION OF CIVIL RIGHTS ACT OF 1964 AND

4 OTHER LAWS.—Nothing in this section shall be construed 

5 to limit otherwise existing obligations of recipients of Fed6 eral financial assistance under title VI of the Civil Rights 

7 Act of 1964 (42 U.S.C. 2000(d) et seq.) or other laws 

8 that protect the civil rights of individuals. 

9 (g) EFFECTIVE DATE.— 

10 (1) IN GENERAL.—Except as otherwise pro11 vided and subject to paragraph (2), the amendments 

12 made by this section shall take effect on January 1, 

13 2017. 

14 (2) EXCEPTION IF STATE LEGISLATION RE15 QUIRED.—In the case of a State plan for medical as16 sistance under title XIX of the Social Security Act 

17 which the Secretary of Health and Human Services 

18 determines requires State legislation (other than leg19 islation appropriating funds) in order for the plan to 

20 meet the additional requirement imposed by the 

21 amendments made by this section, the State plan 

22 shall not be regarded as failing to comply with the 

23 requirements of such title solely on the basis of its 

24 failure to meet this additional requirement before 

25 the first day of the first calendar quarter beginning 


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1 after the close of the first regular session of the 

2 State legislature that begins after the date of the en3 actment of this Act. For purposes of the previous 

4 sentence, in the case of a State that has a 2-year 

5 legislative session, each year of such session shall be 

6 deemed to be a separate regular session of the State 

7 legislature. 

8 SEC. 206. INCREASING UNDERSTANDING OF AND IMPROV9 ING HEALTH LITERACY. 

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

11 Director of the Agency for Healthcare Research and Qual12 ity and the Administrator of the Health Resources and 

13 Services Administration, in consultation with the Director 

14 of the National Institute on Minority Health and Health 

15 Disparities and the Office of Minority Health, shall award 

16 grants to eligible entities to improve health care for pa17 tient populations that have low functional health literacy. 

18 (b) ELIGIBILITY.—To be eligible to receive a grant 

19 under subsection (a), an entity shall— 

20 (1) be a hospital, health center or clinic, health 

21 plan, or other health entity (including a nonprofit 

22 minority health organization or association); and 

23 (2) prepare and submit to the Secretary an ap24 plication at such time, in such manner, and conVerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00118 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475

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1 taining such information as the Secretary may re2 quire. 

3 (c) USE OF FUNDS.— 

4 (1) AGENCY FOR HEALTHCARE RESEARCH AND

5 QUALITY.—Grants awarded under subsection (a) 

6 through the Agency for Healthcare Research and 

7 Quality shall be used— 

8 (A) to define and increase the under9 standing of health literacy; 

10 (B) to investigate the correlation between 

11 low health literacy and health and health care; 

12 (C) to clarify which aspects of health lit13 eracy have an effect on health outcomes; and 

14 (D) for any other activity determined ap15 propriate by the Director of the Agency. 

16 (2) HEALTH RESOURCES AND SERVICES ADMIN17 ISTRATION.—Grants awarded under subsection (a) 

18 through the Health Resources and Services Adminis19 tration shall be used to conduct demonstration 

20 projects for interventions for patients with low 

21 health literacy that may include— 

22 (A) the development of new disease man23 agement programs for patients with low health 

24 literacy; 


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1 (B) the tailoring of existing disease man2 agement programs addressing mental, physical, 

3 oral, and behavioral health conditions for pa4 tients with low health literacy; 

5 (C) the translation of written health mate6 rials for patients with low health literacy; 

7 (D) the identification, implementation, and 

8 testing of low health literacy screening tools; 

9 (E) the conduct of educational campaigns 

10 for patients and providers about low health lit11 eracy; and 

12 (F) other activities determined appropriate 

13 by the Administrator of the Health Resources 

14 and Services Administration. 

15 (d) DEFINITIONS.—In this section, the term ‘‘low 

16 health literacy’’ means the inability of an individual to ob17 tain, process, and understand basic health information 

18 and services needed to make appropriate health decisions. 

19 (e) 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 2017 through 2021. 

23 SEC. 207. ASSURANCES FOR RECEIVING FEDERAL FUNDS. 

24 (a) IN GENERAL.—Any health program or activity, 

25 any part of which is receiving Federal financial assistance, 


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1 including credits, subsidies, or contracts of insurance, and 

2 any program or activity that is administered by an execu3 tive agency or any entity established under title I of the 

4 Patient Protection and Affordable Care Act (or amend5 ments made thereby), as such programs, activities, agen6 cies, and entities are described in section 1557(a) of the 

7 Patient Protection and Affordable Care Act (42 U.S.C. 

8 18116), in order to ensure the right of LEP individuals 

9 to receive access to quality health care, shall— 

10 (1) ensure that appropriate clinical and support 

11 staff receive ongoing education and training in lin12 guistically appropriate service delivery; 

13 (2) offer and provide appropriate language serv14 ices at no additional charge to each patient with lim15 ited-English-proficiency at all points of contact, in a 

16 timely manner during all hours of operation; 

17 (3) notify patients of their right to receive lan18 guage services in their primary language; and 

19 (4) utilize only competent interpreter or trans20 lation services, as defined in section 3400 of the 

21 Public Health Service Act. 

22 (b) EXEMPTIONS.—The requirements of subsection 

23 (a)(4) shall not apply as follows: 

24 (1) When a patient (who has been informed in 

25 his or her primary language of the availability of 


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1 free interpreter and translation services) requests 

2 the use of family, friends, or other persons untrained 

3 in interpretation or translation if the following con4 ditions are met: 

5 (A) The interpreter requested by the pa6 tient is over the age of 18. 

7 (B) The recipient informs the patient that 

8 he or she has the option of having the recipient 

9 provide an interpreter for him or her without 

10 charge, or of using his or her own interpreter. 

11 (C) The recipient informs the patient that 

12 the recipient may not require an LEP person to 

13 use a family member or friend as an inter14 preter. 

15 (D) The recipient evaluates whether the 

16 person the patient wishes to use as an inter17 preter is competent. If the recipient has reason 

18 to believe that the interpreter is not competent, 

19 the recipient provides the recipient’s own inter20 preter to protect the recipient from liability if 

21 the patient’s interpreter is later found not com22 petent. 

23 (E) If the recipient has reason to believe 

24 that there is a conflict of interest between the 


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1 interpreter and patient, the recipient may not 

2 use the patient’s interpreter. 

3 (F) The recipient has the patient sign a 

4 waiver, witnessed by at least 1 individual not 

5 related to the patient, that includes the infor6 mation stated in subparagraphs (A) through 

7 (E) and is translated into the patient’s lan8 guage. 

9 (2) When a medical emergency exists and the 

10 delay directly associated with obtaining competent 

11 interpreter or translation services would jeopardize 

12 the health of the patient, but only until a competent 

13 interpreter or translation service is available. 

14 (c) RULE OF CONSTRUCTION.—Subsection (b)(2) 

15 shall not be construed to mean that emergency rooms or 

16 similar entities that regularly provide health care services 

17 in medical emergencies are exempt from legal or regu18 latory requirements related to competent interpreter serv19 ices. 

20 SEC. 208. REPORT ON FEDERAL EFFORTS TO PROVIDE CUL21 TURALLY AND LINGUISTICALLY APPRO22 PRIATE HEALTH CARE SERVICES. 

23 (a) REPORT.—Not later than 1 year after the date 

24 of enactment of this Act and annually thereafter, the Sec25 retary of Health and Human Services shall enter into a 


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1 contract with the Institute of Medicine for the preparation 

2 and publication of a report that describes Federal efforts 

3 to ensure that all individuals with limited-English pro4 ficiency have meaningful access culturally competent to 

5 health care and health-care-related services. Such report 

6 shall include— 

7 (1) a description and evaluation of the activities 

8 carried out under this Act; 

9 (2) a description and analysis of best practices, 

10 model programs, guidelines, and other effective 

11 strategies for providing access to culturally and lin12 guistically appropriate health care services; 

13 (3) recommendations on the development and 

14 implementation of policies and practices by providers 

15 of health care and health-care-related services for 

16 limited-English-proficient individuals; 

17 (4) a description of the effect of providing lan18 guage services on quality of health care and access 

19 to care; and 

20 (5) a description of the costs associated with or 

21 savings related to the provision of language services. 

22 (b) 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 2017 through 2021. 


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1 SEC. 209. ENGLISH FOR SPEAKERS OF OTHER LANGUAGES. 

2 (a) GRANTS AUTHORIZED.—The Secretary of Edu3 cation is authorized to provide grants to eligible entities 

4 for the provision of English as a second language (in this 

5 section referred to ‘‘ESL’’) instruction and shall deter6 mine, after consultation with appropriate stakeholders, the 

7 mechanism for administering and distributing such 

8 grants. 

9 (b) ELIGIBLE ENTITY DEFINED.—For purposes of 

10 this section, the term ‘‘eligible entity’’ means a State or 

11 community-based organization that employs, and serves, 

12 minority populations. 

13 (c) APPLICATION.—An eligible entity may apply for 

14 a grant under this section by submitting such information 

15 as the Secretary may require and in such form and man16 ner as the Secretary may require. 

17 (d) USE OF GRANT.—As a condition of receiving a 

18 grant under this section, an eligible entity shall— 

19 (1) develop and implement a plan for assuring 

20 the availability of ESL instruction that effectively 

21 integrates information about the nature of the 

22 United States health care system, how to access 

23 care, and any special language skills that may be re24 quired for them to access and regularly negotiate the 

25 system effectively; 


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1 (2) develop a plan, including, where appro2 priate, public-private partnerships, for making ESL 

3 instruction progressively available to all individuals 

4 seeking instruction; and 

5 (3) maintain current ESL instruction efforts by 

6 using the additional funds to supplement rather 

7 than supplant any funds expended for ESL instruc8 tion in the State as of January 1, 2017. 

9 (e) ADDITIONAL DUTIES OF THE SECRETARY.—The 

10 Secretary of Education shall— 

11 (1) collect and publicize annual data on how 

12 much Federal, State, and local governments spend 

13 on ESL instruction; 

14 (2) collect data from State and local govern15 ments to identify the unmet needs of English lan16 guage learners for appropriate ESL instruction, in17 cluding— 

18 (A) the preferred written and spoken lan19 guage of such English language learners; 

20 (B) the extent of waiting lists including 

21 how many programs maintain waiting lists and, 

22 for programs that do not have waiting lists, the 

23 reasons why not; 

24 (C) the availability of programs to geo25 graphically isolated communities; 


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1 (D) the impact of course enrollment poli2 cies, including open enrollment, on the avail3 ability of ESL instruction; 

4 (E) the number individuals in the State 

5 and each participating locality; 

6 (F) the effectiveness of the instruction in 

7 meeting the needs of individuals receiving in8 struction and those needing instruction; 

9 (G) as assessment of the need for pro10 grams that integrate job training and ESL in11 struction, to assist individuals to obtain better 

12 jobs; and 

13 (H) the availability of ESL slots by State 

14 and locality; 

15 (3) determine the cost and most appropriate 

16 methods of making ESL instruction available to all 

17 English language learners seeking instruction; and 

18 (4) within 1 year of the date of enactment of 

19 this Act, issue a report to Congress that assesses the 

20 information collected in paragraphs (1), (2), and (3) 

21 and makes recommendations on steps that should be 

22 taken to progressively realize the goal of making 

23 ESL instruction available to all English language 

24 learners seeking instruction. 


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1 (f) AUTHORIZATION OF APPROPRIATIONS.—There 

2 are authorized to be appropriated to the Secretary of Edu3 cation for each of fiscal years 2017 through 2020 

4 $250,000,000 to carry out this section. 

5 SEC. 210. IMPLEMENTATION. 

6 (a) GENERAL PROVISIONS.— 

7 (1) A State shall not be immune under the 

8 Eleventh Amendment of the Constitution of the 

9 United States from suit in Federal court for failing 

10 to provide the language access funded pursuant to 

11 this title. 

12 (2) In a suit against a State for a violation of 

13 this title, remedies (including remedies at both at 

14 law and in equity) are available for such a violation 

15 to the same extent as such remedies are available for 

16 such a violation in the suit against any public or pri17 vate entity other than a State. 

18 (b) RULE OF CONSTRUCTION.—Nothing in this title 

19 shall be construed to limit otherwise existing obligations 

20 of recipients of Federal financial assistance under title VI 

21 of the Civil Rights Act of 1964 (42 U.S.C. 2000(d) et 

22 seq.) or any other statute. 

23 SEC. 211. LANGUAGE ACCESS SERVICES. 

24 (a) ESSENTIAL BENEFITS.—Section 1302(b)(1) of 

25 the Patient Protection and Affordable Care Act (42 


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1 U.S.C. 18022(b)(1)) is amended by adding at the end the 

2 following: 

3 ‘‘(K) Language access services, including 

4 oral interpretation and written translations.’’. 

5 (b) EMPLOYER-SPONSORED MINIMUM ESSENTIAL

6 COVERAGE.—Section 36B(c)(2)(C) of the Internal Rev7 enue Code of 1986 is amended by adding at the end the 

8 following: 

9 ‘‘(v) COVERAGE MUST INCLUDE LAN10 GUAGE ACCESS AND SERVICES.—Except as 

11 provided in clause (iii), an employee shall 

12 not be treated as eligible for minimum es13 sential coverage if such coverage consists 

14 of an eligible employer-sponsored plan (as 

15 defined in section 5000A(f)(2)) and the 

16 plan does not provide coverage for lan17 guage access services, including oral inter18 pretation and written translations.’’. 

19 (c) QUALITY REPORTING.—Section 2717(a)(1) of the 

20 Public Health Service Act (42 U.S.C. 300gg–17(a)(1)) is 

21 amended— 

22 (1) by striking ‘‘and’’ at the end of subpara23 graph (C); 

24 (2) by striking the period at the end of sub25 paragraph (D) and inserting ‘‘; and’’; and 


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1 (3) by adding at the end the following new sub2 paragraph: 

3 ‘‘(E) reduce health disparities through the 

4 provision of language access services, including 

5 oral interpretation and written translations.’’. 

6 (d) REGULATIONS REGARDING INTERNAL CLAIMS

7 AND APPEALS AND EXTERNAL REVIEW PROCESSES FOR

8 HEALTH PLANS AND HEALTH INSURANCE ISSUERS.— 

9 The Secretary of the Treasury, the Secretary of Labor, 

10 and the Secretary of Health and Human Services shall 

11 amend the regulations in section 54.9815–2719T(e) of 

12 title 26, Code of Federal Regulations, section 2590.715– 

13 2719(e) of title 29, Code of Federal Regulations, and sec14 tion 147.136(e) of title 45, Code of Federal Regulations, 

15 respectively, to require group health plans and health in16 surance issuers offering group or individual health insur17 ance coverage to which such sections apply— 

18 (1) to provide oral interpretation services with19 out any threshold requirements; 

20 (2) to provide in the English versions of all no21 tices a statement prominently displayed in not less 

22 than 15 non-English languages clearly indicating 

23 how to access the language services provided by the 

24 plan or issuer; and 


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1 (3) with respect to written translations of no2 tices, to apply a threshold that 5 percent of the pop3 ulation or at least 500 individuals per service area 

4 are literate only in the same non-English language 

5 in lieu of 10 percent or more residing in a county. 

6 (e) DATA COLLECTION AND REPORTING.—The Sec7 retary of Health and Human Services shall— 

8 (1) amend the single streamlined application 

9 form developed pursuant to section 1413 of the Pa10 tient Protection and Affordable Care Act (42 U.S.C. 

11 18083) to collect the preferred spoken and written 

12 language for each household member applying for 

13 coverage under a qualified health plan through an 

14 Exchange under title I of the Patient Protection and 

15 Affordable Care Act; 

16 (2) require navigators, certified application 

17 counselors, and other enrollment assisters to collect 

18 and report requests for language assistance; and 

19 (3) require the Federal and State call centers 

20 established pursuant to section 1311(d)(4)(b) of the 

21 Patient Protection and Affordable Care Act (42 

22 U.S.C. 18031(d)(4)(b)) to submit an annual report 

23 documenting the number of language assistance re24 quests, the types of languages requested, the range 

25 and average wait time for a consumer to speak with 


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1 an interpreter, and any steps the call center and lan2 guage line have taken to actively address some of 

3 the consumer complaints. 

4 (f) EFFECTIVE DATE.—The amendments made by 

5 this section shall apply to plan years beginning after the 

6 date of the enactment of this Act. 

7 TITLE III—HEALTH WORKFORCE 

8 DIVERSITY 

9 SEC. 301. AMENDMENT TO THE PUBLIC HEALTH SERVICE 

10 ACT. 

11 Title XXXIV of the Public Health Service Act, as 

12 added by section 202, is amended by adding at the end 

13 the following: 

14 ‘‘Subtitle A—Diversifying the 

15 Health Care Workplace 

16 ‘‘SEC. 3411. NATIONAL WORKING GROUP ON WORKFORCE 

17 DIVERSITY. 

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

19 the Bureau of Health Workforce within the Health Re20 sources and Services Administration, shall award a grant 

21 to an entity determined appropriate by the Secretary for 

22 the establishment of a national working group on work23 force diversity. 

24 ‘‘(b) REPRESENTATION.—In establishing the national 

25 working group under subsection (a): 


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1 ‘‘(1) The grantee shall ensure that the group 

2 has representatives of the following: 

3 ‘‘(A) The Health Resources and Services 

4 Administration. 

5 ‘‘(B) The Department of Health and 

6 Human Services Data Council. 

7 ‘‘(C) The Office of Minority Health of the 

8 Department of Health and Human Services. 

9 ‘‘(D) The Substance Abuse and Mental 

10 Health Services Administration. 

11 ‘‘(E) The Bureau of Labor Statistics of 

12 the Department of Labor. 

13 ‘‘(F) The Public Health Practice Program 

14 Office—Office of Workforce Policy and Plan15 ning. 

16 ‘‘(G) The National Institute on Minority 

17 Health and Health Disparities. 

18 ‘‘(H) The Agency for Healthcare Research 

19 and Quality. 

20 ‘‘(I) The Institute of Medicine Study Com21 mittee for the 2004 workforce diversity report. 

22 ‘‘(J) The Indian Health Service. 

23 ‘‘(K) The Department of Education. 

24 ‘‘(L) Minority-serving academic institu25 tions. 


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1 ‘‘(M) Consumer organizations. 

2 ‘‘(N) Health professional associations, in3 cluding those that represent underrepresented 

4 minority populations. 

5 ‘‘(O) Researchers in the area of health 

6 workforce. 

7 ‘‘(P) Health workforce accreditation enti8 ties. 

9 ‘‘(Q) Private (including nonprofit) founda10 tions that have sponsored workforce diversity 

11 initiatives. 

12 ‘‘(R) Local and State health departments. 

13 ‘‘(S) Representatives of community mem14 bers to be included on admissions committees 

15 for health profession schools pursuant to sub16 section (c)(8). 

17 ‘‘(T) 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 ‘‘(U) Other entities determined appropriate 

23 by the Secretary. 

24 ‘‘(2) The grantee shall ensure that, in addition 

25 to the representatives under paragraph (1), the 


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1 group has not less than 5 health professions stu2 dents representing various health profession fields 

3 and levels of training. 

4 ‘‘(c) ACTIVITIES.—The working group established 

5 under subsection (a) shall convene at least twice each year 

6 to complete the following activities: 

7 ‘‘(1) Review current public and private health 

8 workforce diversity initiatives. 

9 ‘‘(2) Identify successful health workforce diver10 sity programs and practices. 

11 ‘‘(3) Examine challenges relating to the devel12 opment and implementation of health workforce di13 versity initiatives. 

14 ‘‘(4) Draft a national strategic work plan for 

15 health workforce diversity, including recommenda16 tions for public and private sector initiatives. 

17 ‘‘(5) Develop a framework and methods for the 

18 evaluation of current and future health workforce di19 versity initiatives. 

20 ‘‘(6) Develop recommended standards for work21 force diversity that could be applicable to all health 

22 professions programs and programs funded under 

23 this Act. 

24 ‘‘(7) Develop guidelines to train health profes25 sionals to care for a diverse population. 


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1 ‘‘(8) Develop a strategy for the inclusion of 

2 community members on admissions committees for 

3 health profession schools. 

4 ‘‘(9) Helping with monitoring and implementa5 tion of standards for diversity, equity, and inclusion. 

6 ‘‘(10) Other activities determined appropriate 

7 by the Secretary. 

8 ‘‘(d) ANNUAL REPORT.—Not later than 1 year after 

9 the establishment of the working group under subsection 

10 (a), and annually thereafter, the working group shall pre11 pare and make available to the general public for com12 ment, an annual report on the activities of the working 

13 group. Such report shall include the recommendations of 

14 the working group for improving health workforce diver15 sity. 

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

17 is authorized to be appropriated to carry out this section 

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

19 2017 through 2022. 

20 ‘‘SEC. 3412. TECHNICAL CLEARINGHOUSE FOR HEALTH 

21 WORKFORCE DIVERSITY. 

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

23 the Deputy Assistant Secretary for Minority Health, and 

24 in collaboration with the Bureau of Health Workforce 

25 within the Health Resources and Services Administration, 


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1 the National Institute on Minority Health and Health Dis2 parities, shall establish a technical clearinghouse on health 

3 workforce diversity within the Office of Minority Health 

4 and coordinate current and future clearinghouses. 

5 ‘‘(b) INFORMATION AND SERVICES.—The clearing6 house established under subsection (a) shall offer the fol7 lowing information and services: 

8 ‘‘(1) Information on the importance of health 

9 workforce diversity. 

10 ‘‘(2) Statistical information relating to under11 represented minority representation in health and al12 lied health professions and occupations. 

13 ‘‘(3) Model health workforce diversity practices 

14 and programs, including integrated models of care. 

15 ‘‘(4) Admissions policies that promote health 

16 workforce diversity and are in compliance with Fed17 eral and State laws. 

18 ‘‘(5) Retainment policies that promote comple19 tion of health profession degrees for underserved 

20 populations. 

21 ‘‘(6) Lists of scholarship, loan repayment, and 

22 loan cancellation grants as well as fellowship infor23 mation for underserved populations for health pro24 fessions schools. 


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1 ‘‘(7) Foundation and other large organizational 

2 initiatives relating to health workforce diversity. 

3 ‘‘(c) CONSULTATION.—In carrying out this section, 

4 the Secretary shall consult with non-Federal entities which 

5 may include minority health professional associations and 

6 minority sections of major health professional associations 

7 to ensure the adequacy and accuracy of information. 

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

9 is authorized to be appropriated to carry out this section 

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

11 2017 through 2022. 

12 ‘‘SEC. 3413. SUPPORT FOR INSTITUTIONS COMMITTED TO 

13 WORKFORCE DIVERSITY, EQUITY, AND IN14 CLUSION. 

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

16 the Administrator of the Health Resources and Services 

17 Administration and the Centers for Disease Control and 

18 Prevention, shall award grants to eligible entities that 

19 demonstrate a commitment to health workforce diversity. 

20 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 

21 under subsection (a), an entity shall— 

22 ‘‘(1) be an educational institution or entity that 

23 historically produces or trains meaningful numbers 

24 of underrepresented minority health professionals, 

25 including— 


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1 ‘‘(A) historically Black colleges and univer2 sities; 

3 ‘‘(B) Hispanic-serving health professions 

4 schools; 

5 ‘‘(C) Hispanic-serving institutions; 

6 ‘‘(D) tribal colleges and universities; 

7 ‘‘(E) Asian-American, Native American, 

8 and Pacific Islander-serving institutions; 

9 ‘‘(F) institutions that have programs to re10 cruit and retain underrepresented minority 

11 health professionals, in which a significant 

12 number of the enrolled participants are under13 represented minorities; 

14 ‘‘(G) health professional associations, 

15 which may include underrepresented minority 

16 health professional associations; and 

17 ‘‘(H) institutions, including national and 

18 regional community-based organizations with 

19 demonstrated commitment to a diversified 

20 workforce— 

21 ‘‘(i) located in communities with pre22 dominantly underrepresented minority pop23 ulations; 


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1 ‘‘(ii) with whom partnerships have 

2 been formed for the purpose of increasing 

3 workforce diversity; and 

4 ‘‘(iii) in which at least 20 percent of 

5 the enrolled participants are underrep6 resented minorities; and 

7 ‘‘(2) submit to the Secretary an application at 

8 such time, in such manner, and containing such in9 formation as the Secretary may require. 

10 ‘‘(c) USE OF FUNDS.—Amounts received under a 

11 grant under subsection (a) shall be used to expand existing 

12 workforce diversity programs, implement new workforce 

13 diversity programs, or evaluate existing or new workforce 

14 diversity programs, including with respect to mental 

15 health care professions. Such programs shall enhance di16 versity by considering minority status as part of an indi17 vidualized consideration of qualifications. Possible activi18 ties may include— 

19 ‘‘(1) educational outreach programs relating to 

20 opportunities in the health professions; 

21 ‘‘(2) scholarship, fellowship, grant, loan repay22 ment, and loan cancellation programs; 

23 ‘‘(3) postbaccalaureate programs; 


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1 ‘‘(4) academic enrichment programs, particu2 larly targeting those who would not be competitive 

3 for health professions schools; 

4 ‘‘(5) kindergarten through 12th grade and 

5 other health pipeline programs; 

6 ‘‘(6) mentoring programs; 

7 ‘‘(7) internship or rotation programs involving 

8 hospitals, health systems, health plans, and other 

9 health entities; 

10 ‘‘(8) community partnership development for 

11 purposes relating to workforce diversity; or 

12 ‘‘(9) leadership training. 

13 ‘‘(d) REPORTS.—Not later than 1 year after receiving 

14 a grant under this section, and annually for the term of 

15 the grant, a grantee shall submit to the Secretary a report 

16 that summarizes and evaluates all activities conducted 

17 under the grant. 

18 ‘‘(e) DEFINITION.—In this section, the term ‘Asian19 American, Native American, and Pacific Islander-serving 

20 institutions’ has the same meaning as the term ‘Asian 

21 American and Native American Pacific Islander-serving 

22 institution’ as defined in section 371(c) of the Higher 

23 Education Act of 1965 (20 U.S.C. 1067q(c)). 

24 ‘‘(f) 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 2017 through 2022. 

3 ‘‘SEC. 3414. CAREER DEVELOPMENT FOR SCIENTISTS AND 

4 RESEARCHERS. 

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

6 the Director of the National Institutes of Health, the Di7 rector of the Centers for Disease Control and Prevention, 

8 the Commissioner of Food and Drugs, the Director of the 

9 Agency for Healthcare Research and Quality, and the Ad10 ministrator of the Health Resources and Services Admin11 istration, shall award grants that expand existing opportu12 nities for scientists and researchers and promote the inclu13 sion of underrepresented minorities in the health profes14 sions. 

15 ‘‘(b) RESEARCH FUNDING.—The head of each entity 

16 within the Department of Health and Human Services 

17 shall establish or expand existing programs to provide re18 search funding to scientists and researchers in training. 

19 Under such programs, the head of each such entity shall 

20 give priority in allocating research funding to support 

21 health research in traditionally underserved communities, 

22 including underrepresented minority communities, and re23 search classified as community or participatory. 

24 ‘‘(c) DATA COLLECTION.—The head of each entity 

25 within the Department of Health and Human Services 


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1 shall collect data on the number (expressed as an absolute 

2 number and a percentage) of underrepresented minority 

3 and nonminority applicants who receive and are denied 

4 agency funding at every stage of review. Such data shall 

5 be reported annually to the Secretary and the appropriate 

6 committees of Congress. 

7 ‘‘(d) STUDENT LOAN REIMBURSEMENT.—The Sec8 retary shall establish a student loan reimbursement pro9 gram to provide student loan reimbursement assistance to 

10 researchers who focus on racial and ethnic disparities in 

11 health. The Secretary shall promulgate regulations to de12 fine the scope and procedures for the program under this 

13 subsection. 

14 ‘‘(e) STUDENT LOAN CANCELLATION.—The Sec15 retary shall establish a student loan cancellation program 

16 to provide student loan cancellation assistance to research17 ers who focus on racial and ethnic disparities in health. 

18 Students participating in the program shall make a min19 imum 5-year commitment to work at an accredited health 

20 profession school. The Secretary shall promulgate addi21 tional regulations to define the scope and procedures for 

22 the program under this subsection. 

23 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 

24 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 2017 through 2022. 

3 ‘‘SEC. 3415. CAREER SUPPORT FOR NONRESEARCH HEALTH 

4 PROFESSIONALS. 

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

6 the Director of the Centers for Disease Control and Pre7 vention, the Administrator of the Substance Abuse and 

8 Mental Health Services Administration, the Administrator 

9 of the Health Resources and Services Administration, and 

10 the Administrator of the Centers for Medicare & Medicaid 

11 Services, shall establish a program to award grants to eli12 gible individuals for career support in nonresearch-related 

13 health and wellness professions. 

14 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 

15 under subsection (a), an individual shall— 

16 ‘‘(1) be a student in a health professions school, 

17 a graduate of such a school who is working in a 

18 health profession, an individual working in a health 

19 or wellness profession (including mental and behav20 ioral health), or a faculty member of such a school; 

21 and 

22 ‘‘(2) 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 individual shall use 

2 amounts received under a grant under this section to— 

3 ‘‘(1) support the individual’s health activities or 

4 projects that involve underserved communities, in5 cluding racial and ethnic minority communities; 

6 ‘‘(2) support health-related career advancement 

7 activities; 

8 ‘‘(3) to pay, or as reimbursement for payments 

9 of, student loans or training or credentialing costs 

10 for individuals who are health professionals and are 

11 focused on health issues affecting underserved com12 munities, including racial and ethnic minority com13 munities; and 

14 ‘‘(4) to establish and promote leadership train15 ing programs to decrease health disparities and to 

16 increase cultural competence with the goal of in17 creasing diversity in leadership positions. 

18 ‘‘(d) DEFINITION.—In this section, the term ‘career 

19 in nonresearch-related health and wellness professions’ 

20 means employment or intended employment in the field 

21 of public health, health policy, health management, health 

22 administration, medicine, nursing, pharmacy, psychology, 

23 social work, psychiatry, other mental and behavioral 

24 health, allied health, community health, social work, or 


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1 other fields determined appropriate by the Secretary, 

2 other than in a position that involves research. 

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 2017 through 2022. 

7 ‘‘SEC. 3416. RESEARCH ON THE EFFECT OF WORKFORCE DI8 VERSITY ON QUALITY. 

9 ‘‘(a) IN GENERAL.—The Director of the Agency for 

10 Healthcare Research and Quality, in collaboration with 

11 the Deputy Assistant Secretary for Minority Health and 

12 the Director of the National Institute on Minority Health 

13 and Health Disparities, shall award grants to eligible enti14 ties to expand research on the link between health work15 force diversity and quality health care. 

16 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 

17 under subsection (a), an entity shall— 

18 ‘‘(1) be a clinical, public health, or health serv19 ices research entity or other entity determined ap20 propriate by the Director; and 

21 ‘‘(2) submit to the Secretary an application at 

22 such time, in such manner, and containing such in23 formation as the Secretary may require. 

24 ‘‘(c) USE OF FUNDS.—Amounts received under a 

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1 port research that investigates the effect of health work2 force diversity on— 

3 ‘‘(1) language access; 

4 ‘‘(2) cultural competence; 

5 ‘‘(3) patient satisfaction; 

6 ‘‘(4) timeliness of care; 

7 ‘‘(5) safety of care; 

8 ‘‘(6) effectiveness of care; 

9 ‘‘(7) efficiency of care; 

10 ‘‘(8) patient outcomes; 

11 ‘‘(9) community engagement; 

12 ‘‘(10) resource allocation; 

13 ‘‘(11) organizational structure; 

14 ‘‘(12) compliance of care; or 

15 ‘‘(13) other topics determined appropriate by 

16 the Director. 

17 ‘‘(d) PRIORITY.—In awarding grants under sub18 section (a), the Director shall give individualized consider19 ation to all relevant aspects of the applicant’s background. 

20 Consideration of prior research experience involving the 

21 health of underserved communities shall be such a factor. 

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

23 is authorized to be appropriated to carry out this section 

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

25 2017 through 2022. 


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1 ‘‘SEC. 3417. HEALTH DISPARITIES EDUCATION PROGRAM. 

2 ‘‘(a) ESTABLISHMENT.—The Secretary, acting 

3 through the National Institute on Minority Health and 

4 Health Disparities and in collaboration with the Office of 

5 Minority Health, the Office for Civil Rights, the Centers 

6 for Disease Control and Prevention, the Centers for Medi7 care & Medicaid Services, the Health Resources and Serv8 ices Administration, and other appropriate public and pri9 vate entities, shall establish and coordinate a health and 

10 health care disparities education program to support, de11 velop, and implement educational initiatives and outreach 

12 strategies that inform health care professionals and the 

13 public about the existence of and methods to reduce racial 

14 and ethnic disparities in health and health care. 

15 ‘‘(b) ACTIVITIES.—The Secretary, through the edu16 cation program established under subsection (a), shall, 

17 through the use of public awareness and outreach cam18 paigns targeting the general public and the medical com19 munity at large— 

20 ‘‘(1) disseminate scientific evidence for the ex21 istence and extent of racial and ethnic disparities in 

22 health care, including disparities that are not other23 wise attributable to known factors such as access to 

24 care, patient preferences, or appropriateness of 

25 intervention, as described in the 2002 Institute of 

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1 fronting Racial and Ethnic Disparities in Health 

2 Care’, as well as the impact of disparities related to 

3 age, disability status, socioeconomic status, sex, gen4 der identity, and sexual orientation on racial and 

5 ethnic minorities; 

6 ‘‘(2) disseminate new research findings to 

7 health care providers and patients to assist them in 

8 understanding, reducing, and eliminating health and 

9 health care disparities; 

10 ‘‘(3) disseminate information about the impact 

11 of linguistic and cultural barriers on health care 

12 quality and the obligation of health providers who 

13 receive Federal financial assistance to ensure that 

14 people with limited-English proficiency have access 

15 to language access services; 

16 ‘‘(4) disseminate information about the impor17 tance and legality of racial, ethnic, disability status, 

18 socioeconomic status, sex, gender identity, and sex19 ual orientation, and primary language data collec20 tion, analysis, and reporting; 

21 ‘‘(5) design and implement specific educational 

22 initiatives to health care providers relating to health 

23 and health care disparities; 

24 ‘‘(6) assess the impact of the programs estab25 lished under this section in raising awareness of 


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1 health and health care disparities and providing in2 formation on available resources; and 

3 ‘‘(7) design and implement specific educational 

4 initiatives to educate the health care workforce relat5 ing to unconscious bias. 

6 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 

7 is authorized to be appropriated to carry out this section 

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

9 2017 through 2022.’’. 

10 SEC. 302. HISPANIC-SERVING HEALTH PROFESSIONS 

11 SCHOOLS. 

12 Part B of title VII of the Public Health Service Act 

13 (42 U.S.C. 293 et seq.) is amended by adding at the end 

14 the following: 

15 ‘‘SEC. 742. HISPANIC-SERVING HEALTH PROFESSIONS 

16 SCHOOLS. 

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

18 the Administrator of the Health Resources and Services 

19 Administration, shall award grants to Hispanic-serving 

20 health professions schools for the purpose of carrying out 

21 programs to recruit Hispanic individuals to enroll in and 

22 graduate from such schools, which may include providing 

23 scholarships and other financial assistance as appropriate. 


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1 ‘‘(b) ELIGIBILITY.—In subsection (a), the term ‘His2 panic-serving health professions school’ means an entity 

3 that— 

4 ‘‘(1) is a school or program under section 

5 799B; 

6 ‘‘(2) has an enrollment of full-time equivalent 

7 students that is made up of at least 9 percent His8 panic students; 

9 ‘‘(3) has been effective in carrying out pro10 grams to recruit Hispanic individuals to enroll in 

11 and graduate from the school; 

12 ‘‘(4) has been effective in recruiting and retain13 ing Hispanic faculty members; 

14 ‘‘(5) has a significant number of graduates who 

15 are providing health services to medically under16 served populations or to individuals in health profes17 sional shortage areas; and 

18 ‘‘(6) is a Regional Hispanic Center of Excel19 lence.’’. 

20 SEC. 303. LOAN REPAYMENT PROGRAM OF CENTERS FOR 

21 DISEASE CONTROL AND PREVENTION. 

22 Section 317F(c) of the Public Health Service Act (42 

23 U.S.C. 247b–7(c)) is amended— 

24 (1) by striking ‘‘and’’ after ‘‘1994,’’; and 


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1 (2) by inserting before the period at the end the 

2 following: ‘‘, $750,000 for fiscal year 2017, and such 

3 sums as may be necessary for each of the fiscal 

4 years 2018 through 2022’’. 

5 SEC. 304. COOPERATIVE AGREEMENTS FOR ONLINE DE6 GREE PROGRAMS AT SCHOOLS OF PUBLIC 

7 HEALTH AND SCHOOLS OF ALLIED HEALTH. 

8 Part B of title VII of the Public Health Service Act 

9 (42 U.S.C. 293 et seq.), as amended by section 302, is 

10 further amended by adding at the end the following: 

11 ‘‘SEC. 743. COOPERATIVE AGREEMENTS FOR ONLINE DE12 GREE PROGRAMS. 

13 ‘‘(a) COOPERATIVE AGREEMENTS.—The Secretary, 

14 acting through the Administrator of the Health Resources 

15 and Services Administration, in consultation with the Di16 rector of the Centers for Disease Control and Prevention, 

17 the Director of the Agency for Healthcare Research and 

18 Quality, and the Deputy Assistant Secretary for Minority 

19 Health, shall award cooperative agreements to schools of 

20 public health and schools of allied health to design and 

21 implement online degree programs. 

22 ‘‘(b) PRIORITY.—In awarding cooperative agreements 

23 under this section, the Secretary shall give priority to any 

24 school of public health or school of allied health that has 


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1 an established track record of serving medically under2 served communities. 

3 ‘‘(c) REQUIREMENTS.—Recipients of cooperative 

4 agreements under this section shall design and implement 

5 an online degree program that meets the following restric6 tions: 

7 ‘‘(1) Enrollment of individuals who have ob8 tained a secondary school diploma or its recognized 

9 equivalent. 

10 ‘‘(2) Maintaining a significant enrollment of 

11 underrepresented minority or disadvantaged stu12 dents. 

13 ‘‘(3) Achieving a high completion rate of en14 rolled underrepresented minority or disadvantaged 

15 students. 

16 ‘‘(d) 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 2017 through 2022.’’. 

20 SEC. 305. SENSE OF CONGRESS ON THE MISSION OF THE 

21 NATIONAL HEALTH CARE WORKFORCE COM22 MISSION. 

23 It is the sense of Congress that the National Health 

24 Care Workforce Commission established by section 5101 

25 of the Patient Protection and Affordable Care Act (42 


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1 U.S.C. 294q) should, in carrying out its assigned duties 

2 under that section, give attention to the needs of racial 

3 and ethnic minorities, individuals with lower socio4 economic status, individuals with mental, developmental, 

5 and physical disabilities, lesbian, gay, bisexual, 

6 transgender, queer, and questioning populations, and indi7 viduals who are members of multiple minority or special 

8 population groups. 

9 SEC. 306. SCHOLARSHIP AND FELLOWSHIP PROGRAMS. 

10 Subtitle A of title XXXIV of the Public Health Serv11 ice Act, as added by section 301, is further amended by 

12 inserting after section 3417 the following: 

13 ‘‘SEC. 3418. DAVID SATCHER PUBLIC HEALTH AND HEALTH 

14 SERVICES CORPS. 

15 ‘‘(a) IN GENERAL.—The Administrator of the Health 

16 Resources and Services Administration and the Director 

17 of the Centers for Disease Control and Prevention, in col18 laboration with the Deputy Assistant Secretary for Minor19 ity Health, shall award grants to eligible entities to in20 crease awareness among postprimary and postsecondary 

21 students of career opportunities in the health professions. 

22 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 

23 under subsection (a), an entity shall— 

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1 tity, or other entity determined appropriate by the 

2 Director of the Centers for Disease Control and Pre3 vention; 

4 ‘‘(2) serve a health professional shortage area, 

5 as determined by the Secretary; 

6 ‘‘(3) work with students, including those from 

7 racial and ethnic minority backgrounds, that have 

8 expressed an interest in the health professions; and 

9 ‘‘(4) submit to the Secretary an application at 

10 such time, in such manner, and containing such in11 formation as the Secretary may require. 

12 ‘‘(c) USE OF FUNDS.—Grant awards under sub13 section (a) shall be used to support internships that will 

14 increase awareness among students of non-research-based, 

15 career opportunities in the following health professions: 

16 ‘‘(1) Medicine. 

17 ‘‘(2) Nursing. 

18 ‘‘(3) Public Health. 

19 ‘‘(4) Pharmacy. 

20 ‘‘(5) Health administration and management. 

21 ‘‘(6) Health policy. 

22 ‘‘(7) Psychology. 

23 ‘‘(8) Dentistry. 

24 ‘‘(9) International health. 

25 ‘‘(10) Social work. 


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1 ‘‘(11) Allied health. 

2 ‘‘(12) Psychiatry. 

3 ‘‘(13) Hospice care. 

4 ‘‘(14) Other professions deemed appropriate by 

5 the Director of the Centers for Disease Control and 

6 Prevention. 

7 ‘‘(d) PRIORITY.—In awarding grants under sub8 section (a), the Director of the Centers for Disease Con9 trol and Prevention shall give priority to those entities 

10 that— 

11 ‘‘(1) serve a high proportion of individuals from 

12 disadvantaged backgrounds; 

13 ‘‘(2) have experience in health disparity elimi14 nation programs; 

15 ‘‘(3) facilitate the entry of disadvantaged indi16 viduals into institutions of higher education; and 

17 ‘‘(4) provide counseling or other services de18 signed to assist disadvantaged individuals in success19 fully completing their education at the postsecondary 

20 level. 

21 ‘‘(e) STIPENDS.—The Secretary may approve sti22 pends under this section for individuals for any period of 

23 education in student-enhancement programs (other than 

24 regular courses) at health professions schools, programs, 

25 or entities, except that such a stipend may not be provided 


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1 to an individual for more than 6 months, and such a sti2 pend may not exceed $20 per day (notwithstanding any 

3 other provision of law regarding the amount of stipends). 

4 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 

5 is authorized to be appropriated to carry out this section 

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

7 2017 through 2022. 

8 ‘‘SEC. 3419. LOUIS STOKES PUBLIC HEALTH SCHOLARS 

9 PROGRAM. 

10 ‘‘(a) IN GENERAL.—The Director of the Centers for 

11 Disease Control and Prevention, in collaboration with the 

12 Deputy Assistant Secretary for Minority Health, shall 

13 award scholarships to postsecondary students who seek a 

14 career in public health. 

15 ‘‘(b) ELIGIBILITY.—To be eligible to receive a schol16 arship under subsection (a), an individual shall— 

17 ‘‘(1) have interest, knowledge, or skill in public 

18 health research or public health practice, or other 

19 health professions as determined appropriate by the 

20 Director of the Centers for Disease Control and Pre21 vention; 

22 ‘‘(2) reside in a health professional shortage 

23 area as determined by the Secretary; 

24 ‘‘(3) demonstrate promise for becoming a leader 

25 in public health; 


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1 ‘‘(4) secure admission to a 4-year institution of 

2 higher education; 

3 ‘‘(5) comply with subsection (e); and 

4 ‘‘(6) submit to the Secretary an application at 

5 such time, in such manner, and containing such in6 formation as the Secretary may require. 

7 ‘‘(c) USE OF FUNDS.—Amounts received under an 

8 award under subsection (a) shall be used to support oppor9 tunities for students to become public health professionals. 

10 ‘‘(d) PRIORITY.—In awarding grants under sub11 section (a), the Director shall give priority to those stu12 dents that— 

13 ‘‘(1) are from disadvantaged backgrounds; 

14 ‘‘(2) have secured admissions to a minority15 serving institution; and 

16 ‘‘(3) have identified a health professional as a 

17 mentor at their school or institution and an aca18 demic advisor to assist in the completion of their 

19 baccalaureate degree. 

20 ‘‘(e) SCHOLARSHIPS.—The Secretary may approve 

21 payment of scholarships under this section for such indi22 viduals for any period of education in student under23 graduate tenure, except that such a scholarship may not 

24 be provided to an individual for more than 4 years, and 

25 such scholarships may not exceed $10,000 per academic 


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1 year (notwithstanding any other provision of law regard2 ing the amount of scholarship). 

3 ‘‘(f) 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 2017 through 2022. 

7 ‘‘SEC. 3420. PATSY MINK HEALTH AND GENDER RESEARCH 

8 FELLOWSHIP PROGRAM. 

9 ‘‘(a) IN GENERAL.—The Director of the Centers for 

10 Disease Control and Prevention, in collaboration with the 

11 Deputy Assistant Secretary for Minority Health, the Ad12 ministrator of the Substance Abuse and Mental Health 

13 Services Administration, and the Director of the Indian 

14 Health Services, shall award research fellowships to post15 baccalaureate students to conduct research that will exam16 ine gender and health disparities and to pursue a career 

17 in the health professions. 

18 ‘‘(b) ELIGIBILITY.—To be eligible to receive a fellow19 ship under subsection (a) an individual shall— 

20 ‘‘(1) have experience in health research or pub21 lic health practice; 

22 ‘‘(2) reside in a health professional shortage 

23 area as determined by the Secretary; 

24 ‘‘(3) have expressed an interest in the health 

25 professions; 


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1 ‘‘(4) demonstrate promise for becoming a leader 

2 in the field of women’s health; 

3 ‘‘(5) secure admission to a health professions 

4 school or graduate program with an emphasis in 

5 gender studies; 

6 ‘‘(6) comply with subsection (f); and 

7 ‘‘(7) submit to the Secretary an application at 

8 such time, in such manner, and containing such in9 formation as the Secretary may require. 

10 ‘‘(c) USE OF FUNDS.—Amounts received under an 

11 award under subsection (a) shall be used to support oppor12 tunities for students to become researchers and advance 

13 the research base on the intersection between gender and 

14 health. 

15 ‘‘(d) PRIORITY.—In awarding grants under sub16 section (a), the Director of the Centers for Disease Con17 trol and Prevention shall give priority to those applicants 

18 that— 

19 ‘‘(1) are from disadvantaged backgrounds; and 

20 ‘‘(2) have identified a mentor and academic ad21 visor who will assist in the completion of their grad22 uate or professional degree and have secured a re23 search assistant position with a researcher working 

24 in the area of gender and health. 


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1 ‘‘(e) FELLOWSHIPS.—The Director of the Centers for 

2 Disease Control and Prevention may approve fellowships 

3 for individuals under this section for any period of edu4 cation in the student’s graduate or health profession ten5 ure, except that such a fellowship may not be provided 

6 to an individual for more than 3 years, and such a fellow7 ship may not exceed $18,000 per academic year (notwith8 standing any other provision of law regarding the amount 

9 of fellowship). 

10 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 

11 is authorized to be appropriated to carry out this section 

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

13 2017 through 2022. 

14 ‘‘SEC. 3420A. PAUL DAVID WELLSTONE INTERNATIONAL 

15 HEALTH FELLOWSHIP PROGRAM. 

16 ‘‘(a) IN GENERAL.—The Director of the Agency for 

17 Healthcare Research and Quality, in collaboration with 

18 the Deputy Assistant Secretary for Minority Health, shall 

19 award research fellowships to college students or recent 

20 graduates to advance their understanding of international 

21 health. 

22 ‘‘(b) ELIGIBILITY.—To be eligible to receive a fellow23 ship under subsection (a) an individual shall— 

24 ‘‘(1) have educational experience in the field of 

25 international health; 


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1 ‘‘(2) reside in a health professional shortage 

2 area as determined by the Secretary; 

3 ‘‘(3) demonstrate promise for becoming a leader 

4 in the field of international health; 

5 ‘‘(4) be a college senior or recent graduate of 

6 a four-year higher education institution; 

7 ‘‘(5) comply with subsection (e); and 

8 ‘‘(6) submit to the Secretary an application at 

9 such time, in such manner, and containing such in10 formation as the Secretary may require. 

11 ‘‘(c) USE OF FUNDS.—Amounts received under an 

12 award under subsection (a) shall be used to support oppor13 tunities for students to become health professionals and 

14 to advance their knowledge about international issues re15 lating to health care access and quality. 

16 ‘‘(d) PRIORITY.—In awarding grants under sub17 section (a), the Director shall give priority to those appli18 cants that— 

19 ‘‘(1) are from a disadvantaged background; and 

20 ‘‘(2) have identified a mentor at a health pro21 fessions school or institution, an academic advisor to 

22 assist in the completion of their graduate or profes23 sional degree, and an advisor from an international 

24 health non-governmental organization, private volun25 teer organization, or other international institution 


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1 or program that focuses on increasing health care 

2 access and quality for residents in developing coun3 tries. 

4 ‘‘(e) FELLOWSHIPS.—The Secretary shall approve 

5 fellowships for college seniors or recent graduates, except 

6 that such a fellowship may not be provided to an indi7 vidual for more than 6 months, may not be awarded to 

8 a graduate that has not been enrolled in school for more 

9 than 1 year, and may not exceed $4,000 per academic year 

10 (notwithstanding any other provision of law regarding the 

11 amount of fellowship). 

12 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 

13 is authorized to be appropriated to carry out this section, 

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

15 2017 through 2022. 

16 ‘‘SEC. 3420B. EDWARD R. ROYBAL HEALTH SCHOLAR PRO17 GRAM. 

18 ‘‘(a) IN GENERAL.—The Director of the Agency for 

19 Healthcare Research and Quality, the Director of the Cen20 ters for Medicare and Medicaid Services, and the Adminis21 trator for Health Resources and Services Administration, 

22 in collaboration with the Deputy Assistant Secretary for 

23 Minority Health, shall award grants to eligible entities to 

24 expose entering graduate students to the health profes25 sions. 


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1 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 

2 under subsection (a), an entity shall— 

3 ‘‘(1) be a clinical, public health, or health serv4 ices organization, community-based, academic, or 

5 nonprofit entity, or other entity determined appro6 priate by the Director of the Agency for Healthcare 

7 Research and Quality; 

8 ‘‘(2) serve in a health professional shortage 

9 area as determined by the Secretary; 

10 ‘‘(3) work with students obtaining a degree in 

11 the health professions; and 

12 ‘‘(4) submit to the Secretary an application at 

13 such time, in such manner, and containing such in14 formation as the Secretary may require. 

15 ‘‘(c) USE OF FUNDS.—Amounts received under a 

16 grant awarded under subsection (a) shall be used to sup17 port opportunities that expose students to non-research18 based health professions, including— 

19 ‘‘(1) public health policy; 

20 ‘‘(2) health care and pharmaceutical policy; 

21 ‘‘(3) health care administration and manage22 ment; 

23 ‘‘(4) health economics; and 

24 ‘‘(5) other professions determined appropriate 

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1 search and Quality, the Director of the Centers for 

2 Medicare and Medicaid Services, and the Adminis3 trator for Health Resources and Services Adminis4 tration. 

5 ‘‘(d) PRIORITY.—In awarding grants under sub6 section (a), the Director of the Agency for Healthcare Re7 search and Quality shall give priority to those entities 

8 that— 

9 ‘‘(1) have experience with health disparity elimi10 nation programs; 

11 ‘‘(2) facilitate training in the fields described in 

12 subsection (c); and 

13 ‘‘(3) provide counseling or other services de14 signed to assist such individuals in successfully com15 pleting their education at the postsecondary level. 

16 ‘‘(e) STIPENDS.—The Secretary may approve the 

17 payment of stipends for individuals under this section for 

18 any period of education in student-enhancement programs 

19 (other than regular courses) at health professions schools 

20 or entities, except that such a stipend may not be provided 

21 to an individual for more than 2 months, and such a sti22 pend may not exceed $100 per day (notwithstanding any 

23 other provision of law regarding the amount of stipends). 

24 ‘‘(f) 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 2017 through 2022.’’. 

3 SEC. 307. MCNAIR POSTBACCALAUREATE ACHIEVEMENT 

4 PROGRAM. 

5 Section 402E of the Higher Education Act of 1965 

6 (20 U.S.C. 1070a–15) is amended by striking subsection 

7 (g) and inserting the following: 

8 ‘‘(g) COLLABORATION IN HEALTH PROFESSION DI9 VERSITY TRAINING PROGRAMS.—The Secretary shall co10 ordinate with the Secretary of Health and Human Serv11 ices to ensure that there is collaboration between the goals 

12 of the program under this section and programs of the 

13 Health Resources and Services Administration that pro14 mote health workforce diversity. The Secretary of Edu15 cation shall take such measures as may be necessary to 

16 encourage students participating in projects assisted 

17 under this section to consider health profession careers. 

18 ‘‘(h) FUNDING.—From amounts appropriated pursu19 ant to the authority of section 402A(g), the Secretary 

20 shall, to the extent practicable, allocate funds for projects 

21 authorized by this section in an amount which is not less 

22 than $31,000,000 for each of the fiscal years 2017 

23 through 2023.’’. 


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1 SEC. 308. RULES FOR DETERMINATION OF FULL-TIME 

2 EQUIVALENT RESIDENTS FOR COST-REPORT3 ING PERIODS. 

4 (a) DGME DETERMINATIONS.—Section 1886(h)(4) 

5 of the Social Security Act (42 U.S.C. 1395ww(h)(4)), as 

6 amended by section 204(a), is amended— 

7 (1) in subparagraph (E), by striking ‘‘Subject 

8 to subparagraphs (J) and (K), such rules’’ and in9 serting ‘‘Subject to subparagraphs (J), (K), and 

10 (M), such rules’’; 

11 (2) in subparagraph (J), by striking ‘‘Such 

12 rules’’ and inserting ‘‘Subject to subparagraph (M), 

13 such rules’’; 

14 (3) in subparagraph (K), by striking ‘‘In deter15 mining’’ and inserting ‘‘Subject to subparagraph 

16 (M), in determining’’; and 

17 (4) by adding at the end the following new sub18 paragraph: 

19 ‘‘(M) TREATMENT OF CERTAIN RESIDENTS

20 AND INTERNS.—For purposes of cost-reporting 

21 periods beginning on or after October 1, 2016, 

22 in determining the hospital’s number of full23 time equivalent residents for purposes of this 

24 paragraph, all the time spent by an intern or 

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1 mination of full-time equivalency if the hos2 pital— 

3 ‘‘(i) is recognized as a subsection (d) 

4 hospital; 

5 ‘‘(ii) is recognized as a subsection (d) 

6 Puerto Rico hospital; 

7 ‘‘(iii) is reimbursed under a reim8 bursement system authorized under section 

9 1814(b)(3); or 

10 ‘‘(iv) is a provider-based hospital out11 patient department.’’. 

12 (b) IME DETERMINATIONS.—Section 

13 1886(d)(5)(B)(x) of the Social Security Act (42 U.S.C. 

14 1395ww(d)(5)(B)(x)) is amended— 

15 (1) in subclause (II), by striking ‘‘In deter16 mining’’ and inserting ‘‘Subject to subclause (IV), in 

17 determining’’; 

18 (2) in subclause (III), by striking ‘‘In deter19 mining’’ and inserting ‘‘Subject to subclause (IV), in 

20 determining’’; and 

21 (3) by inserting after subclause (III) the fol22 lowing new subclause: 

23 ‘‘(IV) The provisions of subparagraph (L) 

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1 paragraph in the same manner as they apply 

2 under such subsection.’’. 

3 SEC. 309. DEVELOPING AND IMPLEMENTING STRATEGIES 

4 FOR LOCAL HEALTH EQUITY. 

5 (a) GRANTS.—The Secretaries of Health and Human 

6 Services, Education, and Labor, acting jointly, shall make 

7 grants to academic institutions for the purposes of— 

8 (1) in accordance with subsection (b), devel9 oping capacity— 

10 (A) to build an evidence base for successful 

11 strategies for increasing local health equity; and 

12 (B) to serve as national models of driving 

13 local health equity; 

14 (2) in accordance with subsection (c), devel15 oping a strategic partnership with the community in 

16 which the academic institution is located; and 

17 (3) collecting data on, and periodically evalu18 ating, the effectiveness of the institution’s programs 

19 funded through this section to enable the institution 

20 to adapt accordingly for maximum efficiency and 

21 success. 

22 (b) DEVELOPING CAPACITY FOR INCREASING LOCAL

23 HEALTH EQUITY.—As a condition on receipt of a grant 

24 under subsection (a), an academic institution shall agree 

25 to use the grant to build an evidence base for successful 


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1 strategies for increasing local health equity, and to serve 

2 as a national model of driving local health equity, by sup3 porting— 

4 (1) resources to strengthen institutional metrics 

5 and capacity to execute institutionwide health work6 force goals that can serve as models for increasing 

7 health equity in communities across the country; 

8 (2) collaborations among a cohort of institu9 tions in implementing systemic change, partnership 

10 development, and programmatic efforts supportive of 

11 health equity goals across disciplines and popu12 lations; and 

13 (3) enhanced or newly developed data systems 

14 and research infrastructure capable of informing 

15 current and future workforce efforts and building a 

16 foundation for a broader research agenda targeting 

17 urban health disparities. 

18 (c) STRATEGIC PARTNERSHIPS.—As a condition on 

19 receipt of a grant under subsection (a), an academic insti20 tution shall agree to use the grant to develop a strategic 

21 partnership with the community in which the institution 

22 is located for the purposes of— 

23 (1) strengthening connections between the insti24 tution and the community— 


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1 (A) to improve evaluation of and address 

2 the community’s health and health workforce 

3 needs; and 

4 (B) to engage the community in health 

5 workforce development; 

6 (2) developing, enhancing, or accelerating inno7 vative undergraduate and graduate programs in the 

8 biomedical sciences and health professions; and 

9 (3) strengthening pipeline programs in the bio10 medical sciences and health professions, including by 

11 developing partnerships between institutions of high12 er education and elementary and secondary schools 

13 to recruit the next generation of health professionals 

14 earlier in the pipeline to a health care career. 

15 SEC. 310. LOAN FORGIVENESS FOR MENTAL AND BEHAV16 IORAL HEALTH SOCIAL WORKERS. 

17 Section 455 of the Higher Education Act of 1965 (20 

18 U.S.C. 1087e) is amended by adding at the end the fol19 lowing new subsection: 

20 ‘‘(r) REPAYMENT PLAN FOR MENTAL AND BEHAV21 IORAL HEALTH SOCIAL WORKERS.— 

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

23 the balance of interest and principal due on any eli24 gible Federal Direct Loan not in default for a bor25 rower who— 


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1 ‘‘(A) has made 120 monthly payments on 

2 the eligible Federal Direct Loan after October 

3 1, 2016, pursuant to any one or a combination 

4 of the following— 

5 ‘‘(i) payments under an income-based 

6 repayment plan under section 493C; 

7 ‘‘(ii) payments under a standard re8 payment plan under subsection (d)(1)(A), 

9 based on a 10-year repayment period; 

10 ‘‘(iii) monthly payments under a re11 payment plan under subsection (d)(1) or 

12 (g) of not less than the monthly amount 

13 calculated under subsection (d)(1)(A), 

14 based on a 10-year repayment period; or 

15 ‘‘(iv) payments under an income con16 tingent repayment plan under subsection 

17 (d)(1)(D); and 

18 ‘‘(B)(i) is employed as a mental health or 

19 behavioral health social worker, as defined by 

20 the Secretary by regulation, at the time of such 

21 forgiveness; and 

22 ‘‘(ii) has been employed as such a mental 

23 health or behavioral health social worker during 

24 the period in which the borrower makes each of 


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1 the 120 payments as described in subparagraph 

2 (A). 

3 ‘‘(2) LOAN CANCELLATION AMOUNT.—After the 

4 conclusion of the employment period described in 

5 paragraph (1), the Secretary shall cancel the obliga6 tion to repay the balance of principal and interest 

7 due as of the time of such cancellation, on the eligi8 ble Federal Direct Loans made to the borrower 

9 under this part. 

10 ‘‘(3) INELIGIBILITY FOR DOUBLE BENEFITS.— 

11 No borrower may, for the same employment as a 

12 mental heath or behavioral health social worker, re13 ceive a reduction of loan obligations under both this 

14 subsection and section 455(m), 428J, 428K, 428L, 

15 or 460. 

16 ‘‘(4) DEFINITION OF ELIGIBLE FEDERAL DI17 RECT LOAN.—In this subsection, the term ‘eligible 

18 Federal Direct Loan’ means a Federal Direct Staf19 ford Loan, Federal Direct PLUS Loan, Federal Di20 rect Unsubsidized Stafford Loan, or a Federal Di21 rect Consolidation Loan.’’. 

22 SEC. 311. HEALTH PROFESSIONS WORKFORCE FUND. 

23 (a) PURPOSE.—It is the purpose of this section to 

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1 ministration within the Department of Health and Human 

2 Services to provide for expanded and sustained national 

3 investment in the health professions and nursing work4 force development programs under title VII and title VIII 

5 of the Public Health Service Act. 

6 (b) ESTABLISHING THE HEALTH PROFESSIONS

7 WORKFORCE FUND.—There is authorized to be appro8 priated, and there is appropriated, out of any monies in 

9 the Treasury not otherwise appropriated, to the Health 

10 Professions Workforce Fund— 

11 (1) $355,000,000 for fiscal year 2017; 

12 (2) $375,000,000 for fiscal year 2018; 

13 (3) $392,000,000 for fiscal year 2019; 

14 (4) $412,000,000 for fiscal year 2020; 

15 (5) $432,000,000 for fiscal year 2021; 

16 (6) $454,000,000 for fiscal year 2022; 

17 (7) $476,000,000 for fiscal year 2023; 

18 (8) $500,000,000 for fiscal year 2024; 

19 (9) $525,000,000 for fiscal year 2025; and 

20 (10) $552,000,000 for fiscal year 2026. 

21 (c) FUNDING.— 

22 (1) For the purpose of carrying out health pro23 fessions education programs authorized under title 

24 VII of the Public Health Service Act, in addition to 

25 any other amounts authorized to be appropriated for 


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1 such purpose, there is authorized to be appropriated 

2 out of any monies in the Health Professions Work3 force Fund, the following: 

4 (A) $240,000,000 for fiscal year 2017. 

5 (B) $253,000,000 for fiscal year 2018. 

6 (C) $265,000,000 for fiscal year 2019. 

7 (D) $278,000,000 for fiscal year 2020. 

8 (E) $292,000,000 for fiscal year 2021. 

9 (F) $307,000,000 for fiscal year 2022. 

10 (G) $322,000,000 for fiscal year 2023. 

11 (H) $338,000,000 for fiscal year 2024. 

12 (I) $355,000,000 for fiscal year 2025. 

13 (J) $373,000,000 for fiscal year 2026. 

14 (2) For the purpose of carrying out nursing 

15 workforce development programs authorized under 

16 Title VIII of the Public Health Service Act, in addi17 tion to any other amounts authorized to be appro18 priated for such purpose, there is authorized to be 

19 appropriated out of any monies in the Health Pro20 fessions Workforce Fund, the following: 

21 (A) $115,000,000 for fiscal year 2017. 

22 (B) $122,000,000 for fiscal year 2018. 

23 (C) $127,000,000 for fiscal year 2019. 

24 (D) $134,000,000 for fiscal year 2020. 

25 (E) $140,000,000 for fiscal year 2021. 


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1 (F) $147,000,000 for fiscal year 2022. 

2 (G) $154,000,000 for fiscal year 2023. 

3 (H) $162,000,000 for fiscal year 2024. 

4 (I) $170,000,000 for fiscal year 2025. 

5 (J) $179,000,000 for fiscal year 2026. 

6 SEC. 312. FINDINGS; SENSE OF CONGRESS RELATING TO 

7 GRADUATE MEDICAL EDUCATION. 

8 (a) FINDINGS.—Congress finds the following: 

9 (1) Projections by the Association of American 

10 Medical Colleges (AAMC) and other expert entities, 

11 such as the Health Resources and Services Adminis12 tration (HRSA), have indicated a nationwide short13 age of up to 90,400 physicians, split evenly between 

14 primary care and specialists, by 2025. 

15 (2) Primarily due to the growing and aging 

16 population, over the next decade, physician demand 

17 is expected to grow up to 17 percent. 

18 (3) The United States Census Bureau estimates 

19 that the United States population will grow from 

20 321 million in 2015 to 347 million in 2025. Further, 

21 the number of Medicare beneficiaries is estimated to 

22 increase from 47.8 million in 2015 to approximately 

23 66 million in 2025. 


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1 (4) Approximately 36 percent of practicing phy2 sicians are over the age of 55 and are likely to retire 

3 within the next decade. 

4 (5) A nationwide physician shortage will result 

5 in many Americans waiting longer and traveling far6 ther for health care; seeking nonemergent care in 

7 emergency departments; and delaying treatment 

8 until their health care needs become more serious, 

9 complex, and costly. 

10 (6) Changing demographics (such as an aging 

11 population), new health care delivery models (such 

12 as medical homes), and other factors (such as dis13 aster preparedness) are contributing to a shortage of 

14 both generalist and specialist physicians. 

15 (7) These shortages will have the most severe 

16 impact on vulnerable and underserved populations, 

17 including racial/ethnic minorities and the approxi18 mately 20 percent of Americans who live in rural or 

19 inner-city locations designated as health professional 

20 shortage areas. 

21 (8) United States medical schools have com22 mitted to and have initiated a 30 percent increase 

23 in enrollment by 2017 to help reduce the Nation’s 

24 shortage of quality physicians. 


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1 (9) An increase in United States medical school 

2 graduates must be accompanied by an increase of 

3 4,000 graduate medical education (GME) training 

4 positions each year. 

5 (10) Graduate medical education programs and 

6 teaching hospitals provide venues in which the next 

7 generation of physicians learns to work collabo8 ratively with other physicians and health profes9 sionals, adopt more efficient care delivery models 

10 (such as care coordination and medical homes), in11 corporate health information technology and elec12 tronic health records in every aspect of their work, 

13 apply new methods of assuring quality and safety, 

14 and participate in groundbreaking clinical and public 

15 health research. 

16 (11) The Medicare Program under title XVIII 

17 of the Social Security Act (having more beneficiaries 

18 than any other health care program), supports its 

19 ‘‘fair share’’ of the costs associated with graduate 

20 medical education (GME). 

21 (12) In general, the level of support of graduate 

22 medical education by the Medicare Program has 

23 been capped since 1997 and has not been increased 

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1 cian shortage or to accommodate the increase in 

2 United States medical school graduates. 

3 (b) SENSE OF CONGRESS.—It is the sense of Con4 gress that eliminating the limit of the number of residency 

5 positions that receive some level of Medicare support 

6 under section 1886(h) of the Social Security Act (42 

7 U.S.C. 1395ww(h)), also referred to as the Medical grad8 uate medical education cap, is critical to— 

9 (1) ensuring an appropriate supply of physi10 cians to meet the Nation’s health care needs; 

11 (2) facilitating equitable access for all who seek 

12 health care; and 

13 (3) mitigating disparities in health and health 

14 care. 

15 SEC. 313. CAREER SUPPORT FOR SKILLED, INTERNATION16 ALLY EDUCATED HEALTH PROFESSIONALS. 

17 (a) FINDINGS.—Congress finds the following: 

18 (1) According to the Association of Schools of 

19 Public Health, projections indicate a nationwide 

20 shortage of up to 250,000 public health workers 

21 needed by 2020. 

22 (2) Similar trends are projected for other health 

23 professions indicating shortages across disciplines, 

24 including within the fields of nursing (500,000 by 

25 2025), dentistry (15,000 by 2025), pharmacy 


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1 (38,000 by 2030), mental and behavioral health, pri2 mary care (46,000 by 2025), and community and al3 lied health. 

4 (3) A nationwide health workforce shortage will 

5 result in serious health threats and more severe and 

6 costly health care needs, due to, in part, a delayed 

7 response to food-borne outbreaks, emerging infec8 tious diseases, natural disasters, fewer cancer 

9 screenings, and delayed treatment. 

10 (4) Vulnerable and underserved populations and 

11 health professional shortage areas will be most se12 verely impacted by the health workforce shortage. 

13 (5) According to the Migration Policy Institute, 

14 over 2,000,000 college-educated immigrants in the 

15 United States today are unemployed or under16 employed in low- or semi-skilled jobs that fail to 

17 draw on their education and expertise. 

18 (6) Approximately 2 out of every 5 internation19 ally educated immigrants are unemployed or under20 employed. 

21 (7) According to Drexel University Center for 

22 Labor Markets and Policy, underemployment for 

23 internationally educated immigrant women is 28 per24 cent higher than for their male counterparts. 


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1 (8) According to the Drexel University Center 

2 for labor markets and policy, the mean annual earn3 ings of underemployed immigrants were $32,000, or 

4 43 percent less than United States born college 

5 graduates employed in the college labor market. 

6 (9) According to Upwardly Global and the Wel7 come Back Initiative, with proper guidance and sup8 port, underemployed skilled immigrants typically in9 crease their income by 215 percent to 900 percent. 

10 (10) According to the Brookings Institution and 

11 the Partnership for a New American Economy, im12 migrants working in the health workforce are, on av13 erage, better educated than United States-born 

14 workers in the health workforce. 

15 (b) GRANTS TO ELIGIBLE ENTITIES.— 

16 (1) AUTHORITY TO PROVIDE GRANTS.—The 

17 Secretary of Health and Human Services acting 

18 through the Bureau of Health Workforce within the 

19 Health Resources and Services Administration, the 

20 National Institute on Minority Health and Health 

21 Disparities, or the Office of Minority Health (in this 

22 section referred to as the ‘‘Secretary’’) may award 

23 grants to eligible entities to carry out activities de24 scribed in subsection (c). 


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1 (2) ELIGIBILITY.—To be eligible to receive a 

2 grant under this section, an entity shall— 

3 (A) be a clinical, public health, or health 

4 services organization, a community-based or 

5 nonprofit entity, an academic institution, a 

6 faith-based organization, a State, county, or 

7 local government, an Area Health Education 

8 Center, or another entity determined appro9 priate by the Secretary; and 

10 (B) submit to the Secretary an application 

11 at such time, in such manner, and containing 

12 such information as the Secretary may require. 

13 (c) AUTHORIZED ACTIVITIES.—A grant awarded 

14 under this section shall be used— 

15 (1) to provide services to assist unemployed and 

16 underemployed skilled immigrants, residing in the 

17 United States, who have legal, permanent work au18 thorization and who are internationally educated 

19 health professionals, enter into the American health 

20 workforce with employment matching their health 

21 professional skills and education, and advance in em22 ployment to positions that better match their health 

23 professional education and expertise; 

24 (2) to provide training opportunities to reduce 

25 barriers to entry and advancement in the health 


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1 workforce for skilled, internationally educated immi2 grants; 

3 (3) to educate employers regarding the abilities 

4 and capacities of internationally educated health 

5 professionals; 

6 (4) to assist in the evaluation of foreign creden7 tials; and 

8 (5) to facilitate access to contextualized and ac9 celerated courses on English as a second language. 

10 (d) DEFINITION.—In this section: 

11 (1) The term ‘‘health professional’’ means an 

12 individual trained for employment or intended em13 ployment in the field of public health, health man14 agement, dentistry, health administration, medicine, 

15 nursing, pharmacy, psychology, social work, psychi16 atry, other mental and behavioral health, allied 

17 health, community health or wellness work, including 

18 fitness and nutrition, or other fields as determined 

19 appropriate by the Secretary. 

20 (2) The term ‘‘underemployed’’ means being 

21 employed at less skilled tasks than an employee’s 

22 training or abilities would otherwise permit. 

23 (e) AUTHORIZATION OF APPROPRIATIONS.—There is 

24 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 2017 through 2021. 

3 TITLE IV—IMPROVEMENT OF 

4 HEALTH CARE SERVICES 

5 Subtitle A—Health Empowerment 

6 Zones 

7 SEC. 401. SHORT TITLE. 

8 This subtitle may be cited as the ‘‘Health Empower9 ment Zone Act of 2016’’. 

10 SEC. 402. FINDINGS. 

11 The Congress finds the following: 

12 (1) Numerous studies and reports, including 

13 the 2012 National Healthcare Disparities Report of 

14 the Administration on Healthcare Research and 

15 Quality and the 2002 Unequal Treatment Report of 

16 the Institute of Medicine, document the extensive17 ness to which health disparities exist across the 

18 country. 

19 (2) These studies have found that, on average, 

20 racial and ethnic minorities are disproportionately 

21 afflicted with chronic and acute conditions—such as 

22 cancer, diabetes, musculoskeletal disease, obesity, 

23 and hypertension—and suffer worse health out24 comes, worse health status, and higher mortality 

25 rates than their White counterparts. 


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1 (3) Several recent studies also show that health 

2 disparities are a function of not only access to health 

3 care, but also the social determinants of health—in4 cluding the environment, the physical structure of 

5 communities, nutrition and food options, educational 

6 attainment, employment, race, ethnicity, geography, 

7 and language preference—that directly and indi8 rectly affect the health, health care, and wellness of 

9 individuals and communities. 

10 (4) Integrally involving and fully supporting the 

11 communities most affected by health inequities in 

12 the assessment, planning, launch, and evaluation of 

13 health disparity elimination efforts are among the 

14 leading recommendations made to adequately ad15 dress and ultimately reduce health disparities. 

16 (5) Recommendations also include supporting 

17 the efforts of community stakeholders from a broad 

18 cross section—including, but not limited to local 

19 businesses, local departments of commerce, edu20 cation, labor, urban planning, and transportation, 

21 and community-based and other nonprofit organiza22 tions, including national and regional intermediaries 

23 with demonstrated capacity to serve low-income 

24 urban communities—to find areas of common 

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1 laborate to improve the overall health and wellness 

2 of a community and its residents. 

3 SEC. 403. DESIGNATION OF HEALTH EMPOWERMENT 

4 ZONES. 

5 (a) IN GENERAL.—At the request of an eligible com6 munity partnership, the Secretary may designate an eligi7 ble area as a health empowerment zone. 

8 (b) ELIGIBILITY CRITERIA.— 

9 (1) ELIGIBLE COMMUNITY PARTNERSHIP.—A 

10 community partnership is eligible to submit a re11 quest under this section if the partnership— 

12 (A) demonstrates widespread public sup13 port from key individuals and entities in the eli14 gible area, including members of the target 

15 community, State and local governments, non16 profit organizations including national and re17 gional intermediaries with demonstrated capac18 ity to serve low-income urban communities, and 

19 community and industry leaders, for designa20 tion of the eligible area as a health empower21 ment zone; and 

22 (B) includes representatives of— 

23 (i) a broad cross section of stake24 holders and residents from communities in 

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1 tionate disparities in health status and 

2 health care; and 

3 (ii) organizations, facilities, and insti4 tutions that have a history of working 

5 within and serving such communities. 

6 (2) ELIGIBLE AREA.—An area is eligible to be 

7 designated as a health empowerment zone under this 

8 section if one or more communities in the area expe9 rience disproportionate disparities in health status 

10 and health care. In determining whether a commu11 nity experiences such disparities, the Secretary shall 

12 consider the data collected by the Department of 

13 Health and Human Services focusing on the fol14 lowing areas: 

15 (A) Access to affordable, high-quality 

16 health services. 

17 (B) The prevalence of disproportionate 

18 rates of certain illnesses or diseases including 

19 the following: 

20 (i) Arthritis, osteoporosis, chronic 

21 back conditions, and other musculoskeletal 

22 diseases. 

23 (ii) Cancer. 

24 (iii) Chronic kidney disease. 

25 (iv) Diabetes. 


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1 (v) Injury (intentional and uninten2 tional). 

3 (vi) Violence (intimate and non4 intimate). 

5 (vii) Maternal and paternal illnesses 

6 and diseases. 

7 (viii) Infant mortality. 

8 (ix) Mental illness and other disabil9 ities. 

10 (x) Substance abuse treatment and 

11 prevention, including underage drinking. 

12 (xi) Nutrition, obesity, and overweight 

13 conditions. 

14 (xii) Heart disease. 

15 (xiii) Hypertension. 

16 (xiv) Cerebrovascular disease or 

17 stroke. 

18 (xv) Tuberculosis. 

19 (xvi) HIV/AIDS and other sexually 

20 transmitted infections. 

21 (xvii) Viral hepatitis. 

22 (xviii) Asthma. 

23 (xix) Tooth decay and other oral 

24 health issues. 


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1 (C) Within the target community, the his2 torical and persistent presence of conditions 

3 that have been found to contribute to health 

4 disparities including any such conditions re5 specting the following: 

6 (i) Poverty. 

7 (ii) Educational status and the quality 

8 of community schools. 

9 (iii) Income. 

10 (iv) Access to high-quality affordable 

11 health care. 

12 (v) Work and work environment. 

13 (vi) Environmental conditions in the 

14 community, including with respect to clean 

15 water, clean air, and the presence or ab16 sence of pollutants. 

17 (vii) Language and English pro18 ficiency. 

19 (viii) Access to affordable healthy 

20 food. 

21 (ix) Access to ethnically and culturally 

22 diverse health and human service providers 

23 and practitioners. 

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1 ices and health and human service pro2 viders. 

3 (xi) Health-supporting infrastructure. 

4 (xii) Health insurance that is ade5 quate and affordable. 

6 (xiii) Race, racism, and bigotry (con7 scious and unconscious). 

8 (xiv) Sexual orientation. 

9 (xv) Health literacy. 

10 (xvi) Place of residence (such as 

11 urban areas, rural areas, and tribal res12 ervations). 

13 (xvii) Stress. 

14 (c) PROCEDURE.— 

15 (1) REQUEST.—A request under subsection (a) 

16 shall— 

17 (A) describe the bounds of the area to be 

18 designated as a health empowerment zone and 

19 the process used to select those bounds; 

20 (B) demonstrate that the partnership sub21 mitting the request is an eligible community 

22 partnership described in subsection (b)(1); 

23 (C) demonstrate that the area is an eligible 

24 area described in subsection (b)(2); 


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1 (D) include a comprehensive assessment of 

2 disparities in health status and health care ex3 perience by one or more communities in the 

4 area; 

5 (E) set forth— 

6 (i) a vision and a set of values for the 

7 area; and 

8 (ii) a comprehensive and holistic set of 

9 goals to be achieved in the area through 

10 designation as a health empowerment zone; 

11 and 

12 (F) include a strategic plan and an action 

13 plan for achieving the goals described in sub14 paragraph (E)(ii). 

15 (2) APPROVAL.—Not later than 60 days after 

16 the receipt of a request for designation of an area 

17 as a health empowerment zone under this section, 

18 the Secretary shall approve or disapprove the re19 quest. 

20 (d) MINIMUM NUMBER.—The Secretary— 

21 (1) shall designate not more than 110 health 

22 empowerment zones under this section; and 

23 (2) shall designate at least one health empower24 ment zone in each of the several States, the District 


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1 of Columbia, and each territory or possession of the 

2 United States. 

3 SEC. 404. ASSISTANCE TO THOSE SEEKING DESIGNATION. 

4 At the request of any organization or entity seeking 

5 to submit a request under section 403(a), the Secretary 

6 shall provide technical assistance, and may award a grant, 

7 to assist such organization or entity— 

8 (1) to form an eligible community partnership 

9 described in section 403(b)(1); 

10 (2) to complete a health assessment, including 

11 an assessment of health disparities under section 

12 403(c)(1)(D); or 

13 (3) to prepare and submit a request, including 

14 a strategic plan, in accordance with section 403. 

15 SEC. 405. BENEFITS OF DESIGNATION. 

16 (a) PRIORITY.—In awarding any competitive grant, 

17 a Federal official shall give priority to any applicant 

18 that— 

19 (1) meets the eligibility criteria for the grant; 

20 (2) proposes to use the grant for activities in a 

21 health empowerment zone; and 

22 (3) demonstrates that such activities will di23 rectly and significantly further the goals of the stra24 tegic plan approved for such zone under section 403. 


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1 (b) GRANTS FOR INITIAL IMPLEMENTATION OF

2 STRATEGIC PLAN.— 

3 (1) IN GENERAL.—Upon designating an eligible 

4 area as a health empowerment zone at the request 

5 of an eligible community partnership, the Secretary 

6 shall, subject to the availability of appropriations, 

7 make a grant to the community partnership for im8 plementation of the strategic plan for such zone. 

9 (2) GRANT PERIOD.—A grant under paragraph 

10 (1) for a health empowerment zone shall be for a pe11 riod of 2 years and may be renewed, except that the 

12 total period of grants under paragraph (1) for such 

13 zone may not exceed 10 years. 

14 (3) LIMITATION.—In awarding grants under 

15 this subsection, the Secretary shall not give less pri16 ority to an applicant or reduce the amount of a 

17 grant because the Secretary rendered technical as18 sistance or made a grant to the same applicant 

19 under section 404. 

20 (4) REPORTING.—The Secretary shall require 

21 each recipient of a grant under this subsection to re22 port to the Secretary not less than every 6 months 

23 on the progress in implementing the strategic plan 

24 for the health empowerment zone. 


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1 SEC. 406. DEFINITION. 

2 In this subtitle, the term ‘‘Secretary’’ means the Sec3 retary of Health and Human Services, acting through the 

4 Administrator of the Health Resources and Services Ad5 ministration and the Deputy Assistant Secretary for Mi6 nority Health, and in cooperation with the Director of the 

7 Office of Community Services and the Director of the Na8 tional Institute for Minority Health and Health Dispari9 ties. 

10 SEC. 407. AUTHORIZATION OF APPROPRIATIONS. 

11 To carry out this subtitle, there is authorized to be 

12 appropriated $100,000,000 for fiscal year 2017. 

13 Subtitle B—Other Improvements of 

14 Health Care Services 

15 CHAPTER 1—EXPANSION OF COVERAGE 

16 SEC. 411. AMENDMENT TO THE PUBLIC HEALTH SERVICE 

17 ACT. 

18 Title XXXIV of the Public Health Service Act, as 

19 amended by titles I, II, III, and IX of this Act, is further 

20 amended by inserting after subtitle C the following: 


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1 ‘‘Subtitle D—Reconstruction and 

2 Improvement Grants for Public 

3 Health Care Facilities Serving 

4 Pacific Islanders and the Insu5 lar Areas 

6 ‘‘SEC. 3451. GRANT SUPPORT FOR QUALITY IMPROVEMENT 

7 INITIATIVES. 

8 ‘‘(a) IN GENERAL.—The Secretary, in collaboration 

9 with the Administrator of the Health Resources and Serv10 ices Administration, the Director of the Agency for 

11 Healthcare Research and Quality, and the Administrator 

12 of the Centers for Medicare & Medicaid Services, shall 

13 award grants to eligible entities for the conduct of dem14 onstration projects to improve the quality of and access 

15 to health care. 

16 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 

17 under subsection (a), an entity shall— 

18 ‘‘(1) be a health center, hospital, health plan, 

19 health system, community clinic. or other health en20 tity determined appropriate by the Secretary— 

21 ‘‘(A) that, by legal mandate or explicitly 

22 adopted mission, provides patients with access 

23 to services regardless of their ability to pay; 

24 ‘‘(B) that provides care or treatment for a 

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1 sured, are receiving assistance under a State 

2 program under title XIX of the Social Security 

3 Act, or are members of vulnerable populations, 

4 as determined by the Secretary; and 

5 ‘‘(C)(i) with respect to which, not less than 

6 50 percent of the entity’s patient population is 

7 made up of racial and ethnic minorities; or 

8 ‘‘(ii) that— 

9 ‘‘(I) serves a disproportionate percent10 age of local, minority racial and ethnic pa11 tients, or that has a patient population, at 

12 least 50 percent of which is limited13 English-proficient; and 

14 ‘‘(II) provides an assurance that 

15 amounts received under the grant will be 

16 used only to support quality improvement 

17 activities in the racial and ethnic popu18 lation served; and 

19 ‘‘(2) prepare and submit to the Secretary an 

20 application at such time, in such manner, and con21 taining such information as the Secretary may re22 quire. 

23 ‘‘(c) PRIORITY.—In awarding grants under sub24 section (a), the Secretary shall give priority to applicants 

25 under subsection (b)(2) that— 


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1 ‘‘(1) demonstrate an intent to operate as part 

2 of a health care partnership, network, collaborative, 

3 coalition, or alliance where each member entity con4 tributes to the design, implementation, and evalua5 tion of the proposed intervention; or 

6 ‘‘(2) intend to use funds to carry out system7 wide changes with respect to health care quality im8 provement, including— 

9 ‘‘(A) improved systems for data collection 

10 and reporting; 

11 ‘‘(B) innovative collaborative or similar 

12 processes; 

13 ‘‘(C) group programs with behavioral or 

14 self-management interventions; 

15 ‘‘(D) case management services; 

16 ‘‘(E) physician or patient reminder sys17 tems; 

18 ‘‘(F) educational interventions; or 

19 ‘‘(G) other activities determined appro20 priate by the Secretary. 

21 ‘‘(d) USE OF FUNDS.—An entity shall use amounts 

22 received under a grant under subsection (a) to support 

23 the implementation and evaluation of health care quality 

24 improvement activities or minority health and health care 

25 disparity reduction activities that include— 


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1 ‘‘(1) with respect to health care systems, activi2 ties relating to improving— 

3 ‘‘(A) patient safety; 

4 ‘‘(B) timeliness of care; 

5 ‘‘(C) effectiveness of care; 

6 ‘‘(D) efficiency of care; 

7 ‘‘(E) patient centeredness; and 

8 ‘‘(F) health information technology; and 

9 ‘‘(2) with respect to patients, activities relating 

10 to— 

11 ‘‘(A) staying healthy; 

12 ‘‘(B) getting well, mentally and physically; 

13 ‘‘(C) living effectively with illness or dis14 ability; and 

15 ‘‘(D) coping with end-of-life issues. 

16 ‘‘(e) COMMON DATA SYSTEMS.—The Secretary shall 

17 provide financial and other technical assistance to grant18 ees under this section for the development of common data 

19 systems. 

20 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 

21 are authorized to be appropriated to carry out this section 

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

23 2017 through 2022. 


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1 ‘‘SEC. 3452. CENTERS OF EXCELLENCE. 

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

3 the Administrator of the Health Resources and Services 

4 Administration, shall designate centers of excellence at 

5 public hospitals, and other health systems serving large 

6 numbers of minority patients, that— 

7 ‘‘(1) meet the requirements of section 

8 3451(b)(1); 

9 ‘‘(2) demonstrate excellence in providing care to 

10 minority populations; and 

11 ‘‘(3) demonstrate excellence in reducing dispari12 ties in health and health care. 

13 ‘‘(b) REQUIREMENTS.—A hospital or health system 

14 that serves as a center of excellence under subsection (a) 

15 shall— 

16 ‘‘(1) design, implement, and evaluate programs 

17 and policies relating to the delivery of care in ra18 cially, ethnically, and linguistically diverse popu19 lations; 

20 ‘‘(2) provide training and technical assistance 

21 to other hospitals and health systems relating to the 

22 provision of quality health care to minority popu23 lations; and 

24 ‘‘(3) develop activities for graduate or con25 tinuing medical education that institutionalize a 


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1 focus on cultural competence training for health care 

2 providers. 

3 ‘‘(c) 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 2017 through 2022. 

7 ‘‘SEC. 3453. RECONSTRUCTION AND IMPROVEMENT GRANTS 

8 FOR PUBLIC HEALTH CARE FACILITIES SERV9 ING PACIFIC ISLANDERS AND THE INSULAR 

10 AREAS. 

11 ‘‘(a) IN GENERAL.—The Secretary shall provide di12 rect financial assistance to designated health care pro13 viders and community health centers in American Samoa, 

14 Guam, the Commonwealth of the Northern Mariana Is15 lands, the United States Virgin Islands, Puerto Rico, and 

16 Hawaii for the purposes of reconstructing and improving 

17 health care facilities and services in a culturally competent 

18 and sustainable manner. 

19 ‘‘(b) ELIGIBILITY.—To be eligible to receive direct fi20 nancial assistance under subsection (a), an entity shall be 

21 a public health facility or community health center located 

22 in American Samoa, Guam, the Commonwealth of the 

23 Northern Mariana Islands, the United States Virgin Is24 lands, Puerto Rico, or Hawaii that— 

25 ‘‘(1) is owned or operated by— 


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1 ‘‘(A) the Government of American Samoa, 

2 Guam, the Commonwealth of the Northern 

3 Mariana Islands, the United States Virgin Is4 lands, Puerto Rico, or Hawaii or a unit of local 

5 government; or 

6 ‘‘(B) a nonprofit organization; and 

7 ‘‘(2)(A) provides care or treatment for a sub8 stantial number of patients who are uninsured, re9 ceiving assistance under a State program under a 

10 title XVIII of the Social Security Act, or a State 

11 program under title XIX of such Act, or who are 

12 members of a vulnerable population, as determined 

13 by the Secretary; or 

14 ‘‘(B) serves a disproportionate percentage of 

15 local, minority racial and ethnic patients. 

16 ‘‘(c) REPORT.—Not later than 180 days after the 

17 date of enactment of this title and annually thereafter, the 

18 Secretary shall submit to the Congress and the President 

19 a report that includes an assessment of health resources 

20 and facilities serving populations in American Samoa, 

21 Guam, the Commonwealth of the Northern Mariana Is22 lands, the United States Virgin Islands, Puerto Rico, and 

23 Hawaii. In preparing such report, the Secretary shall— 


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1 ‘‘(1) consult with and obtain information on all 

2 health care facilities needs from the entities de3 scribed in subsection (b); 

4 ‘‘(2) include all amounts of Federal assistance 

5 received by each entity in the preceding fiscal year; 

6 ‘‘(3) review the total unmet needs of each juris7 diction for health care facilities, including needs for 

8 renovation and expansion of existing facilities; 

9 ‘‘(4) include a strategic plan for addressing the 

10 needs of each jurisdiction identified in the report; 

11 and 

12 ‘‘(5) evaluate the effectiveness of the care pro13 vided by measuring patient outcomes and cost meas14 ures. 

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

16 are authorized to be appropriated such sums as necessary 

17 to carry out this section.’’. 

18 SEC. 412. REMOVING CITIZENSHIP AND IMMIGRATION BAR19 RIERS TO ACCESS TO AFFORDABLE HEALTH 

20 CARE UNDER THE ACA. 

21 (a) IN GENERAL.— 

22 (1) PREMIUM TAX CREDITS.—Section 36B of 

23 the Internal Revenue Code of 1986 is amended— 

24 (A) in subsection (c)(1)(B)— 


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1 (i) by amending the subparagraph 

2 heading to read as follows: ‘‘SPECIAL RULE

3 FOR CERTAIN INDIVIDUALS INELIGIBLE

4 FOR MEDICAID DUE TO STATUS’’, and 

5 (ii) in clause (ii), by striking ‘‘lawfully 

6 present in the United States, but’’ and in7 serting ‘‘who’’, and 

8 (B) by striking subsection (e). 

9 (2) COST-SHARING REDUCTIONS.—Section 1402 

10 of the Patient Protection and Affordable Care Act 

11 (42 U.S.C. 18071) is amended by striking sub12 section (e). 

13 (3) BASIC HEALTH PROGRAM ELIGIBILITY.— 

14 Section 1331(e)(1)(B) of the Patient Protection and 

15 Affordable Care Act (42 U.S.C. 18051(e)(1)(B)) is 

16 amended by striking ‘‘lawfully present in the United 

17 States’’. 

18 (4) RESTRICTIONS ON FEDERAL PAYMENTS.— 

19 Section 1412 of the Patient Protection and Afford20 able Care Act (42 U.S.C. 18082) is amended by 

21 striking subsection (d). 

22 (5) REQUIREMENT TO MAINTAIN MINIMUM ES23 SENTIAL COVERAGE.—Subsection (d) of section 

24 5000A of the Internal Revenue Code of 1986 is 


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1 amended by striking paragraph (3) and by redesig2 nating paragraph (4) as paragraph (3). 

3 (b) CONFORMING AMENDMENT.— 

4 (1) Section 1411(a) of the Patient Protection 

5 and Affordable Care Act (42 U.S.C. 18081(a)) is 

6 amended by striking paragraph (1) and redesig7 nating paragraphs (2), (3), and (4) as paragraphs 

8 (1), (2), and (3), respectively. 

9 (2) Section 1312(f) of the Patient Protection 

10 and Affordable Care Act (42 U.S.C. 18032(f)) is 

11 amended— 

12 (A) in the subsection heading, by striking 

13 ‘‘access limited to citizens and lawful resi14 dents’’; and 

15 (B) by striking paragraph (3). 

16 SEC. 413. STUDY ON THE UNINSURED. 

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

18 Human Services (in this section referred to as the ‘‘Sec19 retary’’) shall— 

20 (1) conduct a study, in accordance with the 

21 standards under section 3101 of the Public Health 

22 Service Act (42 U.S.C. 300kk), on the demographic 

23 characteristics of the population of individuals who 

24 do not have health insurance coverage; and 


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1 (2) predict, based on such study, the demo2 graphic characteristics of the population of individ3 uals who would remain without health insurance cov4 erage after the end of open enrollment or any special 

5 enrollment period. 

6 (b) REPORTING REQUIREMENTS.— 

7 (1) IN GENERAL.—Not later than 12 months 

8 after the date of the enactment of this Act, the Sec9 retary shall submit to the Congress the results of 

10 the study under subsection (a)(1) and the prediction 

11 made under subsection (a)(2). 

12 (2) REPORTING OF DEMOGRAPHIC CHARACTER13 ISTICS.—The Secretary shall report the demographic 

14 characteristics under paragraphs (1) and (2) of sub15 section (a) on the basis of racial and ethnic group, 

16 and shall stratify the reporting on each racial and 

17 ethnic group by other demographic characteristics 

18 that can impact access to health insurance coverage, 

19 such as sexual orientation, gender identity, primary 

20 language, disability status, sex, socioeconomic sta21 tus, age group, and citizenship and immigration sta22 tus, in a manner consistent with title I of this Act. 


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1 SEC. 414. MEDICAID PAYMENT PARITY FOR THE TERRI2 TORIES. 

3 (a) ELIMINATION OF FUNDING LIMITATIONS FOR

4 PUERTO RICO, THE UNITED STATES VIRGIN ISLANDS, 

5 GUAM, THE COMMONWEALTH OF THE NORTHERN MAR6 IANA ISLANDS, AND AMERICAN SAMOA.— 

7 (1) IN GENERAL.—Section 1108 of the Social 

8 Security Act (42 U.S.C. 1308) is amended— 

9 (A) in subsection (f), in the matter pre10 ceding paragraph (1), by striking ‘‘subsection 

11 (g)’’ and inserting ‘‘subsections (g) and (h)’’; 

12 (B) in subsection (g)(2), in the matter pre13 ceding subparagraph (A)— 

14 (i) by striking ‘‘Notwithstanding sub15 section (f) and subject to and’’ and insert16 ing ‘‘Notwithstanding subsection (f) and 

17 subject to’’; and 

18 (ii) by striking ‘‘paragraphs (3) and 

19 (5)’’ and inserting ‘‘, paragraphs (3) and 

20 (5) of this subsection, and subsection (h)’’; 

21 and 

22 (C) by adding at the end the following new 

23 subsection: 

24 ‘‘(h) SUNSET OF FUNDING LIMITATIONS FOR PUER25 TO RICO, THE UNITED STATES VIRGIN ISLANDS, GUAM, 

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1 LANDS, AND AMERICAN SAMOA.—Subsections (f) and (g) 

2 shall not apply to Puerto Rico, the United States Virgin 

3 Islands, Guam, the Commonwealth of the Northern Mar4 iana Islands, and American Samoa for any fiscal year 

5 after fiscal year 2017.’’. 

6 (2) CONFORMING AMENDMENT.—Section 

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

8 1396c(u)) is amended by striking paragraph (4). 

9 (3) EFFECTIVE DATE.—The amendments made 

10 by this subsection shall apply beginning with fiscal 

11 year 2018. 

12 (b) PARITY IN FMAP.— 

13 (1) IN GENERAL.—Section 1905(b) of the So14 cial Security Act (42 U.S.C. 1396d(b)) is amended 

15 by inserting after ‘‘and American Samoa shall be 55 

16 percent,’’ the following: ‘‘(except that, beginning 

17 with fiscal year 2020, the Federal medical assistance 

18 percentage for Puerto Rico, the United States Virgin 

19 Islands, Guam, the Commonwealth of the Northern 

20 Mariana Islands, and American Samoa shall be the 

21 Federal medical assistance percentage determined by 

22 the Secretary in consultation (for the United States 

23 Virgin Islands, Guam, the Commonwealth of the 

24 Northern Mariana Islands, and American Samoa) 

25 with the Secretary of the Interior)’’. 


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1 (2) 2-FISCAL-YEAR TRANSITION.—Notwith2 standing any other provision of law, during fiscal 

3 years 2018 and 2019, the Federal medical assist4 ance percentage established under section 1905(b) of 

5 the Social Security Act (42 U.S.C. 1396d(b)) for 

6 Puerto Rico, the United States Virgin Islands, 

7 Guam, the Commonwealth of the Northern Mariana 

8 Islands, and American Samoa shall be the highest 

9 such Federal medical assistance percentage applica10 ble to any of the 50 States or the District of Colum11 bia for the fiscal year involved. 

12 (3) PER CAPITA INCOME DATA.— 

13 (A) REPORT TO CONGRESS.—Not later 

14 than October 1, 2018, the Secretary of Health 

15 and Human Services shall submit to Congress 

16 a report that describes the per capita income 

17 data used to promulgate the Federal medical 

18 assistance percentage in the territories and how 

19 such data differ from the per capita income 

20 data used to promulgate Federal medical assist21 ance percentages for the 50 States and the Dis22 trict of Columbia. The report should include 

23 recommendations on how the Federal medical 

24 assistance percentages can be calculated for the 


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1 territories to ensure parity with the 50 States 

2 and the District of Columbia. 

3 (B) APPLICATION.—Section 1101(a)(8)(B) 

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

5 1308(a)(8)(B)) is amended— 

6 (i) by striking ‘‘(other than Puerto 

7 Rico, the United States Virgin Islands, and 

8 Guam)’’ and inserting ‘‘(including Puerto 

9 Rico, the United States Virgin Islands, 

10 Guam, the Commonwealth of the Northern 

11 Mariana Islands, and American Samoa)’’; 

12 and 

13 (ii) by inserting ‘‘(or, if such satisfac14 tory data are not available in the case of 

15 the United States Virgin Islands, Guam, 

16 the Northern Mariana Islands, or Amer17 ican Samoa, satisfactory data available 

18 from the Department of the Interior for 

19 the same period, or if such satisfactory 

20 data are not available in the case of Puerto 

21 Rico, satisfactory data available from the 

22 government of the Commonwealth of Puer23 to Rico for the same period)’’ after ‘‘De24 partment of Commerce’’. 


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1 SEC. 415. EXTENSION OF MEDICARE SECONDARY PAYER. 

2 (a) IN GENERAL.—Section 1862(b)(1)(C) of the So3 cial Security Act (42 U.S.C. 1395y(b)(1)(C)) is amend4 ed— 

5 (1) in the last sentence, by inserting ‘‘, and be6 fore January 1, 2017’’ after ‘‘prior to such date)’’; 

7 and 

8 (2) by adding at the end the following new sen9 tence: ‘‘Effective for items and services furnished on 

10 or after January 1, 2017 (with respect to periods 

11 beginning on or after the date that is 42 months 

12 prior to such date), clauses (i) and (ii) shall be ap13 plied by substituting ‘42-month’ for ‘12-month’ each 

14 place it appears in the first sentence.’’. 

15 (b) EFFECTIVE DATE.—The amendments made by 

16 this section shall take effect on the date of enactment of 

17 this Act. For purposes of determining an individual’s sta18 tus under section 1862(b)(1)(C) of the Social Security Act 

19 (42 U.S.C. 1395y(b)(1)(C)), as amended by subsection 

20 (a), an individual who is within the coordinating period 

21 as of the date of enactment of this Act shall have that 

22 period extended to the full 42 months described in the last 

23 sentence of such section, as added by the amendment 

24 made by subsection (a)(2). 


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1 SEC. 416. BORDER HEALTH GRANTS. 

2 (a) ELIGIBLE ENTITY DEFINED.—In this section, 

3 the term ‘‘eligible entity’’ means a State, public institution 

4 of higher education, local government, tribal government, 

5 nonprofit health organization, community health center, or 

6 community clinic receiving assistance under section 330 

7 of the Public Health Service Act (42 U.S.C. 254b), that 

8 is located in the border area. 

9 (b) AUTHORIZATION.—From funds appropriated 

10 under subsection (f), the Secretary of Health and Human 

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

12 acting through the United States members of the United 

13 States-Mexico Border Health Commission, shall award 

14 grants to eligible entities to address priorities and rec15 ommendations to improve the health of border area resi16 dents that are established by— 

17 (1) the United States members of the United 

18 States-Mexico Border Health Commission; 

19 (2) the State border health offices; and 

20 (3) the Secretary. 

21 (c) APPLICATION.—An eligible entity that desires a 

22 grant under subsection (b) shall submit an application to 

23 the Secretary at such time, in such manner, and con24 taining such information as the Secretary may require. 


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1 (d) USE OF FUNDS.—An eligible entity that receives 

2 a grant under subsection (b) shall use the grant funds 

3 for— 

4 (1) programs relating to— 

5 (A) maternal and child health; 

6 (B) primary care and preventative health; 

7 (C) public health and public health infra8 structure; 

9 (D) musculoskeletal health and obesity; 

10 (E) health education and promotion; 

11 (F) oral health; 

12 (G) mental and behavioral health; 

13 (H) substance abuse; 

14 (I) health conditions that have a high prev15 alence in the border area; 

16 (J) medical and health services research; 

17 (K) workforce training and development; 

18 (L) community health workers, patient 

19 navigators, and promotoras; 

20 (M) health care infrastructure problems in 

21 the border area (including planning and con22 struction grants); 

23 (N) health disparities in the border area; 

24 (O) environmental health; and 


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1 (P) outreach and enrollment services with 

2 respect to Federal programs (including pro3 grams authorized under titles XIX and XXI of 

4 the Social Security Act (42 U.S.C. 1396 and 

5 1397aa)); and 

6 (2) other programs determined appropriate by 

7 the Secretary. 

8 (e) SUPPLEMENT, NOT SUPPLANT.—Amounts pro9 vided to an eligible entity awarded a grant under sub10 section (b) shall be used to supplement and not supplant 

11 other funds available to the eligible entity to carry out the 

12 activities described in subsection (d). 

13 (f) AUTHORIZATION OF APPROPRIATIONS.—There 

14 are authorized to be appropriated to carry out this section, 

15 $200,000,000 for fiscal year 2017, and such sums as may 

16 be necessary for each succeeding fiscal year. 

17 SEC. 417. REMOVING MEDICARE BARRIER TO HEALTH 

18 CARE. 

19 (a) PART A.—Section 1818(a)(3) of the Social Secu20 rity Act (42 U.S.C. 1395i–2(a)(3)) is amended by striking 

21 ‘‘an alien’’ and all that follows through ‘‘under this sec22 tion’’ and inserting ‘‘an individual who is lawfully present 

23 in the United States’’. 

24 (b) PART B.—Section 1836(2) of the Social Security 

25 Act (42 U.S.C. 1395o(2)) is amended by striking ‘‘an 


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1 alien’’ and all that follows through ‘‘under this part’’ and 

2 inserting ‘‘an individual who is lawfully present in the 

3 United States’’. 

4 SEC. 418. 100 PERCENT FMAP FOR MEDICAL ASSISTANCE 

5 PROVIDED BY URBAN INDIAN HEALTH CEN6 TERS. 

7 (a) IN GENERAL.—The third sentence of section 

8 1905(b) of the Social Security Act (42 U.S.C. 1396(b)) 

9 is amended by inserting ‘‘or are received through a pro10 gram operated by an urban Indian organization through 

11 a grant or contract under title V of such Act’’ after ‘‘(as 

12 defined in section 4 of the Indian Health Care Improve13 ment Act)’’. 

14 (b) EFFECTIVE DATE.—The amendment made by 

15 this section shall apply to medical assistance provided on 

16 or after the date of enactment of this Act. 

17 SEC. 419. 100 PERCENT FMAP FOR MEDICAL ASSISTANCE 

18 PROVIDED TO A NATIVE HAWAIIAN THROUGH 

19 A FEDERALLY QUALIFIED HEALTH CENTER 

20 OR A NATIVE HAWAIIAN HEALTH CARE SYS21 TEM UNDER THE MEDICAID PROGRAM. 

22 (a) IN GENERAL.—The third sentence of section 

23 1905(b) of the Social Security Act (42 U.S.C. 1396d(b)), 

24 as amended by section 418(a), is amended by inserting 

25 before the period the following: ‘‘; and, with respect to 


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1 medical assistance provided to a Native Hawaiian (as de2 fined in section 12(2) of the Native Hawaiian Health Care 

3 Improvement Act) through a federally qualified health 

4 center or a Native Hawaiian health care system (as de5 fined in section 12(6) of such Act), whether directly, by 

6 referral, or under contract or other arrangement between 

7 such federally qualified health center or Native Hawaiian 

8 health care system and another health care provider’’. 

9 (b) EFFECTIVE DATE.—The amendment made by 

10 this section shall apply to medical assistance provided on 

11 or after the date of enactment of this Act. 

12 CHAPTER 2—EXPANSION OF ACCESS 

13 SEC. 431. GRANTS FOR RACIAL AND ETHNIC APPROACHES 

14 TO COMMUNITY HEALTH. 

15 (a) PURPOSE.—It is the purpose of this section to 

16 provide for the awarding of grants to assist communities 

17 in mobilizing and organizing resources in support of effec18 tive and sustainable programs that will reduce or eliminate 

19 disparities in health and health care experienced by racial 

20 and ethnic minority individuals. 

21 (b) AUTHORITY TO AWARD GRANTS.—The Secretary 

22 of Health and Human Services, acting through the Ad23 ministrator of the Health Resources and Services Admin24 istration, shall award grants to eligible entities to assist 

25 in designing, implementing, and evaluating culturally and 


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1 linguistically appropriate, science-based, and community2 driven sustainable strategies to eliminate racial and ethnic 

3 health and health care disparities. 

4 (c) ELIGIBLE ENTITIES.—To be eligible to receive a 

5 grant under this section, an entity shall— 

6 (1) represent a coalition— 

7 (A) whose principal purpose is to develop 

8 and implement interventions to reduce or elimi9 nate a health or health care disparity in a tar10 geted racial or ethnic minority group in the 

11 community served by the coalition; and 

12 (B) that includes— 

13 (i) members selected from among— 

14 (I) public health departments; 

15 (II) community-based organiza16 tions; 

17 (III) university and research or18 ganizations; 

19 (IV) American Indian tribal or20 ganizations, national American Indian 

21 organizations, Indian Health Service, 

22 or organizations serving Alaska Na23 tives; and 

24 (V) interested public or private 

25 health care providers or organizations 


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1 as deemed appropriate by the Sec2 retary; and 

3 (ii) at least 1 member from a commu4 nity-based organization that represents the 

5 targeted racial or ethnic minority group; 

6 and 

7 (2) submit to the Secretary an application at 

8 such time, in such manner, and containing such in9 formation as the Secretary may require, which shall 

10 include— 

11 (A) a description of the targeted racial or 

12 ethnic populations in the community to be 

13 served under the grant; 

14 (B) a description of at least 1 health dis15 parity that exists in the racial or ethnic tar16 geted populations, including health issues such 

17 as infant mortality, breast and cervical cancer 

18 screening and management, musculoskeletal 

19 diseases and obesity, prostate cancer screening 

20 and management, cardiovascular disease, diabe21 tes, child and adult immunization levels, or 

22 other health priority areas as designated by the 

23 Secretary; and 

24 (C) a demonstration of a proven record of 

25 accomplishment of the coalition members in 


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1 serving and working with the targeted commu2 nity. 

3 (d) SUSTAINABILITY.—The Secretary shall give pri4 ority to an eligible entity under this section if the entity 

5 agrees that, with respect to the costs to be incurred by 

6 the entity in carrying out the activities for which the grant 

7 was awarded, the entity (and each of the participating 

8 partners in the coalition represented by the entity) will 

9 maintain its expenditures of non-Federal funds for such 

10 activities at a level that is not less than the level of such 

11 expenditures during the fiscal year immediately preceding 

12 the first fiscal year for which the grant is awarded. 

13 (e) NONDUPLICATION.—Funds provided through this 

14 grant program should supplement, not supplant, existing 

15 Federal funding, and the funds should not be used to du16 plicate the activities of the other health disparity grant 

17 programs in this Act. 

18 (f) TECHNICAL ASSISTANCE.—The Secretary may, 

19 either directly or by grant or contract, provide any entity 

20 that receives a grant under this section with technical and 

21 other nonfinancial assistance necessary to meet the re22 quirements of this section. 

23 (g) DISSEMINATION.—The Secretary shall encourage 

24 and enable grantees to share best practices, evaluation re25 sults, and reports with communities not affiliated with 


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1 grantees using the Internet, conferences, and other perti2 nent information regarding the projects funded by this 

3 section, including the outreach efforts of the Office of Mi4 nority Health and Health Disparity Elimination and the 

5 Centers for Disease Control and Prevention. 

6 (h) ADMINISTRATIVE BURDENS.—The Secretary 

7 shall make every effort to minimize duplicative or unneces8 sary administrative burdens on grantees. 

9 (i) DEFINITION.—In this section, the term ‘‘Sec10 retary’’ means the Secretary of Health and Human Serv11 ices. 

12 (j) AUTHORIZATION OF APPROPRIATIONS.—There 

13 are authorized to be appropriated such sums as may be 

14 necessary to carry out this section. 

15 SEC. 432. CRITICAL ACCESS HOSPITAL IMPROVEMENTS. 

16 (a) ELIMINATION OF ISOLATION TEST FOR COST17 BASED AMBULANCE REIMBURSEMENT.— 

18 (1) IN GENERAL.—Section 1834(l)(8) of the 

19 Social Security Act (42 U.S.C. 1395m(l)(8)) is 

20 amended— 

21 (A) in subparagraph (B)— 

22 (i) by striking ‘‘owned and’’; and 

23 (ii) by inserting ‘‘(including when 

24 such services are provided by the entity 


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1 under an arrangement with the hospital)’’ 

2 after ‘‘hospital’’; and 

3 (B) by striking the comma at the end of 

4 subparagraph (B) and all that follows and in5 serting a period. 

6 (2) EFFECTIVE DATE.—The amendments made 

7 by this subsection shall apply to services furnished 

8 on or after January 1, 2015. 

9 (b) PROVISION OF A MORE FLEXIBLE ALTERNATIVE

10 TO THE CAH DESIGNATION 25 INPATIENT BED LIMIT

11 REQUIREMENT.— 

12 (1) IN GENERAL.—Section 1820(c)(2) of the 

13 Social Security Act (42 U.S.C. 1395i–4(c)(2)) is 

14 amended— 

15 (A) in subparagraph (B)(iii), by striking 

16 ‘‘provides not more than’’ and inserting ‘‘sub17 ject to subparagraph (F), provides not more 

18 than’’; and 

19 (B) by adding at the end the following new 

20 subparagraph: 

21 ‘‘(F) ALTERNATIVE TO 25 INPATIENT BED

22 LIMIT REQUIREMENT.— 

23 ‘‘(i) IN GENERAL.—A State may elect 

24 to treat a facility, with respect to the des25 ignation of the facility for a cost-reporting 


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1 period, as satisfying the requirement of 

2 subparagraph (B)(iii) relating to a max3 imum number of acute care inpatient beds 

4 if the facility elects, in accordance with a 

5 method specified by the Secretary and be6 fore the beginning of the cost reporting pe7 riod, to meet the requirement under clause 

8 (ii). 

9 ‘‘(ii) ALTERNATE REQUIREMENT.— 

10 The requirement under this clause, with 

11 respect to a facility and a cost-reporting 

12 period, is that the total number of inpa13 tient bed days described in subparagraph 

14 (B)(iii) during such period will not exceed 

15 7,300. For purposes of this subparagraph, 

16 an individual who is an inpatient in a bed 

17 in the facility for a single day shall be 

18 counted as one inpatient bed day. 

19 ‘‘(iii) WITHDRAWAL OF ELECTION.— 

20 The option described in clause (i) shall not 

21 apply to a facility for a cost-reporting pe22 riod if the facility (for any two consecutive 

23 cost-reporting periods during the previous 

24 5 cost-reporting periods) was treated under 

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1 patient bed days for each of such two cost2 reporting periods that exceeded the num3 ber specified in such clause.’’. 

4 (2) EFFECTIVE DATE.—The amendments made 

5 by paragraph (1) shall apply to cost-reporting peri6 ods beginning on or after the date of the enactment 

7 of this Act. 

8 SEC. 433. ESTABLISHMENT OF RURAL COMMUNITY HOS9 PITAL (RCH) PROGRAM. 

10 (a) IN GENERAL.—Section 1861 of the Social Secu11 rity Act (42 U.S.C. 1395x), as amended by section 

12 205(b)(1), is amended by adding at the end of the fol13 lowing new subsection: 

14 ‘‘Rural Community Hospital; Rural Community Hospital 

15 Services 

16 ‘‘(jjj)(1) The term ‘rural community hospital’ means 

17 a hospital (as defined in subsection (e)) that— 

18 ‘‘(A) is located in a rural area (as defined in 

19 section 1886(d)(2)(D)) or treated as being so lo20 cated pursuant to section 1886(d)(8)(E); 

21 ‘‘(B) subject to paragraph (2), has less than 51 

22 acute care inpatient beds, as reported in its most re23 cent cost report; 

24 ‘‘(C) makes available 24-hour emergency care 

25 services; 


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1 ‘‘(D) subject to paragraph (3), has a provider 

2 agreement in effect with the Secretary and is open 

3 to the public as of January 1, 2010; and 

4 ‘‘(E) applies to the Secretary for such designa5 tion. 

6 ‘‘(2) For purposes of paragraph (1)(B), beds in a 

7 psychiatric or rehabilitation unit of the hospital which is 

8 a distinct part of the hospital shall not be counted. 

9 ‘‘(3) Paragraph (1)(D) shall not be construed to pro10 hibit any of the following from qualifying as a rural com11 munity hospital: 

12 ‘‘(A) A replacement facility (as defined by the 

13 Secretary in regulations in effect on January 1, 

14 2012) with the same service area (as defined by the 

15 Secretary in regulations in effect on such date). 

16 ‘‘(B) A facility obtaining a new provider num17 ber pursuant to a change of ownership. 

18 ‘‘(C) A facility which has a binding written 

19 agreement with an outside, unrelated party for the 

20 construction, reconstruction, lease, rental, or financ21 ing of a building as of January 1, 2012. 

22 ‘‘(4) Nothing in this subsection shall be construed as 

23 prohibiting a critical access hospital from qualifying as a 

24 rural community hospital if the critical access hospital 


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1 meets the conditions otherwise applicable to hospitals 

2 under subsection (e) and section 1866. 

3 ‘‘(5) Nothing in this subsection shall be construed as 

4 prohibiting a rural community hospital participating in 

5 the demonstration program under section 410A of the 

6 Medicare Prescription Drug, Improvement, and Mod7 ernization Act of 2003 (Public Law 108–173; 117 Stat. 

8 2313) from qualifying as a rural community hospital if 

9 the rural community hospital meets the conditions other10 wise applicable to hospitals under subsection (e) and sec11 tion 1866.’’. 

12 (b) PAYMENT.— 

13 (1) INPATIENT HOSPITAL SERVICES.—Section 

14 1814 of the Social Security Act (42 U.S.C. 1395f) 

15 is amended by adding at the end the following new 

16 subsection: 

17 ‘‘Payment for Inpatient Services Furnished in Rural 

18 Community Hospitals 

19 ‘‘(m) The amount of payment under this part for in20 patient hospital services furnished in a rural community 

21 hospital, other than such services furnished in a psy22 chiatric or rehabilitation unit of the hospital which is a 

23 distinct part, is, at the election of the hospital in the appli24 cation referred to in section 1861(jjj)(1)(E)— 


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1 ‘‘(1) 101 percent of the reasonable costs of pro2 viding such services, without regard to the amount 

3 of the customary or other charge, or 

4 ‘‘(2) the amount of payment provided for under 

5 the prospective payment system for inpatient hos6 pital services under section 1886(d).’’. 

7 (2) OUTPATIENT SERVICES.—Section 1834 of 

8 such Act (42 U.S.C. 1395m) is amended by adding 

9 at the end the following new subsection: 

10 ‘‘(p) PAYMENT FOR OUTPATIENT SERVICES FUR11 NISHED IN RURAL COMMUNITY HOSPITALS.—The 

12 amount of payment under this part for outpatient services 

13 furnished in a rural community hospital is, at the election 

14 of the hospital in the application referred to in section 

15 1861(jjj)(1)(E)— 

16 ‘‘(1) 101 percent of the reasonable costs of pro17 viding such services, without regard to the amount 

18 of the customary or other charge and any limitation 

19 under section 1861(v)(1)(U), or 

20 ‘‘(2) the amount of payment provided for under 

21 the prospective payment system for covered OPD 

22 services under section 1833(t).’’. 

23 (3) EXEMPTION FROM 30-PERCENT REDUCTION

24 IN REIMBURSEMENT FOR BAD DEBT.—Section 

25 1861(v)(1)(T) of such Act (42 U.S.C. 


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1 1395x(v)(1)(T)) is amended by inserting ‘‘(other 

2 than for a rural community hospital)’’ after ‘‘In de3 termining such reasonable costs for hospitals’’. 

4 (c) BENEFICIARY COST-SHARING FOR OUTPATIENT

5 SERVICES.—Section 1834(p) of such Act (as added by 

6 subsection (b)(2)) is amended— 

7 (1) by redesignating paragraphs (1) and (2) as 

8 subparagraphs (A) and (B), respectively; 

9 (2) by inserting ‘‘(1)’’ after ‘‘(p)’’; and 

10 (3) by adding at the end the following: 

11 ‘‘(2) The amounts of beneficiary cost-sharing for out12 patient services furnished in a rural community hospital 

13 under this part shall be as follows: 

14 ‘‘(A) For items and services that would have 

15 been paid under section 1833(t) if provided by a 

16 hospital, the amount of cost-sharing determined 

17 under paragraph (8) of such section. 

18 ‘‘(B) For items and services that would have 

19 been paid under section 1833(h) if furnished by a 

20 provider or supplier, no cost-sharing shall apply. 

21 ‘‘(C) For all other items and services, the 

22 amount of cost-sharing that would apply to the item 

23 or service under the methodology that would be used 

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1 vided by a physician, provider, or supplier, as the 

2 case may be.’’. 

3 (d) CONFORMING AMENDMENTS.— 

4 (1) PART A PAYMENT.—Section 1814(b) of 

5 such Act (42 U.S.C. 1395f(b)) is amended in the 

6 matter preceding paragraph (1) by inserting ‘‘other 

7 than inpatient hospital services furnished by a rural 

8 community hospital,’’ after ‘‘critical access hospital 

9 services,’’. 

10 (2) PART B PAYMENT.—Section 1833(a) of 

11 such Act (42 U.S.C. 1395l(a)), as amended by sec12 tion 205(b)(3), is amended— 

13 (A) in paragraph (2), in the matter before 

14 subparagraph (A), by striking ‘‘and (I)’’ and in15 serting ‘‘(I), and (K)’’; 

16 (B) by striking ‘‘and’’ at the end of para17 graph (9); 

18 (C) by striking the period at the end of 

19 paragraph (10) and inserting ‘‘; and’’; and 

20 (D) by adding at the end the following: 

21 ‘‘(11) in the case of outpatient services fur22 nished by a rural community hospital, the amounts 

23 described in section 1834(p).’’. 

24 (3) TECHNICAL AMENDMENTS.— 


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1 (A) CONSULTATION WITH STATE AGEN2 CIES.—Section 1863 of such Act (42 U.S.C. 

3 1395z) is amended by striking ‘‘and (dd)(2)’’ 

4 and inserting ‘‘(dd)(2), (mm)(1), and (jjj)(1)’’. 

5 (B) PROVIDER AGREEMENTS.—Section 

6 1866(a)(2)(A) of such Act (42 U.S.C. 

7 1395cc(a)(2)(A)) is amended by inserting ‘‘sec8 tion 1834(p)(2),’’ after ‘‘section 1833(b),’’. 

9 (e) EFFECTIVE DATE.—The amendments made by 

10 this section shall apply to items and services furnished on 

11 or after October 1, 2016. 

12 SEC. 434. MEDICARE REMOTE MONITORING PILOT 

13 PROJECTS. 

14 (a) PILOT PROJECTS.— 

15 (1) IN GENERAL.—Not later than 9 months 

16 after the date of enactment of this Act, the Sec17 retary of Health and Human Services (in this sec18 tion referred to as the ‘‘Secretary’’) shall conduct 

19 pilot projects under title XVIII of the Social Secu20 rity Act for the purpose of providing incentives to 

21 home health agencies to utilize home monitoring and 

22 communications technologies that— 

23 (A) enhance health outcomes for Medicare 

24 beneficiaries; and 

25 (B) reduce expenditures under such title. 


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1 (2) SITE REQUIREMENTS.— 

2 (A) URBAN AND RURAL.—The Secretary 

3 shall conduct the pilot projects under this sec4 tion in both urban and rural areas. 

5 (B) SITE IN A SMALL STATE.—The Sec6 retary shall conduct at least 3 of the pilot 

7 projects in a State with a population of less 

8 than 1,000,000. 

9 (3) DEFINITION OF HOME HEALTH AGENCY.— 

10 In this section, the term ‘‘home health agency’’ has 

11 the meaning given that term in section 1861(o) of 

12 the Social Security Act (42 U.S.C. 1395x(o)). 

13 (b) MEDICARE BENEFICIARIES WITHIN THE SCOPE

14 OF PROJECTS.—The Secretary shall specify the criteria 

15 for identifying those Medicare beneficiaries who shall be 

16 considered within the scope of the pilot projects under this 

17 section for purposes of the application of subsection (c) 

18 and for the assessment of the effectiveness of the home 

19 health agency in achieving the objectives of this section. 

20 Such criteria may provide for the inclusion in the projects 

21 of Medicare beneficiaries who begin receiving home health 

22 services under title XVIII of the Social Security Act after 

23 the date of the implementation of the projects. 

24 (c) INCENTIVES.— 


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1 (1) PERFORMANCE TARGETS.—The Secretary 

2 shall establish for each home health agency partici3 pating in a pilot project under this section a per4 formance target using one of the following meth5 odologies, as determined appropriate by the Sec6 retary: 

7 (A) ADJUSTED HISTORICAL PERFORMANCE

8 TARGET.—The Secretary shall establish for the 

9 agency— 

10 (i) a base expenditure amount equal 

11 to the average total payments made to the 

12 agency under parts A and B of title XVIII 

13 of the Social Security Act for Medicare 

14 beneficiaries determined to be within the 

15 scope of the pilot project in a base period 

16 determined by the Secretary; and 

17 (ii) an annual per capita expenditure 

18 target for such beneficiaries, reflecting the 

19 base expenditure amount adjusted for risk 

20 and adjusted growth rates. 

21 (B) COMPARATIVE PERFORMANCE TAR22 GET.—The Secretary shall establish for the 

23 agency a comparative performance target equal 

24 to the average total payments under such parts 

25 A and B during the pilot project for comparable 


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1 individuals in the same geographic area that 

2 are not determined to be within the scope of the 

3 pilot project. 

4 (2) INCENTIVE.—Subject to paragraph (3), the 

5 Secretary shall pay to each participating home care 

6 agency an incentive payment for each year under the 

7 pilot project equal to a portion of the Medicare sav8 ings realized for such year relative to the perform9 ance target under paragraph (1). 

10 (3) LIMITATION ON EXPENDITURES.—The Sec11 retary shall limit incentive payments under this sec12 tion in order to ensure that the aggregate expendi13 tures under title XVIII of the Social Security Act 

14 (including incentive payments under this subsection) 

15 do not exceed the amount that the Secretary esti16 mates would have been expended if the pilot projects 

17 under this section had not been implemented. 

18 (d) WAIVER AUTHORITY.—The Secretary may waive 

19 such provisions of titles XI and XVIII of the Social Secu20 rity Act as the Secretary determines to be appropriate for 

21 the conduct of the pilot projects under this section. 

22 (e) REPORT TO CONGRESS.—Not later than 5 years 

23 after the date that the first pilot project under this section 

24 is implemented, the Secretary shall submit to Congress a 

25 report on the pilot projects. Such report shall contain a 


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1 detailed description of issues related to the expansion of 

2 the projects under subsection (f) and recommendations for 

3 such legislation and administrative actions as the Sec4 retary considers appropriate. 

5 (f) EXPANSION.—If the Secretary determines that 

6 any of the pilot projects under this section enhance health 

7 outcomes for Medicare beneficiaries and reduce expendi8 tures under title XVIII of the Social Security Act, the Sec9 retary may initiate comparable projects in additional 

10 areas. 

11 (g) INCENTIVE PAYMENTS HAVE NO EFFECT ON

12 OTHER MEDICARE PAYMENTS TO AGENCIES.—An incen13 tive payment under this section— 

14 (1) shall be in addition to the payments that a 

15 home health agency would otherwise receive under 

16 title XVIII of the Social Security Act for the provi17 sion of home health services; and 

18 (2) shall have no effect on the amount of such 

19 payments. 

20 SEC. 435. RURAL HEALTH QUALITY ADVISORY COMMISSION 

21 AND DEMONSTRATION PROJECTS. 

22 (a) RURAL HEALTH QUALITY ADVISORY COMMIS23 SION.— 

24 (1) ESTABLISHMENT.—Not later than 6 

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1 tion, the Secretary of Health and Human Services 

2 (in this section referred to as the ‘‘Secretary’’) shall 

3 establish a commission to be known as the Rural 

4 Health Quality Advisory Commission (in this section 

5 referred to as the ‘‘Commission’’). 

6 (2) DUTIES OF COMMISSION.— 

7 (A) NATIONAL PLAN.—The Commission 

8 shall develop, coordinate, and facilitate imple9 mentation of a national plan for rural health 

10 quality improvement. The national plan shall— 

11 (i) identify objectives for rural health 

12 quality improvement; 

13 (ii) identify strategies to eliminate 

14 known gaps in rural health system capacity 

15 and improve rural health quality; and 

16 (iii) provide for Federal programs to 

17 identify opportunities for strengthening 

18 and aligning policies and programs to im19 prove rural health quality. 

20 (B) DEMONSTRATION PROJECTS.—The 

21 Commission shall design demonstration projects 

22 to test alternative models for rural health qual23 ity improvement, including with respect to both 

24 personal and population health. 


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1 (C) MONITORING.—The Commission shall 

2 monitor progress toward the objectives identi3 fied pursuant to paragraph (1)(A). 

4 (3) MEMBERSHIP.— 

5 (A) NUMBER.—The Commission shall be 

6 composed of 11 members appointed by the Sec7 retary. 

8 (B) SELECTION.—The Secretary shall se9 lect the members of the Commission from 

10 among individuals with significant rural health 

11 care and health care quality expertise, including 

12 expertise in clinical health care, health care 

13 quality research, population or public health, or 

14 purchaser organizations. 

15 (4) CONTRACTING AUTHORITY.—Subject to the 

16 availability of funds, the Commission may enter into 

17 contracts and make other arrangements, as may be 

18 necessary to carry out the duties described in para19 graph (2). 

20 (5) STAFF.—Upon the request of the Commis21 sion, the Secretary may detail, on a reimbursable 

22 basis, any of the personnel of the Office of Rural 

23 Health Policy of the Health Resources and Services 

24 Administration, the Agency for Healthcare Quality 

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1 icaid Services to the Commission to assist in car2 rying out this subsection. 

3 (6) REPORTS TO CONGRESS.—Not later than 1 

4 year after the establishment of the Commission, and 

5 annually thereafter, the Commission shall submit a 

6 report to the Congress on rural health quality. Each 

7 such report shall include the following: 

8 (A) An inventory of relevant programs and 

9 recommendations for improved coordination and 

10 integration of policy and programs. 

11 (B) An assessment of achievement of the 

12 objectives identified in the national plan devel13 oped under paragraph (2) and recommenda14 tions for realizing such objectives. 

15 (C) Recommendations on Federal legisla16 tion, regulations, or administrative policies to 

17 enhance rural health quality and outcomes. 

18 (b) RURAL HEALTH QUALITY DEMONSTRATION

19 PROJECTS.— 

20 (1) IN GENERAL.—Not later than 270 days 

21 after the date of the enactment of this section, the 

22 Secretary, in consultation with the Rural Health 

23 Quality Advisory Commission, the Office of Rural 

24 Health Policy of the Health Resources and Services 

25 Administration, the Agency for Healthcare Research 


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1 and Quality, and the Centers for Medicare & Med2 icaid Services, shall make grants to eligible entities 

3 for 5 demonstration projects to implement and 

4 evaluate methods for improving the quality of health 

5 care in rural communities. Each such demonstration 

6 project shall include— 

7 (A) alternative community models that— 

8 (i) will achieve greater integration of 

9 personal and population health services; 

10 and 

11 (ii) address safety, effectiveness, 

12 patient- or community-centeredness, timeli13 ness, efficiency, and equity (the 6 aims 

14 identified by the Institute of Medicine of 

15 the National Academies in its report enti16 tled ‘‘Crossing the Quality Chasm: A New 

17 Health System for the 21st Century’’ re18 leased on March 1, 2001); 

19 (B) innovative approaches to the financing 

20 and delivery of health services to achieve rural 

21 health quality goals; and 

22 (C) development of quality improvement 

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1 ing, clinical care protocols, and information 

2 technology applications). 

3 (2) ELIGIBLE ENTITIES.—In this subsection, 

4 the term ‘‘eligible entity’’ means a consortium 

5 that— 

6 (A) shall include— 

7 (i) at least one health care provider or 

8 health care delivery system located in a 

9 rural area; and 

10 (ii) at least one organization rep11 resenting multiple community stakeholders; 

12 and 

13 (B) may include other partners such as 

14 rural research centers. 

15 (3) CONSULTATION.—In developing the pro16 gram for awarding grants under this subsection, the 

17 Secretary shall consult with the Administrator of the 

18 Agency for Healthcare Research and Quality, rural 

19 health care providers, rural health care researchers, 

20 and private and nonprofit groups (including national 

21 associations) which are undertaking similar efforts. 

22 (4) EXPEDITED WAIVERS.—The Secretary shall 

23 expedite the processing of any waiver that— 


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1 (A) is authorized under title XVIII or XIX 

2 of the Social Security Act (42 U.S.C. 1395 et 

3 seq.); and 

4 (B) is necessary to carry out a demonstra5 tion project under this subsection. 

6 (5) DEMONSTRATION PROJECT SITES.—The 

7 Secretary shall ensure that the 5 demonstration 

8 projects funded under this subsection are conducted 

9 at a variety of sites representing the diversity of 

10 rural communities in the Nation. 

11 (6) DURATION.—Each demonstration project 

12 under this subsection shall be for a period of 4 

13 years. 

14 (7) INDEPENDENT EVALUATION.—The Sec15 retary shall enter into an arrangement with an enti16 ty that has experience working directly with rural 

17 health systems for the conduct of an independent 

18 evaluation of the program carried out under this 

19 subsection. 

20 (8) REPORT.—Not later than 1 year after the 

21 conclusion of all of the demonstration projects fund22 ed under this subsection, the Secretary shall submit 

23 a report to the Congress on the results of such 

24 projects. The report shall include— 


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1 (A) an evaluation of patient access to care, 

2 patient outcomes, and an analysis of the cost 

3 effectiveness of each such project; and 

4 (B) recommendations on Federal legisla5 tion, regulations, or administrative policies to 

6 enhance rural health quality and outcomes. 

7 (c) APPROPRIATION.— 

8 (1) IN GENERAL.—Out of funds in the Treas9 ury not otherwise appropriated, there are appro10 priated to the Secretary to carry out this section 

11 $30,000,000 for the period of fiscal years 2017 

12 through 2021. 

13 (2) AVAILABILITY.— 

14 (A) IN GENERAL.—Funds appropriated 

15 under paragraph (1) shall remain available for 

16 expenditure through fiscal year 2021. 

17 (B) REPORT.—For purposes of carrying 

18 out subsection (b)(8), funds appropriated under 

19 paragraph (1) shall remain available for ex20 penditure through fiscal year 2022. 

21 (3) RESERVATION.—Of the amount appro22 priated under paragraph (1), the Secretary shall re23 serve— 

24 (A) $5,000,000 to carry out subsection (a); 

25 and 


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1 (B) $25,000,000 to carry out subsection 

2 (b), of which— 

3 (i) 2 percent shall be for the provision 

4 of technical assistance to grant recipients; 

5 and 

6 (ii) 5 percent shall be for independent 

7 evaluation under subsection (b)(7). 

8 SEC. 436. RURAL HEALTH CARE SERVICES. 

9 Section 330A of the Public Health Service Act (42 

10 U.S.C. 254c) is amended to read as follows: 

11 ‘‘SEC. 330A. RURAL HEALTH CARE SERVICES OUTREACH, 

12 RURAL HEALTH NETWORK DEVELOPMENT, 

13 DELTA RURAL DISPARITIES AND HEALTH 

14 SYSTEMS DEVELOPMENT, AND SMALL RURAL 

15 HEALTH CARE PROVIDER QUALITY IMPROVE16 MENT GRANT PROGRAMS. 

17 ‘‘(a) PURPOSE.—The purpose of this section is to 

18 provide for grants— 

19 ‘‘(1) under subsection (b), to promote rural 

20 health care services outreach; 

21 ‘‘(2) under subsection (c), to provide for the 

22 planning and implementation of integrated health 

23 care networks in rural areas; 

24 ‘‘(3) under subsection (d), to assist rural com25 munities in the Delta Region to reduce health disVerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00240 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475

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1 parities and to promote and enhance health system 

2 development; and 

3 ‘‘(4) under subsection (e), to provide for the 

4 planning and implementation of small rural health 

5 care provider quality improvement activities. 

6 ‘‘(b) RURAL HEALTH CARE SERVICES OUTREACH

7 GRANTS.— 

8 ‘‘(1) GRANTS.—The Director of the Office of 

9 Rural Health Policy of the Health Resources and 

10 Services Administration may award grants to eligible 

11 entities to promote rural health care services out12 reach by expanding the delivery of health care serv13 ices to include new and enhanced services in rural 

14 areas. The Director may award the grants for peri15 ods of not more than 3 years. 

16 ‘‘(2) ELIGIBILITY.—To be eligible to receive a 

17 grant under this subsection for a project, an enti18 ty— 

19 ‘‘(A) shall be a rural public or rural non20 profit private entity, a facility that qualifies as 

21 a rural health clinic under title XVIII of the 

22 Social Security Act, a public or nonprofit entity 

23 existing exclusively to provide services to mi24 grant and seasonal farm workers in rural areas, 

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1 tivities will be conducted within federally recog2 nized tribal areas; 

3 ‘‘(B) shall represent a consortium com4 posed of members— 

5 ‘‘(i) that include 3 or more independ6 ently owned health care entities; and 

7 ‘‘(ii) that may be nonprofit or for8 profit entities; and 

9 ‘‘(C) shall not previously have received a 

10 grant under this subsection for the same or a 

11 similar project, unless the entity is proposing to 

12 expand the scope of the project or the area that 

13 will be served through the project. 

14 ‘‘(3) APPLICATIONS.—To be eligible to receive a 

15 grant under this subsection, an eligible entity shall 

16 prepare and submit to the Director an application at 

17 such time, in such manner, and containing such in18 formation as the Director may require, including— 

19 ‘‘(A) a description of the project that the 

20 eligible entity will carry out using the funds 

21 provided under the grant; 

22 ‘‘(B) a description of the manner in which 

23 the project funded under the grant will meet 

24 the health care needs of rural populations in 

25 the local community or region to be served; 


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1 ‘‘(C) a plan for quantifying how health 

2 care needs will be met through identification of 

3 the target population and benchmarks of service 

4 delivery or health status, such as— 

5 ‘‘(i) quantifiable measurements of 

6 health status improvement for projects fo7 cusing on health promotion; or 

8 ‘‘(ii) benchmarks of increased access 

9 to primary care, including tracking factors 

10 such as the number and type of primary 

11 care visits, identification of a medical 

12 home, or other general measures of such 

13 access; 

14 ‘‘(D) a description of how the local com15 munity or region to be served will be involved 

16 in the development and ongoing operations of 

17 the project; 

18 ‘‘(E) a plan for sustaining the project after 

19 Federal support for the project has ended; 

20 ‘‘(F) a description of how the project will 

21 be evaluated; 

22 ‘‘(G) the administrative capacity to submit 

23 annual performance data electronically as speci24 fied by the Director; and 


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1 ‘‘(H) other such information as the Direc2 tor determines to be appropriate. 

3 ‘‘(c) RURAL HEALTH NETWORK DEVELOPMENT

4 GRANTS.— 

5 ‘‘(1) GRANTS.— 

6 ‘‘(A) IN GENERAL.—The Director may 

7 award rural health network development grants 

8 to eligible entities to promote, through planning 

9 and implementation, the development of inte10 grated health care networks that have combined 

11 the functions of the entities participating in the 

12 networks in order to— 

13 ‘‘(i) achieve efficiencies and economies 

14 of scale; 

15 ‘‘(ii) expand access to, coordinate, and 

16 improve the quality of the health care de17 livery system through development of orga18 nizational efficiencies; 

19 ‘‘(iii) implement health information 

20 technology to achieve efficiencies, reduce 

21 medical errors, and improve quality; 

22 ‘‘(iv) coordinate care and manage 

23 chronic illness; and 

24 ‘‘(v) strengthen the rural health care 

25 system as a whole in such a manner as to 


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1 show a quantifiable return on investment 

2 to the participants in the network. 

3 ‘‘(B) GRANT PERIODS.—The Director may 

4 award such a rural health network development 

5 grant— 

6 ‘‘(i) for a period of 3 years for imple7 mentation activities; or 

8 ‘‘(ii) for a period of 1 year for plan9 ning activities to assist in the initial devel10 opment of an integrated health care net11 work, if the proposed participants in the 

12 network do not have a history of collabo13 rative efforts and a 3-year grant would be 

14 inappropriate. 

15 ‘‘(2) ELIGIBILITY.—To be eligible to receive a 

16 grant under this subsection, an entity— 

17 ‘‘(A) shall be a rural public or rural non18 profit private entity, a facility that qualifies as 

19 a rural health clinic under title XVIII of the 

20 Social Security Act, a public or nonprofit entity 

21 existing exclusively to provide services to mi22 grant and seasonal farm workers in rural areas, 

23 or a tribal government whose grant-funded ac24 tivities will be conducted within federally recog25 nized tribal areas; 


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1 ‘‘(B) shall represent a network composed 

2 of participants— 

3 ‘‘(i) that include 3 or more independ4 ently owned health care entities; and 

5 ‘‘(ii) that may be nonprofit or for6 profit entities; and 

7 ‘‘(C) shall not previously have received a 

8 grant under this subsection (other than a 1- 

9 year grant for planning activities) for the same 

10 or a similar project. 

11 ‘‘(3) APPLICATIONS.—To be eligible to receive a 

12 grant under this subsection, an eligible entity, in 

13 consultation with the appropriate State office of 

14 rural health or another appropriate State entity, 

15 shall prepare and submit to the Director an applica16 tion at such time, in such manner, and containing 

17 such information as the Director may require, in18 cluding— 

19 ‘‘(A) a description of the project that the 

20 eligible entity will carry out using the funds 

21 provided under the grant; 

22 ‘‘(B) an explanation of the reasons why 

23 Federal assistance is required to carry out the 

24 project; 

25 ‘‘(C) a description of— 


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1 ‘‘(i) the history of collaborative activi2 ties carried out by the participants in the 

3 network; 

4 ‘‘(ii) the degree to which the partici5 pants are ready to integrate their func6 tions; and 

7 ‘‘(iii) how the local community or re8 gion to be served will benefit from and be 

9 involved in the activities carried out by the 

10 network; 

11 ‘‘(D) a description of how the local com12 munity or region to be served will experience in13 creased access to quality health care services 

14 across the continuum of care as a result of the 

15 integration activities carried out by the net16 work, including a description of— 

17 ‘‘(i) return on investment for the com18 munity and the network members; and 

19 ‘‘(ii) other quantifiable performance 

20 measures that show the benefit of the net21 work activities; 

22 ‘‘(E) a plan for sustaining the project after 

23 Federal support for the project has ended; 

24 ‘‘(F) a description of how the project will 

25 be evaluated; 


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1 ‘‘(G) the administrative capacity to submit 

2 annual performance data electronically as speci3 fied by the Director; and 

4 ‘‘(H) other such information as the Direc5 tor determines to be appropriate. 

6 ‘‘(d) DELTA RURAL DISPARITIES AND HEALTH SYS7 TEMS DEVELOPMENT GRANTS.— 

8 ‘‘(1) GRANTS.—The Director may award grants 

9 to eligible entities to support reduction of health dis10 parities, improve access to health care, and enhance 

11 rural health system development in the Delta Re12 gion. 

13 ‘‘(2) ELIGIBILITY.—To be eligible to receive a 

14 grant under this subsection, an entity shall be a 

15 rural public or rural nonprofit private entity, a facil16 ity that qualifies as a rural health clinic under title 

17 XVIII of the Social Security Act, a public or non18 profit entity existing exclusively to provide services 

19 to migrant and seasonal farm workers in rural 

20 areas, or a tribal government whose grant-funded 

21 activities will be conducted within federally recog22 nized tribal areas. 

23 ‘‘(3) APPLICATIONS.—To be eligible to receive a 

24 grant under this subsection, an eligible entity shall 

25 prepare and submit to the Director an application at 


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1 such time, in such manner, and containing such in2 formation as the Director may require, including— 

3 ‘‘(A) a description of the project that the 

4 eligible entity will carry out using the funds 

5 provided under the grant; 

6 ‘‘(B) an explanation of the reasons why 

7 Federal assistance is required to carry out the 

8 project; 

9 ‘‘(C) a description of the manner in which 

10 the project funded under the grant will meet 

11 the health care needs of the Delta Region; 

12 ‘‘(D) a description of how the local com13 munity or region to be served will experience in14 creased access to quality health care services as 

15 a result of the activities carried out by the enti16 ty; 

17 ‘‘(E) a description of how health dispari18 ties will be reduced or the health system will be 

19 improved; 

20 ‘‘(F) a plan for sustaining the project after 

21 Federal support for the project has ended; 

22 ‘‘(G) a description of how the project will 

23 be evaluated including process and outcome 

24 measures related to the quality of care provided 


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1 or how the health care system improves its per2 formance; 

3 ‘‘(H) a description of how the grantee will 

4 develop an advisory group made up of rep5 resentatives of the communities to be served to 

6 provide guidance to the grantee to best meet 

7 community need; and 

8 ‘‘(I) other such information as the Director 

9 determines to be appropriate. 

10 ‘‘(e) SMALL RURAL HEALTH CARE PROVIDER QUAL11 ITY IMPROVEMENT GRANTS.— 

12 ‘‘(1) GRANTS.—The Director may award grants 

13 to provide for the planning and implementation of 

14 small rural health care provider quality improvement 

15 activities. The Director may award the grants for 

16 periods of 1 to 3 years. 

17 ‘‘(2) ELIGIBILITY.—To be eligible for a grant 

18 under this subsection, an entity— 

19 ‘‘(A) shall be— 

20 ‘‘(i) a rural public or rural nonprofit 

21 private health care provider or provider of 

22 health care services, such as a rural health 

23 clinic; or 

24 ‘‘(ii) another rural provider or net25 work of small rural providers identified by 


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1 the Director as a key source of local care; 

2 and 

3 ‘‘(B) shall not previously have received a 

4 grant under this subsection for the same or a 

5 similar project. 

6 ‘‘(3) PREFERENCE.—In awarding grants under 

7 this subsection, the Director shall give preference to 

8 facilities that qualify as rural health clinics under 

9 title XVIII of the Social Security Act. 

10 ‘‘(4) APPLICATIONS.—To be eligible to receive a 

11 grant under this subsection, an eligible entity shall 

12 prepare and submit to the Director an application at 

13 such time, in such manner, and containing such in14 formation as the Director may require, including— 

15 ‘‘(A) a description of the project that the 

16 eligible entity will carry out using the funds 

17 provided under the grant; 

18 ‘‘(B) an explanation of the reasons why 

19 Federal assistance is required to carry out the 

20 project; 

21 ‘‘(C) a description of the manner in which 

22 the project funded under the grant will assure 

23 continuous quality improvement in the provision 

24 of services by the entity; 


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1 ‘‘(D) a description of how the local com2 munity or region to be served will experience in3 creased access to quality health care services as 

4 a result of the activities carried out by the enti5 ty; 

6 ‘‘(E) a plan for sustaining the project after 

7 Federal support for the project has ended; 

8 ‘‘(F) a description of how the project will 

9 be evaluated including process and outcome 

10 measures related to the quality of care pro11 vided; and 

12 ‘‘(G) other such information as the Direc13 tor determines to be appropriate. 

14 ‘‘(f) GENERAL REQUIREMENTS.— 

15 ‘‘(1) PROHIBITED USES OF FUNDS.—An entity 

16 that receives a grant under this section may not use 

17 funds provided through the grant— 

18 ‘‘(A) to build or acquire real property; or 

19 ‘‘(B) for construction. 

20 ‘‘(2) COORDINATION WITH OTHER AGENCIES.— 

21 The Director shall coordinate activities carried out 

22 under grant programs described in this section, to 

23 the extent practicable, with Federal and State agen24 cies and nonprofit organizations that are operating 


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1 similar grant programs, to maximize the effect of 

2 public dollars in funding meritorious proposals. 

3 ‘‘(g) REPORT.—Not later than September 30, 2018, 

4 the Secretary shall prepare and submit to the appropriate 

5 committees of Congress a report on the progress and ac6 complishments of the grant programs described in sub7 sections (b), (c), (d), and (e). 

8 ‘‘(h) DEFINITIONS.—In this section: 

9 ‘‘(1) The term ‘Delta Region’ has the meaning 

10 given to the term ‘region’ in section 382A of the 

11 Consolidated Farm and Rural Development Act (7 

12 U.S.C. 2009aa). 

13 ‘‘(2) The term ‘Director’ means the Director of 

14 the Office of Rural Health Policy of the Health Re15 sources and Services Administration. 

16 ‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—There 

17 are authorized to be appropriated to carry out this section 

18 $40,000,000 for fiscal year 2017, and such sums as may 

19 be necessary for each of fiscal years 2018 through 2021.’’. 

20 SEC. 437. COMMUNITY HEALTH CENTER COLLABORATIVE 

21 ACCESS EXPANSION. 

22 Section 330 of the Public Health Service Act (42 

23 U.S.C. 254b) is amended by adding at the end the fol24 lowing: 

25 ‘‘(t) MISCELLANEOUS PROVISIONS.— 


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1 ‘‘(1) RULE OF CONSTRUCTION WITH RESPECT

2 TO RURAL HEALTH CLINICS.—Nothing in this sec3 tion shall be construed to prevent a community 

4 health center from contracting with a federally cer5 tified rural health clinic (as defined by section 

6 1861(aa)(2) of the Social Security Act) for the deliv7 ery of primary health care and other mental, dental, 

8 and physical health services that are available at the 

9 rural health clinic to individuals who would other10 wise be eligible for free or reduced cost care if that 

11 individual were able to obtain that care at the com12 munity health center. Such services may be limited 

13 in scope to those primary health care and other 

14 mental, dental, and physical health services available 

15 in that rural health clinic. 

16 ‘‘(2) ENABLING SERVICES.—To the extent pos17 sible, enabling services such as transportation and 

18 translation assistance shall be provided by rural 

19 health clinics described in paragraph (1). 

20 ‘‘(3) ASSURANCES.—In order for a rural health 

21 clinic to receive funds under this section through a 

22 contract with a community health center for the de23 livery of primary health care and other services de24 scribed in paragraph (1), such rural health clinic 

25 shall establish policies to ensure— 


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1 ‘‘(A) nondiscrimination based upon the 

2 ability of a patient to pay; 

3 ‘‘(B) the establishment of a sliding fee 

4 scale for low-income patients; and 

5 ‘‘(C) any such services should be subject to 

6 full reimbursement according to the Prospective 

7 Payment System scale.’’. 

8 SEC. 438. FACILITATING THE PROVISION OF TELEHEALTH 

9 SERVICES ACROSS STATE LINES. 

10 (a) IN GENERAL.—For purposes of expediting the 

11 provision of telehealth services, for which payment is made 

12 under the Medicare Program, across State lines, the Sec13 retary of Health and Human Services shall, in consulta14 tion with representatives of States, physicians, health care 

15 practitioners, and patient advocates, encourage and facili16 tate the adoption of provisions allowing for multistate 

17 practitioner practice across State lines. 

18 (b) DEFINITIONS.—In subsection (a): 

19 (1) TELEHEALTH SERVICE.—The term ‘‘tele20 health service’’ has the meaning given that term in 

21 subparagraph (F) of section 1834(m)(4) of the So22 cial Security Act (42 U.S.C. 1395m(m)(4)). 

23 (2) PHYSICIAN, PRACTITIONER.—The terms 

24 ‘‘physician’’ and ‘‘practitioner’’ have the meaning 


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1 given those terms in subparagraphs (D) and (E), re2 spectively, of such section. 

3 (3) MEDICARE PROGRAM.—The term ‘‘Medicare 

4 Program’’ means the program of health insurance 

5 administered by the Secretary of Health and Human 

6 Services under title XVIII of the Social Security Act 

7 (42 U.S.C. 1395 et seq.). 

8 SEC. 439. SCORING OF PREVENTIVE HEALTH SAVINGS. 

9 Section 202 of the Congressional Budget and Im10 poundment Control Act of 1974 (2 U.S.C. 602) is amend11 ed by adding at the end the following new subsection: 

12 ‘‘(h) SCORING OF PREVENTIVE HEALTH SAVINGS.— 

13 ‘‘(1) DETERMINATION BY THE DIRECTOR.— 

14 Upon a request by the chairman or ranking minority 

15 member of the Committee on the Budget of the Sen16 ate, or by the chairman or ranking minority member 

17 of the Committee on the Budget of the House of 

18 Representatives, the Director shall determine if a 

19 proposed measure would result in reductions in 

20 budget outlays in budgetary outyears through the 

21 use of preventive health and preventive health serv22 ices. 

23 ‘‘(2) PROJECTIONS.—If the Director determines 

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1 tions in budget outlays as described in paragraph 

2 (1), the Director— 

3 ‘‘(A) shall include, in any projection pre4 pared by the Director, a description and esti5 mate of the reductions in budget outlays in the 

6 budgetary outyears and a description of the 

7 basis for such conclusions; and 

8 ‘‘(B) may prepare a budget projection that 

9 includes some or all of the budgetary outyears, 

10 notwithstanding the time periods for projections 

11 described in subsection (e) and sections 308, 

12 402, and 424. 

13 ‘‘(3) DEFINITIONS.—As used in this sub14 section— 

15 ‘‘(A) the term ‘preventive health’ means an 

16 action that focuses on the health of the public, 

17 individuals, and defined populations in order to 

18 protect, promote, and maintain health, wellness, 

19 and functional ability, and prevent disease, dis20 ability, and premature death that is dem21 onstrated by credible and publicly available epi22 demiological projection models, incorporating 

23 clinical trials or observational studies in hu24 mans, to avoid future health care costs; and 


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1 ‘‘(B) the term ‘budgetary outyears’ means 

2 the 2 consecutive 10-year periods beginning 

3 with the first fiscal year that is 10 years after 

4 the budget year provided for in the most re5 cently agreed to concurrent resolution on the 

6 budget.’’. 

7 SEC. 440. SENSE OF CONGRESS. 

8 It is the sense of the Congress that— 

9 (1) the maintenance of effort provisions added 

10 to sections 1902 and 2105(d) of the Social Security 

11 Act by sections 2001(b) and 2101(b) of the Patient 

12 Protection and Affordable Care Act were written to 

13 maintain the eligibility standards for the Medicaid 

14 program under title XIX of the Social Security Act 

15 and Children’s Health Insurance Program under 

16 title XXI of such Act until the American Health 

17 Benefit Exchanges in the States are fully oper18 ational; 

19 (2) it is imperative that the maintenance of ef20 fort provisions are enforced to the strict standard in21 tended by the Congress; 

22 (3) waiving the maintenance of effort provisions 

23 should not be permitted, except in the case of a re24 quest for a waiver that meets the explicit non25 application requirements; 


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1 (4) the maintenance of effort provisions ensure 

2 the continued success of the Medicaid program and 

3 Children’s Health Insurance Program and were writ4 ten deliberately to specifically protect vulnerable and 

5 disabled individuals, children, and senior citizens, 

6 many of whom are also members of communities of 

7 color; and 

8 (5) the maintenance of effort provisions must 

9 be strictly enforced and proposals to weaken the 

10 maintenance of effort provisions must not be consid11 ered. 

12 SEC. 441. REPEAL OF REQUIREMENT FOR DOCUMENTA13 TION EVIDENCING CITIZENSHIP OR NATION14 ALITY UNDER THE MEDICAID PROGRAM. 

15 (a) REPEAL.—Subsections (i)(22) and (x) of section 

16 1903 of the Social Security Act (42 U.S.C. 1396b) are 

17 each repealed. 

18 (b) CONFORMING AMENDMENTS.— 

19 (1) Section 1902 of the Social Security Act (42 

20 U.S.C. 1396a) is amended— 

21 (A) by amending paragraph (46) of sub22 section (a) to read as follows: 

23 ‘‘(46) provide that information is requested and 

24 exchanged for purposes of income and eligibility 

25 verification in accordance with a State system which 


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1 meets the requirements of section 1137 of this 

2 Act;’’; 

3 (B) in subsection (e)(13)(A)(i)— 

4 (i) in the matter preceding subclause 

5 (I), by striking ‘‘sections 1902(a)(46)(B) 

6 and 1137(d)’’ and inserting ‘‘section 

7 1137(d)’’; and 

8 (ii) in subclause (IV), by striking 

9 ‘‘1902(a)(46)(B) or’’; and 

10 (C) by striking subsection (ee). 

11 (2) Section 1903 of the Social Security Act (42 

12 U.S.C. 1396b) is amended— 

13 (A) in subsection (i), by redesignating 

14 paragraphs (23) through (26) as paragraphs 

15 (22) through (25), respectively; and 

16 (B) by redesignating subsections (y) and 

17 (z) as subsections (x) and (y), respectively. 

18 (3) Subsection (c) of section 6036 of the Deficit 

19 Reduction Act of 2005 (42 U.S.C. 1396b note) is re20 pealed. 

21 (c) EFFECTIVE DATE.—The repeals and amend22 ments made by this section shall take effect as if included 

23 in the enactment of the Deficit Reduction Act of 2005. 


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1 SEC. 442. OFFICE OF MINORITY HEALTH IN VETERANS 

2 HEALTH ADMINISTRATION OF DEPARTMENT 

3 OF VETERANS AFFAIRS. 

4 (a) ESTABLISHMENT AND FUNCTIONS.—Subchapter 

5 I of chapter 73 of title 38, United States Code, is amended 

6 by adding at the end the following new section: 

7 ‘‘§ 7310. Office of Minority Health 

8 ‘‘(a) ESTABLISHMENT.—There is established in the 

9 Department within the Office of the Under Secretary for 

10 Health an office to be known as the ‘Office of Minority 

11 Health’ (in this section referred to as the ‘Office’). 

12 ‘‘(b) HEAD.—The Director of the Office of Minority 

13 Health shall be the head of the Office. The Director of 

14 the Office of Minority Health shall be appointed by the 

15 Under Secretary of Health from among individuals quali16 fied to perform the duties of the position. 

17 ‘‘(c) FUNCTIONS.—The functions of the Office are as 

18 follows: 

19 ‘‘(1) To establish short-range and long-range 

20 goals and objectives and coordinate all other activi21 ties within the Veterans Health Administration that 

22 relate to disease prevention, health promotion, health 

23 care services delivery, and health care research con24 cerning veterans who are members of a racial or eth25 nic minority group. 


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1 ‘‘(2) To support research, demonstrations, and 

2 evaluations to test new and innovative models for 

3 the discharge of activities described in paragraph 

4 (1). 

5 ‘‘(3) To increase knowledge and understanding 

6 of health risk factors for veterans who are members 

7 of a racial or ethnic minority group. 

8 ‘‘(4) To develop mechanisms that support bet9 ter health care information dissemination, education, 

10 prevention, and services delivery to veterans from 

11 disadvantaged backgrounds, including veterans who 

12 are members of a racial or ethnic minority group. 

13 ‘‘(5) To enter into contracts or agreements with 

14 appropriate public and nonprofit private entities to 

15 develop and carry out programs to provide bilingual 

16 or interpretive services to assist veterans who are 

17 members of a racial or ethnic minority group and 

18 who lack proficiency in speaking the English lan19 guage in accessing and receiving health care services 

20 through the Veterans Health Administration. 

21 ‘‘(6) To carry out programs to improve access 

22 to health care services through the Veterans Health 

23 Administration for veterans with limited proficiency 

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1 velopment and evaluation of demonstration and pilot 

2 projects for that purpose. 

3 ‘‘(7) To advise the Under Secretary of Health 

4 on matters relating to the development, implementa5 tion, and evaluation of health professions education 

6 in decreasing disparities in health care outcomes be7 tween veterans who are members of a racial or eth8 nic minority group and other veterans, including cul9 tural competency as a method of eliminating such 

10 health disparities. 

11 ‘‘(8) To perform such other functions and du12 ties as the Secretary or the Under Secretary for 

13 Health considers appropriate. 

14 ‘‘(d) DEFINITIONS.—In this section: 

15 ‘‘(1) The term ‘racial or ethnic minority group’ 

16 means the following: 

17 ‘‘(A) American Indians (including Alaska 

18 Natives, Eskimos, and Aleuts). 

19 ‘‘(B) Asian-Americans. 

20 ‘‘(C) Native Hawaiians and other Pacific 

21 Islanders. 

22 ‘‘(D) Blacks. 

23 ‘‘(E) Hispanics. 

24 ‘‘(2) The term ‘Hispanic’ means individuals 

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1 tral or South American, or any other Spanish-speak2 ing country.’’. 

3 (b) CLERICAL AMENDMENT.—The table of sections 

4 at the beginning of such chapter is amended by inserting 

5 after the item relating to section 7309 the following new 

6 item: 

‘‘7310. Office of Minority Health.’’. 

7 SEC. 443. INDIAN DEFINED IN PPACA. 

8 (a) DEFINITION OF INDIAN.—Section 1304 of the 

9 Patient Protection and Affordable Care Act (42 U.S.C. 

10 18024) is amended by adding at the end the following: 

11 ‘‘(f) INDIAN.— 

12 ‘‘(1) IN GENERAL.—In this title, the term ‘In13 dian’ means any individual— 

14 ‘‘(A) described in paragraph (13) or (28) 

15 of section 4 of the Indian Health Care Improve16 ment Act (25 U.S.C. 1603); 

17 ‘‘(B) who is eligible for health services pro18 vided by the Indian Health Service under sec19 tion 809 of the Indian Health Care Improve20 ment Act (25 U.S.C. 1679); 

21 ‘‘(C) who is of Indian descent and belongs 

22 to the Indian community served by the local fa23 cilities and program of the Indian Health Serv24 ice; or 

25 ‘‘(D) who is described in paragraph (2). 


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1 ‘‘(2) INCLUDED INDIVIDUALS.—The following 

2 individuals shall be considered to be an ‘Indian’: 

3 ‘‘(A) A member of a federally recognized 

4 Indian tribe. 

5 ‘‘(B) A resident of an urban center who 

6 meets 1 or more of the following 4 criteria: 

7 ‘‘(i) Membership in a tribe, band, or 

8 other organized group of Indians, including 

9 those tribes, bands, or groups terminated 

10 since 1940 and those recognized as of the 

11 date of enactment of the Health Equity 

12 and Accountability Act of 2016 or later by 

13 the State in which they reside, or being a 

14 descendant, in the first or second degree, 

15 of any such member. 

16 ‘‘(ii) Is an Eskimo or Aleut or other 

17 Alaska Native. 

18 ‘‘(iii) Is considered by the Secretary of 

19 the Interior to be an Indian for any pur20 pose. 

21 ‘‘(iv) Is determined to be an Indian 

22 under regulations promulgated by the Sec23 retary. 


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1 ‘‘(C) An individual who is considered by 

2 the Secretary of the Interior to be an Indian for 

3 any purpose. 

4 ‘‘(D) An individual who is considered by 

5 the Secretary to be an Indian for purposes of 

6 eligibility for Indian health care services, includ7 ing as a California Indian, Eskimo, Aleut, or 

8 other Alaska Native.’’. 

9 (b) CONFORMING AMENDMENTS.— 

10 (1) AFFORDABLE CHOICES HEALTH BENEFIT

11 PLANS.—Section 1311(c)(6)(D) of the Patient Pro12 tection and Affordable Care Act (42 U.S.C. 

13 18031(c)(6)(D)) is amended by striking ‘‘section 4 

14 of the Indian Health Care Improvement Act’’ and 

15 inserting ‘‘section 1304(f)’’. 

16 (2) REDUCED COST-SHARING FOR INDIVIDUALS

17 ENROLLING IN QUALIFIED HEALTH PLANS.—Section 

18 1402(d) of the Patient Protection and Affordable 

19 Care Act (42 U.S.C. 18071(d)) is amended— 

20 (A) in paragraph (1), in the matter pre21 ceding subparagraph (A), by striking ‘‘section 

22 4(d) of the Indian Self-Determination and Edu23 cation Assistance Act (25 U.S.C. 450b(d))’’ and 

24 inserting ‘‘section 1304(f)’’; and 


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1 (B) in paragraph (2), in the matter pre2 ceding subparagraph (A), by striking ‘‘(as so 

3 defined)’’ and inserting ‘‘(as defined in section 

4 1304(f))’’. 

5 (3) EXEMPTION FROM PENALTY FOR NOT

6 MAINTAINING MINIMUM ESSENTIAL COVERAGE.— 

7 Section 5000A(e) of the Internal Revenue Code of 

8 1986 is amended by striking paragraph (3) and in9 serting the following: 

10 ‘‘(3) INDIANS.—Any applicable individual who 

11 is an Indian (as defined in section 1304(f) of the 

12 Patient Protection and Affordable Care Act).’’. 

13 SEC. 444. STUDY OF DSH PAYMENTS TO ENSURE HOSPITAL 

14 ACCESS FOR LOW-INCOME PATIENTS. 

15 (a) IN GENERAL.—Not later than January 1, 2016, 

16 the Comptroller General of the United States shall con17 duct a study on how certain amendments made by the Pa18 tient Protection and Affordable Care Act (Public Law 

19 111–148) to titles XVIII and XIX of the Social Security 

20 Act affect the timely access to health care services for low21 income patients. Such study shall— 

22 (1) evaluate and examine whether States elect23 ing to make medical assistance available under sec24 tion 1902(a)(10)(A)(i)(VIII) of the Social Security 

25 Act (42 U.S.C. 1396a(a)(10)(A)(i)(VIII)) (including 


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1 States making such an election through a waiver of 

2 the State plan) to individuals described in such sec3 tion mitigates the need for payments to dispropor4 tionate share hospitals under section 1886(d)(5)(F) 

5 of the Social Security Act (42 U.S.C. 

6 1395ww(d)(5)(F)) and section 1923 of such Act (42 

7 U.S.C. 1396r–4), including the impact of such 

8 States electing to make medical assistance available 

9 to such individuals on— 

10 (A) the number of individuals in the 

11 United States who are without health insurance 

12 and the distribution of such individuals in rela13 tion to areas primarily served by dispropor14 tionate share hospitals; and 

15 (B) the low-income utilization rate of such 

16 hospitals and the resulting fiscal sustainability 

17 of such hospitals; 

18 (2) evaluate the appropriate level and distribu19 tion of such payments among disproportionate hos20 pitals for purposes of— 

21 (A) sufficiently accounting for the level of 

22 uncompensated care provided by such hospitals 

23 to low-income patients; and 


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1 (B) providing timely access to health serv2 ices for individuals in medically underserved 

3 areas; and 

4 (3) assess, with respect to disproportionate hos5 pitals— 

6 (A) the role played by such hospitals in 

7 providing critical access to emergency, inpa8 tient, and outpatient health services, as well as 

9 the location of such hospitals in relation to 

10 medically underserved areas; and 

11 (B) the extent to which such hospitals sat12 isfy the requirements established for charitable 

13 hospital organizations under section 501(r) of 

14 the Internal Revenue Code of 1986 with respect 

15 to community health needs assessments, finan16 cial assistance policy requirements, limitations 

17 on charges, and billing and collection require18 ments. 

19 (b) REPORTS.— 

20 (1) REPORT TO CONGRESS.—Not later than 

21 180 days after the date on which the study under 

22 subsection (a) is completed, the Comptroller General 

23 of the United States shall submit to the Committee 

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1 cation, Labor, and Pensions of the Senate a report 

2 that contains— 

3 (A) the results of the study; 

4 (B) recommendations to Congress for any 

5 legislative changes to the payments to dis6 proportionate share hospitals under section 

7 1886(d)(5)(F) of the Social Security Act (42 

8 U.S.C. 1395ww(d)(5)(F)) and section 1923 of 

9 such Act (42 U.S.C. 1396r–4) that are needed 

10 to ensure access to health services for low-in11 come patients that— 

12 (i) are based on the number of indi13 viduals without health insurance, the 

14 amount of uncompensated care provided by 

15 such hospitals, and the impact of reduced 

16 payments levels on low-income commu17 nities; and 

18 (ii) takes into account any reports 

19 submitted by the Secretary of the Treas20 ury, in consultation with the Secretary of 

21 Health and Human Services, to Congres22 sional committees regarding the costs in23 curred by charitable hospital organizations 

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1 uals under the Medicare Program under 

2 title XVIII of the Social Security Act and 

3 the Medicaid Program under title XIX of 

4 such Act, and any community benefit ac5 tivities provided by such organizations. 

6 (2) REPORT TO THE SECRETARY OF HEALTH

7 AND HUMAN SERVICES.—Not later than 180 days 

8 after the date on which the study under subsection 

9 (a) is completed, the Comptroller General of the 

10 United States shall submit to the Secretary of 

11 Health and Human Services a report that con12 tains— 

13 (A) the results of the study; and 

14 (B) any recommendations for purposes of 

15 assisting in the development of the methodology 

16 for the adjustment of payments to dispropor17 tionate share hospitals, as required under sec18 tion 1886(r) of the Social Security Act (42 

19 U.S.C. 1395ww(r)) and the reduction of such 

20 payments section 1923(f)(7) of such Act (42 

21 U.S.C. 1396r–4(f)(7)), taking into account the 

22 reports referred to in paragraph (1)(B)(ii). 


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1 SEC. 445. ASSISTANT SECRETARY OF THE INDIAN HEALTH 

2 SERVICE. 

3 (a) REFERENCES.—Any reference in a law, regula4 tion, document, paper, or other record of the United 

5 States to the Director of the Indian Health Service shall 

6 be deemed to be a reference to the Assistant Secretary 

7 of the Indian Health Service. 

8 (b) EXECUTIVE SCHEDULE.—Section 5315 of title 5, 

9 United States Code, is amended in the matter relating to 

10 the Assistant Secretaries of Health and Human Services 

11 by striking ‘‘(6)’’ and inserting ‘‘(7), 1 of whom shall be 

12 the Assistant Secretary of the Indian Health Service’’. 

13 (c) CONFORMING AMENDMENT.—Section 5316 of 

14 title 5, United States Code, is amended by striking ‘‘Direc15 tor, Indian Health Service, Department of Health and 

16 Human Services.’’. 

17 SEC. 446. REAUTHORIZATION OF THE NATIVE HAWAIIAN 

18 HEALTH CARE IMPROVEMENT ACT. 

19 (a) NATIVE HAWAIIAN HEALTH CARE SYSTEMS.— 

20 Section 6(h)(1) of the Native Hawaiian Health Care Im21 provement Act (42 U.S.C. 11705(h)(1)) is amended by 

22 striking ‘‘may be necessary for fiscal years 1993 through 

23 2019’’ and inserting ‘‘are necessary’’. 

24 (b) ADMINISTRATIVE GRANT FOR PAPA OLA

25 LOKAHI.—Section 7(b) of the Native Hawaiian Health 

26 Care Improvement Act (42 U.S.C. 11706(b)) is amended 


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1 by striking ‘‘may be necessary for fiscal years 1993 

2 through 2019’’ and inserting ‘‘are necessary’’. 

3 (c) NATIVE HAWAIIAN HEALTH SCHOLARSHIPS.— 

4 Section 10(c) of the Native Hawaiian Health Care Im5 provement Act (42 U.S.C. 11709(c)) is amended by strik6 ing ‘‘may be necessary for fiscal years 1993 through 

7 2019’’ and inserting ‘‘are necessary’’. 

8 SEC. 447. AVAILABILITY OF NON-ENGLISH LANGUAGE 

9 SPEAKING PROVIDERS. 

10 (a) IN GENERAL.—Section 1311(c)(1)(B) of the Pa11 tient Protection and Affordable Care Act (42 U.S.C. 

12 18031(c)(1)(B)) is amended by inserting before the semi13 colon the following: ‘‘and, with respect to such providers, 

14 a provider’s ability to provide care in a language other 

15 than English either through the provider speaking such 

16 language or by the provider having a training medical in17 terpreter who speaks such language available during office 

18 hours’’. 

19 (b) EFFECTIVE DATE.—The amendment made by 

20 subsection (a) shall apply for plan years beginning more 

21 than 1 year after the date of the enactment of this Act. 

22 SEC. 448. ACCESS TO ESSENTIAL COMMUNITY PROVIDERS. 

23 (a) ESSENTIAL COMMUNITY PROVIDERS.—Section 

24 1311(c)(1)(C) of the Patient Protection and Affordable 

25 Care Act (42 U.S.C. 18031(c)(1)(C)) is amended— 


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1 (1) by inserting ‘‘(i)’’ after ‘‘(C)’’; and 

2 (2) by adding at the end the following new 

3 clauses: 

4 ‘‘(ii) not later than 2018, increase the per5 centage of essential community providers in6 cluded in its network by 10 percent annually 

7 (based on the level in the plan for 2016) until 

8 90 percent of all federally qualified health cen9 ters and 75 percent of all other essential com10 munity providers in the contract service area 

11 are in-network; and 

12 ‘‘(iii) include one of each type of essential 

13 community provider in network in each county 

14 in their service area, where available;’’. 

15 (b) REPORTING REQUIREMENTS.—Section 

16 1311(e)(3) of the Patient Protection and Affordable Care 

17 Act (42 U.S.C. 18031(e)(3)(A)) is amended by adding at 

18 the end the following new subparagraph: 

19 ‘‘(E) DATA ON ESSENTIAL COMMUNITY

20 PROVIDERS.—The Secretary shall require quali21 fied health plans to submit annually to the Sec22 retary data on the percentage of essential com23 munity providers, by county, that contract with 

24 each qualified health plan offered in that county 

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1 viders, by type, that contract with each quali2 fied health plan offered in that county. Data so 

3 submitted shall be made available to the general 

4 public’’. 

5 (c) ESSENTIAL COMMUNITY PROVIDER PROVISIONS

6 APPLIED UNDER MEDICARE AND MEDICAID.— 

7 (1) MEDICARE.—Section 1852(d)(1) of the So8 cial Security Act (42 U.S.C.1395w–22(d)(1)) is 

9 amended— 

10 (A) by striking ‘‘and’’ at the end of sub11 paragraph (D); 

12 (B) by striking the period at the end of 

13 subparagraph (E) and inserting ‘‘; and’’; and 

14 (C) by adding at the end the following new 

15 subparagraph: 

16 ‘‘(F) the plan meets the requirements of 

17 clauses (ii) and (iii) of section 1311(c)(1)(C) of 

18 the Patient Protection and Affordable Care Act 

19 (relating to inclusion in networks of essential 

20 community providers).’’. 

21 (2) MEDICAID.—Section 1932(b)(5) of the So22 cial Security Act (42 U.S.C. 1396u–2(b)(5)) is 

23 amended— 

24 (A) by striking ‘‘and’’ at the end of sub25 paragraph (A); 


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1 (B) by striking the period at the end of 

2 subparagraph (B) and inserting ‘‘; and’’; and 

3 (C) by adding at the end the following new 

4 subparagraph: 

5 ‘‘(C) the plan meets the requirements of 

6 clauses (ii) and (iii) of section 1311(c)(1)(C) of 

7 the Patient Protection and Affordable Care Act 

8 (relating to inclusion in networks of essential 

9 community providers) with respect to services 

10 offered in the service area involved.’’. 

11 SEC. 449. PROVIDER NETWORK ADEQUACY IN COMMU12 NITIES OF COLOR. 

13 (a) IN GENERAL.—Section 1311(c)(1)(B) of the Pa14 tient Protection and Affordable Care Act (42 U.S.C. 

15 18031(c)(1)(B)) is amended— 

16 (1) by inserting ‘‘(i)’’ after ‘‘(B)’’; and 

17 (2) by adding at the end the following the fol18 lowing new clauses: 

19 ‘‘(ii) meet such network adequacy 

20 standards as the Secretary may establish 

21 with regard to— 

22 ‘‘(I) appointment wait time; 

23 ‘‘(II) travel time and distance to 

24 health care provider facilities and pro25 viders by public and private transit; 


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1 ‘‘(III) hours of operation to ac2 commodate individuals who cannot 

3 come to provider appointments during 

4 standard business hours; and 

5 ‘‘(IV) other network adequacy 

6 standards to ensure that care through 

7 these plans is accessible to diverse 

8 communities; and. 

9 ‘‘(iii) provide coverage for services for 

10 enrollees through out-of-network providers 

11 at no additional cost to the enrollees in 

12 cases where in-network providers are un13 able to comply with the standards estab14 lished under clause subclause (III) or (IV) 

15 of clause (ii) for such services and the out16 of-network providers can deliver such serv17 ices in compliance with such standards.. 

18 ‘‘(b) EFFECTIVE DATE.—The amendments made by 

19 subsection (a) shall apply to plan years beginning more 

20 than 1 year after the date of the enactment of this Act..’’. 

21 SEC. 450. IMPROVING ACCESS TO DENTAL CARE. 

22 (a) REPORTS TO CONGRESS.— 

23 (1) GAO REPORT ON DENTAL THERAPIST PRO24 GRAMS.—Not later than 1 year after the date of the 

25 enactment of this Act, the Comptroller General of 


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1 the United States shall submit to Congress a report 

2 on the Alaska Dental Health Aide Therapists Pro3 gram and the Dental Therapist and Advanced Den4 tal Therapist programs in Minnesota, to assess den5 tal therapists’ effectiveness in— 

6 (A) improving access to timely dental care 

7 among communities of color; 

8 (B) providing high quality care; and 

9 (C) providing culturally competent care. 

10 (2) HRSA REPORT ON DENTAL SHORTAGE

11 AREAS.—Not later than 1 year after the date of the 

12 enactment of this Act, the Secretary, acting through 

13 the Administrator of the Health Resources Service 

14 Administration, shall submit to Congress a report 

15 which details geographic dental access shortages and 

16 the preparedness of dental providers to offer cul17 turally and linguistically appropriate, affordable, ac18 cessible, and timely services. 

19 (b) EXPANSION OF DENTAL HEALTH AID THERA20 PISTS IN TRIBAL COMMUNITIES.—Section 119(d) of the 

21 Indian Health Care Improvement Act ( U.S.C. 1616l(d)) 

22 is amended— 

23 (1) in paragraph (2), by striking ‘‘Subject to’’ 

24 and all that follows and inserting ‘‘Subject to para25 graph (3), in establishing a national program under 


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1 paragraph (1), the Secretary shall not reduce the 

2 amounts provided for the Community Health Aide 

3 Program described in subsections (a) and (b).’’; 

4 (2) by striking paragraph (3); and 

5 (3) by redesignating paragraph (4) as para6 graph (3). 

7 (c) COVERAGE OF DENTAL SERVICES UNDER THE

8 MEDICARE PROGRAM.— 

9 (1) COVERAGE.—Section 1861(s)(2) of the So10 cial Security Act (42 U.S.C. 1395x(s)(2)) is amend11 ed— 

12 (A) in subparagraph (EE), by striking 

13 ‘‘and’’ after the semicolon at the end; 

14 (B) in subparagraph (FF), by adding 

15 ‘‘and’’ after the semicolon at the end; and 

16 (C) by adding at the end the following new 

17 subparagraph: 

18 ‘‘(GG) oral health services (as defined in 

19 subsection (kkk);’’. 

20 (2) ORAL HEALTH SERVICES DEFINED.—Sec21 tion 1861 of the Social Security Act (42 U.S.C. 

22 1395x), as amended by sections 205(b) and 433(a), 

23 is amended by adding at the end the following new 

24 subsection: 


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1 ‘‘Oral Health Services 

2 ‘‘(kkk)(1) The term ‘oral health services’ means serv3 ices (as defined by the Secretary) that are necessary to 

4 prevent disease and promote oral health, restore oral 

5 structures to health and function, and treat emergency 

6 conditions. 

7 ‘‘(2) For purposes of paragraph (1), such term shall 

8 include mobile and portable oral health services (as de9 fined by the Secretary) that— 

10 ‘‘(A) are provided for the purpose of over11 coming mobility, transportation, and access barriers 

12 for individuals; and 

13 ‘‘(B) satisfy the standards and certification re14 quirements established under section 1902(a)(82)(B) 

15 for the State in which the services are provided.’’. 

16 (3) PAYMENT AND COINSURANCE.—Section 

17 1833(a)(1) of the Social Security Act (42 U.S.C. 

18 1395l(a)(1)) is amended— 

19 (A) by striking ‘‘and’’ before ‘‘(Z)’’; and 

20 (B) by inserting before the semicolon at 

21 the end the following: ‘‘, and (AA) with respect 

22 to oral health services (as defined in section 

23 1861(kkk)), the amount paid shall be (i) in the 

24 case of such services that are preventive, 100 

25 percent of the lesser of the actual charge for 


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1 the services or the amount determined under 

2 the payment basis determined under section 

3 1848, and (ii) in the case of all other such serv4 ices, 80 percent of the lesser of the actual 

5 charge for the services or the amount deter6 mined under the payment basis determined 

7 under section 1848’’. 

8 (4) PAYMENT UNDER PHYSICIAN FEE SCHED9 ULE.—Section 1848(j)(3) of the Social Security Act 

10 (42 U.S.C. 1395w–4(j)(3)) is amended by inserting 

11 ‘‘(2)(GG),’’ after ‘‘risk assessment),’’. 

12 (5) DENTURES.—Section 1861(s)(8) of the So13 cial Security Act (42 U.S.C. 1395x(s)(8)) is amend14 ed— 

15 (A) by striking ‘‘(other than dental)’’ and 

16 inserting ‘‘(including dentures)’’; and 

17 (B) by striking ‘‘internal body’’. 

18 (6) REPEAL OF GROUND FOR EXCLUSION.— 

19 Section 1862(a) of the Social Security Act (42 

20 U.S.C. 1395y) is amended by striking paragraph 

21 (12). 

22 (7) EFFECTIVE DATE.—The amendments made 

23 by this section shall apply to services furnished on 

24 or after January 1, 2017. 


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1 (d) COVERAGE OF DENTAL SERVICES UNDER THE

2 MEDICAID PROGRAM.— 

3 (1) IN GENERAL.—Section 1905 of the Social 

4 Security Act (42 U.S.C. 1396d) is amended— 

5 (A) in subsection (a)(10), by striking ‘‘den6 tal services’’ and inserting ‘‘oral health services 

7 (as defined in subsection (ee)(1))’’; and 

8 (B) by adding at the end the following new 

9 subsection: 

10 ‘‘(ee)(1) Subject to paragraphs (2) and (3), for pur11 poses of this title, the term ‘oral health services’ means 

12 services (as defined by the Secretary) that are necessary 

13 to prevent disease and promote oral health, restore oral 

14 structures to health and function, and treat emergency 

15 conditions. These services shall include, in the case of 

16 pregnant or postpartum women, such services as are nec17 essary to address oral health conditions that exist or are 

18 exacerbated by pregnancy or childbirth or which, if left 

19 untreated, could adversely affect fetal or child develop20 ment. 

21 ‘‘(2) For purposes of paragraph (1), such term shall 

22 include— 

23 ‘‘(A) dentures; and 

24 ‘‘(B) mobile and portable oral health services 

25 (as defined by the Secretary) that— 


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1 ‘‘(i) are provided for the purpose of over2 coming mobility, transportation, and access bar3 riers for individuals; and 

4 ‘‘(ii) satisfy the standards and certification 

5 requirements established under section 

6 1902(a)(82)(C) for the State in which the serv7 ices are provided. 

8 ‘‘(3) For purposes of paragraph (1), such term shall 

9 not apply to dental care or services provided to individuals 

10 under the age of 21 under subsection (r)(3).’’. 

11 (2) CONFORMING AMENDMENTS.— 

12 (A) STATE PLAN REQUIREMENTS.—Section 

13 1902(a) of the Social Security Act (42 U.S.C. 

14 1396a(a)) is amended— 

15 (i) in paragraph (10)(A), in the mat16 ter preceding clause (i), by inserting 

17 ‘‘(10),’’ after ‘‘(5),’’; 

18 (ii) in paragraph (80), by striking 

19 ‘‘and’’ at the end; 

20 (iii) in paragraph (81), by striking the 

21 period at the end and inserting ‘‘; and’’; 

22 and 

23 (iv) by inserting after paragraph (81) 

24 the following: 

25 ‘‘(82) provide for— 


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1 ‘‘(A) informing, in writing, all individuals 

2 who have been determined to be eligible for 

3 medical assistance of the availability of oral 

4 health services (as defined in section 1905(ee)); 

5 ‘‘(B) conducting targeted outreach to preg6 nant women who have been determined to be el7 igible for medical assistance about the avail8 ability of medical assistance for such dental 

9 services and the importance of receiving dental 

10 care while pregnant; and 

11 ‘‘(C) establishing and maintaining stand12 ards for and certification of mobile and portable 

13 oral health services (as described in subsections 

14 (r)(3)(C) and (ee)(2)(B) of section 1905).’’. 

15 (B) DEFINITION OF MEDICAL ASSIST16 ANCE.—Section 1905(a)(12) of the Social Secu17 rity Act (42 U.S.C. 1396d(a)(12)) is amended 

18 by striking ‘‘, dentures,’’. 

19 (3) MOBILE AND PORTABLE ORAL HEALTH

20 SERVICES UNDER EPSDT.—Section 1905(r)(3) of the 

21 Social Security Act (42 U.S.C. 1396d(r)(3)) is 

22 amended— 

23 (A) in subparagraph (A)(ii), by striking ‘‘; 

24 and’’ and inserting a semicolon; 


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1 (B) in subparagraph (B), by striking the 

2 period at the end and inserting ‘‘; and’’; and 

3 (C) by adding at the end the following new 

4 subparagraph: 

5 ‘‘(C) which shall include mobile and port6 able oral health services (as defined by the Sec7 retary) that— 

8 ‘‘(i) are provided for the purpose of 

9 overcoming mobility, transportation, or ac10 cess barriers for children; and 

11 ‘‘(ii) satisfy the standards and certifi12 cation requirements established under sec13 tion 1902(a)(82)(C) for the State in which 

14 the services are provided.’’. 

15 (e) ORAL HEALTH SERVICES AS AN ESSENTIAL

16 HEALTH BENEFIT.—Section 1302(b) of the Patient Pro17 tection and Affordable Care Act (42 U.S.C. 18022(b)) is 

18 amended— 

19 (1) in paragraph (1)— 

20 (A) in subparagraph (J), by striking ‘‘oral 

21 and’’; and 

22 (B) by adding at the end the following: 

23 ‘‘(K) Oral health services for children and 

24 adults.’’; and 

25 (2) by adding at the end the following: 


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1 ‘‘(6) ORAL HEALTH SERVICES.—For purposes 

2 of paragraph (1)(K), the term ‘oral health services’ 

3 means services (as defined by the Secretary), that 

4 are necessary to prevent disease and promote oral 

5 health, restore oral structures to health and func6 tion, and treat emergency conditions.’’. 

7 (f) DEMONSTRATION PROGRAM ON TRAINING AND

8 EMPLOYMENT OF ALTERNATIVE DENTAL HEALTH CARE

9 PROVIDERS FOR DENTAL HEALTH CARE SERVICES FOR

10 VETERANS IN RURAL AND OTHER UNDERSERVED COM11 MUNITIES.— 

12 (1) DEMONSTRATION PROGRAM AUTHORIZED.— 

13 The Secretary of Veterans Affairs may carry out a 

14 demonstration program to establish programs to 

15 train and employ alternative dental health care pro16 viders in order to increase access to dental health 

17 care services for veterans who are entitled to such 

18 services from the Department of Veterans Affairs 

19 and reside in rural and other underserved commu20 nities. 

21 (2) TELEHEALTH.—For purposes of alternative 

22 dental health care providers and other dental care 

23 providers who are licensed to provide clinical care, 

24 dental services provided under the demonstration 

25 program under this section may be administered by 


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1 such providers through telehealth-enabled collabora2 tion and supervision when appropriate and feasible. 

3 (3) ALTERNATIVE DENTAL HEALTH CARE PRO4 VIDERS DEFINED.—In this section, the term ‘‘alter5 native dental health care providers’’ has the meaning 

6 given that term in section 340G–1(a)(2) of the Pub7 lic Health Service Act (42 U.S.C. 256g–1(a)(2)). 

8 (4) AUTHORIZATION OF APPROPRIATIONS.— 

9 There are authorized to be appropriated such sums 

10 as are necessary to carry out the demonstration pro11 gram under this subsection. 

12 (g) DEMONSTRATION PROGRAM ON TRAINING AND

13 EMPLOYMENT OF ALTERNATIVE DENTAL HEALTH CARE

14 PROVIDERS FOR DENTAL HEALTH CARE SERVICES FOR

15 MEMBERS OF THE ARMED FORCES AND DEPENDENTS

16 LACKING READY ACCESS TO SUCH SERVICES.— 

17 (1) DEMONSTRATION PROGRAM AUTHORIZED.— 

18 The Secretary of Defense may carry out a dem19 onstration program to establish programs to train 

20 and employ alternative dental health care providers 

21 in order to increase access to dental health care 

22 services for members of the Armed Forces and their 

23 dependents who lack ready access to such services, 

24 including the following: 


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1 (A) Members and dependents who reside in 

2 rural areas or areas otherwise underserved by 

3 dental health care providers. 

4 (B) Members of the National Guard and 

5 Reserves in active status who are potentially 

6 deployable. 

7 (2) TELEHEALTH.—For purposes of alternative 

8 dental health care providers and other dental care 

9 providers who are licensed to provide clinical care, 

10 dental services provided under the demonstration 

11 program under this section may be administered by 

12 such providers through telehealth-enabled collabora13 tion and supervision when appropriate and feasible. 

14 (3) ALTERNATIVE DENTAL HEALTH CARE PRO15 VIDERS DEFINED.—In this section, the term ‘‘alter16 native dental health care providers’’ has the meaning 

17 given that term in section 340G–1(a)(2) of the Pub18 lic Health Service Act (42 U.S.C. 256g–1(a)(2)). 

19 (4) AUTHORIZATION OF APPROPRIATIONS.— 

20 There are authorized to be appropriated such sums 

21 as are necessary to carry out the demonstration pro22 gram under this subsection. 

23 (h) DEMONSTRATION PROGRAM ON TRAINING AND

24 EMPLOYMENT OF ALTERNATIVE DENTAL HEALTH CARE

25 PROVIDERS FOR DENTAL HEALTH CARE SERVICES FOR


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1 PRISONERS WITHIN THE CUSTODY OF THE BUREAU OF

2 PRISONS.— 

3 (1) DEMONSTRATION PROGRAM AUTHORIZED.— 

4 The Attorney General, acting through the Director 

5 of the Bureau of Prisons, may carry out a dem6 onstration program to establish programs to train 

7 and employ alternative dental health care providers 

8 in order to increase access to dental health services 

9 for prisoners within the custody of the Bureau of 

10 Prisons. 

11 (2) TELEHEALTH.—For purposes of alternative 

12 dental health care providers and any other dental 

13 care providers who are licensed to provide clinical 

14 care, dental services provided under the demonstra15 tion program under this section may be administered 

16 by such providers through telehealth-enabled collabo17 ration and supervision when deemed appropriate and 

18 feasible. 

19 (3) ALTERNATIVE DENTAL HEALTH CARE PRO20 VIDERS DEFINED.—In this section, the term ‘‘alter21 native dental health care providers’’ has the meaning 

22 given that term in section 340G–1(a)(2) of the Pub23 lic Health Service Act (42 U.S.C. 256g–1(a)(2)). 

24 (4) AUTHORIZATION OF APPROPRIATIONS.— 

25 There are authorized to be appropriated such sums 


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1 as are necessary to carry out the demonstration pro2 gram under this subsection. 

3 (i) DEMONSTRATION PROGRAM ON TRAINING AND

4 EMPLOYMENT OF ALTERNATIVE DENTAL HEALTH CARE

5 PROVIDERS FOR DENTAL HEALTH CARE SERVICES

6 UNDER THE INDIAN HEALTH SERVICE.— 

7 (1) DEMONSTRATION PROGRAM AUTHORIZED.— 

8 The Secretary of Health and Human Services, act9 ing through the Indian Health Service, may carry 

10 out a demonstration program to establish programs 

11 to train and employ alternative dental health care 

12 providers in order to help eliminate oral health dis13 parities and increase access to dental services 

14 through health programs operated by the Indian 

15 Health Service, Indian tribes, tribal organizations, 

16 and urban Indian organizations (as those terms are 

17 defined in section 4 of the Indian Health Care Im18 provement Act (25 U.S.C. 1603)). 

19 (2) TELEHEALTH.—For purposes of alternative 

20 dental health care providers and any other dental 

21 care providers who are licensed to provide clinical 

22 care, dental services provided under the demonstra23 tion program under this section may be administered 

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1 ration and supervision when deemed appropriate and 

2 feasible. 

3 (3) ALTERNATIVE DENTAL HEALTH CARE PRO4 VIDERS DEFINED.—In this section, the term ‘‘alter5 native dental health care providers’’ has the meaning 

6 given that term in section 340G–1(a)(2) of the Pub7 lic Health Service Act (42 U.S.C. 256g–1(a)(2)). 

8 (4) AUTHORIZATION OF APPROPRIATIONS.— 

9 There are authorized to be appropriated such sums 

10 as are necessary to carry out the demonstration pro11 gram under this subsection. 

12 TITLE V—IMPROVING HEALTH 

13 OUTCOMES FOR WOMEN, 

14 CHILDREN, AND FAMILIES 

15 SEC. 501. GRANTS TO PROMOTE POSITIVE HEALTH OUT16 COMES FOR WOMEN AND CHILDREN. 

17 Part Q of title III of the Public Health Service Act 

18 (42 U.S.C. 280g et seq.) is amended by adding at the end 

19 the following: 

20 ‘‘SEC. 399Z–2. GRANTS TO PROMOTE POSITIVE HEALTH 

21 OUTCOMES FOR WOMEN AND CHILDREN. 

22 ‘‘(a) GRANTS AUTHORIZED.—The Secretary, in col23 laboration with the Administrator of the Health Resources 

24 and Services Administration and other Federal officials 

25 determined appropriate by the Secretary, is authorized to 


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1 award grants to eligible entities to promote positive health 

2 outcomes for women and children in target populations, 

3 especially racial and ethnic minority women and children 

4 in medically underserved communities. 

5 ‘‘(b) USE OF FUNDS.—Grants awarded pursuant to 

6 subsection (a) may be used to support the activities of 

7 community health workers, including such activities— 

8 ‘‘(1) to educate and provide outreach regarding 

9 enrollment in health insurance including the State 

10 Children’s Health Insurance Program under title 

11 XXI of the Social Security Act, Medicare under title 

12 XVIII of such Act, and Medicaid under title XIX of 

13 such Act; 

14 ‘‘(2) to educate, guide, and provide outreach in 

15 a community setting regarding health problems prev16 alent among women and children and especially 

17 among racial and ethnic minority women and chil18 dren; 

19 ‘‘(3) to educate, guide, and provide experiential 

20 learning opportunities and target risk factors and 

21 healthy behaviors that impede or contribute to 

22 achieving positive health outcomes, including— 

23 ‘‘(A) healthy nutrition; 

24 ‘‘(B) physical activity; 

25 ‘‘(C) overweight or obesity; 


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1 ‘‘(D) tobacco use; 

2 ‘‘(E) alcohol and substance use; 

3 ‘‘(F) injury and violence; 

4 ‘‘(G) sexual health; 

5 ‘‘(H) mental health; 

6 ‘‘(I) musculoskeletal health and arthritis; 

7 ‘‘(J) dental and oral health; 

8 ‘‘(K) understanding informed consent; and 

9 ‘‘(L) stigma; 

10 ‘‘(4) to educate and guide regarding effective 

11 strategies to promote positive health outcomes for 

12 women and children; 

13 ‘‘(5) to promote community wellness and aware14 ness; and 

15 ‘‘(6) to educate and refer target populations to 

16 appropriate health care agencies and community17 based programs and organizations in order to in18 crease access to quality health care services, includ19 ing preventive health services. 

20 ‘‘(c) APPLICATION.— 

21 ‘‘(1) IN GENERAL.—Each eligible entity that 

22 desires to receive a grant under subsection (a) shall 

23 submit an application to the Secretary, at such time, 

24 in such manner, and accompanied by such additional 

25 information as the Secretary may require. 


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1 ‘‘(2) CONTENTS.—Each application submitted 

2 pursuant to paragraph (1) shall— 

3 ‘‘(A) describe the activities for which as4 sistance under this section is sought; 

5 ‘‘(B) contain an assurance that, with re6 spect to each community health worker pro7 gram receiving funds under the grant awarded, 

8 such program provides in-language training and 

9 supervision to community health workers to en10 able such workers to provide authorized pro11 gram activities in (at least) the most commonly 

12 used languages within a particular geographic 

13 region; 

14 ‘‘(C) contain an assurance that the appli15 cant will evaluate the effectiveness of commu16 nity health worker programs receiving funds 

17 under the grant; 

18 ‘‘(D) contain an assurance that each com19 munity health worker program receiving funds 

20 under the grant will provide culturally com21 petent services in the linguistic context most 

22 appropriate for the individuals served by the 

23 program; 

24 ‘‘(E) contain a plan to document and dis25 seminate project descriptions and results to 


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1 other States and organizations as identified by 

2 the Secretary; and 

3 ‘‘(F) describe plans to enhance the capac4 ity of individuals to utilize health services and 

5 health-related social services under Federal, 

6 State, and local programs by— 

7 ‘‘(i) assisting individuals in estab8 lishing eligibility under the programs and 

9 in receiving the services or other benefits 

10 of the programs; and 

11 ‘‘(ii) providing other services, as the 

12 Secretary determines to be appropriate, 

13 which may include transportation and 

14 translation services. 

15 ‘‘(d) PRIORITY.—In awarding grants under sub16 section (a), the Secretary shall give priority to those appli17 cants— 

18 ‘‘(1) who propose to target geographic areas 

19 that— 

20 ‘‘(A)(i) have a high percentage of residents 

21 who are uninsured or underinsured (if the tar22 geted geographic area is located in a State that 

23 has elected to make medical assistance available 

24 under section 1902(a)(10)(A)(i)(VIII) of the 


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1 Social Security Act to individuals described in 

2 such section); 

3 ‘‘(ii) have a high percentage of under4 insured residents in a particular geographic 

5 area (if the targeted geographic area is located 

6 in a State that has not so elected); or 

7 ‘‘(iii) have a high number of households ex8 periencing extreme poverty; and 

9 ‘‘(B) have a high percentage of families for 

10 whom English is not their primary language or 

11 including smaller limited-English-proficient 

12 communities within the region that are not oth13 erwise reached by linguistically appropriate 

14 health services; 

15 ‘‘(2) with experience in providing health or 

16 health-related social services to individuals who are 

17 underserved with respect to such services; and 

18 ‘‘(3) with documented community activity and 

19 experience with community health workers. 

20 ‘‘(e) COLLABORATION WITH ACADEMIC INSTITU21 TIONS.—The Secretary shall encourage community health 

22 worker programs receiving funds under this section to col23 laborate with academic institutions, including minority24 serving institutions. Nothing in this section shall be con25 strued to require such collaboration. 


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1 ‘‘(f) QUALITY ASSURANCE AND COST EFFECTIVE2 NESS.—The Secretary shall establish guidelines for ensur3 ing the quality of the training and supervision of commu4 nity health workers under the programs funded under this 

5 section and for ensuring the cost effectiveness of such pro6 grams. 

7 ‘‘(g) MONITORING.—The Secretary shall monitor 

8 community health worker programs identified in approved 

9 applications and shall determine whether such programs 

10 are in compliance with the guidelines established under 

11 subsection (f). 

12 ‘‘(h) TECHNICAL ASSISTANCE.—The Secretary may 

13 provide technical assistance to community health worker 

14 programs identified in approved applications with respect 

15 to planning, developing, and operating programs under the 

16 grant. 

17 ‘‘(i) REPORT TO CONGRESS.— 

18 ‘‘(1) IN GENERAL.—Not later than 4 years 

19 after the date on which the Secretary first awards 

20 grants under subsection (a), the Secretary shall sub21 mit to Congress a report regarding the grant 

22 project. 

23 ‘‘(2) CONTENTS.—The report required under 

24 paragraph (1) shall include the following: 


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1 ‘‘(A) A description of the programs for 

2 which grant funds were used. 

3 ‘‘(B) The number of individuals served. 

4 ‘‘(C) An evaluation of— 

5 ‘‘(i) the effectiveness of these pro6 grams; 

7 ‘‘(ii) the cost of these programs; and 

8 ‘‘(iii) the impact of the project on the 

9 health outcomes of the community resi10 dents. 

11 ‘‘(D) Recommendations for sustaining the 

12 community health worker programs developed 

13 or assisted under this section. 

14 ‘‘(E) Recommendations regarding training 

15 to enhance career opportunities for community 

16 health workers. 

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

18 ‘‘(1) COMMUNITY HEALTH WORKER.—The term 

19 ‘community health worker’ means an individual who 

20 promotes health or nutrition within the community 

21 in which the individual resides— 

22 ‘‘(A) by serving as a liaison between com23 munities and health care agencies; 

24 ‘‘(B) by providing guidance and social as25 sistance to community residents; 


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1 ‘‘(C) by enhancing community residents’ 

2 ability to effectively communicate with health 

3 care providers; 

4 ‘‘(D) by providing culturally and linguis5 tically appropriate health or nutrition edu6 cation; 

7 ‘‘(E) by advocating for individual and com8 munity health, including dental, oral, mental, 

9 and environmental health, or nutrition needs; 

10 ‘‘(F) by taking into consideration the 

11 needs of the communities served, including the 

12 prevalence rates of risk factors that impede 

13 achieving positive healthy outcomes among 

14 women and children, especially among racial 

15 and ethnic minority women and children; and 

16 ‘‘(G) by providing referral and followup 

17 services. 

18 ‘‘(2) COMMUNITY SETTING.—The term ‘commu19 nity setting’ means a home or a community organi20 zation that serves a population. 

21 ‘‘(3) ELIGIBLE ENTITY.—The term ‘eligible en22 tity’ means— 

23 ‘‘(A) a unit of State, territorial, local, or 

24 tribal government (including a federally recog25 nized tribe or Alaska Native village); or 


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1 ‘‘(B) a community-based organization. 

2 ‘‘(4) MEDICALLY UNDERSERVED COMMUNITY.— 

3 The term ‘medically underserved community’ means 

4 a community— 

5 ‘‘(A) that has a substantial number of in6 dividuals who are members of a medically un7 derserved population, as defined by section 

8 330(b)(3); 

9 ‘‘(B) a significant portion of which is a 

10 health professional shortage area as designated 

11 under section 332; and 

12 ‘‘(C) that includes populations that are lin13 guistically isolated, such as geographic areas 

14 with a shortage of health professionals able to 

15 provide linguistically appropriate services. 

16 ‘‘(5) SUPPORT.—The term ‘support’ means the 

17 provision of training, supervision, and materials 

18 needed to effectively deliver the services described in 

19 subsection (b), reimbursement for services, and 

20 other benefits. 

21 ‘‘(6) TARGET POPULATION.—The term ‘target 

22 population’ means women of reproductive age, re23 gardless of their current childbearing status and 

24 children under 21 years of age. 


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1 ‘‘(k) AUTHORIZATION OF APPROPRIATIONS.—There 

2 are authorized to be appropriated to carry out this section 

3 $15,000,000 for each of fiscal years 2017 through 2021.’’. 

4 SEC. 502. REMOVING BARRIERS TO HEALTH CARE AND NU5 TRITION ASSISTANCE FOR CHILDREN, PREG6 NANT WOMEN, AND LAWFULLY PRESENT IN7 DIVIDUALS. 

8 (a) MEDICAID.—Section 1903(v) of the Social Secu9 rity Act (42 U.S.C. 1396b(v)) is amended by striking 

10 paragraph (4) and inserting the following new paragraph: 

11 ‘‘(4)(A) Notwithstanding sections 401(a), 402(b), 

12 403, and 421 of the Personal Responsibility and Work Op13 portunity Reconciliation Act of 1996 and paragraph (1), 

14 payment shall be made to a State under this section for 

15 medical assistance furnished to an alien under this title 

16 (including an alien described in such paragraph) who 

17 meets any of the following conditions: 

18 ‘‘(i) The alien is otherwise eligible for such as19 sistance under the State plan approved under this 

20 title (other than the requirement of the receipt of 

21 aid or assistance under title IV, supplemental secu22 rity income benefits under title XVI, or a State sup23 plementary payment) within either or both of the 

24 following eligibility categories: 


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1 ‘‘(I) Children under 21 years of age, in2 cluding any optional targeted low-income child 

3 (as such term is defined in section 

4 1905(u)(2)(B)). 

5 ‘‘(II) Pregnant women during pregnancy 

6 and during the 60-day period beginning on the 

7 last day of the pregnancy. 

8 ‘‘(ii) The alien is lawfully present in the United 

9 States. 

10 ‘‘(B) No debt shall accrue under an affidavit of sup11 port against any sponsor of an alien who meets the condi12 tions specified in subparagraph (A) on the basis of the 

13 provision of medical assistance to such alien under this 

14 paragraph and the cost of such assistance shall not be con15 sidered as an unreimbursed cost.’’. 

16 (b) SCHIP.—Subparagraph (J) of section 

17 2107(e)(1) of the Social Security Act (42 U.S.C. 

18 1397gg(e)(1)) is amended to read as follows: 

19 ‘‘(J) Paragraph (4) of section 1903(v) (re20 lating to coverage of categories of children, 

21 pregnant women, and other lawfully present in22 dividuals).’’. 

23 (c) SUPPLEMENTAL NUTRITION ASSISTANCE.—Not24 withstanding sections 401(a), 402(a), and 403(a) of the 

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1 ation Act of 1996 (8 U.S.C. 1611(a); 1612(a); 1613(a)) 

2 and section 6(f) of the Food and Nutrition Act of 2008 

3 (7 U.S.C. 2015(f)), persons who are lawfully present in 

4 the United States shall be not be ineligible for benefits 

5 under the supplemental nutrition assistance program on 

6 the basis of their immigration status or date of entry into 

7 the United States. 

8 (d) ELIGIBILITY FOR FAMILIES WITH CHILDREN.— 

9 Section 421(d)(3) of the Personal Responsibility and 

10 Work Opportunity Reconciliation Act of 1996 (8 U.S.C. 

11 1631(d)(3)) is amended by striking ‘‘to the extent that 

12 a qualified alien is eligible under section 402(a)(2)(J)’’ 

13 and inserting, ‘‘to the extent that a child is a member of 

14 a household under the supplemental nutrition assistance 

15 program’’. 

16 (e) ENSURING PROPER SCREENING.—Section 

17 11(e)(2)(B) of the Food and Nutrition Act of 2008 (7 

18 U.S.C. 2020(e)(2)(B)) is amended— 

19 (1) by redesignating clauses (vi) and (vii) as 

20 clauses (vii) and (viii); and 

21 (2) by inserting after clause (v) the following: 

22 ‘‘(vi) shall provide a method for imple23 menting section 421 of the Personal Re24 sponsibility and Work Opportunity Rec25 onciliation Act of 1996 (8 U.S.C. 1631) 


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1 that does not require any unnecessary in2 formation from persons who may be ex3 empt from that provision;’’. 

4 SEC. 503. REPEAL OF DENIAL OF BENEFITS. 

5 Section 115 of the Personal Responsibility and Work 

6 Opportunity Reconciliation Act of 1996 (21 U.S.C. 862a) 

7 is amended— 

8 (1) in subsection (a), by striking paragraph (2); 

9 (2) in subsection (b), by striking paragraph (2); 

10 and 

11 (3) in subsection (e), by striking paragraph (2). 

12 SEC. 504. BIRTH DEFECTS PREVENTION, RISK REDUCTION, 

13 AND AWARENESS. 

14 (a) IN GENERAL.—The Secretary shall establish and 

15 implement a birth defects prevention and public awareness 

16 program, consisting of the activities described in sub17 sections (c) and (d). 

18 (b) DEFINITIONS.—In this section: 

19 (1) The term ‘‘pregnancy and breastfeeding in20 formation services’’ includes only— 

21 (A) information services to provide accu22 rate, evidence-based, clinical information re23 garding maternal exposures during pregnancy 

24 that may be associated with birth defects or 

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1 tions, chemicals, infections, foodborne patho2 gens, illnesses, nutrition, or lifestyle factors; 

3 (B) information services to provide accu4 rate, evidence-based, clinical information re5 garding maternal exposures during breast6 feeding that may be associated with health risks 

7 to a breast-fed infant, such as exposures to 

8 medications, chemicals, infections, foodborne 

9 pathogens, illnesses, nutrition, or lifestyle fac10 tors; 

11 (C) the provision of accurate, evidence12 based information weighing risks of exposures 

13 during breastfeeding against the benefits of 

14 breastfeeding; and 

15 (D) the provision of information described 

16 in subparagraph (A), (B), or (C) through coun17 selors, Web sites, fact sheets, telephonic or elec18 tronic communication, community outreach ef19 forts, or other appropriate means. 

20 (2) The term ‘‘Secretary’’ means the Secretary 

21 of Health and Human Services, acting through the 

22 Director of the Centers for Disease Control and Pre23 vention. 

24 (c) NATIONWIDE MEDIA CAMPAIGN.—In carrying out 

25 subsection (a), the Secretary shall conduct or support a 


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1 nationwide media campaign to increase awareness among 

2 health care providers and at-risk populations about preg3 nancy and breastfeeding information services. 

4 (d) GRANTS FOR PREGNANCY AND BREASTFEEDING

5 INFORMATION SERVICES.— 

6 (1) IN GENERAL.—In carrying out subsection 

7 (a), the Secretary shall award grants to State or re8 gional agencies or organizations for any of the fol9 lowing: 

10 (A) INFORMATION SERVICES.—The provi11 sion of, or campaigns to increase awareness 

12 about, pregnancy and breastfeeding information 

13 services. 

14 (B) SURVEILLANCE AND RESEARCH.—The 

15 conduct or support of— 

16 (i) surveillance of or research on— 

17 (I) maternal exposures and ma18 ternal health conditions that may in19 fluence the risk of birth defects, pre20 maturity, or other adverse pregnancy 

21 outcomes; and 

22 (II) maternal exposures that may 

23 influence health risks to a breastfed 

24 infant; or 


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1 (ii) networking to facilitate surveil2 lance or research described in this sub3 paragraph. 

4 (2) PREFERENCE FOR CERTAIN STATES.—The 

5 Secretary, in making any grant under this sub6 section, shall give preference to States, otherwise 

7 equally qualified, that have a pregnancy and 

8 breastfeeding information service in place. 

9 (3) MATCHING FUNDS.—The Secretary may 

10 only award a grant under this subsection to a State 

11 or regional agency or organization that agrees, with 

12 respect to the costs to be incurred in carrying out 

13 the grant activities, to make available (directly or 

14 through donations from public or private entities) 

15 non-Federal funds toward such costs in an amount 

16 equal to not less than 25 percent of the amount of 

17 the grant. 

18 (4) COORDINATION.—The Secretary shall en19 sure that activities funded through a grant under 

20 this subsection are coordinated, to the maximum ex21 tent practicable, with other birth defects prevention 

22 and environmental health activities of the Federal 

23 Government, including with respect to pediatric envi24 ronmental health specialty units and children’s envi25 ronmental health centers. 


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1 (e) EVALUATION.—In furtherance of the program 

2 under subsection (a), the Secretary shall provide for an 

3 evaluation of pregnancy and breastfeeding information 

4 services to identify efficient and effective models of— 

5 (1) providing information; 

6 (2) raising awareness and increasing knowledge 

7 about birth defects prevention measures and tar8 geting education to at-risk groups; 

9 (3) modifying risk behaviors; or 

10 (4) other outcome measures as determined ap11 propriate by the Secretary. 

12 (f) AUTHORIZATION OF APPROPRIATIONS.—To carry 

13 out this section, there are authorized to be appropriated 

14 $5,000,000 for fiscal year 2017, $6,000,000 for fiscal year 

15 2018, $7,000,000 for fiscal year 2019, $8,000,000 for fis16 cal year 2020, and $9,000,000 for fiscal year 2021. 

17 SEC. 505. UNIFORM STATE MATERNAL MORTALITY REVIEW 

18 COMMITTEES ON PREGNANCY-RELATED 

19 DEATHS. 

20 (a) IN GENERAL.—Title V of the Social Security Act 

21 (42 U.S.C. 701 et seq.) is amended by adding at the end 

22 the following new section: 


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1 ‘‘SEC. 514. UNIFORM STATE MATERNAL MORTALITY RE2 VIEW COMMITTEES ON PREGNANCY-RE3 LATED DEATHS. 

4 ‘‘(a) GRANTS.— 

5 ‘‘(1) IN GENERAL.—Notwithstanding any other 

6 provision of this title, for each of fiscal years 2017 

7 through 2023, in addition to payments from allot8 ments for States under section 502 for such year, 

9 the Secretary shall, subject to paragraph (3) and in 

10 accordance with the criteria established under para11 graph (2), award grants to States to— 

12 ‘‘(A) carry out the activities described in 

13 subsection (b)(1); 

14 ‘‘(B) establish a State maternal mortality 

15 review committee, in accordance with subsection 

16 (b)(2), to carry out the activities described in 

17 subsection (b)(2)(A), and to establish the proc18 esses described in subsection (b)(1); 

19 ‘‘(C) ensure the State department of 

20 health carries out the applicable activities de21 scribed in subsection (b)(3), with respect to 

22 pregnancy-related deaths occurring within the 

23 State during such fiscal year; 

24 ‘‘(D) implement and use the comprehensive 

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1 section (c), in accordance with such subsection; 

2 and 

3 ‘‘(E) provide for public disclosure of infor4 mation, in accordance with subsection (e). 

5 ‘‘(2) CRITERIA.—The Secretary shall establish 

6 criteria for determining eligibility for and the 

7 amount of a grant awarded to a State under para8 graph (1). Such criteria shall provide that in the 

9 case of a State that receives such a grant for a fiscal 

10 year and is determined by the Secretary to have not 

11 used such grant in accordance with this section, 

12 such State shall not be eligible for such a grant for 

13 any subsequent fiscal year. 

14 ‘‘(3) AUTHORIZATION OF APPROPRIATIONS.— 

15 For purposes of carrying out the grant program 

16 under this section, including for administrative pur17 poses, there is authorized to be appropriated 

18 $10,000,000 for each of fiscal years 2017 through 

19 2023. 

20 ‘‘(b) PREGNANCY-RELATED DEATH REVIEW.— 

21 ‘‘(1) REVIEW OF PREGNANCY-RELATED DEATH

22 AND PREGNANCY-ASSOCIATED DEATH CASES.—For 

23 purposes of subsection (a), with respect to a State 

24 that receives a grant under subsection (a), the fol25 lowing shall apply: 


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1 ‘‘(A) MANDATORY REPORTING OF PREG2 NANCY-RELATED DEATHS.— 

3 ‘‘(i) IN GENERAL.—The State shall, 

4 through the State maternal mortality re5 view committee, develop a process, sepa6 rate from any reporting process established 

7 by the State department of health prior to 

8 the date of the enactment of this section, 

9 that provides for mandatory and confiden10 tial case reporting by individuals and enti11 ties described in clause (ii) of pregnancy12 related deaths to the State department of 

13 health. 

14 ‘‘(ii) INDIVIDUALS AND ENTITIES DE15 SCRIBED.—Individuals and entities de16 scribed in this clause include each of the 

17 following: 

18 ‘‘(I) Health care providers. 

19 ‘‘(II) Medical examiners. 

20 ‘‘(III) Medical coroners. 

21 ‘‘(IV) Hospitals. 

22 ‘‘(V) Free-standing birth centers. 

23 ‘‘(VI) Federally qualified health 

24 centers. 


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1 ‘‘(VII) Other health care facili2 ties. 

3 ‘‘(VIII) Any other individuals re4 sponsible for completing death certifi5 cates. 

6 ‘‘(IX) Any other appropriate in7 dividuals or entities specified by the 

8 Secretary. 

9 ‘‘(B) VOLUNTARY REPORTING OF PREG10 NANCY-RELATED AND PREGNANCY-ASSOCIATED

11 DEATHS.— 

12 ‘‘(i) The State shall, through the 

13 State maternal mortality review committee, 

14 develop a process for and encourage, sepa15 rate from any reporting process established 

16 by the State department of health prior to 

17 the date of the enactment of this section, 

18 voluntary and confidential case reporting 

19 by individuals described in clause (ii) of 

20 pregnancy-associated deaths to the State 

21 department of health. 

22 ‘‘(ii) The State shall, through the 

23 State maternal mortality review committee, 

24 develop a process for voluntary and con25 fidential reporting by family members of 


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1 the deceased and by other individuals on 

2 possible pregnancy-related and pregnancy3 associated deaths to the State department 

4 of health. Such process shall include— 

5 ‘‘(I) making publicly available on 

6 the Internet Web site of the State de7 partment of health a telephone num8 ber, Internet Web link, and email ad9 dress for such reporting; and 

10 ‘‘(II) publicizing to local profes11 sional organizations, community orga12 nizations, and social services agencies 

13 the availability of the telephone num14 ber, Internet Web link, and email ad15 dress made available under subclause 

16 (I). 

17 ‘‘(C) DEVELOPMENT OF CASE-FINDING.— 

18 The State, through the vital statistics unit of 

19 the State, shall annually identify pregnancy-re20 lated and pregnancy-associated deaths occur21 ring in such State during the year involved 

22 by— 

23 ‘‘(i) matching all death records, with 

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1 fant death certificates to identify deaths of 

2 women that occurred during pregnancy 

3 and within one year after the end of a 

4 pregnancy; 

5 ‘‘(ii) identifying deaths reported dur6 ing such year as having an underlying or 

7 contributing cause of death related to 

8 pregnancy, regardless of the time that has 

9 passed between the end of the pregnancy 

10 and the death; 

11 ‘‘(iii) collecting data from medical ex12 aminer and coroner reports; and 

13 ‘‘(iv) any other methods the States 

14 may devise to identify maternal deaths, 

15 such as through review of a random sam16 ple of reported deaths of women of child17 bearing age to ascertain cases of preg18 nancy-related and pregnancy-associated 

19 deaths that are not discernable from a re20 view of death certificates alone. 

21 When feasible and for purposes of effectively 

22 collecting and obtaining data on pregnancy-re23 lated and pregnancy-associated deaths, the 

24 State shall adopt the most recent standardized 

25 birth and death certificates, as issued by the 


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1 National Center for Vital Health Statistics, in2 cluding the recommended checkbox section for 

3 pregnancy on the death certificates. 

4 ‘‘(D) CASE INVESTIGATION AND DEVELOP5 MENT OF CASE SUMMARIES.—Following receipt 

6 of reports by the State department of health 

7 pursuant to subparagraph (A) or (B) and col8 lection by the vital statistics unit of the State 

9 of possible cases of pregnancy-related and preg10 nancy-associated deaths pursuant to subpara11 graph (C), the State, through the State mater12 nal mortality review committee established 

13 under subsection (a), shall investigate each 

14 case, utilizing the case abstraction form de15 scribed in subsection (c), and prepare de-identi16 fied case summaries, which shall be reviewed by 

17 the committee and included in applicable re18 ports. For purposes of subsection (a), under the 

19 processes established under subparagraphs (A), 

20 (B), and (C), a State department of health or 

21 vital statistics unit of a State shall provide to 

22 the State maternal mortality review committee 

23 access to information collected pursuant to such 

24 subparagraphs as necessary to carry out this 

25 subparagraph. Data and information collected 


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1 for the case summary and review are for pur2 poses of public health activities, in accordance 

3 with HIPAA privacy and security law (as de4 fined in section 3009(a)(2) of the Public Health 

5 Service Act). Such case investigations shall in6 clude data and information obtained through— 

7 ‘‘(i) medical examiner and autopsy re8 ports of the woman involved; 

9 ‘‘(ii) medical records of the woman, 

10 including such records related to health 

11 care prior to pregnancy, prenatal and post12 natal care, labor and delivery care, emer13 gency room care, hospital discharge 

14 records including immunization status and 

15 screening status for prevalent diseases, and 

16 any care delivered up until the time of 

17 death of the woman for purposes of public 

18 health activities, in accordance with 

19 HIPAA privacy and security law (as de20 fined in section 3009(a)(2) of the Public 

21 Health Service Act); 

22 ‘‘(iii) oral and written interviews of in23 dividuals directly involved in the maternal 

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1 cluding health care, mental health, and so2 cial service providers in-language when 

3 possible, as applicable; 

4 ‘‘(iv) optional oral or written inter5 views of the family of the woman; 

6 ‘‘(v) socioeconomic and other relevant 

7 background information about the woman; 

8 ‘‘(vi) information collected in subpara9 graph (C)(i); and 

10 ‘‘(vii) other information on the cause 

11 of death of the woman, such as social serv12 ices and child welfare reports, including ex13 periences with intimate partner violence. 

14 ‘‘(2) STATE MATERNAL MORTALITY REVIEW

15 COMMITTEES.— 

16 ‘‘(A) DUTIES.— 

17 ‘‘(i) REQUIRED COMMITTEE ACTIVI18 TIES.—For purposes of subsection (a), a 

19 maternal mortality review committee estab20 lished by a State pursuant to a grant 

21 under such subsection shall carry out the 

22 following pregnancy-related death and 

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1 straction form developed under subsection 

2 (d): 

3 ‘‘(I) With respect to a case of 

4 pregnancy-related or pregnancy-asso5 ciated death of a woman, review the 

6 case summaries prepared under sub7 paragraphs (A), (B), (C), and (D) of 

8 paragraph (1). 

9 ‘‘(II) Review aggregate statistical 

10 reports developed by the vital statis11 tics unit of the State under paragraph 

12 (1)(C) regarding pregnancy-related 

13 and pregnancy-associated deaths to 

14 identify trends, patterns, and dispari15 ties in adverse outcomes and address 

16 medical, nonmedical, and system-re17 lated factors that may have contrib18 uted to such pregnancy-related and 

19 pregnancy-associated deaths and dis20 parities. 

21 ‘‘(III) Develop recommendations, 

22 based on the review of the case sum23 maries under paragraph (1)(D) and 

24 aggregate statistical reports under 

25 subclause (II), to improve maternal 


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1 care, social and health services, and 

2 public health policy and institutions, 

3 including with respect to improving 

4 access to maternal care, improving the 

5 availability of social services, and 

6 eliminating disparities in maternal 

7 care and outcomes. 

8 ‘‘(ii) OPTIONAL COMMITTEE ACTIVI9 TIES.—For purposes of subsection (a), a 

10 maternal mortality review committee estab11 lished by a State under such subsection 

12 may present findings and recommendations 

13 regarding a specific case or set of cir14 cumstances directly to a health care facil15 ity or its local or State professional organi16 zation for the purpose of instituting policy 

17 changes, educational activities, or other18 wise improving the quality of care provided 

19 by the facilities. 

20 ‘‘(B) COMPOSITION OF MATERNAL MOR21 TALITY REVIEW COMMITTEES.— 

22 ‘‘(i) IN GENERAL.—Each State mater23 nal mortality review committee established 

24 pursuant to a grant under subsection (a) 

25 shall be multidisciplinary, consisting of 


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1 health care, behavioral health, and social 

2 service providers, public health officials, 

3 other persons with professional expertise 

4 on maternal health and mortality, and pa5 tient and community advocates who rep6 resent those communities within such State 

7 that are the most affected by maternal 

8 mortality. Membership on such a com9 mittee of a State shall be reviewed annu10 ally by the State department of health to 

11 ensure that membership representation re12 quirements are being fulfilled in accord13 ance with this paragraph. 

14 ‘‘(ii) REQUIRED MEMBERSHIP.—Each 

15 such review committee shall include— 

16 ‘‘(I) representatives from medical 

17 specialties providing care to pregnant 

18 and postpartum patients, including 

19 obstetricians (including generalists 

20 and maternal fetal medicine special21 ists), and family practice physicians; 

22 ‘‘(II) representatives from mid23 wifery specialties (including certified 

24 professional midwives and certified 

25 midwives); 


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1 ‘‘(III) advanced practice nurses; 

2 ‘‘(IV) hospital-based nurses; 

3 ‘‘(V) representatives of the State 

4 department of health maternal and 

5 child health department; 

6 ‘‘(VI) social service providers or 

7 social workers; 

8 ‘‘(VII) the chief medical exam9 iners or designees; 

10 ‘‘(VIII) facility representatives, 

11 such as from hospitals or free-stand12 ing birth centers; and 

13 ‘‘(IX) community or patient ad14 vocates who represent those commu15 nities within the State that are the 

16 most affected by maternal mortality. 

17 ‘‘(iii) ADDITIONAL MEMBERS.—Each 

18 such review committee may also include 

19 representatives from other relevant aca20 demic, health, social service, or policy pro21 fessions, or community organizations, on 

22 an ongoing basis, or as needed, as deter23 mined beneficial by the review committee, 

24 including— 

25 ‘‘(I) anesthesiologists; 


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1 ‘‘(II) emergency physicians; 

2 ‘‘(III) pathologists; 

3 ‘‘(IV) epidemiologists or biostat4 isticians; 

5 ‘‘(V) intensivists; 

6 ‘‘(VI) orthopedic surgeons and/or 

7 orthopedic physicians; 

8 ‘‘(VII) vital statistics officers; 

9 ‘‘(VIII) nutritionists; 

10 ‘‘(IX) mental health profes11 sionals; 

12 ‘‘(X) substance abuse treatment 

13 specialists; 

14 ‘‘(XI) representatives of relevant 

15 advocacy groups; 

16 ‘‘(XII) academics; 

17 ‘‘(XIII) representatives of bene18 ficiaries of the State plan under the 

19 Medicaid Program under title XIX; 

20 ‘‘(XIV) paramedics; 

21 ‘‘(XV) lawyers; 

22 ‘‘(XVI) risk management special23 ists; 

24 ‘‘(XVII) representatives of the 

25 departments of health or public health 


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1 of major cities in the State involved; 

2 and 

3 ‘‘(XVIII) policymakers. 

4 ‘‘(iv) DIVERSE COMMUNITY MEMBER5 SHIP.—The composition of such a com6 mittee, with respect to a State, shall in7 clude— 

8 ‘‘(I) representatives from diverse 

9 communities, particularly those com10 munities within such State most se11 verely affected by pregnancy-related 

12 deaths or pregnancy-associated deaths 

13 and by a lack of access to relevant 

14 maternal care services, from commu15 nity maternal child health organiza16 tions, and from minority advocacy 

17 groups; 

18 ‘‘(II) members, including health 

19 care providers, from different geo20 graphic regions in the State, including 

21 any rural, urban, and tribal areas; 

22 and 

23 ‘‘(III) health care and social serv24 ice providers who work in commu25 nities that are diverse with regard to 


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1 race, ethnicity, immigration status, in2 digenous status, and English pro3 ficiency. 

4 ‘‘(v) MATERNAL MORTALITY REVIEW

5 STAFF.—Staff of each such review com6 mittee shall include— 

7 ‘‘(I) vital health statisticians, ma8 ternal child health statisticians, or 

9 epidemiologists; 

10 ‘‘(II) a coordinator of the State 

11 maternal mortality review committee, 

12 to be designated by the State; and 

13 ‘‘(III) administrative staff. 

14 ‘‘(C) OPTION FOR STATES TO FORM RE15 GIONAL MATERNAL MORTALITY REVIEWS.— 

16 States with a low rate of occurrence of preg17 nancy-associated or pregnancy-related deaths 

18 may choose to partner with one or more neigh19 boring States to fulfill the activities described in 

20 paragraph (1)(C). In such a case, with respect 

21 to States in such a partnership, any require22 ment under this section relating to the report23 ing of information related to such activities 

24 shall be deemed to be fulfilled by each such 


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1 State if a single such report is submitted for 

2 the partnership. 

3 ‘‘(3) STATE DEPARTMENT OF HEALTH ACTIVI4 TIES.—For purposes of subsection (a), a State de5 partment of health of a State receiving a grant 

6 under such subsection shall— 

7 ‘‘(A) in consultation with the maternal 

8 mortality review committee of the State and in 

9 conjunction with relevant professional organiza10 tions, develop a plan for ongoing health care 

11 provider education, based on the findings and 

12 recommendations of the committee, in order to 

13 improve the quality of maternal care; and 

14 ‘‘(B) take steps to widely disseminate the 

15 findings and recommendations of the State ma16 ternal mortality review committees of the State 

17 and to implement the recommendations of such 

18 committee. 

19 ‘‘(c) CASE ABSTRACTION FORM.— 

20 ‘‘(1) DEVELOPMENT.—The Director of the Cen21 ters for Disease Control and Prevention shall de22 velop a uniform, comprehensive case abstraction 

23 form and make such form available to States for 

24 State maternal mortality review committees for use 

25 by such committees in order to— 


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1 ‘‘(A) ensure that the cases and information 

2 collected and reviewed by such committees can 

3 be pooled for review by the Department of 

4 Health and Human Services and its agencies; 

5 and 

6 ‘‘(B) preserve the uniformity of the infor7 mation and its use for Federal public health 

8 purposes. 

9 ‘‘(2) PERMISSIBLE STATE MODIFICATION.— 

10 Each State may modify the form developed under 

11 paragraph (1) for implementation and use by such 

12 State or by the State maternal mortality review com13 mittee of such State by including on such form addi14 tional information to be collected, but may not alter 

15 the standard questions on such form, in order to en16 sure that the information can be collected and re17 viewed centrally at the Federal level. 

18 ‘‘(d) TREATMENT AS PUBLIC HEALTH AUTHORITY

19 FOR PURPOSES OF HIPAA.—For purposes of applying 

20 HIPAA privacy and security law (as defined in section 

21 3009(a)(2) of the Public Health Service Act), a State ma22 ternal mortality review committee of a State established 

23 pursuant to this section to carry out activities described 

24 in subsection (b)(2)(A) shall be deemed to be a public 

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1 erenced in section 164.512(b)(1)(i)) of title 45, Code of 

2 Federal Regulations (or any successor regulation), car3 rying out public health activities and purposes described 

4 in such section 164.512(b)(1)(i) (or any such successor 

5 regulation). 

6 ‘‘(e) PUBLIC DISCLOSURE OF INFORMATION.— 

7 ‘‘(1) IN GENERAL.—For fiscal year 2017 or a 

8 subsequent fiscal year, each State receiving a grant 

9 under this section for such year shall, subject to 

10 paragraph (3), provide for the public disclosure, and 

11 submission to the information clearinghouse estab12 lished under paragraph (2), of the information in13 cluded in the report of the State under section 

14 506(a)(2)(F) for such year (relating to the findings 

15 for such year of the State maternal mortality review 

16 committee established by the State under this sec17 tion). 

18 ‘‘(2) INFORMATION CLEARINGHOUSE.—The 

19 Secretary of Health and Human Services shall es20 tablish an information clearinghouse, that shall be 

21 administered by the Director of the Centers for Dis22 ease Control and Prevention, that will maintain find23 ings and recommendations submitted pursuant to 

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1 poses by State health departments, maternal mor2 tality review committees, and health providers and 

3 institutions. 

4 ‘‘(3) CONFIDENTIALITY OF INFORMATION.—In 

5 no case shall any individually identifiable health in6 formation be provided to the public, or submitted to 

7 the information clearinghouse, under paragraph (1). 

8 ‘‘(f) CONFIDENTIALITY OF REVIEW COMMITTEE

9 PROCEEDINGS.— 

10 ‘‘(1) IN GENERAL.—All proceedings and activi11 ties of a State maternal mortality review committee 

12 under this section, opinions of members of such a 

13 committee formed as a result of such proceedings 

14 and activities, and records obtained, created, or 

15 maintained pursuant to this section, including 

16 records of interviews, written reports, and state17 ments procured by the Department of Health and 

18 Human Services or by any other person, agency, or 

19 organization acting jointly with the Department, in 

20 connection with morbidity and mortality reviews 

21 under this section, shall be confidential, and not sub22 ject to discovery, subpoena, or introduction into evi23 dence in any civil, criminal, legislative, or other pro24 ceeding. Such records shall not be open to public in25 spection. 


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1 ‘‘(2) TESTIMONY OF MEMBERS OF COM2 MITTEE.— 

3 ‘‘(A) IN GENERAL.—Members of a State 

4 maternal mortality review committee under this 

5 section may not be questioned in any civil, 

6 criminal, legislative, or other proceeding regard7 ing information presented in, or opinions 

8 formed as a result of, a meeting or communica9 tion of the committee. 

10 ‘‘(B) CLARIFICATION.—Nothing in this 

11 subsection shall be construed to prevent a mem12 ber of such a committee from testifying regard13 ing information that was obtained independent 

14 of such member’s participation on the com15 mittee, or that is public information. 

16 ‘‘(3) AVAILABILITY OF INFORMATION FOR RE17 SEARCH PURPOSES.—Nothing in this subsection 

18 shall prohibit the publishing by such a committee or 

19 the Department of Health and Human Services of 

20 statistical compilations and research reports that— 

21 ‘‘(A) are based on confidential information, 

22 relating to morbidity and mortality review; and 

23 ‘‘(B) do not contain identifying informa24 tion or any other information that could be 


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1 used to ultimately identify the individuals con2 cerned. 

3 ‘‘(g) DEFINITIONS.—For purposes of this section: 

4 ‘‘(1) The term ‘pregnancy-associated death’ 

5 means the death of a woman while pregnant or dur6 ing the one-year period following the date of the end 

7 of pregnancy, irrespective of the cause of such death. 

8 ‘‘(2) The term ‘pregnancy-related death’ means 

9 the death of a woman while pregnant or during the 

10 one-year period following the date of the end of 

11 pregnancy, irrespective of the duration or site of the 

12 pregnancy, from any cause related to or aggravated 

13 by the pregnancy or its management, but not from 

14 any accidental or incidental cause. 

15 ‘‘(3) The term ‘woman of childbearing age’ 

16 means a woman who is at least 10 years of age and 

17 not more than 54 years of age.’’. 

18 (b) INCLUSION OF FINDINGS OF REVIEW COMMIT19 TEES IN REQUIRED REPORTS.— 

20 (1) STATE TRIENNIAL REPORTS.—Paragraph 

21 (2) of section 506(a) of the Social Security Act (42 

22 U.S.C. 706(a)) is amended by inserting after sub23 paragraph (E) the following new subparagraph: 

24 ‘‘(F) In the case of a State receiving a 

25 grant under section 514, beginning for the first 


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1 fiscal year beginning after 3 years after the 

2 date of establishment of the State maternal 

3 mortality review committee established by the 

4 State pursuant to such grant and once every 3 

5 years thereafter, information containing the 

6 findings and recommendations of such com7 mittee and information on the implementation 

8 of such recommendations during the period in9 volved.’’. 

10 (2) ANNUAL REPORTS TO CONGRESS.—Para11 graph (3) of such section is amended— 

12 (A) in subparagraph (D) by striking ‘‘and’’ 

13 at the end; 

14 (B) in subparagraph (E) by striking the 

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

16 (C) by adding at the end the following new 

17 subparagraph: 

18 ‘‘(F) For fiscal year 2017 and each subsequent 

19 fiscal year, taking into account the findings, rec20 ommendations, and implementation information sub21 mitted by States pursuant to paragraph (2)(F), on 

22 the status of pregnancy-related deaths and preg23 nancy-associated deaths in the United States and in24 cluding recommendations on methods to prevent 

25 such deaths in the United States.’’. 


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1 SEC. 506. ELIMINATING DISPARITIES IN MATERNITY 

2 HEALTH OUTCOMES. 

3 Part B of title III of the Public Health Service Act 

4 is amended by inserting after section 317V, as added, the 

5 following new section: 

6 ‘‘SEC. 317W. ELIMINATING DISPARITIES IN MATERNITY 

7 HEALTH OUTCOMES. 

8 ‘‘(a) IN GENERAL.—The Secretary (in consultation 

9 with the Deputy Assistant Secretary for Minority Health, 

10 the Director of the National Institutes of Health, the Di11 rector of the Centers for Disease Control and Prevention, 

12 the Administrator of the Centers for Medicare & Medicaid 

13 Services, and the Administrator of the Agency for 

14 Healthcare Research & Quality, and in consultation with 

15 relevant national stakeholder organizations such as na16 tional medical specialty organizations, national maternal 

17 child health organizations, national groups that represent 

18 minority populations, and national health disparity organi19 zations) shall carry out the following activities to eliminate 

20 disparities in maternal health outcomes: 

21 ‘‘(1) Conduct research into the determinants 

22 and the distribution of disparities in maternal care, 

23 health risks, and health outcomes, and improve the 

24 capacity of the performance measurement infrastruc25 ture to measure such disparities. 


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1 ‘‘(2) Expand access to services that have been 

2 demonstrated to improve the quality and outcomes 

3 of maternity care for vulnerable populations. 

4 ‘‘(3) Establish a demonstration project to com5 pare the effectiveness of interventions to reduce dis6 parities in maternity services and outcomes, and im7 plement and assess effective interventions. 

8 ‘‘(b) SCOPE AND SELECTION OF STATES FOR DEM9 ONSTRATION PROJECT.—The demonstration project 

10 under subsection (a)(3) shall be conducted in no more 

11 than 8 States, which shall be selected by the Secretary 

12 based on— 

13 ‘‘(1) applications submitted by States, which 

14 specify which regions and populations the State in15 volved will serve under the demonstration project; 

16 ‘‘(2) criteria designed by the Secretary to en17 sure that, as a whole, the demonstration project is, 

18 to the greatest extent possible, representative of the 

19 demographic and geographic composition of commu20 nities most affected by disparities; 

21 ‘‘(3) criteria designed by the Secretary to en22 sure that a variety of types of models are tested 

23 through the demonstration project and that such 

24 models include interventions that have an existing 

25 evidence base for effectiveness; and 


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1 ‘‘(4) criteria designed by the Secretary to as2 sure that the demonstration projects and models will 

3 be carried out in consultation with local and regional 

4 provider organizations, such as community health 

5 centers, hospital systems, and medical societies rep6 resenting providers of maternity services. 

7 ‘‘(c) DURATION OF DEMONSTRATION PROJECT.— 

8 The demonstration project under subsection (a)(3) shall 

9 begin on January 1, 2017, and end on December 31, 

10 2021. 

11 ‘‘(d) GRANTS FOR EVALUATION AND MONITORING.— 

12 The Secretary may make grants to States and health care 

13 providers participating in the demonstration project under 

14 subsection (a)(3) for the purpose of collecting data nec15 essary for the evaluation and monitoring of such project. 

16 ‘‘(e) REPORTS.— 

17 ‘‘(1) STATE REPORTS.—Each State that par18 ticipates in the demonstration project under sub19 section (a)(3) shall report to the Secretary, in a 

20 time, form, and manner specified by the Secretary, 

21 the data necessary to— 

22 ‘‘(A) monitor the— 

23 ‘‘(i) outcomes of the project; 

24 ‘‘(ii) costs of the project; and 


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1 ‘‘(iii) quality of maternity care pro2 vided under the project; and 

3 ‘‘(B) evaluate the rationale for the selec4 tion of the items and services included in any 

5 bundled payment made by the State under the 

6 project. 

7 ‘‘(2) FINAL REPORT.—Not later than December 

8 31, 2022, the Secretary shall submit to Congress a 

9 report on the results of the demonstration project 

10 under subsection (a)(3).’’. 

11 SEC. 507. DECREASING THE RISK FACTORS FOR SUDDEN 

12 UNEXPECTED INFANT DEATH AND SUDDEN 

13 UNEXPLAINED DEATH IN CHILDHOOD. 

14 (a) ESTABLISHMENT.—The Secretary of Health and 

15 Human Services, acting through the Administrator of the 

16 Health Resources and Services Administration and in con17 sultation with the Director of the Centers for Disease Con18 trol and Prevention and the Director of the National Insti19 tutes of Health (in this section referred to as the ‘‘Sec20 retary’’), shall establish and implement a culturally com21 petent public health awareness and education campaign 

22 to provide information that is focused on decreasing the 

23 risk factors for sudden unexpected infant death and sud24 den unexplained death in childhood, including educating 

25 individuals about safe sleep environments, sleep positions, 


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1 and reducing exposure to smoking during pregnancy and 

2 after birth. 

3 (b) TARGETED POPULATIONS.—The campaign under 

4 subsection (a) shall be designed to reduce health dispari5 ties through the targeting of populations with high rates 

6 of sudden unexpected infant death and sudden unex7 plained death in childhood. 

8 (c) CONSULTATION.—In establishing and imple9 menting the campaign under subsection (a), the Secretary 

10 shall consult with national organizations representing 

11 health care providers, including nurses and physicians, 

12 parents, child care providers, children’s advocacy and safe13 ty organizations, maternal and child health programs, nu14 trition professionals focusing on women, infants, and chil15 dren, and other individuals and groups determined nec16 essary by the Secretary for such establishment and imple17 mentation. 

18 (d) GRANTS.— 

19 (1) IN GENERAL.—In carrying out the cam20 paign under subsection (a), the Secretary shall 

21 award grants to national organizations, State and 

22 local health departments, and community-based or23 ganizations for the conduct of education and out24 reach programs for nurses, parents, child care proVerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00336 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475

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1 viders, public health agencies, and community orga2 nizations. 

3 (2) APPLICATION.—To be eligible to receive a 

4 grant under paragraph (1), an entity shall submit to 

5 the Secretary an application at such time, in such 

6 manner, and containing such information as the Sec7 retary may require. 

8 (e) AUTHORIZATION OF APPROPRIATIONS.—There is 

9 authorized to be appropriated to carry out this section 

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

11 2017 through 2021. 

12 SEC. 508. REDUCING UNINTENDED TEENAGE PREG13 NANCIES. 

14 Title III of the Public Health Service Act (42 U.S.C. 

15 241 et seq.) is amended by adding at the end the following 

16 new part: 

17 ‘‘PART W—YOUTH PREGNANCY PREVENTION 

18 PROGRAMS 

19 ‘‘SEC. 399OO. PURPOSE. 

20 ‘‘It is the purpose of this part to develop and carry 

21 out research and multimedia campaigns on new and exist22 ing program interventions to provide youth in communities 

23 at disproportionate risk for unintended teen pregnancy 

24 (particularly young people of color, immigrant commu25 nities, youth in the foster care system, youth in the juveVerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00337 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475

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1 nile justice system, rural youth, and LGBTQ youth) the 

2 information and skills needed to prevent unintended teen3 age pregnancies, build healthy relationships, and improve 

4 overall health and well-being. 

5 ‘‘SEC. 399OO–1. LIMITATION. 

6 ‘‘No Federal funds provided under this Act may be 

7 used for media awareness campaigns that— 

8 ‘‘(1) withhold health-promoting or life-saving 

9 information about sexuality-related topics; 

10 ‘‘(2) undermine young people’s confidence in 

11 the effectiveness of contraception; 

12 ‘‘(3) are medically inaccurate or have been sci13 entifically shown to be ineffective; 

14 ‘‘(4) promote gender, racial, or ethnic stereo15 types; 

16 ‘‘(5) are insensitive and unresponsive to the 

17 needs of sexually active youth, LGBTQ youth, or 

18 youth survivors of sexual violence; 

19 ‘‘(6) are inconsistent with the ethical impera20 tives of medicine and public health; or 

21 ‘‘(7) stigmatize and shame youth who are par22 enting or choose to parent. 


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1 ‘‘SEC. 399OO–2. MULTIMEDIA CAMPAIGNS TO PROMOTE 

2 TEEN SEXUAL HEALTH. 

3 ‘‘(a) IN GENERAL.—The Secretary shall award com4 petitive grants to public and private entities, including na5 tional or regional intermediaries with affiliates located in 

6 urban communities, to carry out multimedia campaigns to 

7 provide public education and increase public awareness re8 garding teen sexual health, including unintended preg9 nancy, sexually transmitted infections including HIV, sex10 ual violence, and related relationship, emotional, social, 

11 and cultural issues. 

12 ‘‘(b) PRIORITY.—In awarding grants under this sec13 tion, the Secretary shall give priority to applicants pro14 posing to carry out campaigns developed for communities 

15 with a high prevalence of unintended teen pregnancy (par16 ticularly young people of color, immigrant communities, 

17 youth in the foster care system, youth in the juvenile jus18 tice system, rural youth, and LGBTQ youth). 

19 ‘‘(c) INFORMATION TO BE PROVIDED.—As a condi20 tion of receipt of a grant under this section, an entity shall 

21 agree to use the grant to carry out multimedia campaigns 

22 described in subsection (a) that— 

23 ‘‘(1) at a minimum, shall provide information 

24 on— 

25 ‘‘(A) human development; 


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1 ‘‘(B) healthy relationships and personal 

2 skills including communication, consent, and vi3 olence prevention; and 

4 ‘‘(C) sexual behavior and health, including 

5 abstinence, prevention of unintended teen preg6 nancy, and HIV and other sexually transmitted 

7 infections; and 

8 ‘‘(2) may provide information on the prevention 

9 of dating violence and sexual assault. 

10 ‘‘SEC. 399OO–3. RESEARCH ON REDUCING UNINTENDED 

11 TEENAGE PREGNANCIES AND TEENAGE DAT12 ING VIOLENCE AND IMPROVING HEALTHY 

13 RELATIONSHIPS. 

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

15 the Director of the Centers for Disease Control and Pre16 vention, shall make grants to public and private entities 

17 to conduct, support, or coordinate research on teen sexual 

18 health (including unintended teen pregnancy, dating vio19 lence, and healthy relationships among persons of color 

20 and immigrant communities) that— 

21 ‘‘(1) improves data collection on— 

22 ‘‘(A) sexual and reproductive health, in23 cluding unintended teenage pregnancies and 

24 births, among all minority communities and 

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1 lected, including American Indian and Alaska 

2 Native youth; 

3 ‘‘(B) sexual behavior, reproductive and sex4 ual coercion, and teenage contraceptive use pat5 terns at the State level, as appropriate; 

6 ‘‘(C) unintended teenage pregnancies 

7 among youth in and aging out of foster care or 

8 juvenile justice systems and the underlying fac9 tors that lead to unintended teenage pregnancy 

10 among youth in foster care or juvenile justice 

11 systems; and 

12 ‘‘(D) sexual and reproductive health, in13 cluding teenage pregnancies and births, sexual 

14 behavior, reproductive and sexual coercion, and 

15 teenage contraceptive use among— 

16 ‘‘(i) LGBTQ youth; and 

17 ‘‘(ii) rural youth; 

18 ‘‘(2) investigates— 

19 ‘‘(A) the variance in the rates of unin20 tended teenage pregnancy by— 

21 ‘‘(i) racial and ethnic group (such as 

22 Hispanic, Asian-American, African-Amer23 ican, Pacific Islander, American Indian, 

24 and Alaska Native); and 


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1 ‘‘(ii) socioeconomic status, based on 

2 the income of the family and education at3 tainment; 

4 ‘‘(B) factors affecting the risk for youth of 

5 unintended teenage pregnancy or dating vio6 lence, including the physical and social environ7 ment, level of acculturation, access to health 

8 care, aspirations for the future, and history of 

9 physical or sexual violence or abuse; 

10 ‘‘(C) the role that violence and abuse play 

11 in teenage sex, pregnancy, and childbearing; 

12 ‘‘(D) strategies to address the dispropor13 tionate rates of unintended teenage pregnancies 

14 and dating violence in racial or ethnic minority 

15 or immigrant communities; 

16 ‘‘(E) how effective interventions can be 

17 replicated or adapted in other settings to serve 

18 racial or ethnic minority or immigrant commu19 nities in a culturally appropriate manner; and 

20 ‘‘(F) the effectiveness of media campaigns 

21 in addressing healthy relationship development, 

22 dating violence prevention, and unintended 

23 teenage pregnancy; and 

24 ‘‘(3) tests research-based strategies for address25 ing high rates of unintended teenage pregnancy 


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1 through programs that emphasize healthy relation2 ships and violence prevention. 

3 ‘‘(b) PRIORITY.—In carrying out this section, the 

4 Secretary shall give priority to research that incor5 porates— 

6 ‘‘(1) interdisciplinary approaches; 

7 ‘‘(2) a strong emphasis on community-based 

8 participatory research; 

9 ‘‘(3) consideration and assessment of State and 

10 local education and health policies that may impact 

11 teen sexual health; or 

12 ‘‘(4) translational research. 

13 ‘‘SEC. 399OO–4. HHS ADOLESCENT HEALTH WORK GROUP. 

14 ‘‘(a) PURPOSE.—Not later than 30 days after the 

15 date of the enactment of this part, the Secretary shall di16 rect the interagency adolescent health workgroup within 

17 the Office of Adolescent Health of the Department of 

18 Health and Human Services to— 

19 ‘‘(1) include in the work of the group strategies 

20 for teenage dating violence prevention and healthy 

21 teenage relationships with a particular focus among 

22 racial or ethnic minority or immigrant communities; 

23 and 

24 ‘‘(2) with respect to including such strategies, 

25 consult, to the greatest extent possible, with the 


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1 Federal Interagency Workgroup on Teen Dating Vi2 olence formed under the leadership of the National 

3 Institute of Justice of the Department of Justice. 

4 ‘‘(b) REPORT REQUIREMENT.—The Secretary, 

5 through the Office of Adolescent Health, shall periodically 

6 submit to Congress a report that— 

7 ‘‘(1) includes a review of the evidence-based 

8 programs on preventing unintended teenage preg9 nancy, which are carried out and identified by the 

10 Office; and 

11 ‘‘(2) identifies the programs of the Department 

12 of Health and Human Services that include teenage 

13 dating violence prevention and the promotion of 

14 healthy teenage relationships as part of a strategy to 

15 prevent unintended teenage pregnancy. 

16 ‘‘SEC. 399OO–5. GENERAL GRANT PROVISIONS. 

17 ‘‘(a) APPLICATIONS.—To seek a grant under this 

18 part, an entity shall submit an application to the Secretary 

19 in such form, in such manner, and containing such agree20 ments, assurances, and information as the Secretary may 

21 require. 

22 ‘‘(b) ADDITIONAL REQUIREMENTS.—A grant may be 

23 made under this part only if the applicant involved agrees 

24 that information, activities, and services provided under 

25 the grant— 


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1 ‘‘(1) will be evidence-based or evidence-in2 formed; 

3 ‘‘(2) will be factually and medically accurate 

4 and complete; and 

5 ‘‘(3) if directed to a particular population 

6 group, will be provided in an appropriate language 

7 and cultural context. 

8 ‘‘(c) TRAINING AND TECHNICAL ASSISTANCE.— 

9 ‘‘(1) IN GENERAL.—Of the total amount made 

10 available to carry out this part for a fiscal year, the 

11 Secretary shall use 10 percent to provide, directly or 

12 through a competitive grant process, training and 

13 technical assistance to the grant recipients under 

14 this part, including by disseminating research and 

15 information regarding effective and promising prac16 tices, providing consultation and resources on a 

17 broad array of teenage and unintended pregnancy 

18 and violence prevention strategies, and developing 

19 resources and materials. 

20 ‘‘(2) COLLABORATION.—In carrying out this 

21 subsection, the Secretary shall collaborate with Fed22 eral, State, public, and private entities that have ex23 pertise in sexual health education, prevention of un24 intended teen pregnancy, healthy relationship develVerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00345 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475

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1 opment, minority health and health disparities, and 

2 violence prevention. 

3 ‘‘SEC. 399OO–6. DEFINITIONS. 

4 ‘‘In this part: 

5 ‘‘(1) EVIDENCE-BASED OR EVIDENCE-IN6 FORMED.—The terms ‘evidence-based or evidence-in7 formed’ mean having been proven through rigorous 

8 evaluation to change sexual behavior or incorporate 

9 characteristics of effective programs, including devel10 opment, content, and implementation of such pro11 grams, that— 

12 ‘‘(A) have been shown to be effective in 

13 terms of increasing knowledge, clarifying values 

14 and attitudes, increasing skills, and impacting 

15 upon behavior; and 

16 ‘‘(B) are widely recognized by leading med17 ical and public health agencies to be effective in 

18 changing sexual behaviors that lead to unin19 tended pregnancy, sexually transmitted infec20 tions including HIV, and dating violence and 

21 sexual assault among young people. 

22 ‘‘(2) LGBTQ YOUTH.—The term ‘LGBTQ 

23 youth’ means lesbian, gay, bisexual, transgender, 

24 queer, and questioning (LGBTQ) youth. 


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1 ‘‘(3) MEDICALLY ACCURATE AND COMPLETE.— 

2 The term ‘medically accurate and complete’ means, 

3 with respect to information, activities, or services, 

4 verified or supported by the weight of research con5 ducted in compliance with accepted scientific meth6 ods and— 

7 ‘‘(A) published in peer-reviewed journals, 

8 where applicable; or 

9 ‘‘(B) comprising information that leading 

10 professional organizations and agencies with 

11 relevant expertise in the field recognize as accu12 rate, objective, and complete. 

13 ‘‘(4) RACIAL OR ETHNIC MINORITY OR IMMI14 GRANT COMMUNITIES.—The term ‘racial or ethnic 

15 minority or immigrant communities’ means commu16 nities with a substantial number of residents who 

17 are members of racial or ethnic minority groups or 

18 who are immigrants. 

19 ‘‘(5) REPRODUCTIVE AND SEXUAL COERCION.— 

20 The term ‘reproductive and sexual coercion’— 

21 ‘‘(A) means, with respect to a person, coer22 cive behavior that interferes with the ability of 

23 such person to control the reproductive deci24 sionmaking of such person, such as inten25 tionally exposing such person to sexually transVerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00347 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475

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1 mitted infections; attempting to impregnate 

2 such person against their will; intentionally 

3 interfering with the person’s birth control; or 

4 threatening or acting violent if the person does 

5 not comply with the perpetrator’s wishes re6 garding contraception or the decision whether 

7 to terminate or continue a pregnancy; and 

8 ‘‘(B) includes a range of behaviors that a 

9 partner may use related to sexual decision-mak10 ing to pressure or coerce a person to have sex 

11 without using physical force, such as repeatedly 

12 pressuring a partner to have sex when they do 

13 not want to; threatening to end a relationship 

14 if a person does not have sex; and threatening 

15 retaliation if notified of a positive sexually 

16 transmitted infection test result. 

17 ‘‘(6) YOUTH.—The term ‘youth’ means individ18 uals who are 11 to 19 years of age. 

19 ‘‘SEC. 399OO–7. REPORTS. 

20 ‘‘(a) REPORT ON USE OF FUNDS.—Not later than 

21 1 year after the date of the enactment of this part, the 

22 Secretary shall submit to Congress a report on the use 

23 of funds provided pursuant to this part. 

24 ‘‘(b) REPORT ON IMPACT OF PROGRAMS.—Not later 

25 than March 1, 2021, the Secretary shall submit to ConVerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00348 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475

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1 gress a report on the impact of the programs under this 

2 part on reducing unintended teenage pregnancies. 

3 ‘‘SEC. 399OO–8. AUTHORIZATION OF APPROPRIATIONS. 

4 ‘‘(a) IN GENERAL.—There are authorized to be ap5 propriated to carry out this part such sums as may be 

6 necessary for each of the fiscal years 2017 through 2021. 

7 ‘‘(b) AVAILABILITY.—Amounts appropriated pursu8 ant to subsection (a)— 

9 ‘‘(1) are authorized to remain available until ex10 pended; and 

11 ‘‘(2) are in addition to amounts otherwise made 

12 available for such purposes.’’. 

13 SEC. 509. GESTATIONAL DIABETES. 

14 Part B of title III of the Public Health Service Act 

15 (42 U.S.C. 243 et seq.) is amended by adding after section 

16 317H the following: 

17 ‘‘SEC. 317H–1. GESTATIONAL DIABETES. 

18 ‘‘(a) UNDERSTANDING AND MONITORING GESTA19 TIONAL DIABETES.— 

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

21 through the Director of the Centers for Disease 

22 Control and Prevention, in consultation with the Di23 abetes Mellitus Interagency Coordinating Committee 

24 established under section 429 and representatives of 

25 appropriate national health organizations, shall deVerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00349 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475

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1 velop a multisite gestational diabetes research 

2 project within the diabetes program of the Centers 

3 for Disease Control and Prevention to expand and 

4 enhance surveillance data and public health research 

5 on gestational diabetes. 

6 ‘‘(2) AREAS TO BE ADDRESSED.—The research 

7 project developed under paragraph (1) shall ad8 dress— 

9 ‘‘(A) procedures to establish accurate and 

10 efficient systems for the collection of gestational 

11 diabetes data within each State and common12 wealth, territory, or possession of the United 

13 States; 

14 ‘‘(B) the progress of collaborative activities 

15 with the National Vital Statistics System, the 

16 National Center for Health Statistics, and 

17 State health departments with respect to the 

18 standard birth certificate, in order to improve 

19 surveillance of gestational diabetes; 

20 ‘‘(C) postpartum methods of tracking 

21 women with gestational diabetes after delivery 

22 as well as targeted interventions proven to 

23 lower the incidence of type 2 diabetes in that 

24 population; 


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1 ‘‘(D) variations in the distribution of diag2 nosed and undiagnosed gestational diabetes, 

3 and of impaired fasting glucose tolerance and 

4 impaired fasting glucose, within and among 

5 groups of women; and 

6 ‘‘(E) factors and culturally sensitive inter7 ventions that influence risks and reduce the in8 cidence of gestational diabetes and related com9 plications during childbirth, including cultural, 

10 behavioral, racial, ethnic, geographic, demo11 graphic, socioeconomic, and genetic factors. 

12 ‘‘(3) REPORT.—Not later than 2 years after the 

13 date of the enactment of this section, and annually 

14 thereafter, the Secretary shall generate a report on 

15 the findings and recommendations of the research 

16 project including prevalence of gestational diabetes 

17 in the multisite area and disseminate the report to 

18 the appropriate Federal and non-Federal agencies. 

19 ‘‘(b) EXPANSION OF GESTATIONAL DIABETES RE20 SEARCH.— 

21 ‘‘(1) IN GENERAL.—The Secretary shall expand 

22 and intensify public health research regarding gesta23 tional diabetes. Such research may include— 

24 ‘‘(A) developing and testing novel ap25 proaches for improving postpartum diabetes 


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1 testing or screening and for preventing type 2 

2 diabetes in women with a history of gestational 

3 diabetes; and 

4 ‘‘(B) conducting public health research to 

5 further understanding of the epidemiologic, 

6 socioenvironmental, behavioral, translation, and 

7 biomedical factors and health systems that in8 fluence the risk of gestational diabetes and the 

9 development of type 2 diabetes in women with 

10 a history of gestational diabetes. 

11 ‘‘(2) AUTHORIZATION OF APPROPRIATIONS.— 

12 There is authorized to be appropriated to carry out 

13 this subsection $5,000,000 for each of fiscal years 

14 2017 through 2021. 

15 ‘‘(c) DEMONSTRATION GRANTS TO LOWER THE

16 RATE OF GESTATIONAL DIABETES.— 

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

18 through the Director of the Centers for Disease 

19 Control and Prevention, shall award grants, on a 

20 competitive basis, to eligible entities for demonstra21 tion projects that implement evidence-based inter22 ventions to reduce the incidence of gestational diabe23 tes, the recurrence of gestational diabetes in subse24 quent pregnancies, and the development of type 2 diVerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00352 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475

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1 abetes in women with a history of gestational diabe2 tes. 

3 ‘‘(2) PRIORITY.—In making grants under this 

4 subsection, the Secretary shall give priority to 

5 projects focusing on— 

6 ‘‘(A) helping women who have 1 or more 

7 risk factors for developing gestational diabetes; 

8 ‘‘(B) working with women with a history of 

9 gestational diabetes during a previous preg10 nancy; 

11 ‘‘(C) providing postpartum care for women 

12 with gestational diabetes; 

13 ‘‘(D) tracking cases where women with a 

14 history of gestational diabetes developed type 2 

15 diabetes; 

16 ‘‘(E) educating mothers with a history of 

17 gestational diabetes about the increased risk of 

18 their child developing diabetes; 

19 ‘‘(F) working to prevent gestational diabe20 tes and prevent or delay the development of 

21 type 2 diabetes in women with a history of ges22 tational diabetes; and 

23 ‘‘(G) achieving outcomes designed to assess 

24 the efficacy and cost-effectiveness of interven25 tions that can inform decisions on long-term 


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1 sustainability, including third-party reimburse2 ment. 

3 ‘‘(3) APPLICATION.—An eligible entity desiring 

4 to receive a grant under this subsection shall submit 

5 to the Secretary— 

6 ‘‘(A) an application at such time, in such 

7 manner, and containing such information as the 

8 Secretary may require; and 

9 ‘‘(B) a plan to— 

10 ‘‘(i) lower the rate of gestational dia11 betes during pregnancy; or 

12 ‘‘(ii) develop methods of tracking 

13 women with a history of gestational diabe14 tes and develop effective interventions to 

15 lower the incidence of the recurrence of 

16 gestational diabetes in subsequent preg17 nancies and the development of type 2 dia18 betes. 

19 ‘‘(4) USES OF FUNDS.—An eligible entity re20 ceiving a grant under this subsection shall use the 

21 grant funds to carry out demonstration projects de22 scribed in paragraph (1), including— 

23 ‘‘(A) expanding community-based health 

24 promotion education, activities, and incentives 

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1 tes and development of type 2 diabetes in 

2 women with a history of gestational diabetes; 

3 ‘‘(B) aiding State- and tribal-based diabe4 tes prevention and control programs to collect, 

5 analyze, disseminate, and report surveillance 

6 data on women with, and at risk for, gesta7 tional diabetes, the recurrence of gestational di8 abetes in subsequent pregnancies, and, for 

9 women with a history of gestational diabetes, 

10 the development of type 2 diabetes; and 

11 ‘‘(C) training and encouraging health care 

12 providers— 

13 ‘‘(i) to promote risk assessment, high14 quality care, and self-management for ges15 tational diabetes and the recurrence of ges16 tational diabetes in subsequent preg17 nancies; and 

18 ‘‘(ii) to prevent the development of 

19 type 2 diabetes in women with a history of 

20 gestational diabetes, and its complications 

21 in the practice settings of the health care 

22 providers. 

23 ‘‘(5) REPORT.—Not later than 4 years after the 

24 date of the enactment of this section, the Secretary 

25 shall prepare and submit to the Congress a report 


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1 concerning the results of the demonstration projects 

2 conducted through the grants awarded under this 

3 subsection. 

4 ‘‘(6) DEFINITION OF ELIGIBLE ENTITY.—In 

5 this subsection, the term ‘eligible entity’ means a 

6 nonprofit organization (such as a nonprofit academic 

7 center or community health center) or a State, trib8 al, or local health agency. 

9 ‘‘(7) AUTHORIZATION OF APPROPRIATIONS.— 

10 There is authorized to be appropriated to carry out 

11 this subsection $5,000,000 for each of fiscal years 

12 2017 through 2021. 

13 ‘‘(d) POSTPARTUM FOLLOWUP REGARDING GESTA14 TIONAL DIABETES.—The Secretary, acting through the 

15 Director of the Centers for Disease Control and Preven16 tion, shall work with the State- and tribal-based diabetes 

17 prevention and control programs assisted by the Centers 

18 to encourage postpartum followup after gestational diabe19 tes, as medically appropriate, for the purpose of reducing 

20 the incidence of gestational diabetes, the recurrence of 

21 gestational diabetes in subsequent pregnancies, the devel22 opment of type 2 diabetes in women with a history of ges23 tational diabetes, and related complications.’’. 


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1 SEC. 510. EMERGENCY CONTRACEPTION EDUCATION AND 

2 INFORMATION PROGRAMS. 

3 (a) EMERGENCY CONTRACEPTION PUBLIC EDU4 CATION PROGRAM.— 

5 (1) IN GENERAL.—The Secretary, acting 

6 through the Director of the Centers for Disease 

7 Control and Prevention, shall develop and dissemi8 nate to the public medically accurate and complete 

9 information on emergency contraception. 

10 (2) DISSEMINATION.—The Secretary may dis11 seminate medically accurate and complete informa12 tion under paragraph (1) directly or through ar13 rangements with nonprofit organizations, community 

14 health workers including promotoras, consumer 

15 groups, institutions of higher education, clinics, the 

16 media, and Federal, State, and local agencies. 

17 (3) INFORMATION.—The information dissemi18 nated under paragraph (1) shall— 

19 (A) include, at a minimum, a description 

20 of emergency contraception and an explanation 

21 of the use, safety, efficacy, and availability of 

22 such contraception; and 

23 (B) be pilot tested for consumer com24 prehension, cultural and linguistic appropriate25 ness, and acceptance of the messages across 


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1 geographically, racially, ethnically, and linguis2 tically diverse populations. 

3 (b) EMERGENCY CONTRACEPTION INFORMATION

4 PROGRAM FOR HEALTH CARE PROVIDERS.— 

5 (1) IN GENERAL.—The Secretary, acting 

6 through the Administrator of the Health Resources 

7 and Services Administration and in consultation 

8 with major medical and public health organizations, 

9 shall develop and disseminate to health care pro10 viders information on emergency contraception. 

11 (2) INFORMATION.—The information dissemi12 nated under paragraph (1) shall include, at a min13 imum— 

14 (A) information describing the use, safety, 

15 efficacy, and availability of emergency contra16 ception; 

17 (B) a recommendation regarding the use of 

18 such contraception; and 

19 (C) information explaining how to obtain 

20 copies of the information developed under sub21 section (a) for distribution to the patients of 

22 the providers. 

23 (c) DEFINITIONS.—In this section: 

24 (1) EMERGENCY CONTRACEPTION.—The term 

25 ‘‘emergency contraception’’ means a drug or device 


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1 (as the terms are defined in section 201 of the Fed2 eral Food, Drug, and Cosmetic Act (21 U.S.C. 321)) 

3 or a drug regimen that— 

4 (A) is used postcoitally; 

5 (B) prevents pregnancy primarily by pre6 venting or delaying ovulation, and does not ter7 minate an established pregnancy; and 

8 (C) is approved by the Food and Drug Ad9 ministration. 

10 (2) HEALTH CARE PROVIDER.—The term 

11 ‘‘health care provider’’ means an individual who is li12 censed or certified under State law to provide health 

13 care services and who is operating within the scope 

14 of such license. Such term shall include a phar15 macist. 

16 (3) INSTITUTION OF HIGHER EDUCATION.—The 

17 term ‘‘institution of higher education’’ has the same 

18 meaning given such term in section 101(a) of the 

19 Higher Education Act of 1965 (20 U.S.C. 1001(a)). 

20 (4) MEDICALLY ACCURATE AND COMPLETE.— 

21 The term ‘‘medically accurate and complete’’ means, 

22 with respect to information, activities, or services 

23 verified or supported by the weight of research con24 ducted in compliance with accepted scientific meth25 ods and— 


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1 (A) published in peer-reviewed journals, 

2 where applicable; or 

3 (B) comprising information that leading 

4 professional organizations and agencies with 

5 relevant expertise in the field recognize as accu6 rate, objective, and complete. 

7 (5) SECRETARY.—The term ‘‘Secretary’’ means 

8 the Secretary of Health and Human Services. 

9 (d) 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 the fiscal years 

12 2017 through 2021. 

13 SEC. 511. SUPPORTING HEALTHY ADOLESCENT DEVELOP14 MENT. 

15 (a) IN GENERAL.—The Secretary may award a grant 

16 to each eligible State to conduct programs of sex education 

17 described in subsection (b), including education on both 

18 abstinence and contraception for the prevention of teenage 

19 pregnancy and sexually transmitted infections, including 

20 HIV/AIDS and viral hepatitis. 

21 (b) REQUIREMENTS FOR SEX EDUCATION PRO22 GRAMS.—A program of sex education described in this 

23 subsection is a program that— 

24 (1) is age appropriate and medically accurate; 


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1 (2) stresses the value of abstinence while not ig2 noring those young people who have been or are sex3 ually active; 

4 (3) includes information providing a factual un5 derstanding of male and female reproductive anat6 omy; 

7 (4) provides medically accurate and complete 

8 information about the health benefits side effects, 

9 and availability of contraceptive and barrier methods 

10 used— 

11 (A) as a means to prevent pregnancy; and 

12 (B) to reduce the risk of contracting a sex13 ually transmitted infection, including HIV/ 

14 AIDS and viral hepatitis; 

15 (5) encourages family communication between 

16 parent and child about sexuality; 

17 (6) cultivates a respectful dialogue about sexu18 ality, including sexual orientation and gender iden19 tity, and embraces the principles of nondiscrimina20 tion based on sexual orientation and gender identity; 

21 (7) counters the perpetuation of narrow gender 

22 roles, including the sexualization of female children, 

23 adolescents, and adults; 

24 (8) teaches young people the skills to make re25 sponsible decisions about sexuality, including how to 


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1 avoid unwanted verbal, physical, and sexual ad2 vances and how to avoid making verbal, physical, 

3 and sexual advances that are not wanted by the 

4 other party; 

5 (9) develops healthy relationships, including the 

6 prevention of dating and sexual violence; 

7 (10) teaches young people how alcohol and drug 

8 use can affect responsible decisionmaking; and 

9 (11) does not teach or promote religion. 

10 (c) ADDITIONAL ACTIVITIES.—In carrying out a pro11 gram of sex education, a State may expend grant funds 

12 awarded under subsection (a) to carry out educational and 

13 motivational activities that help young people— 

14 (1) gain knowledge about the physical, emo15 tional, biological, and hormonal changes of adoles16 cence and subsequent stages of human maturation; 

17 (2) develop the knowledge and skills nec18 essary— 

19 (A) to ensure and protect their sexual and 

20 reproductive health from unintended pregnancy 

21 and sexually transmitted infection, including 

22 HIV/AIDS, throughout their lifespan; 

23 (B) to be aware that certain racial and 

24 ethnic groups are more affected by certain sex25 ually transmitted infections; and 


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1 (C) to receive the education to prevent fur2 ther transmission; 

3 (3) gain knowledge about the specific involve4 ment and responsibility of each individual in sexual 

5 decisionmaking; 

6 (4) develop healthy attitudes and values about 

7 adolescent growth and development, body image, 

8 gender roles, racial and ethnic diversity, sexual ori9 entation and gender identity, and other subjects; 

10 (5) develop and practice healthy life skills in11 cluding goal-setting, decisionmaking, negotiation, 

12 communication, and stress management; and 

13 (6) promote self-esteem and positive inter14 personal skills focusing on relationship dynamics, in15 cluding friendships, dating, romantic involvement, 

16 marriage, and family interactions. 

17 (d) MATCHING FUNDS.—The Secretary may not 

18 make payments to a State under this section in an amount 

19 exceeding Federal medical assistance percentage for such 

20 State (as such term is defined in section 1905(b) of the 

21 Social Security Act (42 U.S.C. 1396d(b))) of the costs of 

22 the programs conducted by the State under this section. 

23 (e) EVALUATION OF PROGRAMS.— 

24 (1) IN GENERAL.—For the purpose of evalu25 ating the effectiveness of programs of sex education 


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1 carried out with a grant under this section, evalua2 tions shall be carried out in accordance with para3 graphs (2) and (3). 

4 (2) NATIONAL EVALUATION.— 

5 (A) METHOD.—The Secretary shall pro6 vide for a national evaluation of a representa7 tive sample of programs of sex education car8 ried out with grants under this section to deter9 mine— 

10 (i) the effectiveness of such programs 

11 in helping to delay the initiation of sexual 

12 intercourse and other high-risk behaviors; 

13 (ii) the effectiveness of such programs 

14 in preventing adolescent pregnancy; 

15 (iii) the effectiveness of such pro16 grams in preventing sexually transmitted 

17 infection, including HIV/AIDS and viral 

18 hepatitis; 

19 (iv) the effectiveness of such programs 

20 in increasing contraceptive knowledge and 

21 contraceptive behaviors when sexual inter22 course occurs; and 

23 (v) a list of best practices that— 

24 (I) is based upon essential pro25 grammatic components of evaluated 


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1 programs that have led to success de2 scribed in clauses (i) through (iv); and 

3 (II) documents the racial and 

4 ethnic minority populations that are 

5 recipients of grant funds under this 

6 section or are served by programs of 

7 sex education funded under this sec8 tion. 

9 (B) GRANT CONDITION.—A condition for 

10 the receipt of a grant to a State under this sec11 tion is that the State cooperate with the evalua12 tion under subparagraph (A). 

13 (C) REPORT.—The Secretary shall submit 

14 to the Congress— 

15 (i) not later than the end of each fis16 cal year during the 5-year period beginning 

17 with fiscal year 2017, an interim report on 

18 the national evaluation under subpara19 graph (A); and 

20 (ii) not later than March 31, 2020, a 

21 final report providing the results of such 

22 national evaluation. 

23 (3) INDIVIDUAL STATE EVALUATIONS.—A con24 dition for the receipt of a grant under this section 

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1 cation funded through such grant in accordance with 

2 the following requirements: 

3 (A) The evaluation will be conducted by an 

4 external, independent entity. 

5 (B) The purposes of the evaluation will be 

6 the determination of— 

7 (i) the effectiveness of such programs 

8 in helping to delay the initiation of sexual 

9 intercourse and other high-risk behaviors; 

10 (ii) the effectiveness of such programs 

11 in preventing adolescent pregnancy; 

12 (iii) the effectiveness of such pro13 grams in preventing sexually transmitted 

14 infection, including HIV/AIDS; and 

15 (iv) the effectiveness of such programs 

16 in increasing contraceptive and barrier 

17 method knowledge and contraceptive be18 haviors when sexual intercourse occurs. 

19 (f) LIMITATIONS ON USE OF FUNDS.— 

20 (1) LIMITATIONS ON SECRETARY.—Of the 

21 amounts appropriated for a fiscal year for purposes 

22 of this section, the Secretary may not use more 

23 than— 


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1 (A) 7 percent of such amounts for admin2 istrative expenses related to carrying out this 

3 section for that fiscal year; and 

4 (B) 10 percent of such amounts for the 

5 national evaluation under subsection (e)(2). 

6 (2) LIMITATIONS TO STATES.—Of amounts pro7 vided to an eligible State under this subsection, the 

8 State may not use more than 10 percent of the 

9 grant to conduct any evaluation under subsection 

10 (e)(3). 

11 (g) NONDISCRIMINATION REQUIRED.—Programs 

12 funded under this section shall not discriminate on the 

13 basis of sex, race, ethnicity, national origin, disability, reli14 gion, marital status, familial status, sexual orientation, or 

15 gender identity. Nothing in this section shall be construed 

16 to invalidate or limit rights, remedies, procedures, or legal 

17 standards available to victims of discrimination under any 

18 other Federal law or any law of a State or a political sub19 division of a State, including title VI of the Civil Rights 

20 Act of 1964 (42 U.S.C. 2000d et seq.), title IX of the 

21 Education Amendments of 1972 (20 U.S.C. 1681 et seq.), 

22 section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 

23 794), and the Americans with Disabilities Act of 1990 (42 

24 U.S.C. 12101 et seq.). 

25 (h) DEFINITIONS.—For purposes of this section: 


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1 (1) The term ‘‘age appropriate’’ means, with re2 spect to topics, messages, and teaching methods, 

3 those suitable to particular ages or age groups of 

4 children, adolescents, and adults, based on devel5 oping cognitive, emotional, and behavioral capacity 

6 typical for the age or age group. 

7 (2) The term ‘‘eligible State’’ means a State 

8 that submits to the Secretary an application for a 

9 grant under this section that is in such form, is 

10 made in such manner, and contains such agree11 ments, assurances, and information as the Secretary 

12 determines to be necessary to carry out this section. 

13 (3) The term ‘‘HIV/AIDS’’ means the human 

14 immunodeficiency virus, and includes acquired im15 mune deficiency syndrome. 

16 (4) The term ‘‘medically accurate’’, with respect 

17 to information, means information that is supported 

18 by research, recognized as accurate and objective by 

19 leading medical, psychological, psychiatric, and pub20 lic health organizations and agencies, and, published 

21 in journals that are peer reviewed. 

22 (5) The term ‘‘State’’ means the 50 States, the 

23 District of Columbia, the Commonwealth of Puerto 

24 Rico, the Commonwealth of the Northern Mariana 

25 Islands, American Samoa, Guam, the United States 


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1 Virgin Islands, and any other territory or possession 

2 of the United States. 

3 (i) AUTHORIZATION OF APPROPRIATIONS.—For the 

4 purpose of carrying out this section, there is authorized 

5 to be appropriated $50,000,000 for each of the fiscal years 

6 2017 through 2021. 

7 SEC. 512. COMPASSIONATE ASSISTANCE FOR RAPE EMER8 GENCIES. 

9 (a) MEDICARE.— 

10 (1) LIMITATION ON PAYMENT.—Section 

11 1866(a)(1) of the Social Security Act (42 U.S.C. 

12 1395cc(a)(1)) is amended— 

13 (A) in the subparagraph (W) added by sec14 tion 3005(1)(C) of Public Law 111–148— 

15 (i) by striking the period at the end 

16 and inserting a comma; 

17 (ii) by moving the indentation 2 ems 

18 to the left; and 

19 (iii) by moving such subparagraph to 

20 immediately follow subparagraph (V); 

21 (B) in the subparagraph (W) added by sec22 tion 6406(b)(3) of Public Law 111–148— 

23 (i) by striking the period at the end 

24 and inserting ‘‘, and’’; 


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1 (ii) by moving the indentation 2 ems 

2 to the left; 

3 (iii) by redesignating such subpara4 graph as subparagraph (X); and 

5 (iv) by moving such subparagraph to 

6 immediately follow subparagraph (W), as 

7 moved under paragraph (2)(C); and 

8 (C) by inserting after the subparagraph 

9 (X), as redesignated and moved under para10 graph (3), the following: 

11 ‘‘(Y) in the case of a hospital or critical ac12 cess hospital, to adopt and enforce a policy to 

13 ensure compliance with the requirements of 

14 subsection (l) and to meet the requirements of 

15 such subsection.’’. 

16 (2) ASSISTANCE TO VICTIMS.—Section 1866 of 

17 the Social Security Act (42 U.S.C. 1395cc) is 

18 amended by adding at the end the following new 

19 subsection: 

20 ‘‘(l) COMPASSIONATE ASSISTANCE FOR RAPE EMER21 GENCIES.— 

22 ‘‘(1) IN GENERAL.—For purposes of section 

23 1866(a)(1)(Y), a hospital meets the requirements of 

24 this subsection if the hospital provides each of the 

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1 vidual, whether or not eligible for benefits under this 

2 title or under any other form of health insurance. 

3 who comes to the hospital on or after January 1, 

4 2017, and— 

5 ‘‘(A) who states to hospital personnel that 

6 they are victims of sexual assault; 

7 ‘‘(B) who is accompanied by an individual 

8 who states to hospital personnel that the indi9 vidual is a victim of sexual assault; or 

10 ‘‘(C) whom hospital personnel, during the 

11 course of treatment and care for the individual, 

12 have reason to believe is a victim of sexual as13 sault. 

14 ‘‘(2) REQUIRED SERVICES DESCRIBED.—For 

15 purposes of paragraph (1), the services described in 

16 this subparagraph are the following: 

17 ‘‘(A) Provision of medically and factually 

18 accurate and unbiased written and oral infor19 mation about emergency contraception that— 

20 ‘‘(i) is written in clear and concise 

21 language; 

22 ‘‘(ii) is readily comprehensible; 

23 ‘‘(iii) includes an explanation that— 

24 ‘‘(I) emergency contraception has 

25 been approved by the Food and Drug 


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1 Administration as an over-the-counter 

2 medication for individuals, and is a 

3 safe and effective way to prevent 

4 pregnancy after unprotected inter5 course or contraceptive failure if 

6 taken in a timely manner; 

7 ‘‘(II) emergency contraception is 

8 more effective the sooner it is taken; 

9 and 

10 ‘‘(III) emergency contraception 

11 does not cause an abortion and cannot 

12 interrupt an established pregnancy; 

13 ‘‘(iv) meets such conditions regarding 

14 the provision of such information in lan15 guages other than English as the Secretary 

16 may establish; and 

17 ‘‘(v) is provided without regard to the 

18 ability of the individual or their family to 

19 pay costs associated with the provision of 

20 such information to the individual. 

21 ‘‘(B) Immediate offer to provide emergency 

22 contraception to the individual at the hospital 

23 and, in the case that the individual accepts such 

24 offer, immediate provision to the individual of 

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1 quested without regard to the inability of the 

2 individual or their family to pay costs associ3 ated with the offer and provision of such con4 traception. 

5 ‘‘(C) Development and implementation of a 

6 written policy to ensure that an individual is 

7 present at the hospital, or on-call, who— 

8 ‘‘(i) has authority to dispense or pre9 scribe emergency contraception, independ10 ently, or under a protocol prepared by a 

11 physician for the administration of emer12 gency contraception at the hospital to a 

13 victim of sexual assault; and 

14 ‘‘(ii) is trained to comply with the re15 quirements of this section. 

16 ‘‘(3) DEFINITIONS.—For purposes of this para17 graph: 

18 ‘‘(A) The term ‘emergency contraception’ 

19 means a drug or device (as such terms are de20 fined in section 201 of the Federal Food, Drug, 

21 and Cosmetic Act (21 U.S.C. 321)) or a drug 

22 regimen that— 

23 ‘‘(i) is used postcoitally; 

24 ‘‘(ii) prevents pregnancy primarily by 

25 preventing or delaying ovulation, and does 


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1 not terminate an established pregnancy; 

2 and 

3 ‘‘(iii) is approved by the Food and 

4 Drug Administration. 

5 ‘‘(B) The term ‘hospital’ includes a critical 

6 access hospital, as defined in section 

7 1861(mm)(1). 

8 ‘‘(C) The term ‘sexual assault’ means co9 itus in which the individual involved does not 

10 consent or lacks the legal capacity to consent.’’. 

11 (b) LIMITATION ON PAYMENT UNDER MEDICAID.— 

12 Section 1903(i) of the Social Security Act (42 U.S.C. 

13 1396b(i)) is amended by inserting after paragraph (11) 

14 the following new paragraph: 

15 ‘‘(12) with respect to any amount expended for 

16 care or services furnished under the plan by a hos17 pital on or after January 1, 2017, unless such hos18 pital meets the requirements specified in section 

19 1866(l) for purposes of title XVIII.’’. 

20 SEC. 513. ACCESS TO BIRTH CONTROL DUTIES OF PHAR21 MACIES TO ENSURE PROVISION OF FDA-AP22 PROVED CONTRACEPTION. 

23 Part B of title II of the Public Health Service Act 

24 (42 U.S.C. 238 et seq.) is amended by adding at the end 

25 the following: 


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1 ‘‘SEC. 249. DUTIES OF PHARMACIES TO ENSURE PROVISION 

2 OF FDA-APPROVED CONTRACEPTION. 

3 ‘‘(a) IN GENERAL.—Subject to subsection (c), a 

4 pharmacy that receives Food and Drug Administration5 approved drugs or devices in interstate commerce shall 

6 maintain compliance with the following: 

7 ‘‘(1) If a customer requests a contraceptive, in8 cluding emergency contraception, that is in stock, 

9 the pharmacy shall ensure that the contraceptive is 

10 provided to the customer— 

11 ‘‘(A) without delay; 

12 ‘‘(B) without regard to the customer’s age, 

13 gender, gender identity, or sexual orientation; 

14 ‘‘(C) without a requirement that identifica15 tion be presented; and 

16 ‘‘(D) despite any conflicts of employees to 

17 filling a prescription and dispensing a par18 ticular prescription drug or device due to sin19 cerely held moral, philosophical, or religious be20 liefs. 

21 ‘‘(2) If a customer requests a contraceptive that 

22 is not in stock and the pharmacy in the normal 

23 course of business stocks contraception, the phar24 macy shall immediately inform the customer that the 

25 contraceptive is not in stock and without delay offer 

26 the customer the following options: 


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1 ‘‘(A) If the customer prefers to obtain the 

2 contraceptive through a referral or transfer, the 

3 pharmacy shall— 

4 ‘‘(i) locate a pharmacy of the cus5 tomer’s choice or the closest pharmacy 

6 confirmed to have the contraceptive in 

7 stock; and 

8 ‘‘(ii) refer the customer or transfer 

9 the prescription to that pharmacy. 

10 ‘‘(B) If the customer prefers for the phar11 macy to order the contraceptive, the pharmacy 

12 shall obtain the contraceptive under the phar13 macy’s standard procedure for expedited order14 ing of medication and notify the customer when 

15 the contraceptive arrives. 

16 ‘‘(3) The pharmacy shall ensure that its em17 ployees do not— 

18 ‘‘(A) intimidate, threaten, or harass cus19 tomers in the delivery of services relating to a 

20 request for contraception; 

21 ‘‘(B) interfere with or obstruct the delivery 

22 of services relating to a request for contracep23 tion; 


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1 ‘‘(C) intentionally misrepresent or deceive 

2 customers about the availability of contracep3 tion or its mechanism of action; 

4 ‘‘(D) breach medical confidentiality with 

5 respect to a request for contraception or threat6 en to breach such confidentiality; or 

7 ‘‘(E) refuse to return a valid, lawful pre8 scription for contraception upon customer re9 quest. 

10 ‘‘(b) CONTRACEPTIVES NOT ORDINARILY

11 STOCKED.—Nothing in subsection (a)(2) shall be con12 strued to require any pharmacy to comply with such sub13 section if the pharmacy does not ordinarily stock contra14 ceptives in the normal course of business. 

15 ‘‘(c) REFUSALS PURSUANT TO STANDARD PHAR16 MACY PRACTICE.—This section does not prohibit a phar17 macy from refusing to provide a contraceptive to a cus18 tomer in accordance with any of the following: 

19 ‘‘(1) If it is unlawful to dispense the contracep20 tive to the customer without a valid, lawful prescrip21 tion and no such prescription is presented. 

22 ‘‘(2) If the customer is unable to pay for the 

23 contraceptive. 


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1 ‘‘(3) If the employee of the pharmacy refuses to 

2 provide the contraceptive on the basis of a profes3 sional clinical judgment. 

4 ‘‘(d) RULE OF CONSTRUCTION.—Nothing in this sec5 tion shall be construed to invalidate or limit rights, rem6 edies, procedures, or legal standards under title VII of the 

7 Civil Rights Act of 1964. 

8 ‘‘(e) PREEMPTION.—This section does not preempt 

9 any provision of State law or any professional obligation 

10 made applicable by a State board or other entity respon11 sible for licensing or discipline of pharmacies or phar12 macists, to the extent that such State law or professional 

13 obligation provides protections for customers that are 

14 greater than the protections provided by this section. 

15 ‘‘(f) ENFORCEMENT.— 

16 ‘‘(1) CIVIL PENALTY.—A pharmacy that vio17 lates a requirement of subsection (a) is liable to the 

18 United States for a civil penalty in an amount not 

19 exceeding $1,000 per day of violation, not to exceed 

20 $100,000 for all violations adjudicated in a single 

21 proceeding. 

22 ‘‘(2) PRIVATE CAUSE OF ACTION.—Any person 

23 aggrieved as a result of a violation of a requirement 

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1 macy involved to obtain appropriate relief, including 

2 actual and punitive damages, injunctive relief, and a 

3 reasonable attorney’s fee and cost. 

4 ‘‘(3) LIMITATIONS.—A civil action under para5 graph (1) or (2) may not be commenced against a 

6 pharmacy after the expiration of the 5-year period 

7 beginning on the date on which the pharmacy alleg8 edly engaged in the violation involved. 

9 ‘‘(g) DEFINITIONS.—In this section: 

10 ‘‘(1) The term ‘contraception’ or ‘contraceptive’ 

11 means any drug or device approved by the Food and 

12 Drug Administration to prevent pregnancy. 

13 ‘‘(2) The term ‘employee’ means a person hired, 

14 by contract or any other form of an agreement, by 

15 a pharmacy. 

16 ‘‘(3) The term ‘pharmacy’ means an entity 

17 that— 

18 ‘‘(A) is authorized by a State to engage in 

19 the business of selling prescription drugs at re20 tail; and 

21 ‘‘(B) employs one or more employees. 

22 ‘‘(4) The term ‘product’ means a Food and 

23 Drug Administration-approved drug or device. 

24 ‘‘(5) The term ‘professional clinical judgment’ 

25 means the use of professional knowledge and skills 


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1 to form a clinical judgment, in accordance with pre2 vailing medical standards. 

3 ‘‘(6) The term ‘without delay’, with respect to 

4 a pharmacy providing, providing a referral for, or 

5 ordering contraception, or transferring the prescrip6 tion for contraception, means within the usual and 

7 customary timeframe at the pharmacy for providing, 

8 providing a referral for, or ordering other products, 

9 or transferring the prescription for other products, 

10 respectively. 

11 ‘‘(h) EFFECTIVE DATE.—This section shall take ef12 fect on the 31st day after the date of the enactment of 

13 this section, without regard to whether the Secretary has 

14 issued any guidance or final rule regarding this section.’’. 

15 SEC. 514. ADDITIONAL FOCUS AREA FOR THE OFFICE ON 

16 WOMEN’S HEALTH. 

17 Section 229(b) of the Public Health Service Act (42 

18 U.S.C. 237a(b)) is amended— 

19 (1) in paragraph (6), at the end, by striking 

20 ‘‘and’’; 

21 (2) in paragraph (7), at the end, by striking the 

22 period and inserting a semicolon; and 

23 (3) by adding at the end the following new 

24 paragraph: 


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1 ‘‘(8) facilitate policymakers, health system lead2 ers and providers, consumers, and other stake3 holders in understanding optimal maternity care and 

4 support for the provision of such care, including the 

5 priorities of— 

6 ‘‘(A) protecting, promoting, and supporting 

7 the innate capacities of childbearing women and 

8 their newborns for childbirth, breastfeeding, 

9 and attachment; 

10 ‘‘(B) using obstetric interventions only 

11 when such interventions are supported by 

12 strong, high-quality evidence, and minimizing 

13 overuse of maternity practices that have been 

14 shown to have benefit in limited situations and 

15 that can expose women, infants, or both to risk 

16 of harm if used routinely and indiscriminately, 

17 including continuous electronic fetal monitoring, 

18 labor induction, epidural analgesia, primary ce19 sarean section, and routine repeat cesarean 

20 birth; 

21 ‘‘(C) reliably incorporating noninvasive, 

22 evidence-based practices that have documented 

23 correlation with considerable improvement in 

24 outcomes with no detrimental side effects, such 

25 as smoking cessation programs in pregnancy 


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1 and proven models of group prenatal care that 

2 integrate health assessment, education, and 

3 support into a unified program; 

4 ‘‘(D) a shared understanding of the quali5 fications of licensed providers of maternity care 

6 and the best evidence about the safety, satisfac7 tion, outcomes, and costs of their care, and ap8 propriate deployment of such caregivers within 

9 the maternity care workforce to address the 

10 needs of childbearing women and newborns and 

11 the growing shortage of maternity caregivers; 

12 ‘‘(E) a shared understanding of the results 

13 of the best available research comparing hos14 pital, birth center, and planned home births, in15 cluding information about each setting’s safety, 

16 satisfaction, outcomes, and costs; and 

17 ‘‘(F) high-quality, evidence-based child18 birth education that promotes a natural, 

19 healthy, and safe approach to pregnancy, child20 birth, and early parenting; is taught by certified 

21 educators, peer counselors, and health profes22 sionals; and promotes informed decisionmaking 

23 by childbearing women; and’’. 


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1 SEC. 515. INTERAGENCY COORDINATING COMMITTEE ON 

2 THE PROMOTION OF OPTIMAL MATERNITY 

3 OUTCOMES. 

4 (a) IN GENERAL.—Part A of title II of the Public 

5 Health Service Act (42 U.S.C. 202 et seq.) is amended 

6 by adding at the end the following new section: 

7 ‘‘SEC. 229A. INTERAGENCY COORDINATING COMMITTEE ON 

8 THE PROMOTION OF OPTIMAL MATERNITY 

9 OUTCOMES. 

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

11 Human Services, acting through the Deputy Assistant 

12 Secretary for Women’s Health under section 229 and in 

13 collaboration with the Federal officials specified in sub14 section (b), shall establish the Interagency Coordinating 

15 Committee on the Promotion of Optimal Maternity Out16 comes (referred to in this subsection as the ‘ICCPOM’). 

17 ‘‘(b) OTHER AGENCIES.—The officials specified in 

18 this subsection are the Secretary of Labor, the Secretary 

19 of Defense, the Secretary of Veterans Affairs, the Surgeon 

20 General, the Director of the Centers for Disease Control 

21 and Prevention, the Administrator of the Health Re22 sources and Services Agency, the Administrator of the 

23 Centers for Medicare & Medicaid Services, the Director 

24 of the Indian Health Service, the Administrator of the 

25 Substance Abuse and Mental Health Services Administra26 tion, the Director of the National Institute on Child 


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1 Health and Development, the Director of the Agency for 

2 Healthcare Research and Quality, the Assistant Secretary 

3 for Children and Families, the Deputy Assistant Secretary 

4 for Minority Health, the Director of the Office of Per5 sonnel Management, and such other Federal officials as 

6 the Secretary of Health and Human Services determines 

7 to be appropriate. 

8 ‘‘(c) CHAIR.—The Deputy Assistant Secretary for 

9 Women’s Health shall serve as the chair of the ICCPOM. 

10 ‘‘(d) DUTIES.—The ICCPOM shall guide policy and 

11 program development across the Federal Government with 

12 respect to promotion of optimal maternity care, provided, 

13 however, that nothing in this section shall be construed 

14 as transferring regulatory or program authority from an 

15 agency to the ICCPOM. 

16 ‘‘(e) CONSULTATIONS.—The ICCPOM shall actively 

17 seek the input of, and shall consult with, all appropriate 

18 and interested stakeholders, including State health depart19 ments, public health research and interest groups, founda20 tions, childbearing women and their advocates, and mater21 nity care professional associations and organizations, re22 flecting racially, ethnically, demographically, and geo23 graphically diverse communities. 

24 ‘‘(f) ANNUAL REPORT.— 


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1 ‘‘(1) IN GENERAL.—The Secretary, on behalf of 

2 the ICCPOM, shall annually submit to Congress a 

3 report that summarizes— 

4 ‘‘(A) all programs and policies of Federal 

5 agencies (including the Medicare Program 

6 under title XVIII of the Social Security Act and 

7 the Medicaid program under title XIX of such 

8 Act) designed to promote optimal maternity 

9 care, focusing particularly on programs and 

10 policies that support the adoption of evidence 

11 based maternity care, as defined by timely, sci12 entifically sound systematic reviews; 

13 ‘‘(B) all programs and policies of Federal 

14 agencies (including the Medicare Program 

15 under title XVIII of the Social Security Act and 

16 the Medicaid program under title XIX of such 

17 Act) designed to address the problems of mater18 nal mortality and morbidity, infant mortality, 

19 prematurity, and low birth weight, including 

20 such programs and policies designed to address 

21 racial and ethnic disparities with respect to 

22 each of such problems; 

23 ‘‘(C) the extent of progress in reducing 

24 maternal mortality and infant mortality, low 


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1 birth weight, and prematurity at State and na2 tional levels; and 

3 ‘‘(D) such other information regarding op4 timal maternity care as the Secretary deter5 mines to be appropriate. 

6 The information specified in subparagraph (C) shall 

7 be included in each such report in a manner that 

8 disaggregates such information by race, ethnicity, 

9 and indigenous status in order to determine the ex10 tent of progress in reducing racial and ethnic dis11 parities and disparities related to indigenous status. 

12 ‘‘(2) CERTAIN INFORMATION.—Each report 

13 under paragraph (1) shall include information 

14 (disaggregated by race, ethnicity, and indigenous 

15 status, as applicable) on the following rates and 

16 costs by State: 

17 ‘‘(A) The rate of primary cesarean deliv18 eries and repeat cesarean deliveries. 

19 ‘‘(B) The rate of vaginal births after cesar20 ean. 

21 ‘‘(C) The rate of vaginal breech births. 

22 ‘‘(D) The rate of induction of labor. 

23 ‘‘(E) The rate of freestanding birth center 

24 births. 


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1 ‘‘(F) The rate of planned and unplanned 

2 home birth. 

3 ‘‘(G) The rate of attended births by pro4 vider, including by an obstetrician-gynecologist, 

5 family practice physician, obstetrician-gyne6 cologist physician assistant, certified nurse-mid7 wife, certified midwife, and certified profes8 sional midwife. 

9 ‘‘(H) The cost of maternity care 

10 disaggregated by place of birth and provider of 

11 care, including— 

12 ‘‘(i) uncomplicated vaginal birth; 

13 ‘‘(ii) complicated vaginal birth; 

14 ‘‘(iii) uncomplicated cesarean birth; 

15 and 

16 ‘‘(iv) complicated cesarean birth. 

17 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There 

18 is authorized to be appropriated, in addition to amounts 

19 authorized to be appropriated under section 229(e), to 

20 carry out this section $1,000,000 for each of the fiscal 

21 years 2017 through 2021.’’. 

22 (b) CONFORMING AMENDMENTS.— 

23 (1) INCLUSION AS DUTY OF HHS OFFICE ON

24 WOMEN’S HEALTH.—Section 229(b) of such Act (42 

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1 ther amended by adding at the end the following 

2 new paragraph: 

3 ‘‘(9) establish the Interagency Coordinating 

4 Committee on the Promotion of Optimal Maternity 

5 Outcomes in accordance with section 229A.’’. 

6 (2) TREATMENT OF BIENNIAL REPORTS.—Sec7 tion 229(d) of such Act (42 U.S.C. 237a(d)) is 

8 amended by inserting ‘‘(other than under subsection 

9 (b)(9))’’ after ‘‘under this section’’. 

10 SEC. 516. CONSUMER EDUCATION CAMPAIGN. 

11 Section 229 of the Public Health Service Act (42 

12 U.S.C. 237a), as amended, is further amended in sub13 section (b)— 

14 (1) in paragraph (8), at the end, by striking 

15 ‘‘and’’; 

16 (2) in paragraph (9), at the end, by striking the 

17 period and inserting ‘‘; and’’; and 

18 (3) by adding at the end the following new 

19 paragraph: 

20 ‘‘(10) not later than one year after the date of 

21 the enactment of the Health Equity and Account22 ability Act of 2016, develop and implement a 4-year 

23 culturally and linguistically appropriate multimedia 

24 consumer education campaign that is designed to 

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1 based maternity practices and models of care for op2 timal maternity outcomes among women of child3 bearing ages and families of such women and that— 

4 ‘‘(A) highlights the importance of pro5 tecting, promoting, and supporting the innate 

6 capacities of childbearing women and their 

7 newborns for childbirth, breastfeeding, and at8 tachment; 

9 ‘‘(B) promotes understanding of the impor10 tance of using obstetric interventions when 

11 medically necessary and when supported by 

12 strong, high-quality evidence; 

13 ‘‘(C) highlights the widespread overuse of 

14 maternity practices that have been shown to 

15 have benefit when used appropriately in situa16 tions of medical necessity, but which can expose 

17 women, infants, or both to risk of harm if used 

18 routinely and indiscriminately, including contin19 uous fetal monitoring, labor induction, epidural 

20 anesthesia, elective primary cesarean section, 

21 and repeat cesarean delivery; 

22 ‘‘(D) emphasizes the noninvasive maternity 

23 practices that have strong proven correlation or 

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1 fects, and are significantly underused in the 

2 United States, including smoking cessation pro3 grams in pregnancy, group model prenatal care, 

4 continuous labor support, nonsupine positions 

5 for birth, and external version to turn breech 

6 babies at term; 

7 ‘‘(E) educates consumers about the quali8 fications of licensed providers of maternity care 

9 and the best evidence about their safety, satis10 faction, outcomes, and costs; 

11 ‘‘(F) informs consumers about the best 

12 available research comparing birth center 

13 births, planned home births, and hospital 

14 births, including information about each set15 ting’s safety, satisfaction, outcomes, and costs; 

16 ‘‘(G) fosters participation in high-quality, 

17 evidence-based childbirth education that pro18 motes a natural, healthy, and safe approach to 

19 pregnancy, childbirth, and early parenting; is 

20 taught by certified educators, peer counselors, 

21 and health professionals; and promotes in22 formed decisionmaking by childbearing women; 

23 and 

24 ‘‘(H) is pilot tested for consumer com25 prehension, cultural sensitivity, and acceptance 


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1 of the messages across geographically, racially, 

2 ethnically, and linguistically diverse popu3 lations.’’. 

4 SEC. 517. BIBLIOGRAPHIC DATABASE OF SYSTEMATIC RE5 VIEWS FOR CARE OF CHILDBEARING WOMEN 

6 AND NEWBORNS. 

7 (a) IN GENERAL.—Not later than one year after the 

8 date of the enactment of this Act, the Secretary of Health 

9 and Human Services, through the Agency for Healthcare 

10 Research and Quality, shall— 

11 (1) make publicly available an online biblio12 graphic database identifying systematic reviews, in13 cluding an explanation of the level and quality of 

14 evidence, for care of childbearing women and 

15 newborns; and 

16 (2) initiate regular updates that incorporate 

17 newly issued and updated systematic reviews. 

18 (b) SOURCES.—To aim for a comprehensive inventory 

19 of systematic reviews relevant to maternal and newborn 

20 care, the database shall identify reviews from diverse 

21 sources, including— 

22 (1) scientific peer-reviewed journals; 

23 (2) databases, including Cochrane Database of 

24 Systematic Reviews, Clinical Evidence, and Data25 base of Abstracts of Reviews of Effects; and 


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1 (3) Internet Web sites of agencies and organi2 zations throughout the world that produce such sys3 tematic reviews. 

4 (c) FEATURES.—The database shall— 

5 (1) provide bibliographic citations for each 

6 record within the database, and for each such cita7 tion include an explanation of the level and quality 

8 of evidence; 

9 (2) include abstracts, as available; 

10 (3) provide reference to companion documents 

11 as may exist for each review, such as evidence tables 

12 and guidelines or consumer educational materials de13 veloped from the review; 

14 (4) provide links to the source of the full review 

15 and to any companion documents; 

16 (5) provide links to the source of a previous 

17 version or update of the review; 

18 (6) be searchable by intervention or other topic 

19 of the review, reported outcomes, author, title, and 

20 source; and 

21 (7) offer to users periodic electronic notification 

22 of database updates relating to users’ topics of inter23 est. 

24 (d) OUTREACH.—Not later than the first date the 

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1 after, the Secretary of Health and Human Services shall 

2 publicize the availability, features, and uses of the data3 base under this section to the stakeholders described in 

4 subsection (e). 

5 (e) CONSULTATION.—For purposes of developing the 

6 database under this section and maintaining and updating 

7 such database, the Secretary of Health and Human Serv8 ices shall convene and consult with an advisory committee 

9 composed of relevant stakeholders, including— 

10 (1) Federal Medicaid administrators and State 

11 agencies administrating State plans under title XIX 

12 of the Social Security Act pursuant to section 

13 1902(a)(5) of such Act (42 U.S.C. 1396a(a)(5)); 

14 (2) providers of maternity and newborn care 

15 from both academic and community-based settings, 

16 including obstetrician-gynecologists, family physi17 cians, certified nurse midwives, certified midwives, 

18 certified professional midwives, physician assistants, 

19 perinatal nurses, pediatricians, and nurse practi20 tioners; 

21 (3) maternal-fetal medicine specialists; 

22 (4) neonatologists; 

23 (5) childbearing women and advocates for such 

24 women, including childbirth educators certified by a 

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1 nities that are diverse in terms of race, ethnicity, in2 digenous status, and geographic area; 

3 (6) employers and purchasers; 

4 (7) health facility and system leaders, including 

5 both hospital and birth center facilities; 

6 (8) journalists; and 

7 (9) bibliographic informatics specialists. 

8 (f) AUTHORIZATION OF APPROPRIATIONS.—There is 

9 authorized to be appropriated $2,500,000 for each of the 

10 fiscal years 2017 through 2019 for the purpose of devel11 oping the database and such sums as may be necessary 

12 for each subsequent fiscal year for updating the database 

13 and providing outreach and notification to users, as de14 scribed in this section. 

15 SEC. 518. MATERNITY CARE HEALTH PROFESSIONAL 

16 SHORTAGE AREAS. 

17 Section 332 of the Public Health Service Act (42 

18 U.S.C. 254e) is amended by adding at the end the fol19 lowing new subsection: 

20 ‘‘(k)(1) The Secretary, acting through the Adminis21 trator of the Health Resources and Services Administra22 tion, shall designate maternity care health professional 

23 shortage areas in the States, publish a descriptive list of 

24 the area’s population groups, medical facilities, and other 


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1 public facilities so designated, and at least annually review 

2 and, as necessary, revise such designations. 

3 ‘‘(2) For purposes of paragraph (1), a complete de4 scriptive list shall be published in the Federal Register not 

5 later than one year after the date of the enactment of the 

6 Health Equity and Accountability Act of 2016 and annu7 ally thereafter. 

8 ‘‘(3) The provisions of subsections (b), (c), (e), (f), 

9 (g), (h), (i), and (j) (other than (j)(1)(B)) of this section 

10 shall apply to the designation of a maternity care health 

11 professional shortage area in a similar manner and extent 

12 as such provisions apply to the designation of health pro13 fessional shortage areas, except in applying subsection 

14 (b)(3), the reference in such subsection to ‘physicians’ 

15 shall be deemed to be a reference to nationally certified 

16 and State licensed obstetricians, family practice physicians 

17 who practice full-scope maternity care, certified nurse 

18 midwives, certified midwives, certified professional mid19 wives, and physician’s assistants who practice full scope 

20 maternity care. 

21 ‘‘(4) For purposes of this subsection, the term ‘ma22 ternity care health professional shortage area’ means— 

23 ‘‘(A) an area in an urban or rural area (which 

24 need not conform to the geographic boundaries of a 

25 political subdivision and which is a rational area for 


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1 the delivery of health services) which the Secretary 

2 determines has a shortage of providers of maternity 

3 care health services including those referenced in 

4 paragraph (3) or an urban or rural area that the 

5 Secretary determines has lost a significant number 

6 of such providers during the 10-year period begin7 ning with 2004 or has no obstetrical providers li8 censed to provide operative obstetrical services; 

9 ‘‘(B) an area in an urban or rural area (which 

10 need not conform to the geographic boundaries of a 

11 political subdivision and which is a rational area for 

12 the delivery of health services) which the Secretary 

13 determines has a shortage of hospital or labor and 

14 delivery units, hospital birth center units, or free15 standing birth centers or an area that lost a signifi16 cant number of these units during the 10-year pe17 riod beginning with 2004; or 

18 ‘‘(C) a population group which the Secretary 

19 determines has such a shortage of providers or fa20 cilities.’’. 

21 SEC. 519. EXPANSION OF CDC PREVENTION RESEARCH 

22 CENTERS PROGRAM TO INCLUDE CENTERS 

23 ON OPTIMAL MATERNITY OUTCOMES. 

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

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


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1 and Human Services, shall support the establishment of 

2 additional Prevention Research Centers under the Preven3 tion Research Center Program administered by the Cen4 ters for Disease Control and Prevention. Such additional 

5 centers shall each be known as a Center for Excellence 

6 on Optimal Maternity Outcomes. 

7 (b) RESEARCH.—Each Center for Excellence on Opti8 mal Maternity Outcomes shall— 

9 (1) conduct at least one focused program of re10 search to improve maternity outcomes, including the 

11 reduction of cesarean birth rates, elective inductions, 

12 prematurity rates, and low birth weight rates within 

13 an underserved population that has a disproportion14 ately large burden of suboptimal maternity out15 comes, including maternal mortality and morbidity, 

16 infant mortality, prematurity, or low birth weight; 

17 (2) work with partners on special interest 

18 projects, as specified by the Centers for Disease 

19 Control and Prevention and other relevant agencies 

20 within the Department of Health and Human Serv21 ices, and on projects funded by other sources; and 

22 (3) involve a minimum of two distinct birth set23 ting models, such as a hospital labor and delivery 

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1 pital labor and delivery model and planned home 

2 birth model. 

3 (c) INTERDISCIPLINARY PROVIDERS.—Each Center 

4 for Excellence on Optimal Maternity Outcomes shall in5 clude the following interdisciplinary providers of maternity 

6 care: 

7 (1) Obstetrician-gynecologists. 

8 (2) At least two of the following providers: 

9 (A) Family practice physicians. 

10 (B) Nurse practitioners. 

11 (C) Physician assistants. 

12 (D) Certified professional midwives. 

13 (d) SERVICES.—Research conducted by each Center 

14 for Excellence on Optimal Maternity Outcomes shall in15 clude at least 2 (and preferably more) of the following sup16 portive provider services: 

17 (1) Mental health. 

18 (2) Doula labor support. 

19 (3) Nutrition education. 

20 (4) Childbirth education. 

21 (5) Social work. 

22 (6) Physical therapy or occupation therapy. 

23 (7) Substance abuse services. 

24 (8) Home visiting. 


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1 (e) COORDINATION.—The programs of research at 

2 each of the two Centers of Excellence on Optimal Mater3 nity Outcomes shall compliment and not replicate the 

4 work of the other. 

5 (f) AUTHORIZATION OF APPROPRIATIONS.—There is 

6 authorized to be appropriated to carry out this section 

7 $2,000,000 for each of the fiscal years 2017 through 

8 2021. 

9 SEC. 520. EXPANDING MODELS ALLOWED TO BE TESTED BY 

10 CENTER FOR MEDICARE AND MEDICAID IN11 NOVATION TO INCLUDE MATERNITY CARE 

12 MODELS. 

13 Section 1115A(b)(2)(B) of the Social Security Act 

14 (42 U.S.C. 1315a(b)(2)(B)) is amended by adding at the 

15 end the following new clause: 

16 ‘‘(xxv) Promoting evidence-based mod17 els of care that have been associated with 

18 reductions in maternal and infant health 

19 disparities, including incorporating the use 

20 of doula and promotoras support for preg21 nant and childbearing women into evi22 dence-based models of prenatal care, labor 

23 and delivery, and postpartum care, and 

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1 hospital birth models, including births at 

2 home and in freestanding birth centers.’’. 

3 SEC. 521. DEVELOPMENT OF INTERPROFESSIONAL MATER4 NITY CARE EDUCATIONAL MODELS AND 

5 TOOLS. 

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

7 date of the enactment of this Act, the Secretary of Health 

8 and Human Services, acting in conjunction with the Ad9 ministrator of Health Resources and Services Administra10 tion, shall convene, for a 1-year period, an Interprofes11 sional Maternity Provider Education Commission to dis12 cuss and make recommendations for— 

13 (1) a consensus standard physiologic maternity 

14 care curriculum that takes into account the core 

15 competencies for basic midwifery practice such as 

16 those developed by the American College of Nurse 

17 Midwives and the North American Registry of Mid18 wives, and the educational objectives for physicians 

19 practicing in obstetrics and gynecology as deter20 mined by the Council on Resident Education in Ob21 stetrics and Gynecology; 

22 (2) suggestions for multidisciplinary use of the 

23 consensus physiologic curriculum; 

24 (3) strategies to integrate and coordinate edu25 cation across maternity care disciplines, including 


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1 recommendations to increase medical and midwifery 

2 student exposure to out-of-hospital birth; and 

3 (4) pilot demonstrations of interprofessional 

4 educational models. 

5 (b) PARTICIPANTS.—The Commission shall include 

6 maternity care educators, curriculum developers, service 

7 leaders, certification leaders, and accreditation leaders 

8 from the various professions that provide maternity care 

9 in this country. Such professions shall include obstetrician 

10 gynecologists, certified nurse midwives or certified mid11 wives, family practice physicians, nurse practitioners, phy12 sician assistants, certified professional midwives, and 

13 perinatal nurses. Additionally, the Commission shall in14 clude representation from maternity care consumer advo15 cates. 

16 (c) CURRICULUM.—The consensus standard physio17 logic maternity care curriculum described in subsection 

18 (a)(1) shall— 

19 (1) have a public health focus with a foundation 

20 in health promotion and disease prevention; 

21 (2) foster physiologic childbearing and woman 

22 and family centered care; 

23 (3) integrate strategies to reduce maternal and 

24 infant morbidity and mortality; 


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1 (4) incorporate recommendations to ensure re2 spectful, safe, and seamless consultation, referral, 

3 transport, and transfer of care when necessary; and 

4 (5) include cultural sensitivity and strategies to 

5 decrease disparities in maternity outcomes. 

6 (d) REPORT.—Not later than 6 months after the final 

7 meeting of the Commission, the Secretary of Health and 

8 Human Services shall— 

9 (1) submit to Congress a report containing the 

10 recommendations made by the Commission under 

11 this section; and 

12 (2) make such report publicly available. 

13 (e) AUTHORIZATION OF APPROPRIATIONS.—There is 

14 authorized to be appropriated to carry out this section 

15 $1,000,000 for each of the fiscal years 2017 and 2018, 

16 and such sums as are necessary for each of the fiscal years 

17 2019 through 2021. 

18 SEC. 522. INCLUDING WITHIN INPATIENT HOSPITAL SERV19 ICES UNDER MEDICARE SERVICES FUR20 NISHED BY CERTAIN STUDENTS, INTERNS, 

21 AND RESIDENTS SUPERVISED BY CERTIFIED 

22 NURSE MIDWIVES. 

23 (a) IN GENERAL.—Section 1861(b) of the Social Se24 curity Act (42 U.S.C. 1395x(b)) is amended— 


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1 (1) in paragraph (6), by striking ‘‘; or’’ and in2 serting ‘‘, or in the case of services in a hospital or 

3 osteopathic hospital by a student midwife or an in4 tern or resident-in-training under a teaching pro5 gram previously described in this paragraph who is 

6 in the field of obstetrics and gynecology, if such stu7 dent midwife, intern, or resident-in-training is super8 vised by a certified nurse-midwife to the extent per9 mitted under applicable State law and as may be au10 thorized by the hospital;’’; 

11 (2) in paragraph (7), by striking the period at 

12 the end and inserting ‘‘; or’’; and 

13 (3) by adding at the end the following new 

14 paragraph: 

15 ‘‘(8) a certified nurse-midwife where the hos16 pital has a teaching program approved as specified 

17 in paragraph (6), if— 

18 ‘‘(A) the hospital elects to receive any pay19 ment due under this title for reasonable costs of 

20 such services; and 

21 ‘‘(B) all certified nurse-midwives in such 

22 hospital agree not to bill charges for profes23 sional services rendered in such hospital to indi24 viduals covered under the insurance program 

25 established by this title.’’. 


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1 (b) EFFECTIVE DATE.—The amendments made by 

2 subsection (a) shall apply to services furnished on or after 

3 the date of the enactment of this Act. 

4 SEC. 523. GRANTS TO PROFESSIONAL ORGANIZATIONS TO 

5 INCREASE DIVERSITY IN MATERNITY CARE 

6 PROFESSIONALS. 

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

8 Human Services, through the Administrator of the Health 

9 Resources and Services Administration, shall carry out a 

10 grant program under which the Secretary may make to 

11 eligible health professional organizations— 

12 (1) for fiscal year 2017, planning grants de13 scribed in subsection (b); and 

14 (2) for the subsequent 4-year period, implemen15 tation grants described in subsection (c). 

16 (b) PLANNING GRANTS.— 

17 (1) IN GENERAL.—Planning grants described in 

18 this subsection are grants for the following purposes: 

19 (A) To collect data and identify any work20 force disparities, with respect to a health pro21 fession, at each of the following areas along the 

22 health professional continuum: 

23 (i) Pipeline availability with respect to 

24 students at the high school and college or 


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1 university levels considering and working 

2 toward entrance in the profession. 

3 (ii) Entrance into the training pro4 gram for the profession. 

5 (iii) Graduation from such training 

6 program. 

7 (iv) Entrance into practice. 

8 (v) Retention in practice for more 

9 than a 5-year period. 

10 (B) To develop one or more strategies to 

11 address the workforce disparities within the 

12 health profession, as identified under (and in 

13 response to the findings pursuant to) subpara14 graph (A). 

15 (2) APPLICATION.—To be eligible to receive a 

16 grant under this subsection, an eligible health pro17 fessional organization shall submit to the Secretary 

18 of Health and Human Services an application in 

19 such form and manner and containing such informa20 tion as specified by the Secretary. 

21 (3) AMOUNT.—Each grant awarded under this 

22 subsection shall be for an amount not to exceed 

23 $300,000. 


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1 (4) REPORT.—Each recipient of a grant under 

2 this subsection shall submit to the Secretary of 

3 Health and Human Services a report containing— 

4 (A) information on the extent and distribu5 tion of workforce disparities identified through 

6 the grant; and 

7 (B) reasonable objectives and strategies 

8 developed to address such disparities within a 

9 5-, 10-, and 25-year period. 

10 (c) IMPLEMENTATION GRANTS.— 

11 (1) IN GENERAL.—Implementation grants de12 scribed in this subsection are grants to implement 

13 one or more of the strategies developed pursuant to 

14 a planning grant awarded under subsection (b). 

15 (2) APPLICATION.—To be eligible to receive a 

16 grant under this subsection, an eligible health pro17 fessional organization shall submit to the Secretary 

18 of Health and Human Services an application in 

19 such form and manner as specified by the Secretary. 

20 Each such application shall contain information on 

21 the capability of the organization to carry out a 

22 strategy described in paragraph (1), involvement of 

23 partners or coalitions, plans for developing sustain24 ability of the efforts after the culmination of the 


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1 grant cycle, and any other information specified by 

2 the Secretary. 

3 (3) AMOUNT.—Each grant awarded under this 

4 subsection shall be for an amount not to exceed 

5 $500,000 each year during the 4-year period of the 

6 grant. 

7 (4) REPORTS.—For each of the first 3 years for 

8 which an eligible health professional organization is 

9 awarded a grant under this subsection, the organiza10 tion shall submit to the Secretary of Health and 

11 Human Services a report on the activities carried 

12 out by such organization through the grant during 

13 such year and objectives for the subsequent year. 

14 For the fourth year for which an eligible health pro15 fessional organization is awarded a grant under this 

16 subsection, the organization shall submit to the Sec17 retary a report that includes an analysis of all the 

18 activities carried out by the organization through the 

19 grant and a detailed plan for continuation of out20 reach efforts. 

21 (d) ELIGIBLE HEALTH PROFESSIONAL ORGANIZA22 TION DEFINED.—For purposes of this section, the term 

23 ‘‘eligible health professional organization’’ means a profes24 sional organization representing obstetrician-gyne25 cologists, certified nurse midwives, certified midwives, 


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1 family practice physicians, nurse practitioners whose scope 

2 of practice includes maternity care, physician assistants 

3 whose scope of practice includes obstetrical care, or cer4 tified professional midwives. 

5 (e) AUTHORIZATION OF APPROPRIATIONS.—There is 

6 authorized to be appropriated to carry out this section 

7 $2,000,000 for fiscal year 2017 and $3,000,000 for each 

8 of the fiscal years 2018 through 2021. 

9 TITLE VI—MENTAL HEALTH 

10 SEC. 601. COVERAGE OF MARRIAGE AND FAMILY THERA11 PIST SERVICES, MENTAL HEALTH COUN12 SELOR SERVICES, AND SUBSTANCE ABUSE 

13 COUNSELOR SERVICES UNDER PART B OF 

14 THE MEDICARE PROGRAM. 

15 (a) COVERAGE OF SERVICES.— 

16 (1) IN GENERAL.—Section 1861(s)(2) of the 

17 Social Security Act (42 U.S.C. 1395x(s)(2)), as 

18 amended by section 450(c)(1), is amended— 

19 (A) in subparagraph (FF), by striking 

20 ‘‘and’’ at the end; 

21 (B) in subparagraph (GG), by inserting 

22 ‘‘and’’ at the end; and 

23 (C) by adding at the end the following new 

24 subparagraph: 


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1 ‘‘(HH) marriage and family therapist services 

2 (as defined in subsection (lll)(1)) and mental health 

3 counselor services (as defined in subsection (lll)(3)) 

4 and substance abuse counselor services (as defined 

5 in subsection (lll)(5));’’. 

6 (2) DEFINITIONS.—Section 1861 of such Act 

7 (42 U.S.C. 1395x), as amended by sections 

8 205(b)(1)(A), 423(a), and 470(a), is amended by 

9 adding at the end the following new subsection: 

10 ‘‘Marriage and Family Therapist Services; Marriage and 

11 Family Therapist; Mental Health Counselor Serv12 ices; Mental Health Counselor 

13 ‘‘(lll)(1) The term ‘marriage and family therapist 

14 services’ means services performed by a marriage and 

15 family therapist (as defined in paragraph (2)) for the diag16 nosis and treatment of mental illnesses, which the mar17 riage and family therapist is legally authorized to perform 

18 under State law (or the State regulatory mechanism pro19 vided by State law) of the State in which such services 

20 are performed, as would otherwise be covered if furnished 

21 by a physician or as an incident to a physician’s profes22 sional service, but only if no facility or other provider 

23 charges or is paid any amounts with respect to the fur24 nishing of such services. 


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1 ‘‘(2) The term ‘marriage and family therapist’ means 

2 an individual who— 

3 ‘‘(A) possesses a master’s or doctoral degree 

4 which qualifies for licensure or certification as a 

5 marriage and family therapist pursuant to State 

6 law; 

7 ‘‘(B) after obtaining such degree has performed 

8 at least 2 years of clinical supervised experience in 

9 marriage and family therapy; and 

10 ‘‘(C) in the case of an individual performing 

11 services in a State that provides for licensure or cer12 tification of marriage and family therapists, is li13 censed or certified as a marriage and family thera14 pist in such State. 

15 ‘‘(3) The term ‘mental health counselor services’ 

16 means services performed by a mental health counselor (as 

17 defined in paragraph (4)) for the diagnosis and treatment 

18 of mental illnesses which the mental health counselor is 

19 legally authorized to perform under State law (or the 

20 State regulatory mechanism provided by the State law) of 

21 the State in which such services are performed, as would 

22 otherwise be covered if furnished by a physician or as inci23 dent to a physician’s professional service, but only if no 

24 facility or other provider charges or is paid any amounts 

25 with respect to the furnishing of such services. 


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1 ‘‘(4) The term ‘mental health counselor’ means an 

2 individual who— 

3 ‘‘(A) possesses a master’s or doctor’s degree in 

4 mental health counseling or a related field; 

5 ‘‘(B) after obtaining such a degree has per6 formed at least 2 years of supervised mental health 

7 counselor practice; and 

8 ‘‘(C) in the case of an individual performing 

9 services in a State that provides for licensure or cer10 tification of mental health counselors or professional 

11 counselors, is licensed or certified as a mental health 

12 counselor or professional counselor in such State. 

13 ‘‘(5) The term ‘substance abuse counselor services’ 

14 means services performed by a substance abuse counselor 

15 (as defined in paragraph (6)) for the diagnosis and treat16 ment of substance abuse and addiction which the sub17 stance abuse counselor is legally authorized to perform 

18 under State law (or the State regulatory mechanism pro19 vided by the State law) of the State in which such services 

20 are performed, as would otherwise be covered if furnished 

21 by a physician or as incident to a physician’s professional 

22 service, but only if no facility or other provider charges 

23 or is paid any amounts with respect to the furnishing of 

24 such services. 


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1 ‘‘(6) The term ‘substance abuse counselor’ means an 

2 individual who— 

3 ‘‘(A) has performed at least 2 years of super4 vised substance abuse counselor practice; 

5 ‘‘(B) in the case of an individual performing 

6 services in a State that provides for licensure or cer7 tification of substance abuse counselors or profes8 sional counselors, is licensed or certified as a sub9 stance abuse counselor or professional counselor in 

10 such State; or 

11 ‘‘(C) the individual is a drug and alcohol coun12 selor as defined in section 40.281 of title 49, Code 

13 of Federal Regulations.’’. 

14 (3) PROVISION FOR PAYMENT UNDER PART

15 B.—Section 1832(a)(2)(B) of such Act (42 U.S.C. 

16 1395k(a)(2)(B)) is amended— 

17 (A) by striking ‘‘and’’ at the end of clause 

18 (iv); and 

19 (B) by adding at the end the following new 

20 clause: 

21 ‘‘(v) marriage and family therapist 

22 services, mental health counselor services, 

23 and substance abuse counselor services; 

24 and’’. 


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1 (4) AMOUNT OF PAYMENT.—Section 1833(a)(1) 

2 of such Act (42 U.S.C. 1395l(a)(1)), as amended by 

3 section 450(c)(1), is amended— 

4 (A) by striking ‘‘and (AA)’’ and inserting 

5 ‘‘(AA)’’; and 

6 (B) by inserting before the semicolon at 

7 the end the following: ‘‘, and (BB) with respect 

8 to marriage and family therapist services, men9 tal health counselor services, and substance 

10 abuse counselor services under section 

11 1861(s)(2)(HH), the amounts paid shall be 80 

12 percent of the lesser of the actual charge for 

13 the services or 75 percent of the amount deter14 mined for payment of a psychologist under sub15 paragraph (L)’’. 

16 (5) EXCLUSION OF MARRIAGE AND FAMILY

17 THERAPIST SERVICES AND MENTAL HEALTH COUN18 SELOR SERVICES FROM SKILLED NURSING FACILITY

19 PROSPECTIVE PAYMENT SYSTEM.—Section 

20 1888(e)(2)(A)(ii) of such Act (42 U.S.C. 

21 1395yy(e)(2)(A)(ii)) is amended by inserting ‘‘mar22 riage and family therapist services (as defined in 

23 section 1861(lll)(1)), mental health counselor serv24 ices (as defined in section 1861(lll)(3)),’’ after 

25 ‘‘qualified psychologist services,’’. 


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1 (6) INCLUSION OF MARRIAGE AND FAMILY

2 THERAPISTS, MENTAL HEALTH COUNSELORS, AND

3 SUBSTANCE ABUSE COUNSELORS AS PRACTITIONERS

4 FOR ASSIGNMENT OF CLAIMS.—Section 

5 1842(b)(18)(C) of such Act (42 U.S.C. 

6 1395u(b)(18)(C)) is amended by adding at the end 

7 the following new clauses: 

8 ‘‘(vii) A marriage and family therapist (as de9 fined in section 1861(lll)(2)). 

10 ‘‘(viii) A mental health counselor (as defined in 

11 section 1861(lll)(4)). 

12 ‘‘(ix) A substance abuse counselor (as defined 

13 in section 1861 (lll)(6)).’’. 

14 (b) COVERAGE OF CERTAIN MENTAL HEALTH SERV15 ICES PROVIDED IN CERTAIN SETTINGS.— 

16 (1) RURAL HEALTH CLINICS AND FEDERALLY

17 QUALIFIED HEALTH CENTERS.—Section 

18 1861(aa)(1)(B) of the Social Security Act (42 

19 U.S.C. 1395x(aa)(1)(B)) is amended by striking ‘‘or 

20 by a clinical social worker (as defined in subsection 

21 (hh)(1)),’’ and inserting ‘‘, by a clinical social worker 

22 (as defined in subsection (hh)(1)), by a marriage 

23 and family therapist (as defined in subsection 

24 (lll)(2)), or by a mental health counselor (as defined 


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1 in subsection (lll)(4)), or by a substance abuse coun2 selor (as defined in section 1861 (lll)(6)).’’. 

3 (2) HOSPICE PROGRAMS.—Section 

4 1861(dd)(2)(B)(i)(III) of such Act (42 U.S.C. 

5 1395x(dd)(2)(B)(i)(III)) is amended by inserting ‘‘or 

6 one marriage and family therapist (as defined in 

7 subsection (lll)(2))’’ after ‘‘social worker’’. 

8 (c) AUTHORIZATION OF MARRIAGE AND FAMILY

9 THERAPISTS TO DEVELOP DISCHARGE PLANS FOR POST10 HOSPITAL SERVICES.—Section 1861(ee)(2)(G) of the So11 cial Security Act (42 U.S.C. 1395x(ee)(2)(G)) is amended 

12 by inserting ‘‘marriage and family therapist (as defined 

13 in subsection (lll)(2)),’’ after ‘‘social worker,’’. 

14 (d) EFFECTIVE DATE.—The amendments made by 

15 this section shall apply with respect to services furnished 

16 on or after January 1, 2017. 

17 SEC. 602. MINORITY FELLOWSHIP PROGRAM. 

18 Title V of the Public Health Service Act is amended 

19 by inserting after section 506B (42 U.S.C. 290aa–5b) the 

20 following: 

21 ‘‘SEC. 506C. MINORITY FELLOWSHIP PROGRAM. 

22 ‘‘(a) FELLOWSHIPS.—The Administrator shall main23 tain a program, to be known as the Minority Fellowship 

24 Program, under which the Administrator awards grants 

25 or contracts to national associations or other appropriate 


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1 entities for the financial support of graduate students, 

2 postdoctoral fellows, and residents in the professions of 

3 psychology, psychiatry, social work, psychiatric advance4 practice nursing, marriage and family therapy, and profes5 sional counseling to students who demonstrate a commit6 ment to clinical or research careers focused on racial and 

7 ethnic minority populations. 

8 ‘‘(b) TERM OF FINANCIAL SUPPORT.—Financial sup9 port provided to an individual pursuant to subsection (a) 

10 shall be for a term of not more than 12 months and may 

11 be renewed thereafter. 

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

13 carry out this section, there is authorized to be appro14 priated $10,000,000 for each of fiscal years 2017 through 

15 2021.’’. 

16 SEC. 603. INTEGRATED HEALTH CARE DEMONSTRATION 

17 PROGRAM. 

18 Part D of title V of the Public Health Service Act 

19 (42 U.S.C. 290dd et seq.) is amended by adding at the 

20 end the following: 

21 ‘‘SEC. 544. INTERPROFESSIONAL HEALTH CARE TEAMS FOR 

22 PROVISION OF BEHAVIORAL HEALTH CARE 

23 IN PRIMARY CARE SETTINGS. 

24 ‘‘(a) GRANTS.—The Secretary, acting through the 

25 Deputy Assistant Secretary for Minority Health, shall 


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1 award grants to eligible entities for the purpose of pro2 viding technical assistance and training regarding the ef3 fective development and implementation of integrated 

4 interprofessional health care teams that provide behavioral 

5 health care. 

6 ‘‘(b) ELIGIBLE ENTITIES.—To be eligible to receive 

7 a grant under this section, an entity shall be a federally 

8 qualified health center (as defined in section 1861(aa) of 

9 the Social Security Act) serving a high proportion of indi10 viduals from racial and ethnic minority groups (as defined 

11 in section 1707(g)). 

12 ‘‘(c) SCIENTIFICALLY BASED.—The technical assist13 ance and training funded through this section shall be sci14 entifically based, taking into consideration the results of 

15 the most recent peer-reviewed research available. 

16 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—To 

17 carry out this section, there is authorized to be appro18 priated $20,000,000 for each of fiscal years 2017 through 

19 2019.’’. 

20 SEC. 604. ADDRESSING RACIAL AND ETHNIC MINORITY 

21 MENTAL HEALTH DISPARITIES RESEARCH 

22 GAPS. 

23 Not later than 6 months after the date of the enact24 ment of this Act, the Director of the National Institute 

25 on Minority Health and Health Disparities shall enter into 


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1 an arrangement with the Institute of Medicine (or, if the 

2 Institute declines to enter into such an arrangement, an3 other appropriate entity)— 

4 (1) to conduct a study with respect to mental 

5 and behavioral health disparities in racial and ethnic 

6 minority groups (as defined in section 1707(g) of 

7 the Public Health Service Act (42 U.S.C. 300u– 

8 6(g)); and 

9 (2) to submit to the Congress a report on the 

10 results of such study, including— 

11 (A) a compilation of information on the dy12 namics of mental disorders in such racial and 

13 ethnic minority groups; and 

14 (B) a compilation of information on the 

15 impact of exposure to community violence, ad16 verse childhood experiences, and other psycho17 logical traumas on mental disorders in such ra18 cial and minority groups. 

19 SEC. 605. HEALTH PROFESSIONS COMPETENCIES TO AD20 DRESS RACIAL AND ETHNIC MINORITY MEN21 TAL HEALTH DISPARITIES. 

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

23 Human Services, acting through the Administrator of the 

24 Substance Abuse and Mental Health Services AdministraVerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00418 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475

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1 tion, shall award grants to qualified national organizations 

2 for the purposes of— 

3 (1) developing, and disseminating to health pro4 fessional educational programs curricula or core 

5 competencies addressing mental health disparities 

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, peer wellness specialist, mental health coun10 seling, and 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 to address mental health disparities 

16 among racial and ethnic minority groups. 

17 (b) CURRICULA; CORE COMPETENCIES.—Organiza18 tions receiving funds under subsection (a) may use the 

19 funds to engage in the following activities related to the 

20 development and dissemination of curricula or core com21 petencies described in subsection (a)(1): 

22 (1) Formation of committees or working groups 

23 comprised of experts from accredited health profes24 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 into the educational needs as5 sociated with mental health disparities among racial 

6 and ethnic minority groups. 

7 (3) Dissemination and promotion of the use of 

8 curricula or core competencies in undergraduate and 

9 graduate health professions training programs na10 tionwide. 

11 (c) DEFINITIONS.—In this section: 

12 (1) The term ‘‘qualified national organization’’ 

13 means a national organization that focuses on the 

14 education of students in programs of social work, 

15 psychology, psychiatry, and marriage and family 

16 therapy. 

17 (2) The term ‘‘racial and ethnic minority 

18 group’’ has the meaning given to such term in sec19 tion 1707(g) of the Public Health Service Act (42 

20 U.S.C. 300u–6(g)). 

21 (d) AUTHORIZATION OF APPROPRIATIONS.—There 

22 are authorized to be appropriated to carry out this section 

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

24 2017 through 2021. 


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1 TITLE VII—ADDRESSING HIGH 

2 IMPACT MINORITY DISEASES 

3 Subtitle A—Cancer 

4 SEC. 701. LUNG CANCER MORTALITY REDUCTION. 

5 (a) SHORT TITLE.—This section may be cited as the 

6 ‘‘Lung Cancer Mortality Reduction Act of 2016’’. 

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

9 (1) Lung cancer is the leading cause of cancer 

10 death for both men and women, accounting for 28 

11 percent of all cancer deaths. 

12 (2) Lung cancer kills more people annually 

13 than breast cancer, prostate cancer, colon cancer, 

14 liver cancer, melanoma, and kidney cancer combined. 

15 (3) Since the National Cancer Act of 1971 

16 (Public Law 92–218; 85 Stat. 778), coordinated and 

17 comprehensive research has raised the 5-year sur18 vival rates for breast cancer to 88 percent, for pros19 tate cancer to 99 percent, and for colon cancer to 

20 64 percent. 

21 (4) However, the 5-year survival rate for lung 

22 cancer is still only 15 percent and a similar coordi23 nated and comprehensive research effort is required 

24 to achieve increases in lung cancer survivability 

25 rates. 


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1 (5) Sixty percent of lung cancer cases are now 

2 diagnosed nonsmokers or former smokers. 

3 (6) Two-thirds of nonsmokers diagnosed with 

4 lung cancer are women. 

5 (7) Certain minority populations, such as Afri6 can-American males, have disproportionately high 

7 rates of lung cancer incidence and mortality, not8 withstanding their similar smoking rate. 

9 (8) Members of the baby boomer generation are 

10 entering their sixties, the most common age at which 

11 people develop lung cancer. 

12 (9) Tobacco addiction and exposure to other 

13 lung cancer carcinogens such as Agent Orange and 

14 other herbicides and battlefield emissions are serious 

15 problems among military personnel and war vet16 erans. 

17 (10) Significant and rapid improvements in 

18 lung cancer mortality can be expected through great19 er use and access to lung cancer screening tests for 

20 at-risk individuals. 

21 (11) Recent research has shown that screening 

22 with low-dose computed tomography (CT) scan im23 proved lung cancer death mortality by 20 percent for 

24 those with a high risk of lung cancer through early 

25 detection. The Centers for Medicare & Medicaid 


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1 Services supports annual lung cancer screening for 

2 high-risk patients with low-dose computed tomog3 raphy. 

4 (12) Additional strategies are necessary to fur5 ther enhance the existing tests and therapies avail6 able to diagnose and treat lung cancer in the future. 

7 (13) The August 2001 Report of the Lung 

8 Cancer Progress Review Group of the National Can9 cer Institute stated that funding for lung cancer re10 search was ‘‘far below the levels characterized for 

11 other common malignancies and far out of propor12 tion to its massive health impact’’. 

13 (14) The Report of the Lung Cancer Progress 

14 Review Group identified as its ‘‘highest priority’’ the 

15 creation of integrated, multidisciplinary, multi-insti16 tutional research consortia organized around the 

17 problem of lung cancer rather than around specific 

18 research disciplines. 

19 (15) The United States must enhance its re20 sponse to the issues raised in the Report of the 

21 Lung Cancer Progress Review Group, and this can 

22 be accomplished through the establishment of a co23 ordinated effort designed to reduce the lung cancer 

24 mortality rate by 50 percent by 2020 and targeted 

25 funding to support this coordinated effort. 


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1 (c) SENSE OF CONGRESS CONCERNING INVESTMENT

2 IN LUNG CANCER RESEARCH.—It is the sense of the Con3 gress that— 

4 (1) lung cancer mortality reduction should be 

5 made a national public health priority; and 

6 (2) a comprehensive mortality reduction pro7 gram coordinated by the Secretary of Health and 

8 Human Services is justified and necessary to ade9 quately address and reduce lung cancer mortality. 

10 (d) LUNG CANCER MORTALITY REDUCTION PRO11 GRAM.— 

12 (1) IN GENERAL.—Subpart 1 of part C of title 

13 IV of the Public Health Service Act (42 U.S.C. 285 

14 et seq.) is amended by adding at the end the fol15 lowing: 

16 ‘‘SEC. 417H. LUNG CANCER MORTALITY REDUCTION PRO17 GRAM. 

18 ‘‘(a) IN GENERAL.—Not later than 6 months after 

19 the date of the enactment of this section, the Secretary, 

20 in consultation with the Secretary of Defense, the Sec21 retary of Veterans Affairs, the Director of the National 

22 Institutes of Health, the Director of the Centers for Dis23 ease Control and Prevention, the Commissioner of Food 

24 and Drugs, the Administrator of the Centers for Medicare 

25 & Medicaid Services, the Director of the National Institute 


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1 on Minority Health and Health Disparities, and other 

2 members of the Lung Cancer Advisory Board established 

3 under section 701 of the Health Equity and Accountability 

4 Act of 2016, shall implement a comprehensive program, 

5 to be known as the Lung Cancer Mortality Reduction Pro6 gram, to achieve a reduction of at least 25 percent in the 

7 mortality rate of lung cancer by 2020. 

8 ‘‘(b) REQUIREMENTS.—The Program shall include at 

9 least the following: 

10 ‘‘(1) With respect to the National Institutes of 

11 Health— 

12 ‘‘(A) a strategic review and prioritization 

13 by the National Cancer Institute of research 

14 grants to achieve the goal of the Lung Cancer 

15 Mortality Reduction Program in reducing lung 

16 cancer mortality; 

17 ‘‘(B) the provision of funds to enable the 

18 Airway Biology and Disease Branch of the Na19 tional Heart, Lung, and Blood Institute to ex20 pand its research programs to include pre21 dispositions to lung cancer, the interrelationship 

22 between lung cancer and other pulmonary and 

23 cardiac disease, and the diagnosis and treat24 ment of these interrelationships; 


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1 ‘‘(C) the provision of funds to enable the 

2 National Institute of Biomedical Imaging and 

3 Bioengineering to expedite the development of 

4 computer-assisted diagnostic, surgical, treat5 ment, and drug-testing innovations to reduce 

6 lung cancer mortality, such as through expan7 sion of the Institute’s Quantum Grant Program 

8 and Image-Guided Interventions programs; and 

9 ‘‘(D) the provision of funds to enable the 

10 National Institute of Environmental Health 

11 Sciences to implement research programs rel12 ative to the lung cancer incidence. 

13 ‘‘(2) With respect to the Food and Drug Ad14 ministration— 

15 ‘‘(A) activities under section 530 of the 

16 Federal Food, Drug, and Cosmetic Act; and 

17 ‘‘(B) activities under section 561 of the 

18 Federal Food, Drug, and Cosmetic Act to ex19 pand access to investigational drugs and devices 

20 for the diagnosis, monitoring, or treatment of 

21 lung cancer. 

22 ‘‘(3) With respect to the Centers for Disease 

23 Control and Prevention, the establishment of an 

24 early disease research and management program 

25 under section 1511. 


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1 ‘‘(4) With respect to the Agency for Healthcare 

2 Research and Quality, the conduct of a biannual re3 view of lung cancer screening, diagnostic, and treat4 ment protocols, and the issuance of updated guide5 lines. 

6 ‘‘(5) The promotion (including education) of 

7 lung cancer screening within minority and rural pop8 ulations and the study of the effectiveness of efforts 

9 to increase such screening. 

10 ‘‘(6) The cooperation and coordination of all 

11 minority and health disparity programs within the 

12 Department of Health and Human Services to en13 sure that all aspects of the Lung Cancer Mortality 

14 Reduction Program under this section adequately 

15 address the burden of lung cancer on minority and 

16 rural populations. 

17 ‘‘(7) The cooperation and coordination of all to18 bacco control and cessation programs within agen19 cies of the Department of Health and Human Serv20 ices to achieve the goals of the Lung Cancer Mor21 tality Reduction Program under this section with 

22 particular emphasis on the coordination of drug and 

23 other cessation treatments with early detection pro24 tocols.’’. 


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1 (2) FEDERAL FOOD, DRUG, AND COSMETIC

2 ACT.—Subchapter B of chapter V of the Federal 

3 Food, Drug, and Cosmetic Act (21 U.S.C. 360aaa et 

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

5 ‘‘DRUGS RELATING TO LUNG CANCER

6 ‘‘SEC. 530. (a) IN GENERAL.—The provisions of this 

7 subchapter shall apply to a drug described in subsection 

8 (b) to the same extent and in the same manner as such 

9 provisions apply to a drug for a rare disease or condition. 

10 ‘‘(b) QUALIFIED DRUGS.—A drug described in this 

11 subsection is— 

12 ‘‘(1) a chemoprevention drug for precancerous 

13 conditions of the lung; 

14 ‘‘(2) a drug for targeted therapeutic treat15 ments, including any vaccine, for lung cancer; and 

16 ‘‘(3) a drug to curtail or prevent nicotine addic17 tion. 

18 ‘‘(c) BOARD.—The Board established under the 

19 Health Equity and Accountability Act of 2016 shall mon20 itor the program implemented under this section.’’. 

21 (3) ACCESS TO UNAPPROVED THERAPIES.—Sec22 tion 561(e) of the Federal Food, Drug, and Cos23 metic Act (21 U.S.C. 360bbb(e)) is amended by in24 serting before the period the following: ‘‘and shall 

25 include expanding access to drugs under section 

26 530, with substantial consideration being given to 


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1 whether the totality of information available to the 

2 Secretary regarding the safety and effectiveness of 

3 an investigational drug, as compared to the risk of 

4 morbidity and death from the disease, indicates that 

5 a patient may obtain more benefit than risk if treat6 ed with the drug’’. 

7 (4) CDC.—Title XV of the Public Health Serv8 ice Act (42 U.S.C. 300k et seq.) is amended by add9 ing at the end the following: 

10 ‘‘SEC. 1511. EARLY DISEASE RESEARCH AND MANAGEMENT 

11 PROGRAM. 

12 ‘‘The Secretary shall establish and implement an 

13 early disease research and management program targeted 

14 at the high incidence and mortality rates of lung cancer 

15 among minority and low-income populations.’’. 

16 (e) DEPARTMENT OF DEFENSE AND THE DEPART17 MENT OF VETERANS AFFAIRS.—The Secretary of Defense 

18 and the Secretary of Veterans Affairs shall coordinate 

19 with the Secretary of Health and Human Services— 

20 (1) in the development of the Lung Cancer 

21 Mortality Reduction Program under section 417H; 

22 (2) in the implementation within the Depart23 ment of Defense and the Department of Veterans 

24 Affairs of an early detection and disease manage25 ment research program for military personnel and 


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1 veterans whose smoking history and exposure to car2 cinogens during active duty service has increased 

3 their risk for lung cancer; and 

4 (3) in the implementation of coordinated care 

5 programs for military personnel and veterans diag6 nosed with lung cancer. 

7 (f) LUNG CANCER ADVISORY BOARD.— 

8 (1) IN GENERAL.—The Secretary of Health and 

9 Human Services shall convene a Lung Cancer Advi10 sory Board (referred to in this section as the 

11 ‘‘Board’’)— 

12 (A) to monitor the programs established 

13 under this section (and the amendments made 

14 by this section); and 

15 (B) to provide annual reports to the Con16 gress concerning benchmarks, expenditures, 

17 lung cancer statistics, and the public health im18 pact of such programs. 

19 (2) COMPOSITION.—The Board shall be com20 posed of— 

21 (A) the Secretary of Health and Human 

22 Services; 

23 (B) the Secretary of Defense; 

24 (C) the Secretary of Veterans Affairs; and 


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1 (D) two representatives each from the 

2 fields of clinical medicine focused on lung can3 cer, lung cancer research, imaging, drug devel4 opment, and lung cancer advocacy, to be ap5 pointed by the Secretary of Health and Human 

6 Services. 

7 (g) AUTHORIZATION OF APPROPRIATIONS.— 

8 (1) IN GENERAL.—To carry out this section 

9 (and the amendments made by this section), there 

10 are authorized to be appropriated such sums as may 

11 be necessary for each of fiscal years 2017 through 

12 2021. 

13 (2) LUNG CANCER MORTALITY REDUCTION PRO14 GRAM.—Of the amounts authorized to be appro15 priated by subsection (a), there are authorized to be 

16 appropriated— 

17 (A) $25,000,000 for fiscal year 2017, and 

18 such sums as may be necessary for each of fis19 cal years 2018 through 2021, for the activities 

20 described in section 417H(b)(1)(B) of the Pub21 lic Health Service Act, as added by subsection 

22 (d)(1); 

23 (B) $25,000,000 for fiscal year 2017, and 

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1 cal years 2018 through 2021, for the activities 

2 described in section 417H(b)(1)(C) of such Act; 

3 (C) $10,000,000 for fiscal year 2017, and 

4 such sums as may be necessary for each of fis5 cal years 2018 through 2021, for the activities 

6 described in section 417H(b)(1)(D) of such Act; 

7 and 

8 (D) $15,000,000 for fiscal year 2017, and 

9 such sums as may be necessary for each of fis10 cal years 2018 through 2021, for the activities 

11 described in section 417H(b)(3) of such Act. 

12 SEC. 702. EXPANDING PROSTATE CANCER RESEARCH, OUT13 REACH, SCREENING, TESTING, ACCESS, AND 

14 TREATMENT EFFECTIVENESS. 

15 (a) SHORT TITLE.—This section may be cited as the 

16 ‘‘Prostate Research, Outreach, Screening, Testing, Access, 

17 and Treatment Effectiveness Act of 2016’’ or the ‘‘PROS18 TATE Act’’. 

19 (b) FINDINGS.—Congress makes the following find20 ings: 

21 (1) Prostate cancer is the second leading cause 

22 of cancer death among men. 

23 (2) In 2010, more than 217,730 new patients 

24 were diagnosed with prostate cancer and more than 

25 32,000 men died from this disease. 


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1 (3) Roughly 2,000,000 Americans are living 

2 with a diagnosis of prostate cancer and its con3 sequences. 

4 (4) While prostate cancer generally affects older 

5 individuals, younger men are also at risk for the dis6 ease, and when prostate cancer appears in early 

7 middle age it frequently takes on a more aggressive 

8 form. 

9 (5) There are significant racial and ethnic dis10 parities that demand attention, namely African11 Americans have prostate cancer mortality rates that 

12 are more than double those in the White population. 

13 (6) Underserved rural populations have higher 

14 rates of mortality compared to their urban counter15 parts, and innovative and cost-efficient methods to 

16 improve rural access to high quality care should take 

17 advantage of advances in telehealth to diagnose and 

18 treat prostate cancer when appropriate. 

19 (7) Certain veterans populations may have 

20 nearly twice the incidence of prostate cancer as the 

21 general population of the United States. 

22 (8) Urologists may constitute the specialists 

23 who diagnose and treat the vast majority of prostate 

24 cancer patients. 


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1 (9) Although much basic and translational re2 search has been completed and much is currently 

3 known, there are still many unanswered questions. 

4 For example, it is not fully understood how much of 

5 known disparities are attributable to disease eti6 ology, access to care, or education and awareness in 

7 the community. 

8 (10) Causes of prostate cancer are not known. 

9 There is not good information regarding how to dif10 ferentiate accurately, early on, between aggressive 

11 and indolent forms of the disease. As a result, there 

12 is significant overtreatment in prostate cancer. 

13 There are no treatments that can durably arrest 

14 growth or cure prostate cancer once it has metasta15 sized. 

16 (11) A significant proportion (roughly 23 to 54 

17 percent) of cases may be clinically indolent and 

18 ‘‘overdiagnosed’’, resulting in significant overtreat19 ment. More accurate tests will allow men and their 

20 families to face less physical, psychological, financial, 

21 and emotional trauma and billions of dollars could 

22 be saved in private and public health care systems 

23 in an area that has been identified by the Medicare 

24 Program as one of eight high-volume, high-cost 

25 areas in the Resource Utilization Report Program 


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1 authorized by Congress under the Medicare Im2 provements for Patients and Providers Act of 2008. 

3 (12) Prostate cancer research and health care 

4 programs across Federal agencies should be coordi5 nated to improve accountability and actively encour6 age the translation of research into practice, to iden7 tify and implement best practices, in order to foster 

8 an integrated and consistent focus on effective pre9 vention, diagnosis, and treatment of this disease. 

10 (c) PROSTATE CANCER COORDINATION AND EDU11 CATION.— 

12 (1) INTERAGENCY PROSTATE CANCER COORDI13 NATION AND EDUCATION TASK FORCE.—Not later 

14 than 180 days after the date of the enactment of 

15 this section, the Secretary of Veterans Affairs, in co16 operation with the Secretary of Defense and the Sec17 retary of Health and Human Services, shall estab18 lish an Interagency Prostate Cancer Coordination 

19 and Education Task Force (in this section referred 

20 to as the ‘‘Prostate Cancer Task Force’’). 

21 (2) DUTIES.—The Prostate Cancer Task Force 

22 shall— 

23 (A) develop a summary of advances in 

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1 nosis, prevention, and treatment of prostate 

2 cancer, including psychosocial impairments re3 lated to prostate cancer treatment, and compile 

4 a list of best practices that warrant broader 

5 adoption in health care programs; 

6 (B) consider establishing, and advocating 

7 for, a guidance to enable physicians to allow 

8 screening of men who are over age 74, on a 

9 case-by-case basis, taking into account quality 

10 of life and family history of prostate cancer; 

11 (C) share and coordinate information on 

12 Federal research and health care program ac13 tivities, including activities related to— 

14 (i) determining how to improve re15 search and health care programs, including 

16 psychosocial impairments related to pros17 tate cancer treatment; 

18 (ii) identifying any gaps in the overall 

19 research inventory and in health care pro20 grams; 

21 (iii) identifying opportunities to pro22 mote translation of research into practice; 

23 and 

24 (iv) maximizing the effects of Federal 

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1 laboration and leveraging of resources in 

2 research and health care programs that 

3 serve those susceptible to or diagnosed 

4 with prostate cancer; 

5 (D) develop a comprehensive interagency 

6 strategy and advise relevant Federal agencies in 

7 the solicitation of proposals for collaborative, 

8 multidisciplinary research and health care pro9 grams, including proposals to evaluate factors 

10 that may be related to the etiology of prostate 

11 cancer, that would— 

12 (i) result in innovative approaches to 

13 study emerging scientific opportunities or 

14 eliminate knowledge gaps in research to 

15 improve the prostate cancer research port16 folio of the Federal Government; 

17 (ii) outline key research questions, 

18 methodologies, and knowledge gaps; and 

19 (iii) ensure consistent action, as out20 lined by section 402(b) of the Public 

21 Health Service Act; 

22 (E) develop a coordinated message related 

23 to screening and treatment for prostate cancer 

24 to be reflected in educational and beneficiary 


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1 materials for Federal health programs as such 

2 documents are updated; and 

3 (F) not later than 2 years after the date 

4 of the establishment of the Prostate Cancer 

5 Task Force, submit to the Expert Advisory 

6 Panel to be reviewed and returned within 30 

7 days, and then within 90 days submitted to 

8 Congress recommendations— 

9 (i) regarding any appropriate changes 

10 to research and health care programs, in11 cluding recommendations to improve the 

12 research portfolio of the Department of 

13 Veterans Affairs, Department of Defense, 

14 National Institutes of Health, and other 

15 Federal agencies to ensure that scientif16 ically based strategic planning is imple17 mented in support of research and health 

18 care program priorities; 

19 (ii) designed to ensure that the re20 search and health care programs and ac21 tivities of the Department of Veterans Af22 fairs, the Department of Defense, the De23 partment of Health and Human Services, 

24 and other Federal agencies are free of un25 necessary duplication; 


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1 (iii) regarding public participation in 

2 decisions relating to prostate cancer re3 search and health care programs to in4 crease the involvement of patient advo5 cates, community organizations, and med6 ical associations representing a broad geo7 graphical area; 

8 (iv) on how to best disseminate infor9 mation on prostate cancer research and 

10 progress achieved by health care programs; 

11 (v) about how to expand partnerships 

12 between public entities, including Federal 

13 agencies, and private entities to encourage 

14 collaborative, cross-cutting research and 

15 health care delivery; 

16 (vi) assessing any cost savings and ef17 ficiencies realized through the efforts iden18 tified and supported in this section and 

19 recommending expansion of those efforts 

20 that have proved most promising while also 

21 ensuring against any conflicts in directives 

22 from other congressional or statutory man23 dates or enabling statutes; 


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1 (vii) identifying key priority action 

2 items from among the recommendations; 

3 and 

4 (viii) with respect to the level of fund5 ing needed by each agency to implement 

6 the recommendations contained in the re7 port. 

8 (3) MEMBERS OF THE PROSTATE CANCER TASK

9 FORCE.—The Prostate Cancer Task Force described 

10 in subsection (a) shall be composed of representa11 tives from such Federal agencies, as each Secretary 

12 determines necessary, to coordinate a uniform mes13 sage relating to prostate cancer screening and treat14 ment where appropriate, including representatives of 

15 the following: 

16 (A) The Department of Veterans Affairs, 

17 including representatives of each relevant pro18 gram areas of the Department of Veterans Af19 fairs. 

20 (B) The Prostate Cancer Research Pro21 gram of the Congressionally Directed Medical 

22 Research Program of the Department of De23 fense. 


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1 (C) The Department of Health and 

2 Human Services, including at a minimum rep3 resentatives of the following: 

4 (i) The National Institutes of Health. 

5 (ii) National research institutes and 

6 centers, including the National Cancer In7 stitute, the National Institute of Allergy 

8 and Infectious Diseases, and the Office of 

9 Minority Health. 

10 (iii) The Centers for Medicare & Med11 icaid Services. 

12 (iv) The Food and Drug Administra13 tion. 

14 (v) The Centers for Disease Control 

15 and Prevention. 

16 (vi) The Agency for Healthcare Re17 search and Quality. 

18 (vii) The Health Resources and Serv19 ices Administration. 

20 (4) APPOINTING EXPERT ADVISORY PANELS.— 

21 The Prostate Cancer Task Force shall appoint ex22 pert advisory panels, as determined appropriate, to 

23 provide input and concurrence from individuals and 

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1 nities with expertise in prostate cancer diagnosis, 

2 treatment, and research, including practicing urolo3 gists, primary care providers, and others and indi4 viduals with expertise in education and outreach to 

5 underserved populations affected by prostate cancer. 

6 (5) MEETINGS.—The Prostate Cancer Task 

7 Force shall convene not less than twice a year, or 

8 more frequently as the Secretary determines to be 

9 appropriate. 

10 (6) SUBMISSION OF RECOMMENDATIONS TO

11 CONGRESS.—The Secretary of Veterans Affairs shall 

12 submit to Congress any recommendations submitted 

13 to the Secretary under paragraph (2)(E). 

14 (7) FEDERAL ADVISORY COMMITTEE ACT.— 

15 (A) IN GENERAL.—Except as provided in 

16 subparagraph (B), the Federal Advisory Com17 mittee Act (5 U.S.C. App.) shall apply to the 

18 Prostate Cancer Task Force. 

19 (B) EXCEPTION.—Section 14(a)(2)(B) of 

20 such Act (relating to the termination of advi21 sory committees) shall not apply to the Prostate 

22 Cancer Task Force. 

23 (8) SUNSET DATE.—The Prostate Cancer Task 

24 Force shall terminate at the end of fiscal year 2021. 

25 (d) PROSTATE CANCER RESEARCH.— 


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1 (1) RESEARCH COORDINATION.—The Secretary 

2 of Veterans Affairs, in coordination with the Secre3 taries of Defense and of Health and Human Serv4 ices, shall establish and carry out a program to co5 ordinate and intensify prostate cancer research as 

6 needed. Specifically, such research program shall— 

7 (A) develop advances in diagnostic and 

8 prognostic methods and tests, including bio9 markers and an improved prostate cancer 

10 screening blood test, including improvements or 

11 alternatives to the prostate specific antigen test 

12 and additional tests to distinguish indolent from 

13 aggressive disease; 

14 (B) better understand the etiology of the 

15 disease (including an analysis of lifestyle factors 

16 proven to be involved in higher rates of prostate 

17 cancer, such as obesity and diet, and in dif18 ferent ethnic, racial, and socioeconomic groups, 

19 such as the African-American, Latino or His20 panic, and American Indian populations and 

21 men with a family history of prostate cancer) to 

22 improve prevention efforts; 

23 (C) expand basic research into prostate 

24 cancer, including studies of fundamental molec25 ular and cellular mechanisms; 


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1 (D) identify and provide clinical testing of 

2 novel agents for the prevention and treatment 

3 of prostate cancer; 

4 (E) establish clinical registries for prostate 

5 cancer; 

6 (F) use the National Institute of Bio7 medical Imaging and Bioengineering and the 

8 National Cancer Institute for assessment of ap9 propriate imaging modalities; and 

10 (G) address such other matters relating to 

11 prostate cancer research as may be identified by 

12 the Federal agencies participating in the pro13 gram under this section. 

14 (2) PROSTATE CANCER ADVISORY BOARD.— 

15 There is established in the Office of the Chief Sci16 entist of the Food and Drug Administration a Pros17 tate Cancer Scientific Advisory Board. Such board 

18 shall be responsible for accelerating real-time shar19 ing of the latest research data and accelerating 

20 movement of new medicines to patients. 

21 (3) UNDERSERVED MINORITY GRANT PRO22 GRAM.—In carrying out such program, the Secretary 

23 shall— 


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1 (A) award grants to eligible entities to 

2 carry out components of the research outlined 

3 in paragraph (1); 

4 (B) integrate and build upon existing 

5 knowledge gained from comparative effective6 ness research; and 

7 (C) recognize and address— 

8 (i) the racial and ethnic disparities in 

9 the incidence and mortality rates of pros10 tate cancer and men with a family history 

11 of prostate cancer; 

12 (ii) any barriers in access to care and 

13 participation in clinical trials that are spe14 cific to racial, ethnic, and other under15 served minorities and men with a family 

16 history of prostate cancer; 

17 (iii) needed outreach and educational 

18 efforts to raise awareness in these commu19 nities; and 

20 (iv) appropriate access and utilization 

21 of imaging modalities. 

22 (e) TELEHEALTH AND RURAL ACCESS PILOT

23 PROJECT.— 

24 (1) IN GENERAL.—The Secretary of Veterans 

25 Affairs, the Secretary of Defense, and the Secretary 


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1 of Health and Human Services (in this section re2 ferred to as the ‘‘Secretaries’’) shall establish 4-year 

3 telehealth pilot projects for the purpose of analyzing 

4 the clinical outcomes and cost effectiveness associ5 ated with telehealth services in a variety of geo6 graphic areas that contain high proportions of medi7 cally underserved populations, including African8 Americans, Latino or Hispanic, American Indians/ 

9 Alaska Natives, and those in rural areas. Such 

10 projects shall promote efficient use of specialist care 

11 through better coordination of primary care and 

12 physician extender teams in underserved areas and 

13 more effectively employ tumor boards to better coun14 sel patients. 

15 (2) ELIGIBLE ENTITIES.— 

16 (A) IN GENERAL.—The Secretaries shall 

17 select eligible entities to participate in the pilot 

18 projects under this section. 

19 (B) PRIORITY.—In selecting eligible enti20 ties to participate in the pilot projects under 

21 this section, the Secretaries shall give priority 

22 to such entities located in medically under23 served areas, particularly those that include Af24 rican-Americans, Latinos and Hispanics, and 

25 facilities of the Indian Health Service, including 


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1 Indian Health Service operated facilities, trib2 ally operated facilities, and Urban Indian Clin3 ics, and those in rural areas. 

4 (3) EVALUATION.—The Secretaries shall, 

5 through the pilot projects, evaluate— 

6 (A) the effective and economic delivery of 

7 care in diagnosing and treating prostate cancer 

8 with the use of telehealth services in medically 

9 underserved and tribal areas including collabo10 rative uses of health professionals and integra11 tion of the range of telehealth and other tech12 nologies; 

13 (B) the effectiveness of improving the ca14 pacity of nonmedical providers and nonspecial15 ized medical providers to provide health services 

16 for prostate cancer in medically underserved 

17 and tribal areas, including the exploration of in18 novative medical home models with collabora19 tion between urologists, other relevant medical 

20 specialists, including oncologists, radiologists, 

21 and primary care teams and coordination of 

22 care through the efficient use of primary care 

23 teams and physician extenders; and 

24 (C) the effectiveness of using telehealth 

25 services to provide prostate cancer treatment in 


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1 medically underserved areas, including the use 

2 of tumor boards to facilitate better patient 

3 counseling. 

4 (4) REPORT.—Not later than 12 months after 

5 the completion of the pilot projects under this sub6 section, the Secretaries shall submit to Congress a 

7 report describing the outcomes of such pilot projects, 

8 including any cost savings and efficiencies realized, 

9 and providing recommendations, if any, for expand10 ing the use of telehealth services. 

11 (f) EDUCATION AND AWARENESS.— 

12 (1) IN GENERAL.—The Secretary of Veterans 

13 Affairs shall develop a national education campaign 

14 for prostate cancer. Such campaign shall involve the 

15 use of written educational materials and public serv16 ice announcements consistent with the findings of 

17 the Prostate Cancer Task Force under subsection 

18 (c), that are intended to encourage men to seek 

19 prostate cancer screening when appropriate. 

20 (2) RACIAL DISPARITIES AND THE POPULATION

21 OF MEN WITH A FAMILY HISTORY OF PROSTATE

22 CANCER.—In developing the national campaign 

23 under paragraph (1), the Secretary shall ensure that 

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1 nities experiencing racial disparities in the incidence 

2 and mortality rates of prostate cancer and by men 

3 of any race classification with a family history of 

4 prostate cancer. 

5 (3) GRANTS.—In carrying out the national 

6 campaign under this section, the Secretary shall 

7 award grants to nonprofit private entities to enable 

8 such entities to test alternative outreach and edu9 cation strategies. 

10 (g) AUTHORIZATION OF APPROPRIATIONS.— 

11 (1) IN GENERAL.—There is authorized to be 

12 appropriated to carry out this section for the period 

13 of fiscal years 2017 through 2021 an amount equal 

14 to the savings described in paragraph (2). 

15 (2) CORRESPONDING REDUCTION.—The 

16 amount authorized to be appropriated by provisions 

17 of law other than this section for the period of fiscal 

18 years 2017 through 2021 for Federal research and 

19 health care program activities related to prostate 

20 cancer is reduced by the amount of Federal savings 

21 projected to be achieved over such period by imple22 mentation of subsection (c)(2)(C) of this section. 


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1 SEC. 703. IMPROVED MEDICAID COVERAGE FOR CERTAIN 

2 BREAST AND CERVICAL CANCER PATIENTS 

3 IN THE TERRITORIES. 

4 (a) ELIMINATION OF FUNDING LIMITATIONS.— 

5 (1) IN GENERAL.—Section 1108(g)(4) of the 

6 Social Security Act (42 U.S.C. 1308(g)(4)) is 

7 amended by adding at the end the following: ‘‘With 

8 respect to fiscal years beginning with fiscal year 

9 2017, payment for medical assistance for individuals 

10 who are eligible for such assistance only on the basis 

11 of section 1902(a)(10)(A)(ii)(XVIII) shall not be 

12 taken into account in applying subsection (f) (as in13 creased in accordance with paragraphs (1), (2), (3), 

14 and (5) of this subsection) to such commonwealth or 

15 territory for such fiscal year.’’. 

16 (2) TECHNICAL AMENDMENT.—Such section is 

17 further amended by striking ‘‘(3), and (4)’’ and in18 serting ‘‘(3), and (5)’’. 

19 (b) APPLICATION OF ENHANCED FMAP FOR HIGH20 EST STATE.—Section 1905(b) of such Act (42 U.S.C. 

21 1396d(b)) is amended by adding at the end the following: 

22 ‘‘Notwithstanding the first sentence of this subsection, 

23 with respect to medical assistance described in clause (4) 

24 of such sentence that is furnished in Puerto Rico, the 

25 United States Virgin Islands, Guam, the Commonwealth 

26 of the Northern Mariana Islands, or American Samoa in 


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1 a fiscal year, the Federal medical assistance percentage 

2 is equal to the highest such percentage applied under such 

3 clause for such fiscal year for any of the 50 States or the 

4 District of Columbia that provides such medical assistance 

5 for any portion of such fiscal year.’’ 

6 (c) EFFECTIVE DATE.—The amendments made by 

7 this section shall apply to payment for medical assistance 

8 for items and services furnished on or after October 1, 

9 2016. 

10 SEC. 704. CANCER PREVENTION AND TREATMENT DEM11 ONSTRATION FOR ETHNIC AND RACIAL MI12 NORITIES. 

13 (a) DEMONSTRATION.— 

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

15 Human Services (in this section referred to as the 

16 ‘‘Secretary’’) shall conduct demonstration projects 

17 (in this section referred to as ‘‘demonstration 

18 projects’’) for the purpose of developing models and 

19 evaluating methods that— 

20 (A) improve the quality of items and serv21 ices provided to target individuals in order to 

22 facilitate reduced disparities in early detection 

23 and treatment of cancer; 

24 (B) improve clinical outcomes, satisfaction, 

25 quality of life, appropriate use of items and 


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1 services covered under the Medicare Program 

2 under title XVIII of the Social Security Act (42 

3 U.S.C. 1395 et seq.), and referral patterns with 

4 respect to target individuals with cancer; 

5 (C) eliminate disparities in the rate of pre6 ventive cancer screening measures, such as Pap 

7 smears, prostate cancer screenings, colon cancer 

8 screenings, breast cancer screenings, and com9 puted tomography (CT) scans, for lung cancer 

10 among target individuals; 

11 (D) promote collaboration with community12 based organizations to ensure cultural com13 petency of health care professionals and lin14 guistic access for target individuals who are 

15 persons with limited-English proficiency; and 

16 (E) encourage the incorporation of commu17 nity health workers to increase the efficiency 

18 and appropriateness of cancer screening pro19 grams. 

20 (2) COMMUNITY HEALTH WORKER DEFINED.— 

21 In this section, the term ‘‘community health worker’’ 

22 includes a community health advocate, a lay health 

23 worker, a community health representative, a peer 

24 health promotor, a community health outreach work25 er, and a promotore de salud, who promotes health 


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1 or nutrition within the community in which the indi2 vidual resides. 

3 (3) TARGET INDIVIDUAL DEFINED.—In this 

4 section, the term ‘‘target individual’’ means an indi5 vidual of a racial and ethnic minority group, as de6 fined in section 1707(g)(1) of the Public Health 

7 Service Act (42 U.S.C. 300u–6(g)(1)), who is enti8 tled to benefits under part A, and enrolled under 

9 part B, of title XVIII of the Social Security Act. 

10 (b) PROGRAM DESIGN.— 

11 (1) INITIAL DESIGN.—Not later than 1 year 

12 after the date of the enactment of this Act, the Sec13 retary shall evaluate best practices in the private 

14 sector, community programs, and academic research 

15 of methods that reduce disparities among individuals 

16 of racial and ethnic minority groups in the preven17 tion and treatment of cancer and shall design the 

18 demonstration projects based on such evaluation. 

19 (2) NUMBER AND PROJECT AREAS.—Not later 

20 than 2 years after the date of the enactment of this 

21 Act, the Secretary shall implement at least nine 

22 demonstration projects, including the following: 

23 (A) Two projects, each of which shall tar24 get different ethnic subpopulations, for each of 


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1 the four following major racial and ethnic mi2 nority groups: 

3 (i) American Indians and Alaska Na4 tives, Eskimos and Aleuts. 

5 (ii) Asian-Americans. 

6 (iii) Blacks/African-Americans. 

7 (iv) Latinos or Hispanics. 

8 (v) Native Hawaiians and other Pa9 cific Islanders. 

10 (B) One project within the Pacific Islands 

11 or United States insular areas. 

12 (C) At least one project each in a rural 

13 area and inner-city area. 

14 (3) EXPANSION OF PROJECTS; IMPLEMENTA15 TION OF DEMONSTRATION PROJECT RESULTS.—If 

16 the initial report under subsection (c) contains an 

17 evaluation that demonstration projects— 

18 (A) reduce expenditures under the Medi19 care Program under title XVIII of the Social 

20 Security Act (42 U.S.C. 1395 et seq.); or 

21 (B) do not increase expenditures under the 

22 Medicare Program and reduce racial and ethnic 

23 health disparities in the quality of health care 

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1 crease satisfaction of Medicare beneficiaries and 

2 health care providers; 

3 the Secretary shall continue the existing demonstra4 tion projects and may expand the number of dem5 onstration projects. 

6 (c) REPORT TO CONGRESS.— 

7 (1) IN GENERAL.—Not later than 2 years after 

8 the date the Secretary implements the initial dem9 onstration projects, and biannually thereafter, the 

10 Secretary shall submit to Congress a report regard11 ing the demonstration projects. 

12 (2) CONTENTS OF REPORT.—Each report under 

13 paragraph (1) shall include the following: 

14 (A) A description of the demonstration 

15 projects. 

16 (B) An evaluation of— 

17 (i) the cost effectiveness of the dem18 onstration projects; 

19 (ii) the quality of the health care serv20 ices provided to target individuals under 

21 the demonstration projects; and 

22 (iii) beneficiary and health care pro23 vider satisfaction under the demonstration 

24 projects. 


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1 (C) Any other information regarding the 

2 demonstration projects that the Secretary de3 termines to be appropriate. 

4 (d) WAIVER AUTHORITY.—The Secretary shall waive 

5 compliance with the requirements of title XVIII of the So6 cial Security Act (42 U.S.C. 1395 et seq.) to such extent 

7 and for such period as the Secretary determines is nec8 essary to conduct demonstration projects. 

9 SEC. 705. REDUCING CANCER DISPARITIES WITHIN MEDI10 CARE. 

11 (a) DEVELOPMENT OF MEASURES OF DISPARITIES

12 IN QUALITY OF CANCER CARE.— 

13 (1) DEVELOPMENT OF MEASURES.—The Sec14 retary of Health and Human Services (in this sec15 tion referred to as the ‘‘Secretary’’) shall enter into 

16 an agreement with an entity that specializes in de17 veloping quality measures for cancer care under 

18 which the entity shall develop a uniform set of meas19 ures to evaluate disparities in the quality of cancer 

20 care and annually update such set of measures. 

21 (2) MEASURES TO BE INCLUDED.—Such set of 

22 measures shall include, with respect to the treatment 

23 of cancer, measures of patient outcomes, the process 

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1 sionmaking, patient experience of care, resource use, 

2 and practice capabilities, such as care coordination. 

3 (b) ESTABLISHMENT OF REPORTING PROCESS.— 

4 (1) IN GENERAL.—The Secretary shall establish 

5 a reporting process that requires and provides for a 

6 method for health care providers specified under 

7 paragraph (2) to submit to the Secretary and make 

8 public data on the performance of such providers 

9 during each reporting period through use of the 

10 measures developed pursuant to subsection (a). Such 

11 data shall be submitted in a form and manner and 

12 at a time specified by the Secretary. 

13 (2) SPECIFICATION OF PROVIDERS TO REPORT

14 ON MEASURES.—The Secretary shall specify the 

15 classes of Medicare providers of services and sup16 pliers, including hospitals, cancer centers, physi17 cians, primary care providers, and specialty pro18 viders, that will be required under such process to 

19 publicly report on the measures specified under sub20 section (a). 

21 (3) ASSESSMENT OF CHANGES.—Under such 

22 reporting process, the Secretary shall establish a for23 mat that assesses changes in both the absolute and 

24 relative disparities in cancer care over time. These 

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1 sible format, such as those presented in the final 

2 publications relating to Healthy People 2010 or the 

3 National Healthcare Disparities Report. 

4 (4) INITIAL IMPLEMENTATION.—The Secretary 

5 shall implement the reporting process under this 

6 subsection for reporting periods beginning not later 

7 than 6 months after the date that measures are first 

8 established under subsection (a). 

9 Subtitle B—Viral Hepatitis and 

10 Liver Cancer Control and Pre11 vention 

12 SEC. 711. VIRAL HEPATITIS AND LIVER CANCER CONTROL 

13 AND PREVENTION. 

14 (a) SHORT TITLE.—This subtitle may be cited as the 

15 ‘‘Viral Hepatitis and Liver Cancer Control and Prevention 

16 Act of 2016’’. 

17 (b) FINDINGS.—Congress finds the following: 

18 (1) Approximately 5,300,000 Americans are 

19 chronically infected with the hepatitis B virus (re20 ferred to in this section as ‘‘HBV’’), the hepatitis C 

21 virus (referred to in this section as ‘‘HCV’’), or 

22 both. 

23 (2) In the United States, chronic HBV and 

24 HCV are the most common cause of liver cancer, 

25 one of the most lethal and fastest growing cancers 


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1 in this country. It is the most common cause of 

2 chronic liver disease, liver cirrhosis, and the most 

3 common indication for liver transplantation. At least 

4 21,000 deaths per year in the United States can be 

5 attributed to chronic HBV and HCV. Chronic HCV 

6 is also a leading cause of death in Americans living 

7 with HIV/AIDS, many of those living with HIV/ 

8 AIDS are coinfected with chronic HBV, chronic 

9 HCV, or both. 

10 (3) According to the Centers for Disease Con11 trol and Prevention (referred to in this section as 

12 the ‘‘CDC’’), approximately 2 percent of the popu13 lation of the United States is living with chronic 

14 HBV, chronic HCV, or both. The CDC has recog15 nized HCV as the Nation’s most common chronic 

16 bloodborne virus infection and HBV as the deadliest 

17 vaccine-preventable disease. 

18 (4) HBV is easily transmitted and is 100 times 

19 more infectious than HIV. According to the CDC, 

20 HBV is transmitted through contact with infectious 

21 blood, semen, or other body fluids. HCV is trans22 mitted by contact with infectious blood, particularly 

23 through percutaneous exposures (i.e. puncture 

24 through the skin). 


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1 (5) The CDC conservatively estimates that in 

2 2013 approximately 29,700 Americans were newly 

3 infected with HCV and more than 19,800 Americans 

4 were newly infected with HBV. These estimates 

5 could be much higher due to many reasons, includ6 ing lack of screening education and awareness, and 

7 perceived marginalization of the populations at risk. 

8 (6) In 2012, CDC released new guidelines rec9 ommending every person born between 1945 and 

10 1965 receive a one-time test. Among the estimated 

11 102 million (1.6 million chronically HCV-infected) 

12 eligible for screening, birth-cohort screening leads to 

13 84,000 fewer cases of decompensated cirrhosis, 

14 46,000 fewer cases of hepatocellular carcinoma, 

15 10,000 fewer liver transplants, and 78,000 fewer 

16 HCV-related deaths gained versus risk-based screen17 ing. 

18 (7) In 2013, the United States Preventive Serv19 ices Task Force (USPSTF) issued a Grade B rating 

20 for screening for the hepatitis C virus (HCV) infec21 tion in persons at high risk for infection and adults 

22 born between 1945 and 1965. In 2014, the 

23 USPSTF issued a Grade B for screening for the 

24 hepatitis B virus (HBV) in persons at high-risk of 

25 hepatitis B infection. In 2009, the USPSTF issued 


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1 a Grade A for screening pregnant women for the 

2 hepatitis B virus (HBV) during their first prenatal 

3 visit. 

4 (8) There were 44 outbreaks (23 of HBV, 22 

5 of HCV) reported to CDC for investigation from 

6 2008 through 2014 related to health care acquired 

7 infection of HBV and HCV, 42 of which occurred in 

8 nonhospital settings. There were more than 101,100 

9 patients potentially exposed to one of the viruses. 

10 (9) Chronic HBV and chronic HCV usually do 

11 not cause symptoms early in the course of the dis12 ease, but after many years of a clinically ‘‘silent’’ 

13 phase, CDC estimates show more than 33 percent of 

14 infected individuals will develop cirrhosis, end-stage 

15 liver disease, or liver cancer. Since most individuals 

16 with chronic HBV, HCV, or both are unaware of 

17 their infection, they do not know to take precautions 

18 to prevent the spread of their infection and can un19 knowingly exacerbate their own disease progression. 

20 (10) HBV and HCV disproportionately affect 

21 certain populations in the United States. Although 

22 representing only 6 percent of the population, Asian23 Americans and Pacific Islanders account for over 

24 half of the 1,400,000 domestic chronic HBV cases. 

25 Baby boomers (those born between 1945 and 1965) 


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1 account for approximately 75 percent of domestic 

2 chronic hepatitis C cases. In addition, African-Amer3 icans, Latinos (Latinas), and American Indian/Na4 tive Alaskans are among the groups which have dis5 proportionately high rates of HBV and/or HCV in6 fections in the United States. 

7 (11) For both chronic HBV and chronic HCV, 

8 behavioral changes can slow disease progression if 

9 diagnosis is made early. Early diagnosis, which is 

10 determined through simple blood tests, can reduce 

11 the risk of transmission and disease progression 

12 through education and vaccination of household 

13 members and other susceptible persons at risk. 

14 (12) Advancements have led to the development 

15 of improved diagnostic tests for viral hepatitis. 

16 These tests, including rapid, point of care testing 

17 and others in development, can facilitate testing, no18 tification of results and post-test counseling, and re19 ferral to care at the time of the testing visit. In par20 ticular, these tests are also advantageous because 

21 they can be used simultaneously with HIV rapid 

22 testing for persons at risk for both HCV and HIV 

23 infections. 

24 (13) For those chronically infected with HBV 

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1 tection of liver cancer at a stage where a cure is still 

2 possible. Liver cancer is the second deadliest cancer 

3 in the United States; however, liver cancer has re4 ceived little funding for research, prevention, or 

5 treatment. 

6 (14) Treatment for chronic HCV can eradicate 

7 the disease in approximately 90 percent of those cur8 rently treated. The treatment of chronic HBV can 

9 effectively suppress viral replication in the over10 whelming majority (over 80 percent) of those treat11 ed, thereby reducing the risk of transmission and 

12 progression to liver scarring or liver cancer, even 

13 though a complete cure is much less common than 

14 for HCV. 

15 (15) To combat the viral hepatitis epidemic in 

16 the United States, in May 2011, the Department of 

17 Health and Human Services released ‘‘Combating 

18 the Silent Epidemic of Viral Hepatitis: Action Plan 

19 for the Prevention, Care & Treatment of Viral Hepa20 titis’’ (hereafter referred to as the HHS Action 

21 Plan). The Institute of Medicine (IOM) of the Na22 tional Academies produced a 2010 report on the 

23 Federal response to HBV and HCV titled: ‘‘Hepa24 titis and Liver Cancer: A National Strategy for Pre25 vention and Control of Hepatitis B and C’’. These 


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1 recommendations and guidelines provide a frame2 work for HBV and HCV prevention, education, con3 trol, research, and medical management programs. 

4 (16) The annual health care costs attributable 

5 to HBV and HCV in the United States are signifi6 cant. For HBV, it is estimated to be approximately 

7 $2,500,000,000 ($2,000 per infected person). In 

8 2000, the lifetime cost of HBV—before the avail9 ability of most current therapies—was approximately 

10 $80,000 per chronically infected person, totaling 

11 more than $100,000,000,000. For HCV, medical 

12 costs for patients are expected to increase from 

13 $30,000,000,000 in 2009 to over $85,000,000,000 

14 in 2024. Avoiding these costs by screening and diag15 nosing individuals earlier—and connecting them to 

16 appropriate treatment and care, will save lives and 

17 critical health care dollars. Currently, without a 

18 comprehensive screening, testing, and diagnosis pro19 gram, most patients are diagnosed too late when 

20 they need a liver transplant costing at least 

21 $314,000 for uncomplicated cases or when they have 

22 liver cancer or end stage liver disease which costs 

23 $30,980 to $110,576 per hospital admission. As 

24 health care costs continue to grow, it is critical that 


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1 the Federal Government invests in effective mecha2 nisms to avoid documented cost drivers. 

3 (17) According to the IOM report in 2010 (de4 scribed in paragraph (15)), chronic HBV and HCV 

5 infections cause substantial morbidity and mortality 

6 despite being preventable and treatable. Deficiencies 

7 in the implementation of established guidelines for 

8 the prevention, diagnosis, and medical management 

9 of chronic HBV and HCV infections perpetuate per10 sonal and economic burdens. Existing grants are not 

11 sufficient for the scale of the health burden pre12 sented by HBV and HCV. 

13 (18) Screening and testing for HBV and HCV 

14 is aligned with the Healthy People 2020 goal to in15 crease immunization rates and reduce preventable 

16 infectious diseases. Awareness of disease and access 

17 to prevention and treatment remain essential compo18 nents for reducing infectious disease transmission. 

19 (19) Federal support is necessary to increase 

20 knowledge and awareness of HBV and HCV and to 

21 assist State and local prevention and control efforts 

22 in reducing the morbidity and mortality of these 

23 epidemics. 

24 (20) The Secretary of Health and Human Serv25 ices has the discretion to carry out this Act directly 


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1 and through whichever of the agencies of the Public 

2 Health Service the Secretary determines to be ap3 propriate, which may (in the Secretary’s discretion) 

4 include the Centers for Disease Control and Preven5 tion, the Health Resources and Services Administra6 tion, the Substance Abuse and Mental Health Serv7 ices Administration, the National Institutes of 

8 Health (including the National Institute on Minority 

9 Health and Health Disparities), and other agencies 

10 of such Service. 

11 (21) The Centers for Disease Control and Pre12 vention reported a 151 percent increase in hepatitis 

13 C cases from 2010–2013, stemming from the opioid, 

14 heroin, and overdose epidemics affecting commu15 nities nationwide. 

16 (c) BIENNIAL ASSESSMENT OF HHS HEPATITIS B 

17 AND HEPATITIS C PREVENTION, EDUCATION, RESEARCH, 

18 AND MEDICAL MANAGEMENT PLAN.—Title III of the 

19 Public Health Service Act (42 U.S.C. 241 et seq.) is 

20 amended— 

21 (1) by striking section 317N (42 U.S.C. 247b– 

22 15); and 

23 (2) by adding at the end the following: 


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1 ‘‘PART W—BIENNIAL ASSESSMENT OF HHS HEPA2 TITIS B AND HEPATITIS C PREVENTION, EDU3 CATION, RESEARCH, AND MEDICAL MANAGE4 MENT PLAN 

5 ‘‘SEC. 399NN. BIENNIAL UPDATE OF THE PLAN. 

6 ‘‘(a) IN GENERAL.—The Secretary shall conduct a bi7 ennial assessment of the Secretary’s plan for the preven8 tion, control, and medical management of, and education 

9 and research relating to, hepatitis B and hepatitis C, for 

10 the purposes of— 

11 ‘‘(1) incorporating into such plan new knowl12 edge or observations relating to hepatitis B and hep13 atitis C (such as knowledge and observations that 

14 may be derived from clinical, laboratory, and epide15 miological research and disease detection, preven16 tion, and surveillance outcomes); 

17 ‘‘(2) addressing gaps in the coverage or effec18 tiveness of the plan; and 

19 ‘‘(3) evaluating and, if appropriate, updating 

20 recommendations, guidelines, or educational mate21 rials of the Centers for Disease Control and Preven22 tion or the National Institutes of Health for health 

23 care providers or the public on viral hepatitis in 

24 order to be consistent with the plan. 

25 ‘‘(b) PUBLICATION OF NOTICE OF ASSESSMENTS.— 

26 Not later than October 1 of the first even-numbered year 


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1 beginning after the date of the enactment of this part, 

2 and October 1 of each even-numbered year thereafter, the 

3 Secretary shall publish in the Federal Register a notice 

4 of the results of the assessments conducted under para5 graph (1). Such notice shall include— 

6 ‘‘(1) a description of any revisions to the plan 

7 referred to in subsection (a) as a result of the as8 sessment; 

9 ‘‘(2) an explanation of the basis for any such 

10 revisions, including the ways in which such revisions 

11 can reasonably be expected to further promote the 

12 original goals and objectives of the plan; and 

13 ‘‘(3) in the case of a determination by the Sec14 retary that the plan does not need revision, an expla15 nation of the basis for such determination. 

16 ‘‘SEC. 399NN–1. ELEMENTS OF PROGRAM. 

17 ‘‘(a) EDUCATION AND AWARENESS PROGRAMS.—The 

18 Secretary, acting through the Director of the Centers for 

19 Disease Control and Prevention, the Administrator of the 

20 Health Resources and Services Administration, and the 

21 Administrator of the Substance Abuse and Mental Health 

22 Services Administration, and in accordance with the plan 

23 referred to in section 399NN(a), shall implement pro24 grams to increase awareness and enhance knowledge and 


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1 understanding of hepatitis B and hepatitis C. Such pro2 grams shall include— 

3 ‘‘(1) the conduct of culturally and language ap4 propriate health education in primary and secondary 

5 schools, college campuses, public awareness cam6 paigns, and community outreach activities (especially 

7 to the ethnic communities with high rates of chronic 

8 hepatitis B and chronic hepatitis C and other high9 risk groups) to promote public awareness and knowl10 edge about the value of hepatitis A and hepatitis B 

11 immunization, risk factors, the transmission and 

12 prevention of hepatitis B and hepatitis C, the value 

13 of screening for the early detection of hepatitis B 

14 and hepatitis C, and options available for the treat15 ment of chronic hepatitis B and chronic hepatitis C; 

16 ‘‘(2) the promotion of immunization programs 

17 that increase awareness and access to hepatitis A 

18 and hepatitis B vaccines for susceptible adults and 

19 children; 

20 ‘‘(3) the training of health care professionals 

21 regarding the importance of vaccinating individuals 

22 infected with hepatitis C and individuals who are at 

23 risk for hepatitis C infection against hepatitis A and 

24 hepatitis B; 


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1 ‘‘(4) the training of health care professionals 

2 regarding the importance of vaccinating individuals 

3 chronically infected with hepatitis B and individuals 

4 who are at risk for chronic hepatitis B infection 

5 against the hepatitis A virus; 

6 ‘‘(5) the training of health care professionals 

7 and health educators to make them aware of the 

8 high rates of chronic hepatitis B and chronic hepa9 titis C in certain adult ethnic populations, and the 

10 importance of prevention, detection, and medical 

11 management of hepatitis B and hepatitis C and of 

12 liver cancer screening; 

13 ‘‘(6) the development and distribution of health 

14 education curricula (including information relating 

15 to the special needs of individuals infected with hep16 atitis B and hepatitis C, such as the importance of 

17 prevention and early intervention, regular moni18 toring, the recognition of psychosocial needs, appro19 priate treatment, and liver cancer screening) for in20 dividuals providing hepatitis B and hepatitis C coun21 seling; and 

22 ‘‘(7) support for the implementation curricula 

23 described in paragraph (6) by State and local public 

24 health agencies. 


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1 ‘‘(b) IMMUNIZATION, PREVENTION, AND CONTROL

2 PROGRAMS.— 

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

4 through the Director of the Centers for Disease 

5 Control and Prevention, shall support the integra6 tion of activities described in paragraph (3) into ex7 isting clinical and public health programs at State, 

8 local, territorial, and tribal levels (including commu9 nity health clinics, programs for the prevention and 

10 treatment of HIV/AIDS, sexually transmitted infec11 tions, and substance abuse, and programs for indi12 viduals in correctional settings). 

13 ‘‘(2) COORDINATION OF DEVELOPMENT OF

14 FEDERAL SCREENING GUIDELINES.— 

15 ‘‘(A) REFERENCES.—For purposes of this 

16 subsection, the term ‘CDC Director’ means the 

17 Director of the Centers for Disease Control and 

18 Prevention, and the term ‘AHRQ Director’ 

19 means the Director of the Agency for 

20 Healthcare Research and Quality. 

21 ‘‘(B) AGENCY FOR HEALTHCARE RE22 SEARCH AND QUALITY.—Due to the rapidly 

23 evolving standard of care associated with diag24 nosing and treating viral hepatitis infection, the 

25 AHRQ Director shall convene the Preventive 


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1 Services Task Force under section 915(a) of 

2 the Public Health Service Act to review its rec3 ommendation for screening for HBV and HCV 

4 infection every 3 years. 

5 ‘‘(3) ACTIVITIES.— 

6 ‘‘(A) VOLUNTARY TESTING PROGRAMS.— 

7 ‘‘(i) IN GENERAL.—The Secretary 

8 shall establish a mechanism by which to 

9 support and promote the development of 

10 State, local, territorial, and tribal vol11 untary hepatitis B and hepatitis C testing 

12 programs to screen the high-prevalence 

13 populations to aid in the early identifica14 tion of chronically infected individuals. 

15 ‘‘(ii) CONFIDENTIALITY OF THE TEST

16 RESULTS.—The Secretary shall prohibit 

17 the use of the results of a hepatitis B or 

18 hepatitis C test conducted by a testing pro19 gram developed or supported under this 

20 subparagraph for any of the following: 

21 ‘‘(I) Issues relating to health in22 surance. 

23 ‘‘(II) To screen or determine 

24 suitability for employment. 


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1 ‘‘(III) To discharge a person 

2 from employment. 

3 ‘‘(B) COUNSELING REGARDING VIRAL HEP4 ATITIS.—The Secretary shall support State, 

5 local, territorial, and tribal programs in a wide 

6 variety of settings, including those providing 

7 primary and specialty health care services in 

8 nonprofit private and public sectors, to— 

9 ‘‘(i) provide individuals with ongoing 

10 risk factors for hepatitis B and hepatitis C 

11 infection with client-centered education 

12 and counseling which concentrates on— 

13 ‘‘(I) promoting testing of individ14 uals that have been exposed to their 

15 blood, family members, and their sex16 ual partners; and 

17 ‘‘(II) changing behaviors that 

18 place individuals at risk for infection; 

19 ‘‘(ii) provide individuals chronically in20 fected with hepatitis B or hepatitis C with 

21 education, health information, and coun22 seling to reduce their risk of— 

23 ‘‘(I) dying from end-stage liver 

24 disease and liver cancer; and 


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1 ‘‘(II) transmitting viral hepatitis 

2 to others; and 

3 ‘‘(iii) provide women chronically in4 fected with hepatitis B or hepatitis C who 

5 are pregnant or of childbearing age with 

6 culturally and linguistically appropriate 

7 health information, such as how to prevent 

8 hepatitis B perinatal infection, and to al9 leviate fears associated with pregnancy or 

10 raising a family. 

11 ‘‘(C) IMMUNIZATION.—The Secretary shall 

12 support State, local, territorial, and tribal ef13 forts to expand the current vaccination pro14 grams to protect every child in the country and 

15 all susceptible adults, particularly those infected 

16 with hepatitis C and high-prevalence ethnic 

17 populations and other high-risk groups, from 

18 the risks of acute and chronic hepatitis B infec19 tion by— 

20 ‘‘(i) ensuring continued funding for 

21 hepatitis B vaccination for all children 19 

22 years of age or younger through the Vac23 cines for Children Program; 

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1 nization Practices are followed regarding 

2 the birth dose of hepatitis B vaccinations 

3 for newborns; 

4 ‘‘(iii) requiring proof of hepatitis B 

5 vaccination for entry into public or private 

6 daycare, preschool, elementary school, sec7 ondary school, and institutions of higher 

8 education; 

9 ‘‘(iv) expanding the availability of 

10 hepatitis B vaccination for all susceptible 

11 adults to protect them from becoming 

12 acutely or chronically infected, including 

13 ethnic and other populations with high 

14 prevalence rates of chronic hepatitis B in15 fection; 

16 ‘‘(v) expanding the availability of hep17 atitis B vaccination for all susceptible 

18 adults, particularly those in their reproduc19 tive age (women and men less than 45 

20 years of age), to protect them from the 

21 risk of hepatitis B infection; 

22 ‘‘(vi) ensuring the vaccination of indi23 viduals infected, or at risk for infection, 

24 with hepatitis C against hepatitis A, hepa25 titis B, and other infectious diseases, as 


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1 appropriate, for which such individuals 

2 may be at increased risk; and 

3 ‘‘(vii) ensuring the vaccination of indi4 viduals infected, or at risk for infection, 

5 with hepatitis B against hepatitis A virus 

6 and other infectious diseases, as appro7 priate, for which such individuals may be 

8 at increased risk. 

9 ‘‘(D) MEDICAL REFERRAL.—The Secretary 

10 shall support State, local, territorial, and tribal 

11 programs that support— 

12 ‘‘(i) referral of persons chronically in13 fected with hepatitis B or hepatitis C— 

14 ‘‘(I) for medical evaluation to de15 termine the appropriateness for 

16 antiviral treatment to reduce the risk 

17 of progression to cirrhosis and liver 

18 cancer; and 

19 ‘‘(II) for ongoing medical man20 agement including regular monitoring 

21 of liver function and screening for 

22 liver cancer; and 

23 ‘‘(ii) referral of persons infected with 

24 acute or chronic hepatitis B infection or 

25 acute or chronic hepatitis C infection for 


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1 drug and alcohol abuse treatment where 

2 appropriate. 

3 ‘‘(4) INCREASED SUPPORT FOR ADULT VIRAL

4 HEPATITIS PREVENTION COORDINATORS.—The Sec5 retary, acting through the Director of the Centers 

6 for Disease Control and Prevention, shall provide in7 creased support to adult viral hepatitis prevention 

8 coordinators in State, local, territorial, and tribal 

9 health departments in order to enhance the addi10 tional management, networking, and technical exper11 tise needed to ensure successful integration of hepa12 titis B and hepatitis C prevention and control activi13 ties into existing public health programs. 

14 ‘‘(c) EPIDEMIOLOGICAL SURVEILLANCE.— 

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

16 through the Director of the Centers for Disease 

17 Control and Prevention, shall support the establish18 ment and maintenance of a national chronic and 

19 acute hepatitis B and hepatitis C surveillance pro20 gram, in order to identify— 

21 ‘‘(A) trends in the incidence of acute and 

22 chronic hepatitis B and acute and chronic hepa23 titis C; 

24 ‘‘(B) trends in the prevalence of acute and 

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1 titis C infection among groups that may be dis2 proportionately affected; and 

3 ‘‘(C) trends in liver cancer and end-stage 

4 liver disease incidence and deaths, caused by 

5 chronic hepatitis B and chronic hepatitis C in 

6 the high-risk ethnic populations. 

7 ‘‘(2) SEROPREVALENCE AND LIVER CANCER

8 STUDIES.—The Secretary, acting through the Direc9 tor of the Centers for Disease Control and Preven10 tion, shall prepare a report outlining the population11 based seroprevalence studies currently underway, fu12 ture planned studies, the criteria involved in deter13 mining which seroprevalence studies to conduct, 

14 defer, or suspend, and the scope of those studies, the 

15 economic and clinical impact of hepatitis B and hep16 atitis C, and the impact of chronic hepatitis B and 

17 chronic hepatitis C infections on the quality of life. 

18 Not later than one year after the date of the enact19 ment of this part, the Secretary shall submit the re20 port to the Committee on Energy and Commerce of 

21 the House of Representatives and the Committee on 

22 Health, Education, Labor, and Pensions of the Sen23 ate. 

24 ‘‘(3) CONFIDENTIALITY.—The Secretary shall 

25 not disclose any individually identifiable information 


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1 identified under paragraph (1) or derived through 

2 studies under paragraph (2). 

3 ‘‘(d) RESEARCH.—The Secretary, acting through the 

4 Director of the Centers for Disease Control and Preven5 tion, the Director of the National Cancer Institute, and 

6 the Director of the National Institutes of Health, shall— 

7 ‘‘(1) conduct epidemiologic and community8 based research to develop, implement, and evaluate 

9 best practices for hepatitis B and hepatitis C pre10 vention especially in the ethnic populations with high 

11 rates of chronic hepatitis B and chronic hepatitis C 

12 and other high-risk groups; 

13 ‘‘(2) conduct research on hepatitis B and hepa14 titis C natural history, pathophysiology, improved 

15 treatments and prevention (such as the hepatitis C 

16 vaccine), and noninvasive tests that help to predict 

17 the risk of progression to liver cirrhosis and liver 

18 cancer; 

19 ‘‘(3) conduct research that will lead to better 

20 noninvasive or blood tests to screen for liver cancer, 

21 and more effective treatments of liver cancer caused 

22 by chronic hepatitis B and chronic hepatitis C; and 

23 ‘‘(4) conduct research comparing the effective24 ness of screening, diagnostic, management, and 

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1 ic hepatitis C, and liver cancer in the affected com2 munities. 

3 ‘‘(e) UNDERSERVED AND DISPROPORTIONATELY AF4 FECTED POPULATIONS.—In carrying out this section, the 

5 Secretary shall provide expanded support for individuals 

6 with limited access to health education, testing, and health 

7 care services and groups that may be disproportionately 

8 affected by hepatitis B and hepatitis C. 

9 ‘‘(f) EVALUATION OF PROGRAM.—The Secretary 

10 shall develop benchmarks for evaluating the effectiveness 

11 of the programs and activities conducted under this sec12 tion and make determinations as to whether such bench13 marks have been achieved. 

14 ‘‘SEC. 399NN–2. GRANTS. 

15 ‘‘(a) IN GENERAL.—The Secretary may award grants 

16 to, or enter into contracts or cooperative agreements with, 

17 States, political subdivisions of States, territories, Indian 

18 tribes, or nonprofit entities that have special expertise re19 lating to hepatitis B, hepatitis C, or both, to carry out 

20 activities under this part. 

21 ‘‘(b) APPLICATION.—To be eligible for a grant, con22 tract, or cooperative agreement under subsection (a), an 

23 entity shall prepare and submit to the Secretary an appli24 cation at such time, in such manner, and containing such 

25 information as the Secretary may require. 


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1 ‘‘SEC. 399NN–3. AUTHORIZATION OF APPROPRIATIONS. 

2 ‘‘There are authorized to be appropriated to carry out 

3 this part $90,000,000 for fiscal year 2017, $90,000,000 

4 for fiscal year 2018, $110,000,000 for fiscal year 2019, 

5 $130,000,000 for fiscal year 2020, and $150,000,000 for 

6 fiscal year 2021.’’. 

7 (d) ENHANCING SAMHSA’S ROLE IN HEPATITIS AC8 TIVITIES.—Paragraph (6) of section 501(d) of the Public 

9 Health Service Act (42 U.S.C. 290aa(d)) is amended by 

10 striking ‘‘HIV or tuberculosis’’ and inserting ‘‘HIV, tuber11 culosis, or hepatitis’’. 

12 Subtitle C—Acquired Bone Marrow 

13 Failure Diseases 

14 SEC. 721. ACQUIRED BONE MARROW FAILURE DISEASES. 

15 (a) SHORT TITLE.—This subtitle may be cited as the 

16 ‘‘Bone Marrow Failure Disease Research and Treatment 

17 Act of 2016’’. 

18 (b) FINDINGS.—The Congress finds the following: 

19 (1) Between 20,000 and 30,000 Americans are 

20 diagnosed each year with myelodysplastic syndromes, 

21 aplastic anemia, paroxysmal nocturnal hemo22 globinuria, and other acquired bone marrow failure 

23 diseases. 

24 (2) Acquired bone marrow failure diseases have 

25 a debilitating and often fatal impact on those diag26 nosed with these diseases. 


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1 (3) While some treatments for acquired bone 

2 marrow failure diseases can prolong and improve the 

3 quality of patients’ lives, there is no single cure for 

4 these diseases. 

5 (4) The prevalence of acquired bone marrow 

6 failure diseases in the United States will continue to 

7 grow as the general public ages. 

8 (5) Evidence exists suggesting that acquired 

9 bone marrow failure diseases occur more often in 

10 minority populations, particularly in Asian-American 

11 and Latino or Hispanic populations. 

12 (6) The National Heart, Lung, and Blood Insti13 tute and the National Cancer Institute have con14 ducted important research into the causes of and 

15 treatments for acquired bone marrow failure dis16 eases. 

17 (7) The National Marrow Donor Program Reg18 istry has made significant contributions to the fight 

19 against bone marrow failure diseases by connecting 

20 millions of potential marrow donors with individuals 

21 and families suffering from these conditions. 

22 (8) Despite these advances, a more comprehen23 sive Federal strategic effort among numerous Fed24 eral agencies is needed to discover a cure for ac25 quired bone marrow failure disorders. 


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1 (9) Greater Federal surveillance of acquired 

2 bone marrow failure diseases is needed to gain a bet3 ter understanding of the causes of acquired bone 

4 marrow failure diseases. 

5 (10) The Federal Government should increase 

6 its research support for and engage with public and 

7 private organizations in developing a comprehensive 

8 approach to combat and cure acquired bone marrow 

9 failure diseases. 

10 (c) NATIONAL ACQUIRED BONE MARROW FAILURE

11 DISEASE REGISTRY.—Part B of the Public Health Service 

12 Act (42 U.S.C. 311 et seq.) is amended by inserting after 

13 section 317W, as added, the following: 

14 ‘‘SEC. 317X. NATIONAL ACQUIRED BONE MARROW FAILURE 

15 DISEASE REGISTRY. 

16 ‘‘(a) ESTABLISHMENT OF REGISTRY.— 

17 ‘‘(1) IN GENERAL.—Not later than 6 months 

18 after the date of the enactment of this section, the 

19 Secretary, acting through the Director of the Cen20 ters for Disease Control and Prevention, shall— 

21 ‘‘(A) develop a system to collect data on 

22 acquired bone marrow failure diseases; and 

23 ‘‘(B) establish and maintain a national and 

24 publicly available registry, to be known as the 

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1 ease Registry, in accordance with paragraph 

2 (3). 

3 ‘‘(2) RECOMMENDATIONS OF ADVISORY COM4 MITTEE.—In carrying out this subsection, the Sec5 retary shall take into consideration the recommenda6 tions of the Advisory Committee on Acquired Bone 

7 Marrow Failure Diseases established under sub8 section (b). 

9 ‘‘(3) PURPOSES OF REGISTRY.—The National 

10 Acquired Bone Marrow Failure Disease Registry— 

11 ‘‘(A) shall identify the incidence and preva12 lence of acquired bone marrow failure diseases 

13 in the United States; 

14 ‘‘(B) shall be used to collect and store data 

15 on acquired bone marrow failure diseases, in16 cluding data concerning— 

17 ‘‘(i) the age, race or ethnicity, general 

18 geographic location, sex, and family history 

19 of individuals who are diagnosed with ac20 quired bone marrow failure diseases, and 

21 any other characteristics of such individ22 uals determined appropriate by the Sec23 retary; 

24 ‘‘(ii) the genetic and environmental 

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1 oping acquired bone marrow failure dis2 eases; 

3 ‘‘(iii) treatment approaches for deal4 ing with acquired bone marrow failure dis5 eases; 

6 ‘‘(iv) outcomes for individuals treated 

7 for acquired bone marrow failure diseases, 

8 including outcomes for recipients of stem 

9 cell therapeutic products as contained in 

10 the database established pursuant to sec11 tion 379A; and 

12 ‘‘(v) any other factors pertaining to 

13 acquired bone marrow failure diseases de14 termined appropriate by the Secretary; and 

15 ‘‘(C) shall be made available— 

16 ‘‘(i) to the general public; and 

17 ‘‘(ii) to researchers to facilitate fur18 ther research into the causes of, and treat19 ments for, acquired bone marrow failure 

20 diseases in accordance with standard prac21 tices of the Centers for Disease Control 

22 and Preventions. 

23 ‘‘(b) ADVISORY COMMITTEE.— 

24 ‘‘(1) ESTABLISHMENT.—Not later than 6 

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1 tion, the Secretary, acting through the Director of 

2 the Centers for Disease Control and Prevention, 

3 shall establish an advisory committee, to be known 

4 as the Advisory Committee on Acquired Bone Mar5 row Failure Diseases. 

6 ‘‘(2) MEMBERS.—The members of the Advisory 

7 Committee on Acquired Bone Marrow Failure Dis8 eases shall be appointed by the Secretary, acting 

9 through the Director of the Centers for Disease 

10 Control and Prevention, and shall include at least 

11 one representative from each of the following: 

12 ‘‘(A) A national patient advocacy organiza13 tion with experience advocating on behalf of pa14 tients suffering from acquired bone marrow 

15 failure diseases. 

16 ‘‘(B) The National Institutes of Health, in17 cluding at least one representative from each 

18 of— 

19 ‘‘(i) the National Cancer Institute; 

20 ‘‘(ii) the National Heart, Lung, and 

21 Blood Institute; and 

22 ‘‘(iii) the Office of Rare Diseases. 

23 ‘‘(C) The Centers for Disease Control and 

24 Prevention. 

25 ‘‘(D) Clinicians with experience in— 


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1 ‘‘(i) diagnosing or treating acquired 

2 bone marrow failure diseases; and 

3 ‘‘(ii) medical data registries. 

4 ‘‘(E) Epidemiologists who have experience 

5 with data registries. 

6 ‘‘(F) Publicly or privately funded research7 ers who have experience researching acquired 

8 bone marrow failure diseases. 

9 ‘‘(G) The entity operating the C.W. Bill 

10 Young Cell Transplantation Program estab11 lished pursuant to section 379 and the entity 

12 operating the C.W. Bill Young Cell Transplan13 tation Program Outcomes Database. 

14 ‘‘(3) RESPONSIBILITIES.—The Advisory Com15 mittee on Acquired Bone Marrow Failure Diseases 

16 shall provide recommendations to the Secretary on 

17 the establishment and maintenance of the National 

18 Acquired Bone Marrow Failure Disease Registry, in19 cluding recommendations on the collection, mainte20 nance, and dissemination of data. 

21 ‘‘(4) PUBLIC AVAILABILITY.—The Secretary 

22 shall make the recommendations of the Advisory 

23 Committee on Acquired Bone Marrow Failure Dis24 ease publicly available. 


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1 ‘‘(c) GRANTS.—The Secretary, acting through the 

2 Director of the Centers for Disease Control and Preven3 tion, may award grants to, and enter into contracts and 

4 cooperative agreements with, public or private nonprofit 

5 entities for the management of, as well as the collection, 

6 analysis, and reporting of data to be included in, the Na7 tional Acquired Bone Marrow Failure Disease Registry. 

8 ‘‘(d) DEFINITION.—In this section, the term ‘ac9 quired bone marrow failure disease’ means— 

10 ‘‘(1) myelodysplastic syndromes (MDS); 

11 ‘‘(2) aplastic anemia; 

12 ‘‘(3) paroxysmal nocturnal hemoglobinuria 

13 (PNH); 

14 ‘‘(4) pure red cell aplasia; 

15 ‘‘(5) acute myeloid leukemia that has pro16 gressed from myelodysplastic syndromes; or 

17 ‘‘(6) large granular lymphocytic leukemia. 

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

19 is authorized to be appropriated to carry out this section 

20 $3,000,000 for each of fiscal years 2017 through 2021.’’. 

21 (d) PILOT STUDIES THROUGH THE AGENCY FOR

22 TOXIC SUBSTANCES AND DISEASE REGISTRY.— 

23 (1) PILOT STUDIES.—The Secretary of Health 

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1 ease Registry, shall conduct pilot studies to deter2 mine which environmental factors, including expo3 sure to toxins, may cause acquired bone marrow fail4 ure diseases. 

5 (2) COLLABORATION WITH THE RADIATION IN6 JURY TREATMENT NETWORK.—In carrying out the 

7 directives of this section, the Secretary may collabo8 rate with the Radiation Injury Treatment Network 

9 of the C.W. Bill Young Cell Transplantation Pro10 gram established pursuant to section 379 of the 

11 Public Health Service Act (42 U.S.C. 274j) to— 

12 (A) augment data for the pilot studies au13 thorized by this section; 

14 (B) access technical assistance that may be 

15 provided by the Radiation Injury Treatment 

16 Network; or 

17 (C) perform joint research projects. 

18 (3) AUTHORIZATION OF APPROPRIATIONS.— 

19 There is authorized to be appropriated to carry out 

20 this section $1,000,000 for each of fiscal years 2017 

21 through 2021. 

22 (e) MINORITY-FOCUSED PROGRAMS ON ACQUIRED

23 BONE MARROW FAILURE DISEASES.—Title XVII of the 

24 Public Health Service Act (42 U.S.C. 300u et seq.) is 

25 amended by inserting after section 1707A the following: 


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1 ‘‘MINORITY-FOCUSED PROGRAMS ON ACQUIRED BONE

2 MARROW FAILURE DISEASES

3 ‘‘SEC. 1707B. (a) INFORMATION AND REFERRAL

4 SERVICES.— 

5 ‘‘(1) IN GENERAL.—Not later than 6 months 

6 after the date of the enactment of this section, the 

7 Secretary, acting through the Deputy Assistant Sec8 retary for Minority Health, shall establish and co9 ordinate outreach and informational programs tar10 geted to minority populations affected by acquired 

11 bone marrow failure diseases. 

12 ‘‘(2) PROGRAM REQUIREMENTS.—Minority-fo13 cused outreach and informational programs author14 ized by this section— 

15 ‘‘(A) shall make information about treat16 ment options and clinical trials for acquired 

17 bone marrow failure diseases publicly available, 

18 and 

19 ‘‘(B) shall provide referral services for 

20 treatment options and clinical trials, 

21 at the National Minority Health Resource Center 

22 supported under section 1707(b)(8) (including by 

23 means of the Center’s Web site, through appropriate 

24 locations such as the Center’s knowledge center, and 

25 through appropriate programs such as the Center’s 


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1 resource persons network) and through minority 

2 health consultants located at each Department of 

3 Health and Human Services regional office. 

4 ‘‘(b) HISPANIC AND ASIAN-AMERICAN AND PACIFIC

5 ISLANDER OUTREACH.— 

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

7 through the Deputy Assistant Secretary for Minority 

8 Health, shall undertake a coordinated outreach ef9 fort to connect Hispanic, Asian-American, and Pa10 cific Islander communities with comprehensive serv11 ices focused on treatment of, and information about, 

12 acquired bone marrow failure diseases. 

13 ‘‘(2) COLLABORATION.—In carrying out this 

14 subsection, the Secretary may collaborate with public 

15 health agencies, nonprofit organizations, community 

16 groups, and online entities to disseminate informa17 tion about treatment options and clinical trials for 

18 acquired bone marrow failure diseases. 

19 ‘‘(c) GRANTS AND COOPERATIVE AGREEMENTS.— 

20 ‘‘(1) IN GENERAL.—Not later than 6 months 

21 after the date of the enactment of this section, the 

22 Secretary, acting through the Deputy Assistant Sec23 retary for Minority Health, shall award grants to, or 

24 enter into cooperative agreements with, entities to 


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1 perform research on acquired bone marrow failure 

2 diseases. 

3 ‘‘(2) REQUIREMENT.—Grants and cooperative 

4 agreements authorized by this subsection shall be 

5 awarded or entered into on a competitive, peer-re6 viewed basis. 

7 ‘‘(3) SCOPE OF RESEARCH.—Research funded 

8 under this section shall examine factors affecting the 

9 incidence of acquired bone marrow failure diseases 

10 in minority populations. 

11 ‘‘(d) DEFINITION.—In this section, the term ‘ac12 quired bone marrow failure disease’ has the meaning given 

13 to such term in section 317X(d). 

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

15 is authorized to be appropriated to carry out this section 

16 $2,000,000 for each of fiscal years 2017 through 2021.’’. 

17 (f) DIAGNOSIS AND QUALITY OF CARE FOR AC18 QUIRED BONE MARROW FAILURE DISEASES.— 

19 (1) GRANTS.—The Secretary of Health and 

20 Human Services, acting through the Director of the 

21 Agency for Healthcare Research and Quality, shall 

22 award grants to entities to improve diagnostic prac23 tices and quality of care with respect to patients 

24 with acquired bone marrow failure diseases. 


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1 (2) AUTHORIZATION OF APPROPRIATIONS.— 

2 There is authorized to be appropriated to carry out 

3 this section $2,000,000 for each of fiscal years 2017 

4 through 2021. 

5 (g) DEFINITION.—In this section, the term ‘‘acquired 

6 bone marrow failure disease’’ means— 

7 (1) myelodysplastic syndromes (MDS); 

8 (2) aplastic anemia; 

9 (3) paroxysmal nocturnal hemoglobinuria 

10 (PNH); 

11 (4) pure red cell aplasia; 

12 (5) acute myeloid leukemia that progressed 

13 from myelodysplastic syndromes; or 

14 (6) large granular lymphocytic leukemia. 

15 Subtitle D—Cardiovascular Dis16 ease, Chronic Disease, and 

17 Other Disease Issues 

18 SEC. 731. GUIDELINES FOR DISEASE SCREENING FOR MI19 NORITY PATIENTS. 

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

21 Director of the Agency for Healthcare Research and Qual22 ity, shall convene a series of meetings to develop guidelines 

23 for disease screening for minority patient populations 

24 which have a higher than average risk for many chronic 

25 diseases and cancers. 


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1 (b) PARTICIPANTS.—In convening meetings under 

2 subsection (a), the Secretary shall ensure that meeting 

3 participants include representatives of— 

4 (1) professional societies and associations; 

5 (2) minority health organizations; 

6 (3) health care researchers and providers, in7 cluding those with expertise in minority health; 

8 (4) Federal health agencies, including the Of9 fice of Minority Health, the National Institute on 

10 Minority Health and Health Disparities, and the 

11 National Institutes of Health; and 

12 (5) other experts determined appropriate by the 

13 Secretary. 

14 (c) DISEASES.—Screening guidelines for minority 

15 populations shall be developed as appropriate under sub16 section (a) for— 

17 (1) hypertension; 

18 (2) hypercholesterolemia; 

19 (3) diabetes; 

20 (4) cardiovascular disease; 

21 (5) cancers, including breast, prostate, colon, 

22 cervical, and lung cancer; 

23 (6) other pulmonary problems including sleep 

24 apnea; 

25 (7) asthma; 


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1 (8) diabetes; 

2 (9) kidney diseases; 

3 (10) eye diseases and disorders, including glau4 coma; 

5 (11) HIV/AIDS and sexually transmitted infec6 tions; 

7 (12) uterine fibroids; 

8 (13) autoimmune disease; 

9 (14) mental health conditions; 

10 (15) dental health conditions and oral diseases, 

11 including oral cancer; 

12 (16) environmental and related health illnesses 

13 and conditions; 

14 (17) sickle cell disease and sickle cell trait; 

15 (18) violence and injury prevention and control; 

16 (19) genetic and related conditions; 

17 (20) heart disease and stroke; 

18 (21) tuberculosis; 

19 (22) chronic obstructive pulmonary disease; 

20 (23) musculoskeletal diseases, arthritis, and 

21 obesity; and 

22 (24) other diseases determined appropriate by 

23 the Secretary. 

24 (d) DISSEMINATION.—Not later than 24 months 

25 after the date of enactment of this title, the Secretary 


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1 shall publish and disseminate to health care provider orga2 nizations the guidelines developed under subsection (a). 

3 (e) 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 2017 through 2021. 

7 SEC. 732. CDC WISEWOMAN SCREENING PROGRAM. 

8 Section 1509 of the Public Health Service Act (42 

9 U.S.C. 300n–4a) is amended— 

10 (1) in subsection (a)— 

11 (A) by striking the heading and inserting 

12 ‘‘IN GENERAL.—’’; and 

13 (B) in the matter preceding paragraph (1), 

14 by striking ‘‘may make grants’’ and all that fol15 lows through ‘‘purpose’’ and inserting the fol16 lowing: ‘‘may make grants to such States for 

17 the purpose’’; and 

18 (2) in subsection (d)(1), by striking ‘‘there are 

19 authorized’’ and all that follows through the period 

20 and inserting ‘‘there are authorized to be appro21 priated $23,000,000 for fiscal year 2017, 

22 $25,300,000 for fiscal year 2018, $27,800,000 for 

23 fiscal year 2019, $30,800,000 for fiscal year 2020, 

24 and $34,000,000 for fiscal year 2021.’’. 


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1 SEC. 733. REPORT ON CARDIOVASCULAR CARE FOR WOMEN 

2 AND MINORITIES. 

3 Part P of title III of the Public Health Service Act 

4 (42 U.S.C. 280g et seq.) is amended by adding at the end 

5 the following: 

6 ‘‘SEC. 399V–6. REPORT ON CARDIOVASCULAR CARE FOR 

7 WOMEN AND MINORITIES. 

8 ‘‘Not later than September 30, 2017, and annually 

9 thereafter, the Secretary shall prepare and submit to the 

10 Congress a report on the quality of and access to care 

11 for women and minorities with heart disease, stroke, and 

12 other cardiovascular diseases. The report shall contain rec13 ommendations for eliminating disparities in, and improv14 ing the treatment of, heart disease, stroke, and other car15 diovascular diseases in women, racial and ethnic minori16 ties, those for whom English is not their primary lan17 guage, and individuals with disabilities.’’. 

18 SEC. 734. COVERAGE OF COMPREHENSIVE TOBACCO CES19 SATION SERVICES IN MEDICAID AND IN ACA 

20 ESSENTIAL HEALTH BENEFITS . 

21 (a) REQUIRING COVERAGE OF COUNSELING AND

22 PHARMACOTHERAPY FOR CESSATION OF TOBACCO

23 USE.—Section 1905 of the Social Security Act (42 U.S.C. 

24 1396d) is amended— 

25 (1) in subsection (a)(4)(D), is amended by 

26 striking ‘‘by pregnant women’’; and 


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1 (2) in subsection (bb)— 

2 (A) by striking ‘‘by pregnant women’’ each 

3 place it appears; 

4 (B) in paragraph (1), in the matter before 

5 subparagraph (A), by inserting ‘‘by individuals’’ 

6 before ‘‘who use tobacco’’; and 

7 (C) in paragraph (2)(A), by striking ‘‘with 

8 respect to pregnant women’’. 

9 (b) EXCEPTION FROM OPTIONAL RESTRICTION

10 UNDER MEDICAID PRESCRIPTION DRUG COVERAGE.— 

11 Section 1927(d)(2)(F) of the Social Security Act (42 

12 U.S.C. 1396r–8(d)(2)(F)) is amended by striking ‘‘in the 

13 case of pregnant women’’. 

14 (c) STATE MONITORING AND PROMOTING OF COM15 PREHENSIVE TOBACCO CESSATION SERVICES UNDER

16 MEDICAID.—Section 1902(a) of the Social Security Act 

17 (42 U.S.C. 1395a(a)), as amended by section 450(c), is 

18 amended— 

19 (1) by striking ‘‘and’’ at the end of paragraph 

20 (81); 

21 (2) by striking the period at the end of para22 graph (82) and inserting ‘‘; and’’; and 

23 (3) by inserting after paragraph (82) the fol24 lowing new paragraph: 


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1 ‘‘(83) provide for the State to monitor and pro2 mote the use of comprehensive tobacco cessation 

3 services under the State plan;’’. 

4 (d) REMOVAL OF COST SHARING FOR COUNSELING

5 AND PHARMACOTHERAPY FOR CESSATION OF TOBACCO

6 USE UNDER MEDICAID.— 

7 (1) GENERAL COST SHARING LIMITATIONS.— 

8 Section 1916 of the Social Security Act (42 U.S.C. 

9 1396o) is amended— 

10 (A) in subsections (a)(2)(B) and (b)(2)(B), 

11 by striking ‘‘and counseling and pharmacother12 apy for cessation of tobacco use by pregnant 

13 women (as defined in section 1905(bb)) and 

14 covered outpatient drugs (as defined in sub15 section (k)(2) of section 1927 and including 

16 nonprescription drugs described in subsection 

17 (d)(2) of such section) that are prescribed for 

18 purposes of promoting, and when used to pro19 mote, tobacco cessation by pregnant women in 

20 accordance with the Guideline referred to in 

21 section 1905(bb)(2)(A)’’ each place it appears; 

22 and 

23 (B) in each of subsections (a)(2)(D) and 

24 (b)(2)(D) by inserting ‘‘and counseling and 

25 pharmacotherapy for cessation of tobacco use 


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1 (as defined in section 1905(bb)) and covered 

2 outpatient drugs (as defined in subsection 

3 (k)(2) of section 1927 and including non4 prescription drugs described in subsection 

5 (d)(2) of such section) that are prescribed for 

6 purposes of promoting, and when used to pro7 mote, tobacco cessation in accordance with the 

8 Guideline referred to in section 

9 1905(bb)(2)(A),’’ after ‘‘section 

10 1905(a)(4)(C),’’. 

11 (2) APPLICATION TO ALTERNATIVE COST SHAR12 ING.—Section 1916A(b)(3)(B) of such Act (42 

13 U.S.C. 1396o–1(b)(3)(B)42 U.S.C. 1396o– 

14 1(b)(3)(B)) is amended— 

15 (A) in clause (iii), by striking ‘‘, and coun16 seling and pharmacotherapy for cessation of to17 bacco use by pregnant women (as defined in 

18 section 1905(bb))’’; and 

19 (B) by adding at the end the following: 

20 ‘‘(xi) Counseling and pharmacothera21 py for cessation of tobacco use (as defined 

22 in section 1905(bb)) and covered out23 patient drugs (as defined in subsection 

24 (k)(2) of section 1927 and including non25 prescription drugs described in subsection 


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1 (d)(2) of such section) that are prescribed 

2 for purposes of promoting, and when used 

3 to promote, tobacco cessation in accord4 ance with the Guideline referred to in sec5 tion 1905(bb)(2)(A).’’. 

6 (e) COMPREHENSIVE COVERAGE UNDER ACA ES7 SENTIAL HEALTH BENEFITS.— 

8 (1) COVERAGE.—Section 1302(b)(1) of the Pa9 tient Protection and Affordable Care Act (42 U.S.C. 

10 18022(b)(1)) is amended by adding at the end the 

11 following new subparagraph: 

12 ‘‘(K) Comprehensive tobacco cessation 

13 services and medications, including all evidence14 based tobacco cessation counseling and all 

15 medications for tobacco cessation approved by 

16 the Food and Drug Administration.’’. 

17 (2) NO COST SHARING.—Section 1302(c) of the 

18 Patient Protection and Affordable Care Act (42 

19 U.S.C. 18022(c)) is amended by inserting after 

20 paragraph (1) the following new paragraph: 

21 ‘‘(2) NO COST SHARING OR PRIOR AUTHORIZA22 TION FOR COMPREHENSIVE TOBACCO CESSATION

23 COVERAGE.—There shall be no cost sharing or prior 

24 authorization requirement imposed with respect to 

25 services described in subsection (b)(1)(K).’’. 


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1 (f) EFFECTIVE DATE.—The amendments made by 

2 this section shall apply to items and services furnished on 

3 or after January 1, 2017. 

4 SEC. 735. CLINICAL RESEARCH FUNDING FOR ORAL 

5 HEALTH. 

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

7 Human Services shall expand and intensify the conduct 

8 and support of the research activities of the National In9 stitutes of Health and the National Institute of Dental 

10 and Craniofacial Research to improve the oral health of 

11 the population through the prevention and management 

12 of oral diseases and conditions. 

13 (b) INCLUDED RESEARCH ACTIVITIES.—Research 

14 activities under subsection (a) shall include— 

15 (1) comparative effectiveness research and clin16 ical disease management research addressing early 

17 childhood caries and oral cancer; and 

18 (2) awarding of grants and contracts to support 

19 the training and development of health services re20 searchers, comparative effectiveness researchers, and 

21 clinical researchers whose research improves the oral 

22 health of the population. 


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1 SEC. 736. PARTICIPATION BY MEDICAID BENEFICIARIES IN 

2 APPROVED CLINICAL TRIALS. 

3 (a) IN GENERAL.—Title XIX of the Social Security 

4 Act (42 U.S.C. 1396 et seq.) is amended by inserting after 

5 section 1943 the following new section: 

6 ‘‘SEC. 1944. PARTICIPATION IN AN APPROVED CLINICAL 

7 TRIAL. 

8 ‘‘(a) COVERAGE OF ROUTINE PATIENT COSTS ASSO9 CIATED WITH APPROVED CLINICAL TRIALS.— 

10 ‘‘(1) INCLUSION.—Subject to paragraph (2), 

11 routine patient costs shall include all items and serv12 ices consistent with the medical assistance provided 

13 under the State plan that would otherwise be pro14 vided to the individual under such State plan if such 

15 individual was not enrolled in an approved clinical 

16 trial, including any items or services related to the 

17 prevention, detection, and treatment of any medical 

18 complications that arise as a result of participation 

19 in the approved clinical trial. 

20 ‘‘(2) EXCLUSION.—For purposes of paragraph 

21 (1), routine patient costs does not include— 

22 ‘‘(A) the investigational item, device, or 

23 service itself; 

24 ‘‘(B) items and services that are provided 

25 solely to satisfy data collection and analysis 


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1 needs and that are not used in the direct clin2 ical management of the patient; or 

3 ‘‘(C) a service that is clearly inconsistent 

4 with widely accepted and established standards 

5 of care for a particular diagnosis. 

6 ‘‘(3) INFORMATION CONCERNING CLINICAL

7 TRIALS.— 

8 ‘‘(A) IN GENERAL.—Subject to subpara9 graph (B), the Secretary, in consultation with 

10 relevant stakeholders, shall develop a single 

11 standardized electronic form for use by the indi12 vidual or the referring health care provider to 

13 submit to the State agency administering the 

14 State plan in order to verify that the clinical 

15 trial meets the conditions established for an ap16 proved clinical trial (as defined in subsection 

17 (c)). 

18 ‘‘(B) EXCLUDED INFORMATION.—For pur19 poses of subparagraph (A) or any such request 

20 by the State agency for information regarding 

21 a clinical trial, an individual or referring health 

22 care provider shall not be required to submit— 

23 ‘‘(i) the clinical protocol document for 

24 the clinical trial; or 


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1 ‘‘(ii) subject to subparagraph (C), any 

2 additional information other than such in3 formation as is required pursuant to the 

4 form described in subparagraph (A). 

5 ‘‘(C) OPTIONAL INFORMATION.—For pur6 poses of subparagraphs (A) and (B)(ii), the 

7 form may include a requirement that the refer8 ring health care provider attest that the indi9 vidual is eligible to participate in the clinical 

10 trial pursuant to the trial protocol and that 

11 their participation in such trial would be appro12 priate. 

13 ‘‘(D) REVIEW OF INFORMATION.— 

14 ‘‘(i) IN GENERAL.—A State plan 

15 under this title shall establish a process for 

16 timely review by the State agency of the 

17 form and information submitted pursuant 

18 to subparagraph (A) and, not later than 

19 48 hours after receipt of such form, con20 firmation that the information provided in 

21 such form satisfies the requirements estab22 lished under such subparagraph, with such 

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1 ber and e-mail address to provide for expe2 dited communication. 

3 ‘‘(ii) FAILURE TO RESPOND.—If an 

4 individual or the referring health care pro5 vider does not receive a response or re6 quest for additional information from the 

7 State agency following the 48-hour period 

8 described in clause (i), the information 

9 provided in the form may be presumed to 

10 satisfy the requirements established under 

11 this paragraph. 

12 ‘‘(b) ENCOURAGEMENT OF PARTICIPATION IN AP13 PROVED CLINICAL TRIALS.— 

14 ‘‘(1) REASONABLY ACCESSIBLE PROVIDER.— 

15 For purposes of participation in an approved clinical 

16 trial by an individual eligible for medical assistance 

17 under this title, the State agency administering the 

18 State plan shall make reasonable efforts to ensure 

19 that the individual is provided with access to a pro20 vider who is— 

21 ‘‘(A) participating in the approved clinical 

22 trial; 

23 ‘‘(B) located not more than 25 miles from 

24 the residence of the individual (or, if no such 


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1 provider is available, as close as possible to the 

2 residence of the individual); and 

3 ‘‘(C) a participating provider under the 

4 State plan or has been deemed to be a partici5 pating provider under the State plan for pur6 poses of providing medical assistance to the in7 dividual during their participation in the ap8 proved clinical trial. 

9 ‘‘(2) INFORMATIONAL MATERIALS.—The State 

10 agency administering the plan approved under this 

11 title shall develop informational materials and pro12 grams to encourage participating providers to make 

13 appropriate referrals to physicians and other appro14 priate health care professionals who can provide in15 dividuals with access to approved clinical trials. 

16 ‘‘(c) DEFINITION OF APPROVED CLINICAL TRIAL.— 

17 The term ‘approved clinical trial’ has the same meaning 

18 as provided under section 2709(d) of the Public Health 

19 Service Act.’’. 

20 (b) CONFORMING AMENDMENT.—Section 1902(a) of 

21 the Social Security Act (42 U.S.C. 1396a(a)) is amended 

22 by inserting after paragraph (77) the following new para23 graph: 

24 ‘‘(78) provide that participation in an approved 

25 clinical trial and coverage of routine patient costs 


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1 associated with such trial for an individual eligible 

2 for medical assistance under this title is conducted 

3 in accordance with the requirements under section 

4 1944;’’. 

5 (c) EFFECTIVE DATE.— 

6 (1) IN GENERAL.—Except as provided in para7 graph (2), the amendments made by this section 

8 shall apply to calendar quarters beginning on or 

9 after October 1, 2016. 

10 (2) DELAY PERMITTED FOR STATE PLAN

11 AMENDMENT.—In the case of a State plan for med12 ical assistance under title XIX of the Social Security 

13 Act which the Secretary of Health and Human Serv14 ices determines requires State legislation (other than 

15 legislation appropriating funds) in order for the plan 

16 to meet the additional requirements imposed by the 

17 amendments made by this section, the State plan 

18 shall not be regarded as failing to comply with the 

19 requirements of such title solely on the basis of its 

20 failure to meet these additional requirements before 

21 the first day of the first calendar quarter beginning 

22 after the close of the first regular session of the 

23 State legislature that begins after the date of enact24 ment of this Act. For purposes of the previous sen25 tence, in the case of a State that has a 2-year legisVerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00508 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475

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1 lative session, each year of such session shall be 

2 deemed to be a separate regular session of the State 

3 legislature. 

4 Subtitle E—HIV/AIDS 

5 SEC. 741. STATEMENT OF POLICY. 

6 It is the policy of the United States to achieve an 

7 AIDS-free generation, and to— 

8 (1) expand access to lifesaving antiretroviral 

9 therapy for people living with HIV/AIDS and imme10 diately link people to continuous and coordinated 

11 high-quality care when they learn they are infected 

12 with HIV; 

13 (2) expand targeted efforts to prevent HIV in14 fection using a combination of effective, evidence15 based approaches, including routine HIV screening, 

16 and universal access to HIV prevention tools in the 

17 communities where HIV/AIDS is most heavily con18 centrated, particularly communities of color; 

19 (3) ensure laws, policies, and regulations do not 

20 impede access to prevention, treatment, and care for 

21 people living with HIV/AIDS or at risk for acquiring 

22 HIV; 

23 (4) accelerate research for more efficacious HIV 

24 prevention and treatments tools, a cure, and a vac25 cine; and 


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1 (5) respect the human rights and dignity of 

2 persons living with HIV/AIDS. 

3 SEC. 742. FINDINGS. 

4 The Congress finds the following: 

5 (1) Over one million people are estimated to be 

6 living with HIV in the United States according to 

7 the Centers for Disease Control and Prevention, 16 

8 percent of whom are unaware of their HIV-positive 

9 status. 

10 (2) Annually there are over 50,000 new HIV in11 fections and 20,000 deaths in people with an HIV 

12 diagnoses in 50 States and 6 dependent areas of the 

13 United States. 

14 (3) The Centers for Disease Control and Pre15 vention estimates that in 2010 there were approxi16 mately 47,500 people newly diagnosed with HIV. 

17 Though this number seems to be staying relatively 

18 stable, the number of new infections is rapidly in19 creasing among certain populations especially among 

20 young African-American men who have sex with men 

21 (MSM). CDC data show that since 2006, HIV inci22 dence has increased among Black and Latino gay 

23 men/MSM, notably those aged 13 to 24 years. Even 

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1 fections among young African American gay men/ 

2 MSM than any other subgroup of gay men/MSM. 

3 (4) HIV disproportionately affects certain popu4 lations in the United States. Though African-Ameri5 cans represent approximately 14 percent of the pop6 ulation, African-Americans account for almost half 

7 (44 percent) of all people living with HIV in the 

8 United States. Men who have sex with men (MSM) 

9 make up approximately 4 percent of the population, 

10 but account for 78 percent of all new HIV infections 

11 and are the only risk group in which HIV infections 

12 continue to increase. 

13 (5) Disparities exist among Latinos/Hispanics; 

14 they make up 16 percent of the United States popu15 lation and 21 percent of new infections (2010). 

16 (6) Though American Indians/Alaska Natives 

17 represent less than 2 percent of the total number of 

18 HIV/AIDS cases, American Indians and Alaska Na19 tives rank fifth in rates of HIV/AIDS diagnosis, still 

20 higher than their White counterparts. 

21 (7) While Asian-Americans, Native Hawaiians, 

22 and Pacific Islanders HIV/AIDS cases account for 

23 approximately 1 percent of cases nationally, between 

24 2010 and 2011, the rate of new HIV diagnoses in25 creased for Asian-Americans by 22 percent. 


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1 (8) The latest data from the CDC (2013) indi2 cate that women account for 1 in 5 (20 percent) new 

3 HIV infections in the United States. Women of 

4 color, particularly Black women, have been especially 

5 hard hit and represent the majority of women living 

6 with the disease and women newly infected. In addi7 tion, Black women accounted for nearly two-thirds 

8 (64 percent) of all estimated new HIV infections 

9 among women, while only accounting for 13 percent 

10 of the female population; White women accounted 

11 for 18 percent and Latinas 15 percent of new infec12 tions among women. 

13 (9) The history of HIV shows that culturally 

14 relevant and gender-responsive supportive services, 

15 including psychosocial support, treatment literacy, 

16 case management, and transportation are necessary 

17 strategies to reach and engage women and girls in 

18 medical care. 

19 (10) The limited data available on transgender 

20 individuals point to a disproportionate burden of 

21 HIV infection. 

22 (11) Stigma and discrimination contribute to 

23 these disparities. 

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1 tion of people who know their HIV status is an es2 sential component of comprehensive HIV/AIDS 

3 treatment and prevention efforts and that early di4 agnosis is critical in order for people with HIV/ 

5 AIDS to receive life-extending therapy. Additionally, 

6 the Centers for Disease Control and Prevention rec7 ommend routine HIV screening in health care set8 tings for all patients aged 13 to 64, regardless of 

9 risk. 

10 (13) In 1998, Congress created the National 

11 Minority AIDS Initiative to provide technical assist12 ance, build capacity, and strengthen outreach efforts 

13 among local institutions and community-based orga14 nizations that serve racial and ethnic minorities liv15 ing with or vulnerable to HIV/AIDS. 

16 (14) To combat the HIV epidemic in the United 

17 States, the National HIV/AIDS Strategy (NHAS) 

18 from the White House Office of National AIDS Pol19 icy provides a framework of increasing access to 

20 care, reducing new infections, and eliminating HIV21 related health disparities. The vision of NHAS is 

22 ‘‘The United States will become a place where new 

23 HIV infections are rare and when they do occur, 

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1 cumstance, will have unfettered access to high qual2 ity, life-extending care, free from stigma and dis3 crimination.’’. 

4 (15) In recent years, several thousand people 

5 across the country were waiting to receive AIDS 

6 treatment through the AIDS Drug Assistance Pro7 gram authorized by the provisions popularly known 

8 as the Ryan White CARE Act. 

9 (16) At present, 32 States and 2 United States 

10 territories have criminal statutes based on ‘‘expo11 sure’’ to HIV. Most of these laws were adopted be12 fore the availability of effective antiretroviral treat13 ment for HIV/AIDS. 

14 (17) Although the cost of education, treatment 

15 and care, and research are not inconsequential, they 

16 are substantially less than the annual health care 

17 cost attributable to HIV in the United States. The 

18 lifetime cost of HIV care and treatment was esti19 mated to be $326,500 to $435,000 dollars in a life20 time. Preventing 50,000 new infections in the 

21 United States each year could save $22 billion. 

22 (18) According to the Centers for Disease Con23 trol and Prevention (CDC), latex condoms, when 

24 used consistently and correctly, are highly effective 

25 in preventing the transmission of HIV. Latex 


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1 condoms also reduce the risk of other STIs. Despite 

2 the effectiveness of condoms in reducing the spread 

3 of STIs, the Bureau of Prisons does not recommend 

4 their use in correctional facilities. 

5 (19) The distribution of condoms in correctional 

6 facilities is currently legal in certain parts of the 

7 United States and the world. The States of Vermont 

8 and Mississippi, the District of Columbia, and the 

9 cities of New York, San Francisco, Los Angeles, 

10 Washington, DC, and Philadelphia allow condom 

11 distribution in their correctional facilities. However, 

12 these States and cities operate fewer than 1 percent 

13 of all correctional facilities. 

14 (20) Many correctional facilities in the United 

15 States do not provide comprehensive testing and 

16 treatment programs to reduce the spread of STIs. 

17 Fewer than half of correctional facilities provide 

18 counseling to HIV-positive incarcerated persons. 

19 (21) Incarcerated individuals living with HIV/ 

20 AIDS who are eligible for Medicaid would benefit 

21 from prompt and automatic enrollment upon their 

22 release in order to ensure their continued ability to 

23 access health services, including antiretroviral treat24 ment. 


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1 (22) Research shows that stable housing leads 

2 to better health outcomes for those living with HIV. 

3 Inadequate or unstable housing is not only a barrier 

4 to effective treatment, but also increases the likeli5 hood of engaging in risky behaviors leading to HIV 

6 infection. Insecure housing puts people with HIV/ 

7 AIDS at risk of premature death from exposure to 

8 other diseases, poor nutrition, and lack of medical 

9 care. 

10 (23) Due to advances in treatment, many peo11 ple living with HIV/AIDS (PLWHA) today are liv12 ing healthy lives and have the ability and desire to 

13 fully participate in all aspects of community life, in14 cluding employment. Research associates being em15 ployed with tremendous economic, social, and health 

16 benefits for many people living with HIV/AIDS. 

17 (24) The common benefits associated with em18 ployment include income, autonomy, productivity, 

19 and status within society, daily structure, making a 

20 contribution to one’s community, and increased skills 

21 and self-esteem. Research also indicates that many 

22 people with disabilities, including PLWHA, report 

23 perceiving themselves as being less disabled or not 

24 disabled at all, when working. Furthermore, some 

25 studies link working with better physical and mental 


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1 health outcomes for PLWHA when compared to 

2 those who are not working. Preliminary data also 

3 suggest that transitioning to employment is associ4 ated with reduced HIV-related health risk behavior 

5 for many people. 

6 (25) On July 16, 2012, the Food and Drug Ad7 ministration approved the first drug to reduce the 

8 risk of HIV infection in uninfected individuals who 

9 are at high risk of HIV infection and who may en10 gage in sexual activity with HIV-infected partners. 

11 SEC. 743. ADDITIONAL FUNDING FOR AIDS DRUG ASSIST12 ANCE PROGRAM TREATMENTS. 

13 Section 2623 of the Public Health Service Act (42 

14 U.S.C. 300ff–31b) is amended by adding at the end the 

15 following: 

16 ‘‘(c) ADDITIONAL FUNDING FOR AIDS DRUG AS17 SISTANCE PROGRAM TREATMENTS.—In addition to 

18 amounts otherwise authorized to be appropriated for car19 rying out this subpart, there are authorized to be appro20 priated such sums as may be necessary to carry out sec21 tions 2612(b)(3)(B) and 2616 for each of fiscal years 

22 2017 through 2020.’’. 


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1 SEC. 744. ENHANCING THE NATIONAL HIV SURVEILLANCE 

2 SYSTEM. 

3 (a) GRANTS.—The Secretary of Health and Human 

4 Services, acting through the Director of the Centers for 

5 Disease Control and Prevention, shall make grants to 

6 States to support integration of public health surveillance 

7 systems into all electronic health records in order to allow 

8 rapid communications between the clinical setting and 

9 health departments, by means that include— 

10 (1) providing technical assistance and policy 

11 guidance to State and local health departments, clin12 ical providers, and other agencies serving individuals 

13 with HIV to improve the interoperability of data sys14 tems relevant to monitoring HIV care and sup15 portive services; 

16 (2) capturing longitudinal data pertaining to 

17 the initiation and ongoing prescription or dispensing 

18 of antiretroviral therapy for individuals diagnosed 

19 with HIV (such as through pharmacy-based report20 ing); 

21 (3) obtaining information— 

22 (A) on a voluntary basis, on sexual orienta23 tion and gender identity; and 

24 (B) on sources of coverage (or the lack 

25 thereof) for medical treatment (including cov26 erage through Medicaid, Medicare, the program 


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1 under title XXVI of the Public Health Service 

2 Act (42 U.S.C. 300ff–11 et seq.; commonly re3 ferred to as the ‘‘Ryan White HIV/AIDS Pro4 gram’’), other public funding, private insurance, 

5 and health maintenance organizations); and 

6 (4) obtaining and using current geographic 

7 markers of residence (such as current address, zip 

8 code, partial zip code, and census block). 

9 (b) PRIVACY AND SECURITY SAFEGUARDS.—In car10 rying out this section, the Secretary of Health and Human 

11 Services shall ensure that appropriate privacy and security 

12 safeguards are met to prevent unauthorized disclosure of 

13 protected health information and compliance with the 

14 HIPAA privacy and security law (as defined in section 

15 3009 of the Public Health Service Act (42 U.S.C. 300jj– 

16 19)) and other relevant laws and regulations. 

17 (c) PROHIBITION AGAINST IMPROPER USE OF

18 DATA.—No grant under this section may be used to allow 

19 or facilitate the collection or use of surveillance or clinical 

20 data or records— 

21 (1) for punitive measures of any kind, civil or 

22 criminal, against the subject of such data or records; 

23 or 


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1 (2) for imposing any requirement or restriction 

2 with respect to an individual without the individual’s 

3 written consent. 

4 (d) AUTHORIZATION OF APPROPRIATIONS.—To carry 

5 out this section, there are authorized to be appropriated 

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

7 2017 through 2021. 

8 SEC. 745. EVIDENCE-BASED STRATEGIES FOR IMPROVING 

9 LINKAGE TO AND RETENTION IN APPRO10 PRIATE CARE. 

11 (a) STRATEGIES.—The Secretary of Health and 

12 Human Services, in collaboration with the Director of the 

13 Centers for Disease Control and Prevention, the Adminis14 trator of the Substance Abuse and Mental Health Services 

15 Administration, the Director of the Office of AIDS Re16 search, the Administrator of the Health Resources and 

17 Services Administration, and the Administrator of the 

18 Centers for Medicare & Medicaid Services, shall— 

19 (1) identify evidence-based strategies most ef20 fective at addressing the multifaceted issues that im21 pede disease status awareness and linkage to and re22 tention in appropriate care, taking into consideration 

23 health care systems issues, clinic and provider 

24 issues, and individual psychosocial, environmental, 

25 and other contextual factors; 


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1 (2) support the wide-scale implementation of 

2 the evidence-based strategies identified pursuant to 

3 paragraph (1), including through incorporating such 

4 strategies into health care coverage supported by the 

5 Medicaid program under title XIX of the Social Se6 curity Act (42 U.S.C. 1396 et seq.), the program 

7 under title XXVI of the Public Health Service Act 

8 (42 U.S.C. 300ff–11 et seq.; commonly referred to 

9 as the ‘‘Ryan White HIV/AIDS Program’’), and 

10 health plans purchased through an American Health 

11 Benefit Exchange established pursuant to section 

12 1311 of the Patient Protection and Affordable Care 

13 Act (42 U.S.C. 18031); and 

14 (3) not later than 12 months after the date of 

15 the enactment of this Act, submit a report to the 

16 Congress on the status of activities under para17 graphs (1) and (2). 

18 (b) AUTHORIZATION OF APPROPRIATIONS.—To carry 

19 out this section, there are authorized to be appropriated 

20 such sums as may be necessary for fiscal years 2017 

21 through 2021. 


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1 SEC. 746. IMPROVING ENTRY INTO AND RETENTION IN 

2 CARE AND ANTIRETROVIRAL ADHERENCE 

3 FOR PERSONS WITH HIV. 

4 (a) SENSE OF CONGRESS.—It is the sense of the Con5 gress that AIDS research has led to scientific advance6 ments that have— 

7 (1) saved the lives of millions of people with 

8 HIV/AIDS; 

9 (2) prevented millions of people from being in10 fected; and 

11 (3) had broad benefits that extend far beyond 

12 helping people at risk for or living with HIV. 

13 (b) IN GENERAL.—The Secretary of Health and 

14 Human Services, acting through the Director of the Na15 tional Institutes of Health, shall expand, intensify, and co16 ordinate operational and translational research and other 

17 activities of the National Institutes of Health regarding 

18 methods— 

19 (1) to increase adoption of evidence-based ad20 herence strategies within HIV care and treatment 

21 programs; 

22 (2) to increase HIV testing and case detection 

23 rates; 

24 (3) to reduce HIV-related health disparities; 


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1 (4) to ensure that research to improve adher2 ence to HIV care and treatment programs address 

3 the unique concerns of women; 

4 (5) to integrate HIV/AIDS prevention and care 

5 services with mental health and substance use pre6 vention and treatment delivery systems; and 

7 (6) to increase knowledge on the implementa8 tion of preexposure prophylaxis (PrEP), including 

9 with respect to— 

10 (A) who can benefit most from PrEP; 

11 (B) how to provide PrEP safely and effi12 ciently; 

13 (C) how to integrate PrEP with other es14 sential prevention methods such as condoms; 

15 and 

16 (D) how to ensure high levels of adherence. 

17 (c) AUTHORIZATION OF APPROPRIATIONS.—To carry 

18 out this section, there are authorized to be appropriated 

19 such sums as may be necessary for fiscal years 2017 

20 through 2021. 

21 SEC. 747. SERVICES TO REDUCE HIV/AIDS IN RACIAL AND 

22 ETHNIC MINORITY COMMUNITIES. 

23 (a) IN GENERAL.—For the purpose of reducing HIV/ 

24 AIDS in racial and ethnic minority communities, the Sec25 retary, acting through the Deputy Assistant Secretary for 


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1 Minority Health, may make grants to public health agen2 cies and faith-based organizations to conduct— 

3 (1) outreach activities related to HIV/AIDS 

4 prevention and testing activities; 

5 (2) HIV/AIDS prevention activities; and 

6 (3) HIV/AIDS testing activities. 

7 (b) AUTHORIZATION OF APPROPRIATIONS.—To carry 

8 out this section, there are authorized to be appropriated 

9 such sums as may be necessary for fiscal years 2017 

10 through 2021. 

11 SEC. 748. MINORITY AIDS INITIATIVE. 

12 (a) EXPANDED FUNDING.—The Secretary, in col13 laboration with the Deputy Assistant Secretary for Minor14 ity Health, the Director of the Centers for Disease Control 

15 and Prevention, the Administrator of the Health Re16 sources and Services Administration, and the Adminis17 trator of the Substance Abuse and Mental Health Services 

18 Administration, shall provide funds and carry out activi19 ties to expand the Minority HIV/AIDS Initiative. 

20 (b) USE OF FUNDS.—The additional funds made 

21 available under this section may be used, through the Mi22 nority AIDS Initiative, to support the following activities: 

23 (1) Providing technical assistance and infra24 structure support to reduce HIV/AIDS in minority 

25 populations. 


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1 (2) Increasing minority populations’ access to 

2 HIV/AIDS prevention and care services. 

3 (3) Building strong community programs and 

4 partnerships to address HIV prevention and the 

5 health care needs of specific racial and ethnic minor6 ity populations. 

7 (c) PRIORITY INTERVENTIONS.—Within the racial 

8 and ethnic minority populations referred to in subsection 

9 (b), priority in conducting intervention services shall be 

10 given to— 

11 (1) men who have sex with men; 

12 (2) youth; 

13 (3) persons who engage in intravenous drug 

14 abuse; 

15 (4) women; 

16 (5) homeless individuals; and 

17 (6) individuals incarcerated or in the penal sys18 tem. 

19 (d) AUTHORIZATION OF APPROPRIATIONS.—For car20 rying out this section, there are authorized to be appro21 priated $610,000,0000 for fiscal year 2017 and such sums 

22 as may be necessary for each of fiscal years 2018 through 

23 2021. 


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1 SEC. 749. HEALTH CARE PROFESSIONALS TREATING INDI2 VIDUALS WITH HIV/AIDS. 

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

4 Human Services, acting through the Administrator of the 

5 Health Resources and Services Administration, shall ex6 pand, intensify, and coordinate workforce initiatives of the 

7 Health Resources and Services Administration to increase 

8 the capacity of the health workforce focusing primarily on 

9 HIV/AIDS to meet the demand for culturally competent 

10 care, and may award grants for any of the following: 

11 (1) Development of curricula for training pri12 mary care providers in HIV/AIDS prevention and 

13 care, including routine HIV testing. 

14 (2) Support to expand access to culturally and 

15 linguistically accessible benefits counselors, trained 

16 peer navigators, and mental and behavioral health 

17 professionals with expertise in HIV/AIDS. 

18 (3) Training health care professionals to pro19 vide care to individuals with HIV/AIDS. 

20 (4) Development by grant recipients under title 

21 XXVI of the Public Health Service Act (42 U.S.C. 

22 300ff–11 et seq.; commonly referred to as the Ryan 

23 White HIV/AIDS Program) and other persons, of 

24 policies for providing culturally relevant and sen25 sitive treatment to individuals with HIV/AIDS, with 

26 particular emphasis on treatment to racial and ethVerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00526 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475

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1 nic minorities, men who have sex with men, and 

2 women, young people, and children with HIV/AIDS. 

3 (5) Development and implementation of pro4 grams to increase the use of telehealth to respond to 

5 HIV/AIDS-specific health care needs in rural and 

6 minority communities, with particular emphasis 

7 given to medically underserved communities and in8 sular areas. 

9 (6) Evaluating interdisciplinary medical pro10 vider care team models that promote high quality 

11 care, with particular emphasis on care to racial and 

12 ethnic minorities. 

13 (7) Training health care professionals to make 

14 them aware of the high rates of chronic hepatitis B 

15 and chronic hepatitis C in adult racial and ethnic 

16 populations, and the importance of prevention, de17 tection, and medical management of hepatitis B and 

18 hepatitis C and of liver cancer screening. 

19 (b) AUTHORIZATION OF APPROPRIATIONS.—To carry 

20 out this section, there are authorized to be appropriated 

21 such sums as may be necessary for fiscal years 2017 

22 through 2021. 


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1 SEC. 750. HIV/AIDS PROVIDER LOAN REPAYMENT PRO2 GRAM. 

3 (a) IN GENERAL.—The Secretary may enter into an 

4 agreement with any physician, nurse practitioner, or phy5 sician assistant under which— 

6 (1) the physician, nurse practitioner, or physi7 cian assistant agrees to serve as a medical provider 

8 for a period of not less than 2 years— 

9 (A) at a Ryan White-funded or title X10 funded facility with a critical shortage of doc11 tors (as determined by the Secretary); or 

12 (B) in an area with a high incidence of 

13 HIV/AIDS; and 

14 (2) the Secretary agrees to make payments in 

15 accordance with subsection (b) on the professional 

16 education loans of the physician, nurse practitioner, 

17 or physician assistant. 

18 (b) MANNER OF PAYMENTS.—The payments de19 scribed in subsection (a) shall be made by the Secretary 

20 as follows: 

21 (1) Upon completion by the physician, nurse 

22 practitioner, or physician assistant for whom the 

23 payments are to be made of the first year of the 

24 service specified in the agreement entered into with 

25 the Secretary under subsection (a), the Secretary 

26 shall pay 30 percent of the principal of and the inVerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00528 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475

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1 terest on the individual’s professional education 

2 loans. 

3 (2) Upon completion by the physician, nurse 

4 practitioner, or physician assistant of the second 

5 year of such service, the Secretary shall pay another 

6 30 percent of the principal of and the interest on 

7 such loans. 

8 (3) Upon completion by that individual of a 

9 third year of such service, the Secretary shall pay 

10 another 25 percent of the principal of and the inter11 est on such loans. 

12 (c) APPLICABILITY OF CERTAIN PROVISIONS.—The 

13 provisions of subpart III of part D of title III of the Public 

14 Health Service Act (42 U.S.C. 254l et seq.) shall, except 

15 as inconsistent with this section, apply to the program car16 ried out under this section in the same manner and to 

17 the same extent as such provisions apply to the National 

18 Health Service Corps Loan Repayment Program. 

19 (d) REPORTS.—Not later than 18 months after the 

20 date of the enactment of this Act, and annually thereafter, 

21 the Secretary shall prepare and submit to the Congress 

22 a report describing the program carried out under this sec23 tion, including statements regarding the following: 


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1 (1) The number of physicians, nurse practi2 tioners, and physician assistants enrolled in the pro3 gram. 

4 (2) The number and amount of loan repay5 ments. 

6 (3) The placement location of loan repayment 

7 recipients at facilities described in subsection (a)(1). 

8 (4) The default rate and actions required. 

9 (5) The amount of outstanding default funds. 

10 (6) To the extent that it can be determined, the 

11 reason for the default. 

12 (7) The demographics of individuals partici13 pating in the program. 

14 (8) An evaluation of the overall costs and bene15 fits of the program. 

16 (e) DEFINITIONS.—In this section: 

17 (1) The term ‘‘HIV/AIDS’’ means human im18 munodeficiency virus and acquired immune defi19 ciency syndrome. 

20 (2) The term ‘‘nurse practitioner’’ means a reg21 istered nurse who has completed an accredited grad22 uate degree program in advanced nurse practice and 

23 has successfully passed a national certification exam. 


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1 (3) The term ‘‘physician’’ means a graduate of 

2 a school of medicine who has completed post3 graduate training in general or pediatric medicine. 

4 (4) The term ‘‘physician assistant’’ means a 

5 medical provider who completed an accredited physi6 cian assistant training program and successfully 

7 passed the Physician Assistant National Certifying 

8 Examination. 

9 (5) The term ‘‘professional education loan’’— 

10 (A) means a loan that is incurred for the 

11 cost of attendance (including tuition, other rea12 sonable educational expenses, and reasonable 

13 living costs) at a school of medicine, nursing, or 

14 physician assistant training program; and 

15 (B) includes only the portion of the loan 

16 that is outstanding on the date the physician, 

17 nurse practitioner, or physician assistant in18 volved begins the service specified in the agree19 ment under subsection (a). 

20 (6) The term ‘‘Ryan White-funded’’ means, 

21 with respect to a facility, receiving funds under title 

22 XXVI of the Public Health Service Act (42 U.S.C. 

23 300ff–11 et seq.). 

24 (7) The term ‘‘Secretary’’ means the Secretary 

25 of Health and Human Services. 


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1 (8) The term ‘‘school of medicine’’ has the 

2 meaning given to that term in section 799B of the 

3 Public Health Service Act (42 U.S.C. 295p). 

4 (9) The term ‘‘title X-funded’’ means, with re5 spect to a facility, receiving funds under title X of 

6 the Public Health Service Act (42 U.S.C. 300 et 

7 seq.). 

8 (f) AUTHORIZATION OF APPROPRIATIONS.—To carry 

9 out this section, there are authorized to be appropriated 

10 such sums as may be necessary for fiscal years 2017 

11 through 2021. 

12 SEC. 751. DENTAL EDUCATION LOAN REPAYMENT PRO13 GRAM. 

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

15 Human Services may enter into an agreement with any 

16 dentist under which— 

17 (1) the dentist agrees to serve as a dentist for 

18 a period of not less than 2 years at a facility with 

19 a critical shortage of dentists (as determined by the 

20 Secretary) in an area with a high incidence of HIV/ 

21 AIDS; and 

22 (2) the Secretary agrees to make payments in 

23 accordance with subsection (b) on the dental edu24 cation loans of the dentist. 


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1 (b) MANNER OF PAYMENTS.—The payments de2 scribed in subsection (a) shall be made by the Secretary 

3 as follows: 

4 (1) Upon completion by the dentist for whom 

5 the payments are to be made of the first year of the 

6 service specified in the agreement entered into with 

7 the Secretary under subsection (a), the Secretary 

8 shall pay 30 percent of the principal of and the in9 terest on the dental education loans of the dentist. 

10 (2) Upon completion by the dentist of the sec11 ond year of such service, the Secretary shall pay an12 other 30 percent of the principal of and the interest 

13 on such loans. 

14 (3) Upon completion by that individual of a 

15 third year of such service, the Secretary shall pay 

16 another 25 percent of the principal of and the inter17 est on such loans. 

18 (c) APPLICABILITY OF CERTAIN PROVISIONS.—The 

19 provisions of subpart III of part D of title III of the Public 

20 Health Service Act (42 U.S.C. 254l et seq.) shall, except 

21 as inconsistent with this section, apply to the program car22 ried out under this section in the same manner and to 

23 the same extent as such provisions apply to the National 

24 Health Service Corps Loan Repayment Program. 


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1 (d) REPORTS.—Not later than 18 months after the 

2 date of the enactment of this Act, and annually thereafter, 

3 the Secretary shall prepare and submit to the Congress 

4 a report describing the program carried out under this sec5 tion, including statements regarding the following: 

6 (1) The number of dentists enrolled in the pro7 gram. 

8 (2) The number and amount of loan repay9 ments. 

10 (3) The placement location of loan repayment 

11 recipients at facilities described in subsection (a)(1). 

12 (4) The default rate and actions required. 

13 (5) The amount of outstanding default funds. 

14 (6) To the extent that it can be determined, the 

15 reason for the default. 

16 (7) The demographics of individuals partici17 pating in the program. 

18 (8) An evaluation of the overall costs and bene19 fits of the program. 

20 (e) DEFINITIONS.—In this section: 

21 (1) The term ‘‘dental education loan’’— 

22 (A) means a loan that is incurred for the 

23 cost of attendance (including tuition, other rea24 sonable educational expenses, and reasonable 

25 living costs) at a school of dentistry; and 


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1 (B) includes only the portion of the loan 

2 that is outstanding on the date the dentist in3 volved begins the service specified in the agree4 ment under subsection (a). 

5 (2) The term ‘‘dentist’’ means a graduate of a 

6 school of dentistry who has completed postgraduate 

7 training in general or pediatric dentistry. 

8 (3) The term ‘‘HIV/AIDS’’ means human im9 munodeficiency virus and acquired immune defi10 ciency syndrome. 

11 (4) The term ‘‘school of dentistry’’ has the 

12 meaning given to that term in section 799B of the 

13 Public Health Service Act (42 U.S.C. 295p). 

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

15 of Health and Human Services. 

16 (f) AUTHORIZATION OF APPROPRIATIONS.—To carry 

17 out this section, there are authorized to be appropriated 

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

19 2017 through 2021. 

20 SEC. 752. REDUCING NEW HIV INFECTIONS AMONG INJECT21 ING DRUG USERS. 

22 (a) SENSE OF CONGRESS.—It is the sense of the Con23 gress that providing sterile syringes and sterilized equip24 ment to injecting drug users substantially reduces risk of 


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1 HIV infection, increases the probability that they will ini2 tiate drug treatment, and does not increase drug use. 

3 (b) IN GENERAL.—The Secretary of Health and 

4 Human Services may provide grants and technical assist5 ance for the purpose of reducing the rate of HIV infections 

6 among injecting drug users through a comprehensive 

7 package of services for such users, including the provision 

8 of sterile syringes, education and outreach, access to infec9 tious disease testing, overdose prevention, and treatment 

10 for drug dependence. 

11 (c) AUTHORIZATION OF APPROPRIATIONS.—To carry 

12 out this section, there are authorized to be appropriated 

13 such sums as may be necessary for fiscal years 2017 

14 through 2021. 

15 SEC. 753. SUPPORT FOR EXPANSION OF COMPREHENSIVE 

16 SEXUAL HEALTH AND EDUCATION PRO17 GRAMS. 

18 (a) SENSE OF CONGRESS.—It is the sense of Con19 gress that— 

20 (1) federally funded sex education programs 

21 should aim to— 

22 (A) reduce unintended pregnancy and sex23 ually transmitted infections, including HIV; 

24 (B) promote safe and healthy relation25 ships; 


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1 (C) use, and be informed by, the best sci2 entific information available; 

3 (D) be built on characteristics of effective 

4 programs; 

5 (E) expand the existing body of evidence 

6 on comprehensive sex education programs 

7 through program evaluation; 

8 (F) expand training programs for teachers 

9 of comprehensive sex education; 

10 (G) build on the personal responsibility 

11 education programs funded under section 513 

12 of the Social Security Act (42 U.S.C. 713) and 

13 the President’s Teen Pregnancy Prevention pro14 gram, funded under title II of the Consolidated 

15 Appropriations Act, 2010 (Public Law 111– 

16 117; 123 Stat. 3253); and 

17 (H) promote and uphold the rights of 

18 young people to information in order to make 

19 healthy and responsible decisions about their 

20 sexual health; and 

21 (2) no Federal funds should be used for health 

22 education programs that— 

23 (A) deliberately withhold life-saving infor24 mation about HIV; 


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1 (B) are medically inaccurate or have been 

2 scientifically shown to be ineffective; 

3 (C) promote gender stereotypes; 

4 (D) are insensitive and unresponsive to the 

5 needs of sexually active adolescents; 

6 (E) are insensitive and unresponsive to the 

7 needs of lesbian, gay, bisexual, transgender, 

8 queer, or questioning youth; or 

9 (F) are inconsistent with the ethical im10 peratives of medicine and public health. 

11 (b) GRANTS FOR COMPREHENSIVE SEX EDUCATION

12 FOR ADOLESCENTS.— 

13 (1) PROGRAM AUTHORIZED.—The Secretary, in 

14 coordination with the Director of the Office of Ado15 lescent Health, shall award grants, on a competitive 

16 basis, to eligible entities to enable such eligible enti17 ties to carry out programs that provide adolescents 

18 with comprehensive sex education, as described in 

19 paragraph (6). 

20 (2) DURATION.—Grants awarded under this 

21 subsection shall be for a period of 5 years. 

22 (3) ELIGIBLE ENTITY.—In this subsection, the 

23 term ‘‘eligible entity’’ means a public or private enti24 ty that focuses on adolescent health or education or 


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1 has experience working with adolescents, which may 

2 include— 

3 (A) a State educational agency; 

4 (B) a local educational agency; 

5 (C) a tribe or tribal organization, as de6 fined in section 4 of the Indian Self-Determina7 tion and Education Assistance Act (25 U.S.C. 

8 450b); 

9 (D) a State or local department of health; 

10 (E) a State or local department of edu11 cation; 

12 (F) a nonprofit organization; 

13 (G) a nonprofit or public institution of 

14 higher education; or 

15 (H) a hospital. 

16 (4) APPLICATIONS.—An eligible entity desiring 

17 a grant under this subsection shall submit an appli18 cation to the Secretary at such time, in such man19 ner, and containing such information as the Sec20 retary may require, including the evaluation plan de21 scribed in paragraph (7)(A). 

22 (5) PRIORITY.—In awarding grants under this 

23 subsection, the Secretary shall give priority to eligi24 ble entities that— 


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1 (A) are State or local public entities, with 

2 an additional priority for State or local edu3 cational agencies; and 

4 (B) address health disparities among 

5 young people that are at highest risk for not 

6 less than 1 of the following: 

7 (i) Unintended pregnancies. 

8 (ii) Sexually transmitted infections, 

9 including HIV. 

10 (iii) Dating violence and sexual as11 sault. 

12 (6) USE OF FUNDS.— 

13 (A) IN GENERAL.—Each eligible entity 

14 that receives a grant under this subsection shall 

15 use grant funds to carry out a program that 

16 provides adolescents with comprehensive sex 

17 education that— 

18 (i) replicates evidence-based sex edu19 cation programs; 

20 (ii) substantially incorporates ele21 ments of evidence-based sex education pro22 grams; or 

23 (iii) creates a demonstration project 

24 based on generally accepted characteristics 

25 of effective sex education programs. 


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1 (B) CONTENTS OF SEX EDUCATION PRO2 GRAMS.—The sex education programs funded 

3 under this subsection shall include curricula 

4 and program materials that address— 

5 (i) abstinence and delaying sexual ini6 tiation; 

7 (ii) the health benefits and side effects 

8 of all contraceptive and barrier methods as 

9 a means to prevent pregnancy and sexually 

10 transmitted infections, including HIV; 

11 (iii) healthy relationships, including 

12 the development of healthy attitudes and 

13 skills necessary for understanding— 

14 (I) healthy relationships between 

15 oneself and family, others, and soci16 ety; and 

17 (II) the prevention of sexual 

18 abuse, teen dating violence, bullying, 

19 harassment, and suicide; 

20 (iv) healthy life skills including goal21 setting, decisionmaking, interpersonal skills 

22 (such as communication, assertiveness, and 

23 peer refusal skills), critical thinking, self24 esteem and self-efficacy, and stress man25 agement; 


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1 (v) how to make responsible decisions 

2 about sex and sexuality, including— 

3 (I) how to avoid, and how to 

4 avoid making, unwanted verbal, phys5 ical, and sexual advances; and 

6 (II) how alcohol and drug use 

7 can affect responsible decisionmaking; 

8 (vi) the development of healthy atti9 tudes and values about such topics as ado10 lescent growth and development, body 

11 image, gender roles and gender identity, 

12 racial and ethnic diversity, and sexual ori13 entation; and 

14 (vii) referral services for local health 

15 clinics and services where adolescents can 

16 obtain additional information and services 

17 related to sexual and reproductive health, 

18 dating violence and sexual assault, and sui19 cide prevention. 

20 (7) EVALUATION; REPORT.— 

21 (A) INDEPENDENT EVALUATION.—Each 

22 eligible entity applying for a grant under this 

23 subsection shall develop and submit to the Sec24 retary a plan for a rigorous independent evaluaVerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00542 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475

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1 tion of such grant program. The plan shall de2 scribe an independent evaluation that— 

3 (i) uses sound statistical methods and 

4 techniques relating to the behavioral 

5 sciences, including random assignment 

6 methodologies, whenever possible; 

7 (ii) uses quantitative data for assess8 ments and impact evaluations, whenever 

9 possible; and 

10 (iii) is carried out by an entity inde11 pendent from such eligible entity. 

12 (B) SELECTION OF EVALUATED PRO13 GRAMS; BUDGET.— 

14 (i) SELECTION OF EVALUATED PRO15 GRAMS.—The Secretary shall select, at 

16 random, a subset of the eligible entities 

17 that the Secretary has selected to receive a 

18 grant under this subsection to receive addi19 tional funding to carry out the evaluation 

20 plan described in subparagraph (A). 

21 (ii) BUDGET FOR EVALUATION ACTIVI22 TIES.—The Secretary, in coordination with 

23 the Director of the Office of Adolescent 

24 Health, shall establish a budget for each 

25 eligible entity selected under clause (i) for 


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1 the costs of carrying out the evaluation 

2 plan described in subparagraph (A). 

3 (C) FUNDS FOR EVALUATION.—The Sec4 retary shall provide eligible entities who are se5 lected under subparagraph (B)(i) with addi6 tional funds, in accordance with the budget de7 scribed in subparagraph (B)(ii), to carry out 

8 and report to the Secretary on the evaluation 

9 plan described in subparagraph (A). 

10 (D) PERFORMANCE MEASURES.—The Sec11 retary, in coordination with the Director of the 

12 Centers for Disease Control and Prevention, 

13 shall establish a common set of performance 

14 measures to assess the implementation and im15 pact of grant programs funded under this sub16 section. Such performance measures shall in17 clude— 

18 (i) output measures, such as the num19 ber of individuals served and the number 

20 of hours of service delivery; 

21 (ii) outcome measures, including 

22 measures relating to— 

23 (I) the knowledge that youth par24 ticipating in the grant program have 

25 gained about— 


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1 (aa) adolescent growth and 

2 development; 

3 (bb) relationship dynamics; 

4 (cc) ways to prevent unin5 tended pregnancy and sexually 

6 transmitted infections, including 

7 HIV; and 

8 (dd) sexual health; 

9 (II) the skills that adolescents 

10 participating in the grant program 

11 have gained regarding— 

12 (aa) negotiation and commu13 nication; 

14 (bb) decisionmaking and 

15 goal-setting; 

16 (cc) interpersonal skills and 

17 healthy relationships; and 

18 (dd) condom use; and 

19 (III) the behaviors of adolescents 

20 participating in the grant program, 

21 including data about— 

22 (aa) age of first intercourse; 

23 (bb) number of sexual part24 ners; 


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1 (cc) condom and contracep2 tive use at first intercourse; 

3 (dd) recent condom and con4 traceptive use; and 

5 (ee) dating abuse and life6 time history of domestic violence, 

7 sexual assault, dating violence, 

8 bullying, harassment, and stalk9 ing. 

10 (E) REPORT TO THE SECRETARY.—Eligi11 ble entities receiving a grant under this sub12 section who have been selected to receive funds 

13 to carry out the evaluation plan described in 

14 subparagraph (A), in accordance with subpara15 graph (B)(i), shall collect and report to the Sec16 retary— 

17 (i) the results of the independent eval18 uation described in subparagraph (A); and 

19 (ii) information about the perform20 ance measures described in subparagraph 

21 (B). 

22 (F) EFFECTIVE PROGRAMS.—The Sec23 retary, in coordination with the Director of the 

24 Centers for Disease Control and Prevention, 

25 shall publish on the Web site of the Centers for 


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1 Disease Control and Prevention, a list of pro2 grams funded under this subsection that the 

3 Secretary has determined to be effective pro4 grams. 

5 (c) GRANTS FOR COMPREHENSIVE SEX EDUCATION

6 AT INSTITUTIONS OF HIGHER EDUCATION.— 

7 (1) PROGRAM AUTHORIZED.—The Secretary, in 

8 coordination with the Office of Adolescent Health 

9 and the Secretary of Education, shall award grants, 

10 on a competitive basis, to institutions of higher edu11 cation to enable such institutions to provide young 

12 people with comprehensive sex education, described 

13 in paragraph (5)(B), with an emphasis on reducing 

14 HIV, other sexually transmitted infections, and un15 intended pregnancy through instruction about— 

16 (A) abstinence and contraception; 

17 (B) reducing dating violence, sexual as18 sault, bullying, and harassment; 

19 (C) increasing healthy relationships; and 

20 (D) academic achievement. 

21 (2) DURATION.—Grants awarded under this 

22 subsection shall be for a period of 5 years. 

23 (3) APPLICATIONS.—An institution of higher 

24 education desiring a grant under this subsection 

25 shall submit an application to the Secretary at such 


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1 time, in such manner, and containing such informa2 tion as the Secretary may require. 

3 (4) PRIORITY.—In awarding grants under this 

4 subsection, the Secretary shall give priority to an in5 stitution of higher education that— 

6 (A) has an enrollment of needy students as 

7 defined in section 318(b) of the Higher Edu8 cation Act of 1965 (20 U.S.C. 1059e(b)); 

9 (B) is a Hispanic-serving institution, as 

10 defined in section 502(a) of such Act (20 

11 U.S.C. 1101a(a)); 

12 (C) is a Tribal College or University, as 

13 defined in section 316(b) of such Act (20 

14 U.S.C. 1059c(b)); 

15 (D) is an Alaska Native-serving institution, 

16 as defined in section 317(b) of such Act (20 

17 U.S.C. 1059d(b)); 

18 (E) is a Native Hawaiian-serving institu19 tion, as defined in section 317(b) of such Act 

20 (20 U.S.C. 1059d(b)); 

21 (F) is a Predominately Black Institution, 

22 as defined in section 318(b) of such Act (20 

23 U.S.C. 1059e(b)); 


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1 (G) is a Native American-serving, non2 tribal institution, as defined in section 319(b) 

3 of such Act (20 U.S.C. 1059f(b)); 

4 (H) is an Asian American and Native 

5 American Pacific Islander-serving institution, as 

6 defined in section 320(b) of such Act (20 

7 U.S.C. 1059g(b)); or 

8 (I) is a minority institution, as defined in 

9 section 365 of such Act (20 U.S.C. 1067k), 

10 with an enrollment of needy students, as de11 fined in section 312 of such Act (20 U.S.C. 

12 1058). 

13 (5) USES OF FUNDS.— 

14 (A) IN GENERAL.—An institution of higher 

15 education receiving a grant under this sub16 section may use grant funds to integrate issues 

17 relating to comprehensive sex education into the 

18 academic or support sectors of the institution of 

19 higher education in order to reach a large num20 ber of students, by carrying out 1 or more of 

21 the following activities: 

22 (i) Developing educational content for 

23 issues relating to comprehensive sex edu24 cation that will be incorporated into first25 year orientation or core courses. 


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1 (ii) Developing and employing 

2 schoolwide educational programming out3 side of class that delivers elements of com4 prehensive sex education programs to stu5 dents, faculty, and staff. 

6 (iii) Creating innovative technology7 based approaches to deliver sex education 

8 to students, faculty, and staff. 

9 (iv) Developing and employing peer10 outreach and education programs to gen11 erate discussion, educate, and raise aware12 ness among students about issues relating 

13 to comprehensive sex education. 

14 (B) CONTENTS OF SEX EDUCATION PRO15 GRAMS.—Each institution of higher education’s 

16 program of comprehensive sex education funded 

17 under this subsection shall include curricula 

18 and program materials that address informa19 tion about— 

20 (i) safe and responsible sexual behav21 ior with respect to the prevention of preg22 nancy and sexually transmitted infections, 

23 including HIV, including through— 

24 (I) abstinence; 


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1 (II) a reduced number of sexual 

2 partners; and 

3 (III) the use of condoms and con4 traception; 

5 (ii) healthy relationships, including 

6 the development of healthy attitudes and 

7 insights necessary for understanding— 

8 (I) relationships between oneself, 

9 family, partners, others, and society; 

10 and 

11 (II) the prevention of sexual 

12 abuse, dating violence, bullying, har13 assment, and suicide; and 

14 (iii) referral services to local health 

15 clinics where young people can obtain addi16 tional information and services related to 

17 sexual and reproductive health, dating vio18 lence and sexual assault, and suicide pre19 vention. 

20 (C) OPTIONAL COMPONENTS OF SEX EDU21 CATION.—Each institution of higher education’s 

22 program of comprehensive sex education may 

23 also include information and skills development 

24 relating to— 


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1 (i) how to make responsible decisions 

2 about sex and sexuality, including— 

3 (I) how to avoid, and avoid mak4 ing, unwanted verbal, physical, and 

5 sexual advances; and 

6 (II) how alcohol and drug use 

7 can affect responsible decisionmaking; 

8 (ii) healthy life skills, including— 

9 (I) goal-setting and decision10 making; 

11 (II) interpersonal skills, such as 

12 communication, assertiveness, and 

13 peer refusal skills; 

14 (III) critical thinking; 

15 (IV) self-esteem and self-efficacy; 

16 and 

17 (V) stress management; 

18 (iii) the development of healthy atti19 tudes and values about such topics as body 

20 image, gender roles and gender identity, 

21 racial and ethnic diversity, and sexual ori22 entation; and 

23 (iv) the responsibilities of parenting 

24 and the skills necessary to parent well. 


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1 (6) EVALUATION; REPORT.—The requirements 

2 described in section 125B(g) shall also apply to eligi3 ble entities receiving a grant under this subsection 

4 in the same manner as such requirements apply to 

5 eligible entities receiving grants under section 125B. 

6 (d) GRANTS FOR PRE-SERVICE AND IN-SERVICE

7 TEACHER TRAINING.— 

8 (1) PROGRAM AUTHORIZED.—The Secretary, in 

9 coordination with the Director of the Centers for 

10 Disease Control and Prevention and the Secretary of 

11 Education, shall award grants, on a competitive 

12 basis, to eligible entities to enable such eligible enti13 ties to carry out the activities described in para14 graph (5). 

15 (2) DURATION.—Grants awarded under this 

16 subsection shall be for a period of 5 years. 

17 (3) ELIGIBLE ENTITY.—In this subsection, the 

18 term ‘‘eligible entity’’ means— 

19 (A) a State educational agency; 

20 (B) a local educational agency; 

21 (C) a tribe or tribal organization, as de22 fined in section 4 of the Indian Self-Determina23 tion and Education Assistance Act (25 U.S.C. 

24 450b); 

25 (D) a State or local department of health; 


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1 (E) a State or local department of edu2 cation; 

3 (F) a nonprofit institution of higher edu4 cation; 

5 (G) a national or statewide nonprofit orga6 nization that has as its primary purpose the im7 provement of provision of comprehensive sex 

8 education through effective teaching of com9 prehensive sex education; or 

10 (H) a consortium of nonprofit organiza11 tions that has as its primary purpose the im12 provement of provision of comprehensive sex 

13 education through effective teaching of com14 prehensive sex education. 

15 (4) APPLICATION.—An eligible entity desiring a 

16 grant under this subsection shall submit an applica17 tion to the Secretary at such time, in such manner, 

18 and containing such information as the Secretary 

19 may require. 

20 (5) AUTHORIZED ACTIVITIES.— 

21 (A) REQUIRED ACTIVITY.—Each eligible 

22 entity receiving a grant under this subsection 

23 shall use grant funds to train targeted faculty 

24 and staff, in order to increase effective teaching 


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1 of comprehensive sex education for elementary 

2 school and secondary school students. 

3 (B) PERMISSIBLE ACTIVITIES.—Each eligi4 ble entity receiving a grant under this sub5 section may use grant funds to— 

6 (i) strengthen and expand the eligible 

7 entity’s relationships with— 

8 (I) institutions of higher edu9 cation; 

10 (II) State educational agencies; 

11 (III) local educational agencies; 

12 or 

13 (IV) other public and private or14 ganizations with a commitment to 

15 comprehensive sex education and the 

16 benefits of comprehensive sex edu17 cation; 

18 (ii) support and promote research19 based training of teachers of comprehen20 sive sex education and related disciplines 

21 in elementary schools and secondary 

22 schools as a means of broadening student 

23 knowledge about issues related to human 

24 development, relationships, personal skills, 


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1 sexual behavior, sexual health, and society 

2 and culture; 

3 (iii) support the dissemination of in4 formation on effective practices and re5 search findings concerning the teaching of 

6 comprehensive sex education; 

7 (iv) support research on— 

8 (I) effective comprehensive sex 

9 education teaching practices; and 

10 (II) the development of assess11 ment instruments and strategies to 

12 document— 

13 (aa) student understanding 

14 of comprehensive sex education; 

15 and 

16 (bb) the effects of com17 prehensive sex education; 

18 (v) convene national conferences on 

19 comprehensive sex education, in order to 

20 effectively train teachers in the provision of 

21 comprehensive sex education; and 

22 (vi) develop and disseminate appro23 priate research-based materials to foster 

24 comprehensive sex education. 


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1 (C) SUBGRANTS.—Each eligible entity re2 ceiving a grant under this subsection may 

3 award subgrants to nonprofit organizations, 

4 State educational agencies, or local educational 

5 agencies to enable such organizations or agen6 cies to— 

7 (i) train teachers in comprehensive 

8 sex education; 

9 (ii) support Internet or distance learn10 ing related to comprehensive sex education; 

11 (iii) promote rigorous academic stand12 ards and assessment techniques to guide 

13 and measure student performance in com14 prehensive sex education; 

15 (iv) encourage replication of best 

16 practices and model programs to promote 

17 comprehensive sex education; 

18 (v) develop and disseminate effective, 

19 research-based comprehensive sex edu20 cation learning materials; 

21 (vi) develop academic courses on the 

22 pedagogy of sex education at institutions 

23 of higher education; or 

24 (vii) convene State-based conferences 

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1 cation and to identify strategies for im2 provement. 

3 (e) REPORT TO CONGRESS.— 

4 (1) IN GENERAL.—Not later than 1 year after 

5 the date of the enactment of this Act, and annually 

6 thereafter for a period of 5 years, the Secretary shall 

7 prepare and submit to the appropriate committees of 

8 Congress a report on the activities to provide adoles9 cents and young people with comprehensive sex edu10 cation funded under this section. 

11 (2) REPORT ELEMENTS.—The report described 

12 in paragraph (1) shall include information about— 

13 (A) the number of eligible entities and in14 stitutions of higher education that are receiving 

15 grant funds under subsections (b) and (c); 

16 (B) the specific activities supported by 

17 grant funds awarded under subsections (b) and 

18 (c); 

19 (C) the number of adolescents served by 

20 grant programs funded under subsection (b); 

21 (D) the number of young people served by 

22 grant programs funded under subsection (c); 

23 and 

24 (E) the status of program evaluations de25 scribed under subsections (b) and (c). 


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1 (f) LIMITATION.—No Federal funds provided under 

2 this section may be used for health education programs 

3 that— 

4 (1) deliberately withhold life-saving information 

5 about HIV; 

6 (2) are medically inaccurate or have been sci7 entifically shown to be ineffective; 

8 (3) promote gender stereotypes; 

9 (4) are insensitive and unresponsive to the 

10 needs of sexually active youth or lesbian, gay, bisex11 ual, transgender, queer, or questioning youth; or 

12 (5) are inconsistent with the ethical imperatives 

13 of medicine and public health. 

14 (g) DEFINITIONS.—In this section: 

15 (1) ESEA DEFINITIONS.—The terms ‘‘elemen16 tary school’’, ‘‘local educational agency’’, ‘‘secondary 

17 school’’, and ‘‘State educational agency’’ have the 

18 meanings given the terms in section 8101 of the Ele19 mentary and Secondary Education Act of 1965 (20 

20 U.S.C. 7801). 

21 (2) AGE AND DEVELOPMENTALLY APPRO22 PRIATE.—The term ‘‘age and developmentally appro23 priate’’ means suitable for a particular age or age 

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1 oping cognitive, emotional, and behavioral capacity 

2 typical for that age or age group. 

3 (3) ADOLESCENTS.—The term ‘‘adolescents’’ 

4 means individuals who are ages 10 through 19 at 

5 the time of commencement of participation in a pro6 gram supported under this section. 

7 (4) CHARACTERISTICS OF EFFECTIVE PRO8 GRAMS.—The term ‘‘characteristics of effective pro9 grams’’ means the aspects of evidence-based pro10 grams, including development, content, and imple11 mentation of such programs, that— 

12 (A) have been shown to be effective in 

13 terms of increasing knowledge, clarifying values 

14 and attitudes, increasing skills, and impacting 

15 upon behavior; and 

16 (B) are widely recognized by leading med17 ical and public health agencies to be effective in 

18 changing sexual behaviors that lead to sexually 

19 transmitted infections, including HIV, unin20 tended pregnancy, and dating violence and sex21 ual assault among young people. 

22 (5) COMPREHENSIVE SEX EDUCATION.—The 

23 term ‘‘comprehensive sex education’’ means a pro24 gram that— 


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1 (A) includes age- and developmentally ap2 propriate, culturally and linguistically relevant 

3 information on a broad set of topics related to 

4 sexuality including human development, rela5 tionships, decisionmaking, communication, ab6 stinence, contraception, and disease and preg7 nancy prevention; 

8 (B) provides students with opportunities 

9 for developing skills as well as learning informa10 tion; 

11 (C) is inclusive of lesbian, gay, bisexual, 

12 transgender, queer, questioning, and hetero13 sexual young people; and 

14 (D) aims to— 

15 (i) provide scientifically accurate and 

16 realistic information about human sexu17 ality; 

18 (ii) provide opportunities for individ19 uals to understand their own, their fami20 lies’, and their communities’ values, atti21 tudes, and insights about sexuality; 

22 (iii) help individuals develop healthy 

23 relationships and interpersonal skills; and 

24 (iv) help individuals exercise responsi25 bility regarding sexual relationships, which 


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1 includes addressing abstinence, pressures 

2 to become prematurely involved in sexual 

3 intercourse, and the use of contraception 

4 and other sexual health measures. 

5 (6) EVIDENCE-BASED PROGRAM.—The term 

6 ‘‘evidence-based program’’ means a sex education 

7 program that has been proven through rigorous eval8 uation to be effective in changing sexual behavior or 

9 incorporates elements of other sex education pro10 grams that have been proven to be effective in 

11 changing sexual behavior. 

12 (7) INSTITUTION OF HIGHER EDUCATION.—The 

13 term ‘‘institution of higher education’’ has the 

14 meaning given the term in section 101 of the Higher 

15 Education Act of 1965 (20 U.S.C. 1001). 

16 (8) MEDICALLY ACCURATE AND COMPLETE.— 

17 The term ‘‘medically accurate and complete’’, when 

18 used with respect to a sex education program, means 

19 that— 

20 (A) the information provided through the 

21 program is verified or supported by the weight 

22 of research conducted in compliance with ac23 cepted scientific methods and is published in 

24 peer-reviewed journals, where applicable; or 


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1 (B)(i) the program contains information 

2 that leading professional organizations and 

3 agencies with relevant expertise in the field rec4 ognize as accurate, objective, and complete; and 

5 (ii) the program does not withhold infor6 mation about the effectiveness and benefits of 

7 correct and consistent use of condoms and 

8 other contraceptives. 

9 (9) SECRETARY.—The term ‘‘Secretary’’ means 

10 the Secretary of Health and Human Services. 

11 (10) YOUNG PEOPLE.—The term ‘‘young peo12 ple’’ means individuals who are ages 10 through 24 

13 at the time of commencement of participation in a 

14 program supported under this section. 

15 (h) FUNDING.— 

16 (1) ELIMINATION OF ABSTINENCE-ONLY-UNTIL17 MARRIAGE PROGRAM.—Title V of the Social Security 

18 Act (42 U.S.C. 701 et seq.) is amended by striking 

19 section 510. 

20 (2) RESCISSION.—Amounts appropriated for 

21 fiscal years 2016 and 2017 under section 510(d) of 

22 the Social Security Act (42 U.S.C. 710(d)) (as in ef23 fect on the day before the date of enactment of this 

24 Act) that are unobligated as of the date of enact25 ment of this Act are rescinded. 


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1 (3) AUTHORIZATION OF APPROPRIATIONS.— 

2 There are authorized to be appropriated to carry out 

3 this section for fiscal years 2017 through 2021 an 

4 amount equal to the funds appropriated for fiscal 

5 years 2016 and 2017 under section 510(d) of the 

6 Social Security Act (42 U.S.C. 710(d)) (as in effect 

7 on the day before the date of enactment of this Act) 

8 that are rescinded by paragraph (2). 

9 SEC. 754. REPORT ON IMPACT OF HIV/AIDS IN VULNERABLE 

10 POPULATIONS. 

11 (a) IN GENERAL.—The Secretary shall submit to the 

12 Congress and the President an annual report on the im13 pact of HIV/AIDS for racial and ethnic minority commu14 nities, women, and youth aged 24 and younger. 

15 (b) CONTENTS.—The report under subsection (a) 

16 shall include information on the— 

17 (1) progress that has been made in reducing 

18 the impact of HIV/AIDS in such communities; 

19 (2) opportunities that exist to make additional 

20 progress in reducing the impact of HIV/AIDS in 

21 such communities; 

22 (3) challenges that may impede such additional 

23 progress; and 


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1 (4) Federal funding necessary to achieve sub2 stantial reductions in HIV/AIDS in racial and ethnic 

3 minority communities. 

4 SEC. 755. NATIONAL HIV/AIDS OBSERVANCE DAYS. 

5 (a) NATIONAL OBSERVANCE DAYS.—It is the sense 

6 of the Congress that national observance days highlighting 

7 the impact of HIV/AIDS on communities of color include 

8 the following: 

9 (1) National Black HIV/AIDS Awareness Day. 

10 (2) National Latino AIDS Awareness Day. 

11 (3) National Asian and Pacific Islander HIV/ 

12 AIDS Awareness Day. 

13 (4) National Native American HIV/AIDS 

14 Awareness Day. 

15 (5) Caribbean-American HIV/AIDS Awareness 

16 Day. 

17 (6) National Youth HIV/AIDS Awareness Day. 

18 (7) National Black Clergy HIV/AIDS Aware19 ness Sunday. 

20 (b) CALL TO ACTION.—It is the sense of the Con21 gress that the President should call on members of com22 munities of color— 

23 (1) to become involved at the local community 

24 level in HIV/AIDS testing, policy, and advocacy; 


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1 (2) to become aware, engaged, and empowered 

2 on the HIV/AIDS epidemic within their commu3 nities; and 

4 (3) to urge members of their communities to re5 duce risk factors, practice safe sex and other preven6 tive measures, be tested for HIV/AIDS, and seek 

7 care when appropriate. 

8 SEC. 756. REVIEW OF ALL FEDERAL AND STATE LAWS, 

9 POLICIES, AND REGULATIONS REGARDING 

10 THE CRIMINAL PROSECUTION OF INDIVID11 UALS FOR HIV-RELATED OFFENSES. 

12 (a) DEFINITIONS.— 

13 (1) HIV AND HIV/AIDS.—The terms ‘‘HIV’’ and 

14 ‘‘HIV/AIDS’’ have the meanings given to such terms 

15 in section 2689 of the Public Health Service Act (42 

16 U.S.C. 300ff–88). 

17 (2) STATE.—The term ‘‘State’’ includes the 

18 District of Columbia, American Samoa, the Com19 monwealth of the Northern Mariana Islands, Guam, 

20 Puerto Rico, and the United States Virgin Islands. 

21 (b) SENSE OF CONGRESS REGARDING LAWS OR REG22 ULATIONS DIRECTED AT PEOPLE LIVING WITH HIV/ 

23 AIDS.—It is the sense of the Congress that Federal and 

24 State laws, policies, and regulations regarding people liv25 ing with HIV/AIDS— 


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1 (1) should not place unique or additional bur2 dens on such individuals solely as a result of their 

3 HIV status; and 

4 (2) should instead demonstrate a public health5 oriented, evidence-based, medically accurate, and 

6 contemporary understanding of— 

7 (A) the multiple factors that lead to HIV 

8 transmission; 

9 (B) the relative risk of HIV transmission 

10 routes; 

11 (C) the current health implications of liv12 ing with HIV; 

13 (D) the associated benefits of treatment 

14 and support services for people living with HIV; 

15 and 

16 (E) the impact of punitive HIV-specific 

17 laws and policies on public health, on people liv18 ing with or affected by HIV, and on their fami19 lies and communities. 

20 (c) REVIEW OF ALL FEDERAL AND STATE LAWS, 

21 POLICIES, AND REGULATIONS REGARDING THE CRIMINAL

22 PROSECUTION OF INDIVIDUALS FOR HIV-RELATED OF23 FENSES.— 

24 (1) REVIEW OF FEDERAL AND STATE LAWS.— 


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1 (A) IN GENERAL.—No later than 90 days 

2 after the date of the enactment of this Act, the 

3 Attorney General, the Secretary of Health and 

4 Human Services, and the Secretary of Defense 

5 acting jointly (in this paragraph and paragraph 

6 (2) referred to as the ‘‘designated officials’’) 

7 shall initiate a national review of Federal and 

8 State laws, policies, regulations, and judicial 

9 precedents and decisions regarding criminal and 

10 related civil commitment cases involving people 

11 living with HIV/AIDS, including in regards to 

12 the Uniform Code of Military Justice. 

13 (B) CONSULTATION.—In carrying out the 

14 review under subparagraph (A), the designated 

15 officials shall ensure diverse participation and 

16 consultation from each State, including with— 

17 (i) State attorneys general (or their 

18 representatives); 

19 (ii) State public health officials (or 

20 their representatives); 

21 (iii) State judicial and court system 

22 officers, including judges, district attor23 neys, prosecutors, defense attorneys, law 

24 enforcement, and correctional officers; 


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1 (iv) members of the United States 

2 Armed Forces, including members of other 

3 Federal services subject to the Uniform 

4 Code of Military Justice; 

5 (v) people living with HIV/AIDS, par6 ticularly those who have been subject to 

7 HIV-related prosecution or who are from 

8 communities whose members have been 

9 disproportionately subject to HIV-specific 

10 arrests and prosecutions; 

11 (vi) legal advocacy and HIV/AIDS 

12 service organizations that work with people 

13 living with HIV/AIDS; 

14 (vii) nongovernmental health organi15 zations that work on behalf of people living 

16 with HIV/AIDS; and 

17 (viii) trade organizations or associa18 tions representing persons or entities de19 scribed in clauses (i) through (vii). 

20 (C) RELATION TO OTHER REVIEWS.—In 

21 carrying out the review under subparagraph 

22 (A), the designated officials may utilize other 

23 existing reviews of criminal and related civil 

24 commitment cases involving people living with 

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1 ducted by any Federal or State agency or any 

2 public health, legal advocacy, or trade organiza3 tion or association if the designated officials de4 termine that such reviews were conducted in ac5 cordance with the principles set forth in sub6 section (b). 

7 (2) REPORT.—No later than 180 days after ini8 tiating the review required by paragraph (1), the At9 torney General shall transmit to the Congress and 

10 make publicly available a report containing the re11 sults of the review, which includes the following: 

12 (A) For each State and for the Uniform 

13 Code of Military Justice, a summary of the rel14 evant laws, policies, regulations, and judicial 

15 precedents and decisions regarding criminal 

16 cases involving people living with HIV/AIDS, 

17 including, if applicable, the following: 

18 (i) A determination of whether such 

19 laws, policies, regulations, and judicial 

20 precedents and decisions place any unique 

21 or additional burdens upon people living 

22 with HIV/AIDS. 

23 (ii) A determination of whether such 

24 laws, policies, regulations, and judicial 

25 precedents and decisions demonstrate a 


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1 public health-oriented, evidence-based, 

2 medically accurate, and contemporary un3 derstanding of— 

4 (I) the multiple factors that lead 

5 to HIV transmission; 

6 (II) the relative risk of HIV 

7 transmission routes; 

8 (III) the current health implica9 tions of living with HIV; 

10 (IV) the associated benefits of 

11 treatment and support services for 

12 people living with HIV; and 

13 (V) the impact of punitive HIV14 specific laws and policies on public 

15 health, on people living with or af16 fected by HIV, and on their families 

17 and communities. 

18 (iii) An analysis of the public health 

19 and legal implications of such laws, poli20 cies, regulations, and judicial precedents, 

21 including an analysis of the consequences 

22 of having a similar penal scheme applied to 

23 comparable situations involving other com24 municable diseases. 


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1 (iv) An analysis of the proportionality 

2 of punishments imposed under HIV-spe3 cific laws, policies, regulations, and judicial 

4 precedents, taking into consideration pen5 alties attached to violation of State laws 

6 against similar degrees of endangerment or 

7 harm, such as driving while intoxicated 

8 (DWI) or transmission of other commu9 nicable diseases, or more serious harms, 

10 such as vehicular manslaughter offenses. 

11 (B) An analysis of common elements 

12 shared among State laws, policies, regulations, 

13 and judicial precedents. 

14 (C) A set of best practice recommendations 

15 directed to State governments, including State 

16 attorneys general, public health officials, and 

17 judicial officers, in order to ensure that laws, 

18 policies, regulations, and judicial precedents re19 garding people living with HIV/AIDS are in ac20 cordance with the principles set forth in sub21 section (b). 

22 (D) Recommendations for adjustments to 

23 the Uniform Code of Military Justice, as may 

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1 garding people living with HIV/AIDS are in ac2 cordance with the principles set forth in sub3 section (b). 

4 (3) GUIDANCE.—Within 90 days of the release 

5 of the report required by paragraph (2), the Attor6 ney General and the Secretary of Health and 

7 Human Services, acting jointly, shall develop and 

8 publicly release updated guidance for States based 

9 on the set of best practice recommendations required 

10 by paragraph (2)(C) in order to assist States dealing 

11 with criminal and related civil commitment cases re12 garding people living with HIV/AIDS. 

13 (4) MONITORING AND EVALUATION SYSTEM.— 

14 Within 60 days of the release of the guidance re15 quired by paragraph (3), the Attorney General and 

16 the Secretary of Health and Human Services, acting 

17 jointly, shall establish an integrated monitoring and 

18 evaluation system which includes, where appropriate, 

19 objective and quantifiable performance goals and in20 dicators to measure progress toward statewide im21 plementation in each State of the best practice rec22 ommendations required in paragraph (2)(C), includ23 ing to monitor, track, and evaluate the effectiveness 

24 of assistance provided pursuant to subsection (d). 


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1 (5) ADJUSTMENTS TO FEDERAL LAWS, POLI2 CIES, OR REGULATIONS.—Within 90 days of the re3 lease of the report required by paragraph (2), the 

4 Attorney General, the Secretary of Health and 

5 Human Services, and the Secretary of Defense, act6 ing jointly, shall develop and transmit to the Presi7 dent and the Congress, and make publicly available, 

8 such proposals as may be necessary to implement 

9 adjustments to Federal laws, policies, or regulations, 

10 including to the Uniform Code of Military Justice, 

11 based on the recommendations required by para12 graph (2)(D), either through Executive order or 

13 through changes to statutory law. 

14 (6) AUTHORIZATION OF APPROPRIATIONS.— 

15 (A) IN GENERAL.—There are authorized to 

16 be appropriated such sums as may be necessary 

17 for the purpose of carrying out this subsection. 

18 Amounts authorized to be appropriated by the 

19 preceding sentence are in addition to amounts 

20 otherwise authorized to be appropriated for 

21 such purpose. 

22 (B) AVAILABILITY OF FUNDS.—Amounts 

23 appropriated pursuant to the authorization of 

24 appropriations in subparagraph (A) are author25 ized to remain available until expended. 


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1 (d) AUTHORIZATION TO PROVIDE GRANTS.— 

2 (1) GRANTS BY ATTORNEY GENERAL.— 

3 (A) IN GENERAL.—The Attorney General 

4 may provide assistance to eligible State and 

5 local entities and eligible nongovernmental orga6 nizations for the purpose of incorporating the 

7 best practice recommendations developed under 

8 subsection (c)(2)(C) within relevant State laws, 

9 policies, regulations, and judicial decisions re10 garding people living with HIV/AIDS. 

11 (B) AUTHORIZED ACTIVITIES.—The assist12 ance authorized by subparagraph (A) may in13 clude— 

14 (i) direct technical assistance to eligi15 ble State and local entities in order to de16 velop, disseminate, or implement State 

17 laws, policies, regulations, or judicial deci18 sions that conform with the best practice 

19 recommendations developed under sub20 section (c)(2)(C); 

21 (ii) direct technical assistance to eligi22 ble nongovernmental organizations in order 

23 to provide education and training, includ24 ing through classes, conferences, meetings, 


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1 and other educational activities, to eligible 

2 State and local entities; and 

3 (iii) subcontracting authority to allow 

4 eligible State and local entities and eligible 

5 nongovernmental organizations to seek 

6 technical assistance from legal and public 

7 health experts with a demonstrated under8 standing of the principles underlying the 

9 best practice recommendations developed 

10 under subsection (c)(2)(C). 

11 (2) GRANTS BY SECRETARY OF HEALTH AND

12 HUMAN SERVICES.— 

13 (A) IN GENERAL.—The Secretary of 

14 Health and Human Services, acting through the 

15 Director of the Centers for Disease Control and 

16 Prevention, may provide assistance to State and 

17 local public health departments and eligible 

18 nongovernmental organizations for the purpose 

19 of supporting eligible State and local entities to 

20 incorporate the best practice recommendations 

21 developed under subsection (c)(2)(C) within rel22 evant State laws, policies, regulations, and judi23 cial decisions regarding people living with HIV/ 

24 AIDS. 


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1 (B) AUTHORIZED ACTIVITIES.—The assist2 ance authorized by subparagraph (A) may in3 clude— 

4 (i) direct technical assistance to State 

5 and local public health departments in 

6 order to support the development, dissemi7 nation, or implementation of State laws, 

8 policies, regulations, or judicial decisions 

9 that conform with the set of best practice 

10 recommendations developed under sub11 section (c)(2)(C); 

12 (ii) direct technical assistance to eligi13 ble nongovernmental organizations in order 

14 to provide education and training, includ15 ing through classes, conferences, meetings, 

16 and other educational activities, to State 

17 and local public health departments; and 

18 (iii) subcontracting authority to allow 

19 State and local public health departments 

20 and eligible nongovernmental organizations 

21 to seek technical assistance from legal and 

22 public health experts with a demonstrated 

23 understanding of the principles underlying 

24 the best practice recommendations devel25 oped under subsection (c)(2)(C). 


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1 (3) LIMITATION.—As a condition of receiving 

2 assistance through this subsection, eligible State and 

3 local entities, State and local public health depart4 ments, and eligible nongovernmental organizations 

5 shall agree— 

6 (A) not to place any unique or additional 

7 burdens on people living with HIV/AIDS solely 

8 as a result of their HIV status; and 

9 (B) that if the entity, department, or orga10 nization promulgates any laws, policies, regula11 tions, or judicial decisions regarding people liv12 ing with HIV/AIDS, such actions shall dem13 onstrate a public health-oriented, evidence14 based, medically accurate, and contemporary 

15 understanding of— 

16 (i) the multiple factors that lead to 

17 HIV transmission; 

18 (ii) the relative risk of HIV trans19 mission routes; 

20 (iii) the current health implications of 

21 living with HIV; 

22 (iv) the associated benefits of treat23 ment and support services for people living 

24 with HIV; and 


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1 (v) the impact of punitive HIV-spe2 cific laws and policies on public health, on 

3 people living with or affected by HIV, and 

4 on their families and communities. 

5 (4) REPORT.—No later than 1 year after the 

6 date of the enactment of this Act, and annually 

7 thereafter, the Attorney General and the Secretary 

8 of Health and Human Services, acting jointly, shall 

9 transmit to Congress and make publicly available a 

10 report describing, for each State, the impact and ef11 fectiveness of the assistance provided through this 

12 Act. Each such report shall include— 

13 (A) a detailed description of the progress 

14 each State has made, if any, in implementing 

15 the best practice recommendations developed 

16 under subsection (c)(2)(C) as a result of the as17 sistance provided under this subsection, and 

18 based on the performance goals and indicators 

19 established as part of the monitoring and eval20 uation system in subsection (c)(4); 

21 (B) a brief summary of any outreach ef22 forts undertaken during the prior year by the 

23 Attorney General and the Secretary of Health 

24 and Human Services to encourage States to 

25 seek assistance under this subsection in order 


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1 to implement the best practice recommenda2 tions developed under subsection (c)(2)(C); 

3 (C) a summary of how assistance provided 

4 through this subsection is being utilized by eli5 gible State and local entities, State and local 

6 public health departments, and eligible non7 governmental organizations and, if applicable, 

8 any contractors, including with respect to non9 governmental organizations, the type of tech10 nical assistance provided, and an evaluation of 

11 the impact of such assistance on eligible State 

12 and local entities; and 

13 (D) a summary and description of eligible 

14 State and local entities, State and local public 

15 health departments, and eligible nongovern16 mental organizations receiving assistance 

17 through this subsection, including if applicable, 

18 a summary and description of any contractors 

19 selected to assist in implementing such assist20 ance. 

21 (5) DEFINITIONS.—For the purposes of this 

22 subsection: 

23 (A) ELIGIBLE STATE AND LOCAL ENTI24 TIES.—The term ‘‘eligible State and local enti25 ties’’ means the relevant individuals, offices, or 


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1 organizations that directly participate in the de2 velopment, dissemination, or implementation of 

3 State laws, policies, regulations, or judicial deci4 sions, including— 

5 (i) State governments, including State 

6 attorneys general, State departments of 

7 justice, and State National Guards, or 

8 their equivalents; 

9 (ii) State judicial and court systems, 

10 including trial courts, appellate courts, 

11 State supreme courts and courts of appeal, 

12 and State correctional facilities, or their 

13 equivalents; and 

14 (iii) local governments, including city 

15 and county governments, district attorneys, 

16 and local law enforcement departments, or 

17 their equivalents. 

18 (B) STATE AND LOCAL PUBLIC HEALTH

19 DEPARTMENTS.—The term ‘‘State and local 

20 public health departments’’ means the fol21 lowing: 

22 (i) State public health departments, or 

23 their equivalents, including the chief officer 

24 of such departments and infectious disease 


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1 and communicable disease specialists with2 in such departments. 

3 (ii) Local public health departments, 

4 or their equivalents, including city and 

5 county public health departments, the chief 

6 officer of such departments, and infectious 

7 disease and communicable disease special8 ists within such departments. 

9 (iii) Public health departments or offi10 cials, or their equivalents, within State or 

11 local correctional facilities. 

12 (iv) Public health departments or offi13 cials, or their equivalents, within State Na14 tional Guards. 

15 (v) Any other recognized State or 

16 local public health organization or entity 

17 charged with carrying out official State or 

18 local public health duties. 

19 (C) ELIGIBLE NONGOVERNMENTAL ORGA20 NIZATIONS.—The term ‘‘eligible nongovern21 mental organizations’’ means the following: 

22 (i) Nongovernmental organizations, 

23 including trade organizations or associa24 tions that represent— 


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1 (I) State attorneys general, or 

2 their equivalents; 

3 (II) State public health officials, 

4 or their equivalents; 

5 (III) State judicial and court offi6 cers, including judges, district attor7 neys, prosecutors, defense attorneys, 

8 law enforcement, and correctional offi9 cers; 

10 (IV) State National Guards; 

11 (V) people living with HIV/AIDS; 

12 (VI) legal advocacy and HIV/ 

13 AIDS service organizations that work 

14 with people living with HIV/AIDS; 

15 and 

16 (VII) nongovernmental health or17 ganizations that work on behalf of 

18 people living with HIV/AIDS. 

19 (ii) Nongovernmental organizations, 

20 including trade organizations or associa21 tions that demonstrate a public-health ori22 ented, evidence-based, medically accurate, 

23 and contemporary understanding of— 

24 (I) the multiple factors that lead 

25 to HIV transmission; 


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1 (II) the relative risk of HIV 

2 transmission routes; 

3 (III) the current health implica4 tions of living with HIV; 

5 (IV) the associated benefits of 

6 treatment and support services for 

7 people living with HIV; and 

8 (V) the impact of punitive HIV9 specific laws and policies on public 

10 health, on people living with or af11 fected by HIV, and on their families 

12 and communities. 

13 (6) AUTHORIZATION OF APPROPRIATIONS.— 

14 (A) IN GENERAL.—In addition to amounts 

15 otherwise made available, there are authorized 

16 to be appropriated to the Attorney General and 

17 the Secretary of Health and Human Services 

18 such sums as may be necessary to carry out 

19 this subsection for each of the fiscal years 2017 

20 through 2021. 

21 (B) AVAILABILITY OF FUNDS.—Amounts 

22 appropriated pursuant to the authorizations of 

23 appropriations in subparagraph (A) are author24 ized to remain available until expended. 


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1 SEC. 757. REPEAL OF LIMITATION AGAINST USE OF FUNDS 

2 FOR EDUCATION OR INFORMATION DE3 SIGNED TO PROMOTE OR ENCOURAGE, DI4 RECTLY, HOMOSEXUAL OR HETEROSEXUAL 

5 ACTIVITY OR INTRAVENOUS SUBSTANCE 

6 ABUSE. 

7 Section 2500 of the Public Health Service Act (42 

8 U.S.C. 300ee) is amended— 

9 (1) by striking subsection (c); and 

10 (2) by redesignating subsection (d) as sub11 section (c). 

12 SEC. 758. EXPANDING SUPPORT FOR CONDOMS IN PRIS13 ONS. 

14 (a) AUTHORITY TO ALLOW COMMUNITY ORGANIZA15 TIONS TO PROVIDE STI COUNSELING, STI PREVENTION

16 EDUCATION, AND SEXUAL BARRIER PROTECTION DE17 VICES IN FEDERAL CORRECTIONAL FACILITIES.— 

18 (1) DIRECTIVE TO ATTORNEY GENERAL.—Not 

19 later than 30 days after the date of enactment of 

20 this Act, the Attorney General shall direct the Bu21 reau of Prisons to allow community organizations to 

22 distribute sexual barrier protection devices and to 

23 engage in STI counseling and STI prevention edu24 cation in Federal correctional facilities. These activi25 ties shall be subject to all relevant Federal laws and 


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1 regulations which govern visitation in correctional 

2 facilities. 

3 (2) INFORMATION REQUIREMENT.—Any com4 munity organization permitted to distribute sexual 

5 barrier protection devices under paragraph (1) shall 

6 ensure that the persons to whom the devices are dis7 tributed are informed about the proper use and dis8 posal of sexual barrier protection devices in accord9 ance with established public health practices. Any 

10 community organization conducting STI counseling 

11 or STI prevention education under paragraph (1) 

12 shall offer comprehensive sexuality education. 

13 (3) POSSESSION OF DEVICE PROTECTED.—No 

14 Federal correctional facility may, because of the pos15 session or use of a sexual barrier protection device— 

16 (A) take adverse action against an incar17 cerated person; or 

18 (B) consider possession or use as evidence 

19 of prohibited activity for the purpose of any 

20 Federal correctional facility administrative pro21 ceeding. 

22 (4) IMPLEMENTATION.—The Attorney General 

23 and Bureau of Prisons shall implement this section 

24 according to established public health practices in a 

25 manner that protects the health, safety, and privacy 


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1 of incarcerated persons and of correctional facility 

2 staff. 

3 (b) SENSE OF CONGRESS REGARDING DISTRIBUTION

4 OF SEXUAL BARRIER PROTECTION DEVICES IN STATE

5 PRISON SYSTEMS.—It is the sense of the Congress that 

6 States should allow for the legal distribution of sexual bar7 rier protection devices in State correctional facilities to re8 duce the prevalence and spread of STIs in those facilities. 

9 (c) SURVEY OF AND REPORT ON CORRECTIONAL FA10 CILITY PROGRAMS AIMED AT REDUCING THE SPREAD OF

11 STIS.— 

12 (1) SURVEY.—The Attorney General, after con13 sulting with the Secretary of Health and Human 

14 Services, State officials, and community organiza15 tions, shall, to the maximum extent practicable, con16 duct a survey of all Federal and State correctional 

17 facilities, not later than 180 days after the date of 

18 enactment of this Act and annually thereafter for 5 

19 years, to determine the following: 

20 (A) COUNSELING, TREATMENT, AND SUP21 PORTIVE SERVICES.—Whether the correctional 

22 facility requires incarcerated persons to partici23 pate in counseling, treatment, and supportive 

24 services related to STIs, or whether it offers 

25 such programs to incarcerated persons. 


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1 (B) ACCESS TO SEXUAL BARRIER PROTEC2 TION DEVICES.—Whether incarcerated persons 

3 can— 

4 (i) possess sexual barrier protection 

5 devices; 

6 (ii) purchase sexual barrier protection 

7 devices; 

8 (iii) purchase sexual barrier protection 

9 devices at a reduced cost; and 

10 (iv) obtain sexual barrier protection 

11 devices without cost. 

12 (C) INCIDENCE OF SEXUAL VIOLENCE.— 

13 The incidence of sexual violence and assault 

14 committed by incarcerated persons and by cor15 rectional facility staff. 

16 (D) PREVENTION EDUCATION OFFERED.— 

17 The type of prevention education, information, 

18 or training offered to incarcerated persons and 

19 correctional facility staff regarding sexual vio20 lence and the spread of STIs, including whether 

21 such education, information, or training— 

22 (i) constitutes comprehensive sexuality 

23 education; 

24 (ii) is compulsory for new incarcerated 

25 persons and for new staff; and 


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1 (iii) is offered on an ongoing basis. 

2 (E) STI TESTING.—Whether the correc3 tional facility tests incarcerated persons for 

4 STIs or gives them the option to undergo such 

5 testing— 

6 (i) at intake; 

7 (ii) on a regular basis; and 

8 (iii) prior to release. 

9 (F) STI TEST RESULTS.—The number of 

10 incarcerated persons who are tested for STIs 

11 and the outcome of such tests at each correc12 tional facility, disaggregated to include results 

13 for— 

14 (i) the type of sexually transmitted in15 fection tested for; 

16 (ii) the race and/or ethnicity of indi17 viduals tested; 

18 (iii) the age of individuals tested; and 

19 (iv) the gender of individuals tested. 

20 (G) PRERELEASE REFERRAL POLICY.— 

21 Whether incarcerated persons are informed 

22 prior to release about STI-related services or 

23 other health services in their communities, in24 cluding free and low-cost counseling and treat25 ment options. 


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1 (H) PRERELEASE REFERRALS MADE.— 

2 The number of referrals to community-based 

3 organizations or public health facilities offering 

4 STI-related or other health services provided to 

5 incarcerated persons prior to release, and the 

6 type of counseling or treatment for which the 

7 referral was made. 

8 (I) REINSTATEMENT OF MEDICAID BENE9 FITS.—Whether the correctional facility assists 

10 incarcerated persons that were enrolled in the 

11 State Medicaid program prior to their incarcer12 ation, in reinstating their enrollment upon re13 lease and whether such individuals receive refer14 rals as provided by subparagraph (G) to entities 

15 that accept the State Medicaid program, includ16 ing if applicable— 

17 (i) the number of such individuals, in18 cluding those diagnosed with the human 

19 immunodeficiency virus, that have been re20 instated; 

21 (ii) a list of obstacles to reinstating 

22 enrollment or to making determinations of 

23 eligibility for reinstatement, if any; and 

24 (iii) the number of individuals denied 

25 enrollment. 


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1 (J) OTHER ACTIONS TAKEN.—Whether the 

2 correctional facility has taken any other action, 

3 in conjunction with community organizations or 

4 otherwise, to reduce the prevalence and spread 

5 of STIs in that facility. 

6 (2) PRIVACY.—In conducting the survey, the 

7 Attorney General shall not request or retain the 

8 identity of any person who has sought or been of9 fered counseling, treatment, testing, or prevention 

10 education information regarding an STI (including 

11 information about sexual barrier protection devices), 

12 or who has tested positive for an STI. 

13 (3) REPORT.—The Attorney General shall 

14 transmit to Congress and make publicly available 

15 the results of the survey required under paragraph 

16 (1), both for the Nation as a whole and 

17 disaggregated as to each State and each correctional 

18 facility. To the maximum extent possible, the Attor19 ney General shall issue the first report no later than 

20 1 year after the date of enactment of this Act and 

21 shall issue reports annually thereafter for 5 years. 

22 (d) STRATEGY.— 

23 (1) DIRECTIVE TO ATTORNEY GENERAL.—The 

24 Attorney General, in consultation with the Secretary 

25 of Health and Human Services, State officials, and 


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1 community organizations, shall develop and imple2 ment a 5-year strategy to reduce the prevalence and 

3 spread of STIs in Federal and State correctional fa4 cilities. To the maximum extent possible, the strat5 egy shall be developed, transmitted to Congress, and 

6 made publicly available no later than 180 days after 

7 the transmission of the first report required under 

8 subsection (c)(3). 

9 (2) CONTENTS OF STRATEGY.—The strategy 

10 shall include the following: 

11 (A) PREVENTION EDUCATION.—A plan for 

12 improving prevention education, information, 

13 and training offered to incarcerated persons 

14 and correctional facility staff, including infor15 mation and training on sexual violence and the 

16 spread of STIs, and comprehensive sexuality 

17 education. 

18 (B) SEXUAL BARRIER PROTECTION DEVICE

19 ACCESS.—A plan for expanding access to sexual 

20 barrier protection devices in correctional facili21 ties. 

22 (C) SEXUAL VIOLENCE REDUCTION.—A 

23 plan for reducing the incidence of sexual vio24 lence among incarcerated persons and correc25 tional facility staff, developed in consultation 


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1 with the National Prison Rape Elimination 

2 Commission. 

3 (D) COUNSELING AND SUPPORTIVE SERV4 ICES.—A plan for expanding access to coun5 seling and supportive services related to STIs in 

6 correctional facilities. 

7 (E) TESTING.—A plan for testing incarcer8 ated persons for STIs during intake, during 

9 regular health exams, and prior to release, and 

10 that— 

11 (i) is conducted in accordance with 

12 guidelines established by the Centers for 

13 Disease Control and Prevention; 

14 (ii) includes pretest counseling; 

15 (iii) requires that incarcerated persons 

16 are notified of their option to decline test17 ing at any time; 

18 (iv) requires that incarcerated persons 

19 are confidentially notified of their test re20 sults in a timely manner; and 

21 (v) ensures that incarcerated persons 

22 testing positive for STIs receive post-test 

23 counseling, care, treatment, and supportive 

24 services. 


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1 (F) TREATMENT.—A plan for ensuring 

2 that correctional facilities have the necessary 

3 medicine and equipment to treat and monitor 

4 STIs and for ensuring that incarcerated per5 sons living with or testing positive for STIs re6 ceive and have access to care and treatment 

7 services. 

8 (G) STRATEGIES FOR DEMOGRAPHIC

9 GROUPS.—A plan for developing and imple10 menting culturally appropriate, sensitive, and 

11 specific strategies to reduce the spread of STIs 

12 among demographic groups heavily impacted by 

13 STIs. 

14 (H) LINKAGES WITH COMMUNITIES AND

15 FACILITIES.—A plan for establishing and 

16 strengthening linkages to local communities and 

17 health facilities that— 

18 (i) provide counseling, testing, care, 

19 and treatment services; 

20 (ii) may receive persons recently re21 leased from incarceration who are living 

22 with STIs; and 

23 (iii) accept payment through the State 

24 Medicaid program. 


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1 (I) ENROLLMENT IN STATE MEDICAID

2 PROGRAMS.—Plans to ensure that incarcerated 

3 persons who were— 

4 (i) enrolled in their State Medicaid 

5 program prior to incarceration in a correc6 tional facility are automatically re-enrolled 

7 in such program upon their release; and 

8 (ii) not enrolled in their State Med9 icaid program prior to incarceration, but 

10 who are diagnosed with the human im11 munodeficiency virus while incarcerated in 

12 a correctional facility, are automatically 

13 enrolled in such program upon their re14 lease. 

15 (J) OTHER PLANS.—Any other plans de16 veloped by the Attorney General for reducing 

17 the spread of STIs or improving the quality of 

18 health care in correctional facilities. 

19 (K) MONITORING SYSTEM.—A monitoring 

20 system that establishes performance goals re21 lated to reducing the prevalence and spread of 

22 STIs in correctional facilities and which, where 

23 feasible, expresses such goals in quantifiable 

24 form. 


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1 (L) MONITORING SYSTEM PERFORMANCE

2 INDICATORS.—Performance indicators that 

3 measure or assess the achievement of the per4 formance goals described in subparagraph (K). 

5 (M) COST ESTIMATE.—A detailed estimate 

6 of the funding necessary to implement the 

7 strategy at the Federal and State levels for all 

8 5 years, including the amount of funds required 

9 by community organizations to implement the 

10 parts of the strategy in which they take part. 

11 (3) REPORT.—The Attorney General shall 

12 transmit to Congress and make publicly available an 

13 annual progress report regarding the implementation 

14 and effectiveness of the strategy described in para15 graph (1). The progress report shall include an eval16 uation of the implementation of the strategy using 

17 the monitoring system and performance indicators 

18 provided for in subparagraphs (K) and (L) of para19 graph (2). 

20 (e) AUTHORIZATION OF APPROPRIATIONS.— 

21 (1) IN GENERAL.—There are authorized to be 

22 appropriated such sums as may be necessary to 

23 carry out this section for each of fiscal years 2017 

24 through 2021. 


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1 (2) AVAILABILITY OF FUNDS.—Amounts made 

2 available under paragraph (1) are authorized to re3 main available until expended. 

4 (f) DEFINITIONS.—For the purposes of this section: 

5 (1) COMMUNITY ORGANIZATION.—The term 

6 ‘‘community organization’’ means a public health 

7 care facility or a nonprofit organization which pro8 vides health- or STI-related services according to es9 tablished public health standards. 

10 (2) COMPREHENSIVE SEXUALITY EDUCATION.— 

11 The term ‘‘comprehensive sexuality education’’ 

12 means sexuality education that includes information 

13 about abstinence and about the proper use and dis14 posal of sexual barrier protection devices and which 

15 is— 

16 (A) evidence-based; 

17 (B) medically accurate; 

18 (C) age and developmentally appropriate; 

19 (D) gender and identity sensitive; 

20 (E) culturally and linguistically appro21 priate; and 

22 (F) structured to promote critical thinking, 

23 self-esteem, respect for others, and the develop24 ment of healthy attitudes and relationships. 


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1 (3) CORRECTIONAL FACILITY.—The term ‘‘cor2 rectional facility’’ means any prison, penitentiary, 

3 adult detention facility, juvenile detention facility, 

4 jail, or other facility to which persons may be sent 

5 after conviction of a crime or act of juvenile delin6 quency within the United States. 

7 (4) INCARCERATED PERSON.—The term ‘‘incar8 cerated person’’ means any person who is serving a 

9 sentence in a correctional facility after conviction of 

10 a crime. 

11 (5) SEXUALLY TRANSMITTED INFECTION.—The 

12 term ‘‘sexually transmitted infection’’ or ‘‘STI’’ 

13 means any disease or infection that is commonly 

14 transmitted through sexual activity, including HIV/ 

15 AIDS, gonorrhea, chlamydia, syphilis, genital her16 pes, viral hepatitis, and human papillomavirus. 

17 (6) SEXUAL BARRIER PROTECTION DEVICE.— 

18 The term ‘‘sexual barrier protection device’’ means 

19 any FDA-approved physical device which has not 

20 been tampered with and which reduces the prob21 ability of STI transmission or infection between sex22 ual partners, including female condoms, male 

23 condoms, and dental dams. 

24 (7) STATE.—The term ‘‘State’’ includes the 

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1 monwealth of the Northern Mariana Islands, Guam, 

2 Puerto Rico, and the United States Virgin Islands. 

3 SEC. 759. AUTOMATIC REINSTATEMENT OR ENROLLMENT 

4 IN MEDICAID FOR PEOPLE WHO TEST POSI5 TIVE FOR HIV BEFORE REENTERING COMMU6 NITIES. 

7 (a) IN GENERAL.—Section 1902(e) of the Social Se8 curity Act (42 U.S.C. 1396a(e)) is amended by adding at 

9 the end the following: 

10 ‘‘(15) ENROLLMENT OF EX-OFFENDERS.— 

11 ‘‘(A) AUTOMATIC ENROLLMENT OR REIN12 STATEMENT.— 

13 ‘‘(i) IN GENERAL.—The State plan 

14 shall provide for the automatic enrollment 

15 or reinstatement of enrollment of an eligi16 ble individual— 

17 ‘‘(I) if such individual is sched18 uled to be released from a public insti19 tution due to the completion of sen20 tence, not less than 30 days prior to 

21 the scheduled date of the release; and 

22 ‘‘(II) if such individual is to be 

23 released from a public institution on 

24 parole or on probation, as soon as 

25 possible after the date on which the 


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1 determination to release such indi2 vidual was made, and before the date 

3 such individual is released. 

4 ‘‘(ii) EXCEPTION.—If a State makes a 

5 determination that an individual is not eli6 gible to be enrolled under the State plan— 

7 ‘‘(I) on or before the date by 

8 which the individual would be enrolled 

9 under clause (i), such clause shall not 

10 apply to such individual; or 

11 ‘‘(II) after such date, the State 

12 may terminate the enrollment of such 

13 individual. 

14 ‘‘(B) RELATIONSHIP OF ENROLLMENT TO

15 PAYMENT FOR SERVICES.— 

16 ‘‘(i) IN GENERAL.—Subject to sub17 paragraph (A)(ii), an eligible individual 

18 who is enrolled, or whose enrollment is re19 instated, under subparagraph (A) shall be 

20 eligible for medical assistance that is pro21 vided after the date that the eligible indi22 vidual is released from the public institu23 tion. 

24 ‘‘(ii) RELATIONSHIP TO PAYMENT

25 PROHIBITION FOR INMATES.—No provision 


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1 of this paragraph may be construed to per2 mit payment for care or services for which 

3 payment is excluded under the subdivision 

4 (A) that follows paragraph (30) of section 

5 1905(a). 

6 ‘‘(C) TREATMENT OF CONTINUOUS ELIGI7 BILITY.— 

8 ‘‘(i) SUSPENSION FOR INMATES.—Any 

9 period of continuous eligibility under this 

10 title shall be suspended on the date an in11 dividual enrolled under this title becomes 

12 an inmate of a public institution (except as 

13 a patient of a medical institution). 

14 ‘‘(ii) DETERMINATION OF REMAINING

15 PERIOD.—Notwithstanding any changes to 

16 State law related to continuous eligibility 

17 during the time that an individual is an in18 mate of a public institution (except as a 

19 patient of a medical institution), subject to 

20 clause (iii), with respect to an eligible indi21 vidual who was subject to a suspension 

22 under clause (i), on the date that such in23 dividual is released from a public institu24 tion the suspension of continuous eligibility 

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1 riod that is equal to the time remaining in 

2 the period of continuous eligibility for such 

3 individual on the date that such period was 

4 suspended under such clause. 

5 ‘‘(iii) EXCEPTION.—If a State makes 

6 a determination that an individual is not 

7 eligible to be enrolled under the State 

8 plan— 

9 ‘‘(I) on or before the date that 

10 the suspension of continuous eligibility 

11 is lifted under clause (ii), such clause 

12 shall not apply to such individual; or 

13 ‘‘(II) after such date, the State 

14 may terminate the enrollment of such 

15 individual. 

16 ‘‘(D) AUTOMATIC ENROLLMENT OR REIN17 STATEMENT OF ENROLLMENT DEFINED.—For 

18 purposes of this paragraph, the term ‘automatic 

19 enrollment or reinstatement of enrollment’ 

20 means that the State determines eligibility for 

21 medical assistance under the State plan without 

22 a program application from, or on behalf of, the 

23 eligible individual, but an individual can only be 

24 automatically enrolled in the State Medicaid 

25 plan if the individual affirmatively consents to 


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1 being enrolled through affirmation in writing, 

2 by telephone, orally, through electronic signa3 ture, or through any other means specified by 

4 the Secretary. 

5 ‘‘(E) ELIGIBLE INDIVIDUAL DEFINED.— 

6 For purposes of this paragraph, the term ‘eligi7 ble individual’ means an individual who is an 

8 inmate of a public institution (except as a pa9 tient in a medical institution)— 

10 ‘‘(i) who was enrolled under the State 

11 plan for medical assistance immediately be12 fore becoming an inmate of such an insti13 tution; or 

14 ‘‘(ii) is diagnosed with human im15 munodeficiency virus.’’. 

16 (b) SUPPLEMENTAL FUNDING FOR STATE IMPLE17 MENTATION OF AUTOMATIC REINSTATEMENT OF MED18 ICAID BENEFITS.— 

19 (1) IN GENERAL.—Subject to paragraph (6), 

20 for each State for which the Secretary of Health and 

21 Human Services has approved an application under 

22 paragraph (3), the Federal matching payments (in23 cluding payments based on the Federal medical as24 sistance percentage) made to such State under sec25 tion 1903 of the Social Security Act (42 U.S.C. 


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1 1396b) shall be increased by 5.0 percentage points 

2 for payments to the State for the activities per3 mitted under paragraph (2) or a period of one year. 

4 (2) USE OF FUNDS.—A State may only use in5 creased matching payments authorized under para6 graph (1)— 

7 (A) to strengthen the State’s enrollment 

8 and administrative resources for the purpose of 

9 improving processes for enrolling (or reinstating 

10 the enrollment of) eligible individuals (as such 

11 term is defined in subparagraph (E) of para12 graph (15) of section 1902(e) of the Social Se13 curity Act (as amended by subsection (a))); and 

14 (B) for medical assistance (as such term is 

15 defined in section 1905(a) of the Social Secu16 rity Act) provided to such eligible individuals. 

17 (3) APPLICATION AND AGREEMENT.—The Sec18 retary may only make payments to a State in the in19 creased amount if— 

20 (A) the State has amended the State plan 

21 under section 1902(e) of the Social Security 

22 Act to incorporate the requirements of para23 graph (15) of such section (as added by sub24 section (a)); 


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1 (B) the State has submitted an application 

2 to the Secretary that includes a plan for imple3 menting the requirements of section 

4 1902(e)(15) of the Social Security Act under 

5 the State’s amended State plan before the end 

6 of the 90-day period beginning on the date that 

7 the State receives increased matching payments 

8 under paragraph (1); 

9 (C) the State’s application meets the satis10 faction of the Secretary; and 

11 (D) the State enters an agreement with 

12 the Secretary that states that— 

13 (i) the State will only use the in14 creased matching funds for the uses per15 mitted under paragraph (2); and 

16 (ii) at the end of the period under 

17 paragraph (1), the State will submit to the 

18 Secretary, and make publicly available, a 

19 report that contains the information re20 quired under paragraph (4). 

21 (4) REQUIRED REPORT INFORMATION.—The in22 formation that is required in the report under para23 graph (3)(D)(ii) includes— 

24 (A) the results of an evaluation of the im25 pact of the implementation of the requirements 


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1 of section 1902(e)(15) of the Social Security 

2 Act on improving the State’s processes for en3 rolling of individuals who are released from 

4 public institutions into the Medicaid program; 

5 (B) the number of individuals who were 

6 automatically enrolled (or whose enrollment is 

7 reinstated) under such section 1902(e)(15) dur8 ing the period under paragraph (1); and 

9 (C) any other information that is required 

10 by the Secretary. 

11 (5) INCREASE IN CAP ON MEDICAID PAYMENTS

12 TO TERRITORIES.—Subject to paragraph (6), the 

13 amounts otherwise determined for Puerto Rico, the 

14 United States Virgin Islands, Guam, the Northern 

15 Mariana Islands, and American Samoa under sub16 sections (f) and (g) of section 1108 of the Social Se17 curity Act (42 U.S.C. 1308) shall each be increased 

18 by the necessary amount to allow for the increase in 

19 the Federal matching payments under paragraph 

20 (1), but only for the period under such paragraph 

21 for such State. In the case of such an increase for 

22 a territory, subsection (a)(1) of such section 1108 

23 shall be applied without regard to any increase in 

24 payment made to the territory under part E of title 

25 IV of such Act that is attributable to the increase 


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1 in Federal medical assistance percentage effected 

2 under paragraph (1) for the territory. 

3 (6) LIMITATIONS.— 

4 (A) TIMING.—With respect to a State, at 

5 the end of the period under paragraph (1), no 

6 increased matching payments may be made to 

7 such State under this subsection. 

8 (B) MAINTENANCE OF ELIGIBILITY.— 

9 (i) IN GENERAL.—Subject to clause 

10 (ii), a State is not eligible for an increase 

11 in its Federal matching payments under 

12 paragraph (1), or an increase in a cap 

13 amount under paragraph (5), if eligibility 

14 standards, methodologies, or procedures 

15 under its State plan under title XIX of the 

16 Social Security Act (including any waiver 

17 under such title or under section 1115 of 

18 such Act (42 U.S.C. 1315)) are more re19 strictive than the eligibility standards, 

20 methodologies, or procedures, respectively, 

21 under such plan (or waiver) as in effect on 

22 the date of enactment of this Act. 

23 (ii) STATE REINSTATEMENT OF ELIGI24 BILITY PERMITTED.—A State that has re25 stricted eligibility standards, methodoloVerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00607 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475

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1 gies, or procedures under its State plan 

2 under title XIX of the Social Security Act 

3 (including any waiver under such title or 

4 under section 1115 of such Act (42 U.S.C. 

5 1315)) after the date of enactment of this 

6 Act, is no longer ineligible under subpara7 graph (A) beginning with the first calendar 

8 quarter in which the State has reinstated 

9 eligibility standards, methodologies, or pro10 cedures that are no more restrictive than 

11 the eligibility standards, methodologies, or 

12 procedures, respectively, under such plan 

13 (or waiver) as in effect on such date. 

14 (C) NO WAIVER AUTHORITY.—The Sec15 retary may not waive the application of this 

16 subsection under section 1115 of the Social Se17 curity Act or otherwise. 

18 (D) LIMITATION OF MATCHING PAYMENTS

19 TO 100 PERCENT.—In no case shall an increase 

20 in Federal matching payments under this sub21 section result in Federal matching payments 

22 that exceed 100 percent. 

23 (c) EFFECTIVE DATE.— 

24 (1) IN GENERAL.—Except as provided in para25 graph (2), the amendments made by subsection (a) 


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1 shall take effect 180 days after the date of the en2 actment of this Act and shall apply to services fur3 nished on or after such date. 

4 (2) RULE FOR CHANGES REQUIRING STATE

5 LEGISLATION.—In the case of a State plan for med6 ical assistance under title XIX of the Social Security 

7 Act which the Secretary of Health and Human Serv8 ices determines requires State legislation (other than 

9 legislation appropriating funds) in order for the plan 

10 to meet the additional requirement imposed by the 

11 amendments made by this section, the State plan 

12 shall not be regarded as failing to comply with the 

13 requirements of such title solely on the basis of its 

14 failure to meet this additional requirement before 

15 the first day of the first calendar quarter beginning 

16 after the close of the first regular session of the 

17 State legislature that begins after the date of the en18 actment of this Act. For purposes of the previous 

19 sentence, in the case of a State that has a 2-year 

20 legislative session, each year of such session shall be 

21 deemed to be a separate regular session of the State 

22 legislature. 

23 SEC. 760. STOP AIDS IN PRISON. 

24 (a) SHORT TITLE.—This section may be cited as the 

25 ‘‘Stop AIDS in Prison Act’’. 


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1 (b) IN GENERAL.—The Bureau of Prisons (herein2 after in this section referred to as the ‘‘Bureau’’) shall 

3 develop a comprehensive policy to provide HIV testing, 

4 treatment, and prevention for inmates within the correc5 tional setting and upon reentry. 

6 (c) PURPOSE.—The purposes of this policy shall be 

7 as follows: 

8 (1) To stop the spread of HIV/AIDS among in9 mates. 

10 (2) To protect prison guards and other per11 sonnel from HIV/AIDS infection. 

12 (3) To provide comprehensive medical treat13 ment to inmates who are living with HIV/AIDS. 

14 (4) To promote HIV/AIDS awareness and pre15 vention among inmates. 

16 (5) To encourage inmates to take personal re17 sponsibility for their health. 

18 (6) To reduce the risk that inmates will trans19 mit HIV/AIDS to other persons in the community 

20 following their release from prison. 

21 (d) CONSULTATION.—The Bureau shall consult with 

22 appropriate officials of the Department of Health and 

23 Human Services, the Office of National Drug Control Pol24 icy, the Office of National AIDS Policy, and the Centers 


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1 for Disease Control and Prevention regarding the develop2 ment of this policy. 

3 (e) TIME LIMIT.—The Bureau shall draft appro4 priate regulations to implement this policy not later than 

5 1 year after the date of the enactment of this Act. 

6 (f) REQUIREMENTS FOR POLICY.—The policy created 

7 under subsection (b) shall provide for the following: 

8 (1) TESTING AND COUNSELING UPON IN9 TAKE.— 

10 (A) Health care personnel shall provide 

11 routine HIV testing to all inmates as a part of 

12 a comprehensive medical examination imme13 diately following admission to a facility. (Health 

14 care personnel need not provide routine HIV 

15 testing to an inmate who is transferred to a fa16 cility from another facility if the inmate’s med17 ical records are transferred with the inmate and 

18 indicate that the inmate has been tested pre19 viously.) 

20 (B) To all inmates admitted to a facility 

21 prior to the effective date of this policy, health 

22 care personnel shall provide routine HIV testing 

23 within no more than 6 months. HIV testing for 

24 these inmates may be performed in conjunction 


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1 with other health services provided to these in2 mates by health care personnel. 

3 (C) All HIV tests under this paragraph 

4 shall comply with the opt-out provision. 

5 (2) PRE-TEST AND POST-TEST COUNSELING.— 

6 Health care personnel shall provide confidential pre7 test and post-test counseling to all inmates who are 

8 tested for HIV. Counseling may be included with 

9 other general health counseling provided to inmates 

10 by health care personnel. 

11 (3) HIV/AIDS PREVENTION EDUCATION.— 

12 (A) Health care personnel shall improve 

13 HIV/AIDS awareness through frequent edu14 cational programs for all inmates. HIV/AIDS 

15 educational programs may be provided by com16 munity-based organizations, local health depart17 ments, and inmate peer educators. 

18 (B) HIV/AIDS educational materials shall 

19 be made available to all inmates at orientation, 

20 at health care clinics, at regular educational 

21 programs, and prior to release. Both written 

22 and audiovisual materials shall be made avail23 able to all inmates. 


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1 (C)(i) The HIV/AIDS educational pro2 grams and materials under this paragraph shall 

3 include information on— 

4 (I) modes of transmission, including 

5 transmission through tattooing, sexual con6 tact, and intravenous drug use; 

7 (II) prevention methods; 

8 (III) treatment; and 

9 (IV) disease progression. 

10 (ii) The programs and materials shall be 

11 culturally sensitive, written or designed for low12 literacy levels, available in a variety of lan13 guages, and present scientifically accurate in14 formation in a clear and understandable man15 ner. 

16 (4) HIV TESTING UPON REQUEST.— 

17 (A) Health care personnel shall allow in18 mates to obtain HIV tests upon request once 

19 per year or whenever an inmate has a reason to 

20 believe the inmate may have been exposed to 

21 HIV. Health care personnel shall, both orally 

22 and in writing, inform inmates, during orienta23 tion and periodically throughout incarceration, 

24 of their right to obtain HIV tests. 


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1 (B) Health care personnel shall encourage 

2 inmates to request HIV tests if the inmate is 

3 sexually active, has been raped, uses intra4 venous drugs, receives a tattoo, or if the inmate 

5 is concerned that the inmate may have been ex6 posed to HIV/AIDS. 

7 (C) An inmate’s request for an HIV test 

8 shall not be considered an indication that the 

9 inmate has put him/herself at risk of infection 

10 and/or committed a violation of prison rules. 

11 (5) HIV TESTING OF PREGNANT WOMAN.— 

12 (A) Health care personnel shall provide 

13 routine HIV testing to all inmates who become 

14 pregnant. 

15 (B) All HIV tests under this paragraph 

16 shall comply with the opt-out provision. 

17 (6) COMPREHENSIVE TREATMENT.— 

18 (A) Health care personnel shall provide all 

19 inmates who test positive for HIV— 

20 (i) timely, comprehensive medical 

21 treatment; 

22 (ii) confidential counseling on man23 aging their medical condition and pre24 venting its transmission to other persons; 

25 and 


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1 (iii) voluntary partner notification 

2 services. 

3 (B) Health care provided under this para4 graph shall be consistent with current Depart5 ment of Health and Human Services guidelines 

6 and standard medical practice. Health care per7 sonnel shall discuss treatment options, the im8 portance of adherence to antiretroviral therapy, 

9 and the side effects of medications with inmates 

10 receiving treatment. 

11 (C) Health care personnel and pharmacy 

12 personnel shall ensure that the facility for13 mulary contains all Food and Drug Administra14 tion-approved medications necessary to provide 

15 comprehensive treatment for inmates living with 

16 HIV/AIDS, and that the facility maintains ade17 quate supplies of such medications to meet in18 mates’ medical needs. Health care personnel 

19 and pharmacy personnel shall also develop and 

20 implement automatic renewal systems for these 

21 medications to prevent interruptions in care. 

22 (D) Correctional staff, health care per23 sonnel, and pharmacy personnel shall develop 

24 and implement distribution procedures to enVerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00615 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475

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1 sure timely and confidential access to medica2 tions. 

3 (7) PROTECTION OF CONFIDENTIALITY.— 

4 (A) Health care personnel shall develop 

5 and implement procedures to ensure the con6 fidentiality of inmate tests, diagnoses, and 

7 treatment. Health care personnel and correc8 tional staff shall receive regular training on the 

9 implementation of these procedures. Penalties 

10 for violations of inmate confidentiality by health 

11 care personnel or correctional staff shall be 

12 specified and strictly enforced. 

13 (B) HIV testing, counseling, and treat14 ment shall be provided in a confidential setting 

15 where other routine health services are provided 

16 and in a manner that allows the inmate to re17 quest and obtain these services as routine med18 ical services. 

19 (8) TESTING, COUNSELING, AND REFERRAL

20 PRIOR TO REENTRY.— 

21 (A) Health care personnel shall provide 

22 routine HIV testing to all inmates no more 

23 than 3 months prior to their release and re24 entry into the community. (Inmates who are al25 ready known to be infected need not be tested 


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1 again.) This requirement may be waived if an 

2 inmate’s release occurs without sufficient notice 

3 to the Bureau to allow health care personnel to 

4 perform a routine HIV test and notify the in5 mate of the results. 

6 (B) All HIV tests under this paragraph 

7 shall comply with the opt-out provision. 

8 (C) To all inmates who test positive for 

9 HIV and all inmates who already are known to 

10 have HIV/AIDS, health care personnel shall 

11 provide— 

12 (i) confidential prerelease counseling 

13 on managing their medical condition in the 

14 community, accessing appropriate treat15 ment and services in the community, and 

16 preventing the transmission of their condi17 tion to family members and other persons 

18 in the community; 

19 (ii) referrals to appropriate health 

20 care providers and social service agencies 

21 in the community that meet the inmate’s 

22 individual needs, including voluntary part23 ner notification services and prevention 

24 counseling services for people living with 

25 HIV/AIDS; and 


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1 (iii) a 30-day supply of any medically 

2 necessary medications the inmate is cur3 rently receiving. 

4 (9) OPT-OUT PROVISION.—Inmates shall have 

5 the right to refuse routine HIV testing. Inmates 

6 shall be informed both orally and in writing of this 

7 right. Oral and written disclosure of this right may 

8 be included with other general health information 

9 and counseling provided to inmates by health care 

10 personnel. If an inmate refuses a routine test for 

11 HIV, health care personnel shall make a note of the 

12 inmate’s refusal in the inmate’s confidential medical 

13 records. However, the inmate’s refusal shall not be 

14 considered a violation of prison rules or result in dis15 ciplinary action. Any reference in this section to the 

16 ‘‘opt-out provision’’ shall be deemed a reference to 

17 the requirement of this paragraph. 

18 (10) EXCLUSION OF TESTS PERFORMED UNDER

19 SECTION 4014(b) FROM THE DEFINITION OF ROU20 TINE HIV TESTING.—HIV testing of an inmate 

21 under section 4014(b) of title 18, United States 

22 Code, is not routine HIV testing for the purposes of 

23 the opt-out provision. Health care personnel shall 

24 document the reason for testing under section 


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1 4014(b) of title 18, United States Code, in the in2 mate’s confidential medical records. 

3 (11) TIMELY NOTIFICATION OF TEST RE4 SULTS.—Health care personnel shall provide timely 

5 notification to inmates of the results of HIV tests. 

6 (g) CHANGES IN EXISTING LAW.— 

7 (1) SCREENING IN GENERA.—Section 4014(a) 

8 of title 18, United States Code, is amended— 

9 (A) by striking ‘‘for a period of 6 months 

10 or more’’; 

11 (B) by striking ‘‘, as appropriate,’’; and 

12 (C) by striking ‘‘if such individual is deter13 mined to be at risk for infection with such virus 

14 in accordance with the guidelines issued by the 

15 Bureau of Prisons relating to infectious disease 

16 management’’ and inserting ‘‘unless the indi17 vidual declines. The Attorney General shall also 

18 cause such individual to be so tested before re19 lease unless the individual declines.’’. 

20 (2) INADMISSIBILITY OF HIV TEST RESULTS IN

21 CIVIL AND CRIMINAL PROCEEDINGS.—Section 

22 4014(d) of title 18, United States Code, is amended 

23 by inserting ‘‘or under the Stop AIDS in Prison 

24 Act’’ after ‘‘under this section’’. 


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1 (3) SCREENING AS PART OF ROUTINE SCREEN2 ING.—Section 4014(e) of title 18, United States 

3 Code, is amended by adding at the end the fol4 lowing: ‘‘Such rules shall also provide that the initial 

5 test under this section be performed as part of the 

6 routine health screening conducted at intake.’’. 

7 (h) REPORTING REQUIREMENTS.— 

8 (1) REPORT ON HEPATITIS, LIVER, AND OTHER

9 DISEASES.—Not later than 1 year after the date of 

10 the enactment of this Act, the Bureau shall provide 

11 a report to the Congress on Bureau policies and pro12 cedures to provide testing, treatment, and prevention 

13 education programs for hepatitis, liver failure, and 

14 other liver-related diseases transmitted through sex15 ual activity, intravenous drug use, or other means. 

16 The Bureau shall consult with appropriate officials 

17 of the Department of Health and Human Services, 

18 the Office of National Drug Control Policy, the Of19 fice of National AIDS Policy, and the Centers for 

20 Disease Control and Prevention regarding the devel21 opment of this report. 

22 (2) ANNUAL REPORTS.— 

23 (A) GENERALLY.—Not later than 2 years 

24 after the date of the enactment of this Act, and 

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1 port to Congress on the incidence among in2 mates of diseases transmitted through sexual 

3 activity and intravenous drug use. 

4 (B) MATTERS PERTAINING TO VARIOUS

5 DISEASES.—Reports under paragraph (1) shall 

6 discuss— 

7 (i) the incidence among inmates of 

8 HIV/AIDS, hepatitis, and other diseases 

9 transmitted through sexual activity and in10 travenous drug use; and 

11 (ii) updates on Bureau testing, treat12 ment, and prevention education programs 

13 for these diseases. 

14 (C) MATTERS PERTAINING TO HIV/AIDS

15 ONLY.—Reports under paragraph (1) shall also 

16 include— 

17 (i) the number of inmates who tested 

18 positive for HIV upon intake; 

19 (ii) the number of inmates who tested 

20 positive prior to reentry; 

21 (iii) the number of inmates who were 

22 not tested prior to reentry because they 

23 were released without sufficient notice; 

24 (iv) the number of inmates who opted25 out of taking the test; 


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1 (v) the number of inmates who were 

2 tested under section 4014(b) of title 18, 

3 United States Code; and 

4 (vi) the number of inmates under 

5 treatment for HIV/AIDS. 

6 (D) CONSULTATION.—The Bureau shall 

7 consult with appropriate officials of the Depart8 ment of Health and Human Services, the Office 

9 of National Drug Control Policy, the Office of 

10 National AIDS Policy, and the Centers for Dis11 ease Control and Prevention regarding the de12 velopment of reports under paragraph (1). 

13 SEC. 761. SUPPORT DATA SYSTEM REVIEW AND INDICA14 TORS FOR MONITORING HIV CARE. 

15 The Secretary of Health and Human Services, in col16 laboration with the Assistant Secretary for Health, the Di17 rector of the Office of HIV/AIDS and Infectious Disease 

18 Policy, the Director of the Centers for Disease Control and 

19 Prevention, the Administrator of the Substance Abuse and 

20 Mental Health Services Administration, the Director of 

21 the Department of Housing and Urban Development, the 

22 Director of the Office of AIDS Research, the Adminis23 trator of the Health Resources and Services Administra24 tion, and the Administrator of the Centers for Medicare 

25 & Medicaid Services, shall expand and coordinate efforts 


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1 to align metrics across agencies and modify Federal data 

2 systems, to— 

3 (1) adopt the Institute of Medicine’s clinical 

4 HIV care indicators as the core metrics for moni5 toring the quality of HIV care, mental health, sub6 stance abuse, and supportive services; 

7 (2) better enable assessment of the impact of 

8 the National HIV/AIDS Strategy and the Patient 

9 Protection and Affordable Care Act on improving 

10 HIV/AIDS care and access to supportive services for 

11 individuals with HIV; 

12 (3) expand the demographic data elements to be 

13 captured by Federal data systems relevant to HIV 

14 care to permit calculation of the indicators for sub15 groups of the population of people with diagnosed 

16 HIV infection, including— 

17 (A) age; 

18 (B) race; 

19 (C) ethnicity; 

20 (D) sex (assigned at birth); 

21 (E) gender identity; 

22 (F) sexual orientation; 

23 (G) current geographic marker of resi24 dence; 

25 (H) income or poverty level; and 


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1 (I) primary means of reimbursement for 

2 medical services (including Medicaid, Medicare, 

3 the Ryan White HIV/AIDS Program, private 

4 insurance, health maintenance organizations, 

5 and no coverage); and 

6 (4) streamline data collection and systematically 

7 review all existing reporting requirements for feder8 ally funded HIV/AIDS programs to ensure that only 

9 essential data are collected. 

10 SEC. 762. TRANSFER OF FUNDS FOR IMPLEMENTATION OF 

11 NATIONAL HIV/AIDS STRATEGY. 

12 Title II of the Public Health Service Act (42 U.S.C. 

13 202 et seq.) is amended by inserting after section 241 the 

14 following: 

15 ‘‘SEC. 241A. TRANSFER OF FUNDS FOR IMPLEMENTATION 

16 OF NATIONAL HIV/AIDS STRATEGY. 

17 ‘‘(a) TRANSFER AUTHORIZATION.—Of the discre18 tionary appropriations made available to the Department 

19 of Health and Human Services for any fiscal year for pro20 grams and activities that, as determined by the Secretary 

21 of Health and Human Services, pertain to HIV/AIDS, the 

22 Secretary, in coordination with the Director of the Office 

23 of National HIV/AIDS Policy, may transfer up to 1 per24 cent of such appropriations to the Office of the Assistant 


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1 Secretary for Health for implementation of the National 

2 HIV/AIDS Strategy. 

3 ‘‘(b) CONGRESSIONAL NOTIFICATION.—Not less than 

4 30 days before making any transfer under this section, 

5 the Secretary shall give notice of the transfer to the Con6 gress. 

7 ‘‘(c) DEFINITIONS.—In this section: 

8 ‘‘(1) The term ‘HIV/AIDS’ has the meaning 

9 given to such term in section 2689. 

10 ‘‘(2) The term ‘National HIV/AIDS Strategy’ 

11 means the National HIV/AIDS Strategy for the 

12 United States issued by the President in July 2010 

13 and includes any subsequent revisions to such Strat14 egy.’’. 

15 SEC. 763. HIV INTEGRATED SERVICES DELIVERY MODEL 

16 DEMONSTRATION. 

17 (a) IN GENERAL.—Consistent with the National 

18 HIV/AIDS Strategy for the United States and in accord19 ance with this section, the Secretary of Health and 

20 Human Services acting through the Center for Medicare 

21 & Medicaid Innovation and in cooperation with CDC, 

22 HRSA, SAMHSA, and HUD, shall conduct a 3-year dem23 onstration project that is designed to integrate services 

24 and funding under the Medicare and Medicaid programs, 

25 under HIV-related programs conducted by the CDC, and 


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1 under the Ryan White HIV/AIDS Program, to reduce new 

2 HIV infections, to increase the proportion of people who 

3 know their status, to increase access to care, to improve 

4 health outcomes, to reduce HIV-related health disparities 

5 among Medicaid and Medicare beneficiaries, and to reduce 

6 the cost of care provided to HIV positive Medicare and 

7 Medicaid beneficiaries. 

8 (b) OBJECTIVES.—The objectives of the demonstra9 tion are the following: 

10 (1) To ensure the early identification of HIV 

11 positive beneficiaries to reduce costly HIV-related 

12 clinical conditions through HIV screening and rapid 

13 linkage to high quality HIV medical care. 

14 (2) To reduce new HIV infections among Med15 icaid and Medicare beneficiaries through routine 

16 HIV testing, prevention services for HIV negative 

17 beneficiaries, and intensive ‘‘prevention for positive’’ 

18 services for HIV positive beneficiaries. 

19 (3) To reduce morbidity, mortality, and high 

20 cost inpatient and specialty care among HIV positive 

21 beneficiaries by ensuring access to high quality HIV 

22 medical care, HIV medications, and support services. 

23 (4) To promote HIV treatment adherence and 

24 retention in care through intensive case manage25 ment, treatment education, and outreach services. 


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1 (5) To effectively treat behavioral health condi2 tions among HIV positive beneficiaries that impair 

3 their HIV treatment adherence and lead to sec4 ondary HIV infections through services funded 

5 under Medicare and Medicaid and programs admin6 istered by SAMHSA. 

7 (6) To promote independence, treatment adher8 ence, and stable housing for HIV positive bene9 ficiaries through highly coordinated HIV health, 

10 housing, and support services funded by HRSA and 

11 HUD. 

12 (c) DEMONSTRATION DESIGN.— 

13 (1) IN GENERAL.—The Secretary shall design 

14 the demonstration to test both— 

15 (A) the service delivery model described in 

16 paragraph (2); and 

17 (B) the payment model described in para18 graph (3). 

19 (2) SERVICE DELIVERY MODEL.— 

20 (A) IN GENERAL.—Under the service deliv21 ery model described in this paragraph, the dem22 onstration shall test comprehensive HIV test23 ing, linkage to care, HIV medical care, and an24 cillary services to individuals enrolled under 

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1 ery model will integrate services furnished 

2 under Medicare and Medicaid with prevention 

3 services funded by CDC for HIV positive bene4 ficiaries, intensive case management services 

5 funded by HRSA, behavioral services funded by 

6 SAMHSA, and housing assistance services 

7 funded through HUD. 

8 (B) CORE ELEMENTS.—The model under 

9 this paragraph shall have the following 8 core 

10 elements: 

11 (i) HIV testing services that apply the 

12 CDC’s 2006 recommendations for uni13 versal opt-out testing among Medicare and 

14 Medicaid beneficiary populations. 

15 (ii) Rapid linkage from HIV testing 

16 settings to treatment for HIV positive 

17 beneficiaries to ensure they are engaged in 

18 care in a timely basis. 

19 (iii) Access to high quality HIV expe20 rienced medical care, laboratory moni21 toring, HIV medications, and other re22 quired services. 

23 (iv) Routine screening and treatment 

24 for HIV-related and other chronic condi25 tions, including behavioral health. 


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1 (v) Prevention and treatment edu2 cation services, including an adapted Medi3 cation Therapy Management (MTM) pro4 gram model, to optimize the benefit of 

5 HIV therapeutics. 

6 (vi) Risk-stratified medical case man7 agement. 

8 (vii) Provision of preventive care, in9 cluding counseling to prevent secondary 

10 HIV infection. 

11 (viii) Wrap-around support and hous12 ing services. 

13 (3) PAYMENT MODEL.—Under the payment 

14 model described in this paragraph, the demonstra15 tion shall test the following: 

16 (A) A prepaid capitated payment model 

17 that adjusts payment for HIV and behavioral 

18 health acuity, to be applied under contracts 

19 with managed care organizations with dem20 onstrated HIV experience. 

21 (B) Use of funds under the Ryan White 

22 HIV/AIDS Program to purchase capitated serv23 ices from the contracted managed care organi24 zations. 


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1 (C) Provision of additional funds to sup2 port services to the extent that Medicaid and 

3 Medicare coverage is limited, including for serv4 ices such as HIV testing (for Medicaid bene5 ficiaries), medical case management, prevention 

6 case management, treatment education, case 

7 finding, behavioral health services, and housing 

8 assistance. 

9 (d) BENEFICIARY CRITERIA.—Beneficiaries eligible 

10 for participation in the demonstration are the following: 

11 (1) MEDICAID FFS BENEFICIARIES.—Fee-for12 service Medicaid beneficiaries 18 years of age or 

13 older. 

14 (2) DUAL ELIGIBLES.—Individuals who are— 

15 (A) entitled to medical assistance under 

16 Medicaid; and 

17 (B) entitled to benefits under part A, and 

18 enrolled under part B, of Medicare but are not 

19 enrolled under a Medicare Advantage plan 

20 under Medicare. 

21 (e) ROLES AND RESPONSIBILITIES IN DEMONSTRA22 TION.— 

23 (1) IN GENERAL.—Consistent with the National 

24 HIV/AIDS Strategy for the United States, Federal 

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1 lected States or cities covered under the demonstra2 tion to provide resources to fund the delivery of serv3 ices within the demonstration. 

4 (2) HHS.—In carrying out the demonstration, 

5 the Secretary shall— 

6 (A) design the application process; 

7 (B) solicit applications from 5 to 7 State 

8 Medicaid agencies to host the demonstration; 

9 (C) with respect to the service delivery 

10 model described in subsection (c)(2), collaborate 

11 with the CDC, HRSA, and the National Insti12 tutes of Health to design a minimum service de13 livery model that reflects the current standard 

14 of care as established by the Public Health 

15 Service and CDC guidelines and recommenda16 tions; and 

17 (D) fund an evaluation of the demonstra18 tion to ensure collection of system, provider, 

19 and beneficiary-level data to address their rou20 tine reporting requirements. 

21 The Secretary may carry out the Secretary’s author22 ity under this paragraph through CMMI. 

23 (3) CDC.—The CDC shall collaborate with the 

24 Secretary and CDC-funded HIV prevention grantees 

25 in the selected States and cities to provide technical 


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1 assistance to design cost-effective HIV and sexually 

2 transmitted infection (STI) screening and testing 

3 services for Medicaid and Medicare beneficiaries, in4 cluding partner notification services and commu5 nicable disease reporting. CDC and CMS shall deter6 mine the extent to which testing funds shall be sup7 ported jointly or separately by these agencies. 

8 (4) HRSA.—HRSA shall allocate funds avail9 able through the Special Projects of National Sig10 nificance (SPNS) Initiative Program (under subpart 

11 I of part F of the Ryan White HIV/AIDS Program) 

12 to support wrap-around core and support services 

13 not covered under Medicare or Medicaid and shall 

14 authorize the use of Ryan White HIV/AIDS Pro15 gram funds to purchase services through capitated 

16 managed care programs that meet or exceed the 

17 services covered by the Ryan White HIV/AIDS Pro18 gram at rates that are no greater than current per 

19 capita expenditures. HRSA is authorized to use 

20 funds under SPNS, and to waive such requirements 

21 of SPNS as may be necessary, to carry out the dem22 onstration. 

23 (5) SAMHSA.—SAMHSA shall allocate funds 

24 through the Minority HIV/AIDS Initiative or other 


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1 programs to support behavioral health services not 

2 covered under Medicare or Medicaid. 

3 (6) HOPWA.—HUD shall directly allocate 

4 funds under the Housing Opportunities for People 

5 With AIDS (HOPWA) program to the States or cit6 ies participating in the demonstration to provide 

7 supportive housing and other housing assistance to 

8 beneficiaries who otherwise meet HOPWA eligibility 

9 criteria. HUD is authorized to use such HOPWA 

10 funds, and to waive such requirements under 

11 HOPWA as may be necessary, to carry out the dem12 onstration. 

13 (7) STATE MEDICAID AGENCIES.—Single State 

14 agencies responsible for administration of the Med15 icaid program for individuals who are accepted to 

16 participate in the demonstration shall— 

17 (A) collaborate with CMS to design or re18 fine a prepaid capitated payment model, to allo19 cate and award contracts with capitated man20 aged care plans, to ensure such plans meet 

21 State statutory or regulatory requirements, to 

22 contract with a coordinating agency to organize 

23 and deliver integrated HIV testing, medical 

24 care, support, and housing services funded 

25 under Medicare and Medicaid, other Federal, 


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1 State, and local government sponsors, and to 

2 coordinate their activities with the State HIV/ 

3 AIDS program; and 

4 (B) identify and contract with a coordi5 nating agency to organize the demonstration in 

6 the State, to establish a coordinating body rep7 resenting State, local, and provider agencies 

8 participating in the demonstration, to establish 

9 systems of care that integrate HIV prevention, 

10 testing, treatment, support, and housing serv11 ices, to establish mechanisms to gather evalua12 tion data for reporting to CMMI and other par13 ticipating Federal agencies, and to establish a 

14 quality management program to monitor pro15 vider performance in delivering the services pro16 vided to participating beneficiaries under the 

17 demonstration. 

18 (8) MANAGED CARE ORGANIZATIONS.— 

19 Capitated managed care organizations participating 

20 in the demonstration shall organize and deliver serv21 ices as specified by the minimum service delivery 

22 model established by CMMI through a network of 

23 providers with demonstrated HIV experience, high 

24 quality, and sufficient provider capacity. 

25 (f) DEFINITIONS.—In this section: 


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1 (1) CDC.—The term ‘‘CDC’’ means the Direc2 tor of the Centers for Disease Control and Preven3 tion. 

4 (2) CMMI.—The term ‘‘CMMI’’ means the Di5 rector of the Center for Medicare & Medicaid Inno6 vation. 

7 (3) CMS.—The term ‘‘CMS’’ means the Ad8 ministrator of the Centers for Medicare & Medicaid 

9 Services. 

10 (4) DEMONSTRATION.—The term ‘‘demonstra11 tion’’ means the demonstration conducted under this 

12 section. 

13 (5) HRSA.—The term ‘‘HRSA’’ means the Ad14 ministrator of the Health Resources and Services 

15 Administration. 

16 (6) HUD.—The term ‘‘HUD’’ means the Sec17 retary of Housing and Urban Development. 

18 (7) MEDICARE; MEDICAID.—The terms ‘‘Medi19 care’’ and ‘‘Medicaid’’ mean the programs under ti20 tles XVIII and XIX, respectively, of the Social Secu21 rity Act. 

22 (8) NATIONAL HIV/AIDS STRATEGY FOR THE

23 UNITED STATES.—The term ‘‘National HIV/AIDS 

24 Strategy for the United States’’ has the meaning 


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1 given such term under section 241A(b) of the Public 

2 Health Service Act. 

3 (9) RYAN WHITE HIV/AIDS PROGRAM.—The 

4 term ‘‘Ryan White HIV/AIDS Program’’ means the 

5 program under title XXVI of the Public Health 

6 Service Act. 

7 (10) SAMHSA.—The term ‘‘SAMHSA’’ means 

8 the Substance Abuse and Mental Health Services 

9 Administration. 

10 (11) SECRETARY.—The term ‘‘Secretary’’ 

11 means the Secretary of Health and Human Services, 

12 acting through CMMI. 

13 SEC. 764. REPORT ON THE IMPLEMENTATION OF GOAL 4 

14 (IMPROVED COORDINATION) OF THE NA15 TIONAL HIV/AIDS STRATEGY. 

16 (a) REPORT REQUIRED.—The President, in consulta17 tion with the heads of all relevant Federal departments 

18 and agencies including the Department of Education, the 

19 Department of Health and Human Services, the Depart20 ment of Housing and Urban Development, the Depart21 ment of Justice, the Department of Labor, the Depart22 ment of Veteran Affairs, and the Social Security Adminis23 tration, shall transmit to the Congress and make publicly 

24 available a report on the status of implementation of Goal 

25 4 of the National HIV/AIDS Strategy. 


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1 (b) CONTENTS.—The report required by subsection 

2 (a) shall include a description, an analysis, and an evalua3 tion of— 

4 (1) the extent to which the National HIV/AIDS 

5 Strategy has improved coordination of efforts, en6 hanced capacity, and strengthened infrastructure in 

7 order to maximize the effective delivery of HIV/ 

8 AIDS prevention, care, and treatment services at the 

9 community level, including coordination— 

10 (A) within and among Federal agencies 

11 and departments; 

12 (B) between the Federal Government and 

13 State and local governments and health depart14 ments; 

15 (C) between the Federal Government and 

16 nonprofit foundations and civil society organiza17 tions, including community- and faith-based or18 ganizations focused on addressing the issue of 

19 HIV/AIDS; and 

20 (D) between the Federal Government and 

21 private businesses; and 

22 (2) efforts by the Federal Government to edu23 cate, involve, and establish and strengthen partner24 ships with civil society organizations, including 

25 community- and faith-based organizations, in order 


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1 to implement the National HIV/AIDS Strategy and 

2 achieve its goals. 

3 (c) DEFINITION.—In this section, the term ‘‘National 

4 HIV/AIDS Strategy’’ means the National HIV/AIDS 

5 Strategy for the United States issued by the President in 

6 July 2010, the revision to such Strategy issued in July 

7 2015, and any subsequent revisions to such Strategy. 

8 Subtitle F—Diabetes 

9 SEC. 771. RESEARCH, TREATMENT, AND EDUCATION. 

10 Subpart 3 of part C of title IV of the Public Health 

11 Service Act (42 U.S.C. 285c et seq.) is amended by adding 

12 at the end the following new section: 

13 ‘‘SEC. 434B. DIABETES IN MINORITY POPULATIONS. 

14 ‘‘(a) IN GENERAL.—The Director of NIH shall ex15 pand, intensify, and support ongoing research and other 

16 activities with respect to prediabetes and diabetes, particu17 larly type 2, in minority populations. 

18 ‘‘(b) RESEARCH.— 

19 ‘‘(1) DESCRIPTION.—Research under subsection 

20 (a) shall include investigation into— 

21 ‘‘(A) the causes of diabetes, including so22 cioeconomic, geographic, clinical, environmental, 

23 genetic, and other factors that may contribute 

24 to increased rates of diabetes in minority popu25 lations; and 


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1 ‘‘(B) the causes of increased incidence of 

2 diabetes complications in minority populations, 

3 and possible interventions to decrease such inci4 dence. 

5 ‘‘(2) INCLUSION OF MINORITY PARTICIPANTS.— 

6 In conducting and supporting research described in 

7 subsection (a), the Director of NIH shall seek to in8 clude minority participants as study subjects in clin9 ical trials. 

10 ‘‘(c) REPORT; COMPREHENSIVE PLAN.— 

11 ‘‘(1) IN GENERAL.—The Diabetes Mellitus 

12 Interagency Coordinating Committee shall— 

13 ‘‘(A) prepare and submit to the Congress, 

14 not later than 6 months after the date of enact15 ment of this section, a report on Federal re16 search and public health activities with respect 

17 to prediabetes and diabetes in minority popu18 lations; and 

19 ‘‘(B) develop and submit to the Congress, 

20 not later than 1 year after the date of enact21 ment of this section, an effective and com22 prehensive Federal plan (including all appro23 priate Federal health programs) to address 

24 prediabetes and diabetes in minority popu25 lations. 


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1 ‘‘(2) CONTENTS.—The report under paragraph 

2 (1)(A) shall at minimum address each of the fol3 lowing: 

4 ‘‘(A) Research on diabetes and prediabetes 

5 in minority populations, including such research 

6 on— 

7 ‘‘(i) genetic, behavioral, and environ8 mental factors; and 

9 ‘‘(ii) prevention and complications 

10 among individuals within these populations 

11 who have already developed diabetes. 

12 ‘‘(B) Surveillance and data collection on 

13 diabetes and prediabetes in minority popu14 lations, including with respect to— 

15 ‘‘(i) efforts to better determine the 

16 prevalence of diabetes among Asian-Amer17 ican and Pacific Islander subgroups; and 

18 ‘‘(ii) efforts to coordinate data collec19 tion on the American Indian population. 

20 ‘‘(C) Community-based interventions to ad21 dress diabetes and prediabetes targeting minor22 ity populations, including— 

23 ‘‘(i) the evidence base for such inter24 ventions; 


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1 ‘‘(ii) the cultural appropriateness of 

2 such interventions; and 

3 ‘‘(iii) efforts to educate the public on 

4 the causes and consequences of diabetes. 

5 ‘‘(D) Education and training programs for 

6 health professionals (including community 

7 health workers) on the prevention and manage8 ment of diabetes and its related complications 

9 that is supported by the Health Resources and 

10 Services Administration, including such pro11 grams supported by— 

12 ‘‘(i) the National Health Service 

13 Corps; or 

14 ‘‘(ii) the community health centers 

15 program under section 330. 

16 ‘‘(d) EDUCATION.—The Director of NIH shall— 

17 ‘‘(1) through the National Institute on Minority 

18 Health and Health Disparities and the National Di19 abetes Education Program— 

20 ‘‘(A) make grants to programs funded 

21 under section 464z–4 (relating to centers of ex22 cellence) for the purpose of establishing a men23 toring program for health care professionals to 

24 be more involved in weight counseling, obesity 

25 research, and nutrition; and 


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1 ‘‘(B) provide for the participation of mi2 nority health professionals in diabetes-focused 

3 research programs; and 

4 ‘‘(2) make grants for programs to establish a 

5 pipeline from high school to professional school that 

6 will increase minority representation in diabetes-fo7 cused health fields by expanding Minority Access to 

8 Research Careers (MARC) program internships and 

9 mentoring opportunities for recruitment. 

10 ‘‘(e) DEFINITIONS.—For purposes of this section: 

11 ‘‘(1) The ‘Diabetes Mellitus Interagency Coordi12 nating Committee’ means the Diabetes Mellitus 

13 Interagency Coordinating Committee established 

14 under section 429. 

15 ‘‘(2) The term ‘minority population’ means a 

16 racial and ethnic minority group, as defined in sec17 tion 1707.’’. 

18 SEC. 772. RESEARCH, EDUCATION, AND OTHER ACTIVITIES. 

19 Part B of title III of the Public Health Service Act 

20 (42 U.S.C. 243 et seq.) is amended by inserting after sec21 tion 317T the following section: 

22 ‘‘SEC. 317U. DIABETES IN MINORITY POPULATIONS. 

23 ‘‘(a) RESEARCH AND OTHER ACTIVITIES.— 

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

25 through the Director of the Centers for Disease 


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1 Control and Prevention, shall conduct and support 

2 research and public health activities with respect to 

3 diabetes in minority populations. 

4 ‘‘(2) CERTAIN ACTIVITIES.—Activities under 

5 paragraph (1) regarding diabetes in minority popu6 lations shall include the following: 

7 ‘‘(A) Further enhancing the National 

8 Health and Nutrition Examination Survey by 

9 over-sampling Asian-American, Native Hawai10 ian, and Other Pacific Islanders in appropriate 

11 geographic areas to better determine the preva12 lence of diabetes in such populations as well as 

13 to improve the data collection of diabetes pene14 tration disaggregated into major ethnic groups 

15 within such populations. The Secretary shall en16 sure that any such oversampling does not re17 duce the oversampling of other minority popu18 lations including African-American and Latino 

19 populations. 

20 ‘‘(B) Through the Division of Diabetes 

21 Translation— 

22 ‘‘(i) providing for prevention research 

23 to better understand how to influence 

24 health care systems changes to improve 


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1 quality of care being delivered to such pop2 ulations; 

3 ‘‘(ii) carrying out model demonstra4 tion projects to design, implement, and 

5 evaluate effective diabetes prevention and 

6 control interventions for minority popu7 lations, including culturally appropriate 

8 community-based interventions; 

9 ‘‘(iii) developing and implementing a 

10 strategic plan to reduce diabetes in minor11 ity populations through applied research to 

12 reduce disparities and culturally and lin13 guistically appropriate community-based 

14 interventions; 

15 ‘‘(iv) supporting, through the national 

16 diabetes prevention program under section 

17 399V–3, diabetes prevention program sites 

18 in underserved regions highly impacted by 

19 diabetes; and 

20 ‘‘(v) implementing, through the na21 tional diabetes prevention program under 

22 section 399V–3, a demonstration program 

23 developing new metrics measuring health 

24 outcomes related to diabetes that can be 

25 stratified by specific minority populations. 


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1 ‘‘(b) EDUCATION.—The Secretary, acting through 

2 the Director of the Centers for Disease Control and Pre3 vention, shall direct the Division of Diabetes Translation 

4 to conduct and support both programs to educate the pub5 lic on diabetes in minority populations and programs to 

6 educate minority populations about the causes and effects 

7 of diabetes. 

8 ‘‘(c) DIABETES; HEALTH PROMOTION, PREVENTION

9 ACTIVITIES, AND ACCESS.—The Secretary, acting through 

10 the Director of the Centers for Disease Control and Pre11 vention and the National Diabetes Education Program, 

12 shall conduct and support programs to educate specific 

13 minority populations through culturally appropriate and 

14 linguistically appropriate information campaigns about 

15 prevention of, and managing, diabetes. 

16 ‘‘(d) DEFINITION.—For purposes of this section, the 

17 term ‘minority population’ means a racial and ethnic mi18 nority group, as defined in section 1707.’’. 

19 SEC. 773. RESEARCH, EDUCATION, AND OTHER ACTIVITIES. 

20 Part P of title III of the Public Health Service Act 

21 (42 U.S.C. 280g et seq.), as amended, is further amended 

22 by adding at the end the following new section: 


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1 ‘‘SEC. 399V–7. PROGRAMS TO EDUCATE HEALTH PRO2 VIDERS ON THE CAUSES AND EFFECTS OF DI3 ABETES IN MINORITY POPULATIONS. 

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

5 the Director of the Health Resources and Services Admin6 istration, shall conduct and support programs described 

7 in subsection (b) to educate health professionals on the 

8 causes and effects of diabetes in minority populations. 

9 ‘‘(b) PROGRAMS.—Programs described in this sub10 section, with respect to education on diabetes in minority 

11 populations, shall include the following: 

12 ‘‘(1) Giving priority, under the primary care 

13 training and enhancement program under section 

14 747— 

15 ‘‘(A) to awarding grants to focus on or ad16 dress diabetes; and 

17 ‘‘(B) adding minority populations to the 

18 list of vulnerable populations that should be 

19 served by such grants. 

20 ‘‘(2) Providing additional funds for the Health 

21 Careers Opportunity Program, Centers for Excel22 lence, and the Minority Faculty Fellowship Program 

23 to partner with the Office of Minority Health under 

24 section 1707 and the National Institutes of Health 

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1 cused on diabetes treatment and care within under2 served regions highly impacted by diabetes. 

3 ‘‘(3) Developing a diabetes focus within, and 

4 providing additional funds for, the National Health 

5 Service Corps Scholarship Program— 

6 ‘‘(A) to place individuals in areas that are 

7 disproportionately affected by diabetes and to 

8 provide diabetes treatment and care in such 

9 areas; and 

10 ‘‘(B) to provide such individuals continuing 

11 medical education specific to diabetes care.’’. 

12 SEC. 774. RESEARCH, EDUCATION, AND OTHER ACTIVITIES. 

13 Part P of title III of the Public Health Service Act 

14 (42 U.S.C. 280g et seq.), as amended, is further amended 

15 by adding at the end the following section: 

16 ‘‘SEC. 399V–8. RESEARCH, EDUCATION, AND OTHER ACTIVI17 TIES REGARDING DIABETES IN AMERICAN IN18 DIAN POPULATIONS. 

19 ‘‘In addition to activities under sections 317V–6 and 

20 434B, the Secretary, acting through the Indian Health 

21 Service and in collaboration with other appropriate Fed22 eral agencies, shall— 

23 ‘‘(1) conduct and support research and other 

24 activities with respect to diabetes; and 


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1 ‘‘(2) coordinate the collection of data on clini2 cally and culturally appropriate diabetes treatment, 

3 care, prevention, and services by health care profes4 sionals to the American Indian population.’’. 

5 SEC. 775. UPDATED REPORT ON HEALTH DISPARITIES. 

6 The Secretary of Health and Human Services shall 

7 seek to enter into an arrangement with the Institute of 

8 Medicine under which the Institute will— 

9 (1) not later than 1 year after the date of en10 actment of this Act, submit to the Congress an up11 dated version of the Institute’s 2002 report entitled 

12 ‘‘Unequal Treatment: Confronting Racial and Ethnic 

13 Disparities in Health Care’’; and 

14 (2) in such updated version, address how racial 

15 and ethnic health disparities have changed since the 

16 publication of the original report. 

17 Subtitle G—Lung Disease 

18 SEC. 776. EXPANSION OF THE NATIONAL ASTHMA EDU19 CATION AND PREVENTION PROGRAM. 

20 (a) FINDINGS.—The Congress finds as follows: 

21 (1) The prevalence of asthma has increased 

22 since 1980 and affects 25 million Americans. 

23 (2) Significant disparities in asthma morbidity 

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1 ticularly for low-income and minority populations, 

2 particularly African-Americans and Puerto Ricans. 

3 (3) African-American children are twice as like4 ly to have asthma as White children. 

5 (4) In 2010, almost 4.5 million non-Hispanic 

6 African-Americans reported having asthma. African7 Americans with asthma are three times as likely to 

8 visit the emergency department and twice as likely 

9 to get hospitalized as White patients with asthma. 

10 (5) Puerto Ricans are 3.4 times as likely to die 

11 from asthma compared with all other Hispanic or 

12 Latino groups. Overall Hispanic Americans are 30 

13 percent more likely to be hospitalized for asthma 

14 than non-Hispanic Whites. 

15 (6) More than 65 percent of adults with asthma 

16 are women. 

17 (b) IN GENERAL.—Not later than 2 years after the 

18 date of the enactment of this Act, the Secretary of Health 

19 and Human Services shall convene a working group com20 prised of patient groups, nonprofit organizations, medical 

21 societies, and other relevant governmental and nongovern22 mental entities, including those that participate in the Na23 tional Asthma Education and Prevention Program, to de24 velop a report to Congress that— 


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1 (1) catalogs, with respect to asthma prevention, 

2 management, and surveillance— 

3 (A) the activities of the Federal Govern4 ment, including identifying all Federal pro5 grams that carry out asthma-related activities, 

6 as well as assessment of the progress of the 

7 Federal Government and States, with respect to 

8 achieving the goals of the Healthy People 2020 

9 initiative; and 

10 (B) the activities of other entities that par11 ticipate in the program, including nonprofit or12 ganizations, patient advocacy groups, and med13 ical societies; and 

14 (2) makes recommendations for the future di15 rection of asthma activities, in consultation with re16 searchers from the National Institutes of Health and 

17 other member bodies of the National Asthma Edu18 cation and Prevention Program who are qualified to 

19 review and analyze data and evaluate interventions, 

20 including— 

21 (A) description of how the Federal Govern22 ment may better coordinate and improve its re23 sponse to asthma including identifying any bar24 riers that may exist; 


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1 (B) description of how the Federal Govern2 ment may continue, expand, and improve its 

3 private-public partnerships with respect to asth4 ma including identifying any barriers that may 

5 exist; 

6 (C) identification of steps that may be 

7 taken to reduce the— 

8 (i) morbidity, mortality, and overall 

9 prevalence of asthma; 

10 (ii) financial burden of asthma on so11 ciety; 

12 (iii) burden of asthma on dispropor13 tionately affected areas, particularly those 

14 in medically underserved populations (as 

15 defined in section 330(b)(3) of the Public 

16 Health Service Act (42 U.S.C. 

17 254b(b)(3))); and 

18 (iv) burden of asthma as a chronic 

19 disease; 

20 (D) identification of programs and policies 

21 that have achieved the steps described in sub22 paragraph (C), and steps that may be taken to 

23 expand such programs and policies to benefit 

24 larger populations; and 


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1 (E) recommendations for future research 

2 and interventions. 

3 (c) REPORT TO CONGRESS.—At the end of the 5-year 

4 period following the submission of the report under sub5 section (a), the National Asthma Education and Preven6 tion Program shall evaluate the analyses and rec7 ommendations under such report and determine whether 

8 a new report to the Congress is necessary, and make ap9 propriate recommendations to the Congress. 

10 SEC. 777. ASTHMA-RELATED ACTIVITIES OF THE CENTERS 

11 FOR DISEASE CONTROL AND PREVENTION. 

12 Section 317I of the Public Health Service Act (42 

13 U.S.C. 247b–10) is amended to read as follows: 

14 ‘‘SEC. 317I. ASTHMA-RELATED ACTIVITIES OF THE CENTERS 

15 FOR DISEASE CONTROL AND PREVENTION. 

16 ‘‘(a) PROGRAM FOR PROVIDING INFORMATION AND

17 EDUCATION TO THE PUBLIC.—The Secretary, acting 

18 through the Director of the Centers for Disease Control 

19 and Prevention, shall collaborate with State and local 

20 health departments to conduct activities, including the 

21 provision of information and education to the public re22 garding asthma including— 

23 ‘‘(1) deterring the harmful consequences of un24 controlled asthma; and 


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1 ‘‘(2) disseminating health education and infor2 mation regarding prevention of asthma episodes and 

3 strategies for managing asthma. 

4 ‘‘(b) DEVELOPMENT OF STATE ASTHMA PLANS.— 

5 The Secretary, acting through the Director of the Centers 

6 for Disease Control and Prevention, shall collaborate with 

7 State and local health departments to develop State plans 

8 incorporating public health responses to reduce the burden 

9 of asthma, particularly regarding disproportionately af10 fected populations. 

11 ‘‘(c) COMPILATION OF DATA.—The Secretary, acting 

12 through the Director of the Centers for Disease Control 

13 and Prevention, shall, in cooperation with State and local 

14 public health officials— 

15 ‘‘(1) conduct asthma surveillance activities to 

16 collect data on the prevalence and severity of asth17 ma, the effectiveness of public health asthma inter18 ventions, and the quality of asthma management, in19 cluding— 

20 ‘‘(A) collection of household data on the 

21 local burden of asthma; 

22 ‘‘(B) surveillance of health care facilities; 

23 and 

24 ‘‘(C) collection of data not containing indi25 vidually identifiable information from electronic 


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1 health records or other electronic communica2 tions; 

3 ‘‘(2) compile and annually publish data regard4 ing the prevalence and incidence of childhood asth5 ma, the child mortality rate, and the number of hos6 pital admissions and emergency department visits by 

7 children associated with asthma nationally and in 

8 each State and at the county level by age, sex, race, 

9 and ethnicity, as well as lifetime and current preva10 lence; and 

11 ‘‘(3) compile and annually publish data regard12 ing the prevalence and incidence of adult asthma, 

13 the adult mortality rate, and the number of hospital 

14 admissions and emergency department visits by 

15 adults associated with asthma nationally and in each 

16 State and at the county level by age, sex, race, eth17 nicity, industry, and occupation, as well as lifetime 

18 and current prevalence. 

19 ‘‘(d) COORDINATION OF DATA COLLECTION.—The 

20 Director of the Centers for Disease Control and Preven21 tion, in conjunction with State and local health depart22 ments, shall coordinate data collection activities under 

23 subsection (c)(2) so as to maximize comparability of re24 sults. 


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1 ‘‘(e) COLLABORATION.—The Centers for Disease 

2 Control and Prevention are encouraged to collaborate with 

3 national, State, and local nonprofit organizations to pro4 vide information and education about asthma, and to 

5 strengthen such collaborations when possible. 

6 ‘‘(f) ADDITIONAL FUNDING.—In addition to any 

7 other authorization of appropriations that is available to 

8 the Centers for Disease Control and Prevention for the 

9 purpose of carrying out this section, there are authorized 

10 to be appropriated to such Centers such sums as may be 

11 necessary for each of fiscal years 2017 through 2021 for 

12 the purpose of carrying out this section.’’. 

13 SEC. 778. INFLUENZA AND PNEUMONIA VACCINATION CAM14 PAIGN. 

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

16 Human Services shall— 

17 (1) enhance the annual campaign by the De18 partment of Health and Human Services to increase 

19 the number of people vaccinated each year for influ20 enza and pneumonia; and 

21 (2) include in such campaign the use of written 

22 educational materials, public service announcements, 

23 physician education, and any other means which the 

24 Secretary deems effective. 


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1 (b) MATERIALS AND ANNOUNCEMENTS.—In carrying 

2 out the annual campaign described in subsection (a), the 

3 Secretary of Health and Human Services shall ensure 

4 that— 

5 (1) educational materials and public service an6 nouncements are readily and widely available in 

7 communities experiencing disparities in the incidence 

8 and mortality rates of influenza and pneumonia; and 

9 (2) the campaign uses targeted, culturally ap10 propriate messages and messengers to reach under11 served communities. 

12 (c) AUTHORIZATION OF APPROPRIATIONS.—There 

13 are authorized to be appropriated to carry out this section 

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

15 2017 through 2021. 

16 SEC. 779. CHRONIC OBSTRUCTIVE PULMONARY DISEASE 

17 ACTION PLAN. 

18 (a) FINDINGS.—The Congress finds as follows: 

19 (1) Chronic obstructive pulmonary disease 

20 (‘‘COPD’’) refers to chronic bronchitis and emphy21 sema, incurable diseases that make it difficult to ex22 hale all the air from one’s lungs, and that can cause 

23 persistent coughing, shortness of breath, and spu24 tum. 


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1 (2) COPD exacerbations—episodes of acute dif2 ficulty breathing and moderate to severe fatigue— 

3 are dangerous, and their treatment often requires 

4 hospitalization. 

5 (3) While smoking is the primary risk factor for 

6 COPD, other risk factors include air pollution, occu7 pational exposures, heredity, a history of childhood 

8 respiratory infections, and socioeconomic status. 

9 (4) Over 13.5 million United States adults are 

10 estimated to have COPD. 

11 (5) COPD is the third leading cause of death 

12 in America, claiming over 134,000 lives in 2010. 

13 (6) Since 2000, deaths for women with COPD 

14 have exceed deaths in men. 

15 (7) Although African-Americans have a lower 

16 prevalence of COPD in the United States, research17 ers have shown that African-Americans may be 

18 underdiagnosed. Furthermore, research has shown 

19 that African-Americans develop COPD with less cu20 mulative smoke exposure and at a younger age. 

21 (b) IN GENERAL.—The Director of the Centers for 

22 Disease Control and Prevention shall conduct, support, 

23 and expand public health strategies, prevention, diagnosis, 

24 surveillance, and public and professional awareness activi25 ties regarding chronic obstructive pulmonary disease. 


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1 (c) NATIONAL ACTION PLAN.— 

2 (1) DEVELOPMENT.—Not later than 2 years 

3 after the date of the enactment of this Act, the Di4 rector of the National Heart, Lung, and Blood Insti5 tute, in consultation with the Director of the Centers 

6 for Disease Control and Prevention, shall develop a 

7 national action plan to address chronic obstructive 

8 pulmonary disease in the United States with partici9 pation from patients, caregivers, health profes10 sionals, patient advocacy organizations, researchers, 

11 providers, public health professionals, and other 

12 stakeholders. 

13 (2) CONTENTS.—At a minimum, such plan 

14 shall include recommendations for— 

15 (A) public health interventions for the pur16 pose of implementation of the national plan; 

17 (B) biomedical, health services, and public 

18 health research on chronic obstructive pul19 monary disease; and 

20 (C) inclusion of chronic obstructive pul21 monary disease in the health data collections of 

22 all Federal agencies. 

23 (3) CONSIDERATION.—In developing such plan, 

24 the Director of the National Heart, Lung, and Blood 

25 Institute shall consider the recommendations and 


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1 findings of the Institute of Medicine in the report 

2 entitled ‘‘A Nationwide Framework for Surveillance 

3 of Cardiovascular and Chronic Lung Diseases’’ (July 

4 22, 2011). 

5 (d) CHRONIC DISEASE PREVENTION PROGRAMS.— 

6 The Director of the National Heart, Lung, and Blood In7 stitute shall carry out the following: 

8 (1) Conduct public education and awareness ac9 tivities with patient and professional organizations 

10 to stimulate earlier diagnosis and improve patient 

11 outcomes from treatment of chronic obstructive pul12 monary disease. To the extent known and relevant, 

13 such public education and awareness activities shall 

14 reflect differences in chronic obstructive pulmonary 

15 disease by cause (tobacco, environmental, occupa16 tional, biological, and genetic) and include a focus 

17 on outreach to undiagnosed and, as appropriate, mi18 nority populations. 

19 (2) Supplement and expand upon the activities 

20 of the National Heart, Lung, and Blood Institute by 

21 making grants to nonprofit organizations, State and 

22 local jurisdictions, and Indian tribes for the purpose 

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1 pacted communities, through public health interven2 tions and related activities. 

3 (3) Coordinate with the Centers for Disease 

4 Control and Prevention, the Indian Health Service, 

5 the Health Resources and Services Administration, 

6 and the Department of Veterans Affairs to develop 

7 pilot programs to demonstrate best practices for the 

8 diagnosis and management of chronic obstructive 

9 pulmonary disease. 

10 (4) Develop improved techniques and identify 

11 best practices, in coordination with the Secretary of 

12 Veterans Affairs, for assisting chronic obstructive 

13 pulmonary disease patients to successfully stop 

14 smoking, including identification of subpopulations 

15 with different needs. Initiatives under this para16 graph may include research to determine whether 

17 successful smoking cessation strategies are different 

18 for chronic obstructive pulmonary disease patients 

19 compared to such strategies for patients with other 

20 chronic diseases. 

21 (e) ENVIRONMENTAL AND OCCUPATIONAL HEALTH

22 PROGRAMS.—The Director of the Centers for Disease 

23 Control and Prevention shall— 

24 (1) support research into the environmental and 

25 occupational causes and biological mechanisms that 


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1 contribute to chronic obstructive pulmonary disease; 

2 and 

3 (2) develop and disseminate public health inter4 ventions that will lessen the impact of environmental 

5 and occupational causes of chronic obstructive pul6 monary disease. 

7 (f) DATA COLLECTION.—Not later than 180 days 

8 after the enactment of this Act, the Director of the Na9 tional Heart, Lung, and Blood Institute and the Director 

10 of the Centers for Disease Control and Prevention, acting 

11 jointly, shall assess the depth and quality of information 

12 on chronic obstructive pulmonary disease that is collected 

13 in surveys and population studies conducted by the Cen14 ters for Disease Control and Prevention, including wheth15 er there are additional opportunities for information to be 

16 collected in the National Health and Nutrition Examina17 tion Survey, the National Health Interview Survey, and 

18 the Behavioral Risk Factors Surveillance System surveys. 

19 The Director of the National Heart, Lung, and Blood In20 stitute shall include the results of such assessment in the 

21 national action plan under subsection (b). 

22 (g) 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 2017 through 2021. 


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1 Subtitle H—Osteoarthritis and 

2 Musculoskeletal Diseases 

3 SEC. 781. FINDINGS. 

4 The Congress finds as follows: 

5 (1) Eighty percent of African-American women 

6 and nearly 74 percent of Hispanic men are either 

7 overweight or obese, speeding the onset and progres8 sion of arthritis. 

9 (2) Arthritis affects 46 million Americans, and 

10 that number will rise to 67 million by the year 2030. 

11 (3) Twenty-seven million Americans suffer from 

12 osteoarthritis, the most common form of arthritis, 

13 making it the leading cause of disability in the 

14 United States. Osteoarthritis is sometimes referred 

15 to as degenerative joint disease. 

16 (4) Obesity accelerates the onset of arthritis: 70 

17 percent of obese adults with mild osteoarthritis of 

18 the knee at age 60 will develop advanced end-stage 

19 disease by age 80. In contrast, just 43 percent of 

20 non-obese adults will have end-stage disease over the 

21 same time period. 

22 (5) Arthritis affects one in five Americans, and 

23 is the single greatest cause of chronic pain and dis24 ability in the United States. 


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1 (6) Women, African-Americans, and Hispanics 

2 have more severe arthritis and functional limitations. 

3 These same individuals are more likely to be obese, 

4 diabetic, and have higher incidence of heart dis5 ease—medical conditions that can be improved with 

6 physical activity. Instead of moving; however, these 

7 groups have an inactivity rate of 40 to 50 percent, 

8 which continues to increase. 

9 (7) Arthritis costs $128 billion a year, including 

10 $81 billion in direct costs (medical) and $47 billion 

11 in indirect costs (lost earnings). Each year, $309 bil12 lion in direct and indirect costs is lost due to dis13 parities in osteoarthritis and musculoskeletal dis14 eases. 

15 (8) Obesity and other chronic health conditions 

16 exacerbate the debilitating impact of arthritis, lead17 ing to inactivity, loss of independence, and a per18 petual cycle of comorbid chronic conditions. 

19 (9) Sixty-one percent of arthritis sufferers are 

20 women, and women represent 64 percent of an esti21 mated 43 million annual visits to physicians’ offices 

22 and outpatient clinics where arthritis was the pri23 mary diagnosis. Women also represented 60 percent 

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1 curred in 2003 for which arthritis was the primary 

2 diagnosis. 

(10) Women ages 65 and older have up to 21 3 ⁄2

4 times more disabilities than men of the same age. 

5 Higher rates of obesity and arthritis among this 

6 group explained up to 48 percent of the gender gap 

7 in disability, above all other common chronic health 

8 conditions. 

9 (11) The primary indication for total knee 

10 arthroplasty (TKA), also known as knee replace11 ment, is relief of significant, disabling pain caused 

12 by severe arthritis. 

13 (12) Knee replacement is surgery for people 

14 with severe knee damage. Knee replacement can re15 lieve pain and allow you to be more active. When 

16 you have a total knee replacement, the surgeon re17 moves damaged cartilage and bone from the surface 

18 of your knee joint and replaces them with a man19 made surface of metal and plastic. In a partial knee 

20 replacement, the surgeon only replaces one part of 

21 your knee joint. 

22 (13) Total hip replacement, also called total hip 

23 arthroplasty (THA), is used if your hip pain inter24 feres with daily activities and more-conservative 


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1 treatments have not helped. Arthritis damage is the 

2 most common reason to need hip replacement. 

3 (14) The odds of a family practice physician 

4 recommending TKA to a male patient with moderate 

5 arthritis are twice that of a female patient, while the 

6 odds of an orthopaedic surgeon recommending TKA 

7 to a male patient with moderate arthritis are 22 

8 times that of a female patient. 

9 (15) African-Americans with doctor-diagnosed 

10 arthritis have a higher prevalence of severe pain at11 tributable to arthritis, compared with Whites (34.0 

12 percent versus 22.6 percent). African-Americans, 

13 compared to Whites, report a higher proportion of 

14 work limitations (39.5 percent versus 28.0 percent) 

15 and a higher prevalence of arthritis-attributable 

16 work limitation (6.6 percent versus 4.6 percent). 

17 (16) Hispanics are 50 percent more likely than 

18 non-Hispanic Whites to report needing assistance 

19 with at least one instrumental activity of daily living 

20 and to have difficulty walking. 

21 (17) African-Americans and Hispanics were 1.3 

22 times more likely to have activity limitation, 1.6 

23 times more likely to have work limitations, and 1.9 

24 times more likely to have severe joint pain than 

25 Whites. 


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1 (18) In 2003, the Institute of Medicine reported 

2 that the rates of TKA and THA among African3 American and Hispanic patients are significantly 

4 lower than for Whites—even for those with equitable 

5 health care coverage such as through Medicare or 

6 the Department of Veterans Affairs. 

7 (19) According to the Centers for Disease Con8 trol and Prevention, in 2000, African-American 

9 Medicare enrollees were 37 percent less likely than 

10 White Medicare enrollees to undergo total knee re11 placements. In 2006, the disparity increased to 39 

12 percent. 

13 (20) Even after adjusting for insurance and 

14 health access, Hispanics and African-Americans are 

15 almost 50 percent less likely to undergo total knee 

16 replacement than Whites. 

17 SEC. 782. OSTEOARTHRITIS AND OTHER MUSCULO18 SKELETAL HEALTH-RELATED ACTIVITIES OF 

19 THE CENTERS FOR DISEASE CONTROL AND 

20 PREVENTION. 

21 (a) EDUCATION AND AWARENESS ACTIVITIES.—The 

22 Secretary of Health and Human Services, acting through 

23 the Director of the Centers for Disease Control and Pre24 vention, shall direct the National Center for Chronic Dis25 ease Prevention and Health Promotion to conduct and exVerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00666 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475

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1 pand the Health Community Program and Arthritis Pro2 gram to educate the public on— 

3 (1) the causes of, preventive health actions for, 

4 and effects of arthritis and other musculoskeletal 

5 conditions in minority patient populations; and 

6 (2) the effects of such conditions on other 

7 comorbidities including obesity, hypertension, and 

8 cardiovascular disease. 

9 (b) PROGRAMS ON ARTHRITIS AND MUSCULO10 SKELETAL CONDITIONS.—Education and awareness pro11 grams of the Centers for Disease Control and Prevention 

12 on arthritis and other musculoskeletal conditions in minor13 ity communities shall— 

14 (1) be culturally and linguistically appropriate 

15 to minority patients, targeting musculoskeletal 

16 health promotion and prevention programs of each 

17 major ethnic group, including— 

18 (A) Native Americans and Alaska Natives; 

19 (B) Asian-Americans; 

20 (C) African-Americans/Blacks; 

21 (D) Hispanic/Latino-Americans; and 

22 (E) Native Hawaiians and Pacific Island23 ers; and 

24 (2) include public awareness campaigns directed 

25 toward these patient populations that emphasize the 


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1 importance of musculoskeletal health, physical activ2 ity, diet and healthy lifestyle, and weight reduction 

3 for overweight and obese patients. 

4 (c) AUTHORIZATION OF APPROPRIATIONS.—To carry 

5 out this section, there are authorized to be appropriated 

6 such sums as necessary for fiscal year 2017 and each sub7 sequent fiscal year. 

8 SEC. 783. GRANTS FOR COMPREHENSIVE OSTEOARTHRITIS 

9 AND MUSCULOSKELETAL DISEASE HEALTH 

10 EDUCATION WITHIN HEALTH PROFESSIONS 

11 SCHOOLS. 

12 (a) PROGRAM AUTHORIZED.—The Secretary of 

13 Health and Human Services (in this section referred to 

14 as the ‘‘Secretary’’), in coordination with the Secretary of 

15 Education, shall award grants, on a competitive basis, to 

16 academic health science centers, health professions 

17 schools, and other institutions of higher education to en18 able such institutions to provide people with comprehen19 sive education on arthritis and musculoskeletal health, 

20 particularly— 

21 (1) obesity related musculoskeletal diseases; 

22 (2) arthritis and osteoarthritis; 

23 (3) arthritis and musculoskeletal health dispari24 ties; and 


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1 (4) the relationship between arthritis and mus2 culoskeletal diseases and metabolic activity, psycho3 logical health, and co-morbidities such as diabetes, 

4 cardiovascular disease, and hypertension. 

5 (b) DURATION.—Grants awarded under this section 

6 shall be for a period of 5 years. 

7 (c) APPLICATIONS.—An academic health science cen8 ter, health professions school, or other institution of high9 er education seeking a grant under this section shall sub10 mit an application to the Secretary at such time, in such 

11 manner, and containing such information as the Secretary 

12 may require. 

13 (d) PRIORITY.—In awarding grants under this sec14 tion, the Secretary shall give priority to an institution of 

15 higher education that— 

16 (1) has an enrollment of needy students, as de17 fined in section 318(b) of the Higher Education Act 

18 of 1965 (20 U.S.C. 1059e(b)); 

19 (2) is a Hispanic-serving institution, as defined 

20 in section 502(a) of such Act (20 U.S.C. 1101a(a)); 

21 (3) is a Tribal College or University, as defined 

22 in section 316(b) of such Act (20 U.S.C. 1059c(b)); 

23 (4) is an Alaska Native-serving institution, as 

24 defined in section 317(b) of such Act (20 U.S.C. 

25 1059d(b)); 


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1 (5) is a Native Hawaiian-serving institution, as 

2 defined in section 317(b) of such Act (20 U.S.C. 

3 1059d(b)); 

4 (6) is a Predominately Black Institution, as de5 fined in section 318(b) of such Act (20 U.S.C. 

6 1059e(b)); 

7 (7) is a Native American-serving, nontribal in8 stitution, as defined in section 319(b) of such Act 

9 (20 U.S.C. 1059f(b)); 

10 (8) is an Asian American and Native American 

11 Pacific Islander-serving institution, as defined in 

12 section 320(b) of such Act (20 U.S.C. 1059g(b)); or 

13 (9) is a minority institution, as defined in sec14 tion 365 of such Act (20 U.S.C. 1067k), with an en15 rollment of needy students, as defined in section 312 

16 of such Act (20 U.S.C. 1058). 

17 (e) USES OF FUNDS.—An institution of higher edu18 cation receiving a grant under this section may use grant 

19 funds to integrate issues relating to comprehensive arthri20 tis and musculoskeletal health into the academic or sup21 port sectors of the institution in order to reach a large 

22 number of students, by carrying out 1 or more of the fol23 lowing activities: 

24 (1) Developing educational content for issues 

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1 skeletal health education that will be incorporated 

2 into first-year orientation or core courses. 

3 (2) Creating innovative technology-based ap4 proaches to deliver arthritis and musculoskeletal 

5 health education to students, faculty, and staff. 

6 (3) Developing and employing peer-outreach 

7 and education programs to generate discussion, edu8 cate, and raise awareness among students about 

9 issues relating to arthritis and musculoskeletal 

10 health disorders, and their relationship to diabetes, 

11 hypertension, cardiovascular disease, psychological 

12 health, and other co-morbid conditions. 

13 (f) REPORT TO CONGRESS.— 

14 (1) IN GENERAL.—Not later than 1 year after 

15 the date of the enactment of this Act, and annually 

16 thereafter for a period of 5 years, the Secretary shall 

17 prepare and submit to the appropriate committees of 

18 Congress a report on the activities to provide health 

19 professions students with comprehensive arthritis 

20 and musculoskeletal health education funded under 

21 this section. 

22 (2) REPORT ELEMENTS.—The report described 

23 in paragraph (1) shall include information about— 

24 (A) the number of entities that are receiv25 ing grant funds; 


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1 (B) the specific activities supported by 

2 grant funds; 

3 (C) the number of students served by 

4 grant programs; and 

5 (D) the status of program evaluations. 

6 Subtitle I—Sleep and Circadian 

7 Rhythm Disorders 

8 SEC. 791. SHORT TITLE; FINDINGS. 

9 (a) SHORT TITLE.—This subtitle may be cited as the 

10 ‘‘Sleep and Circadian Rhythm Disorders Health Dispari11 ties Act’’. 

12 (b) FINDINGS.—The Congress finds the following: 

13 (1) Decrements in sleep health such as sleep 

14 apnea, insufficient sleep time, and insomnia, affect 

15 50–70 million United States adults. Twelve to eight16 een million United States adults have sleep apnea, a 

17 chronic disorder characterized by one or more 

18 pauses in breathing which can last from a few sec19 onds to minutes. They may occur 30 times or more 

20 an hour, disrupting sleep and resulting in excessive 

21 daytime sleepiness and loss in productivity. 

22 (2) Seventy percent of high school students are 

23 not getting enough sleep on school nights, while 33 

24 percent of Americans get fewer than 7 hours of sleep 


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1 per night and roughly 6,000 fatal motor vehicle 

2 crashes are caused by drowsy drivers. 

3 (3) Insufficient sleep and insomnia are more 

4 prevalent in women. Women who are pregnant and 

5 have sleep apnea are at an increased risk of cardio6 vascular complications during pregnancy. The im7 pact of disparities in sleep health is associated with 

8 a growing number of health problems, including the 

9 following: 

10 (A) Hypertension. 

11 (B) Cancer. 

12 (C) Stroke. 

13 (D) Cardiac arrhythmia. 

14 (E) Chronic heart failure and heart dis15 ease. 

16 (F) Diabetes. 

17 (G) Cognitive functioning and behavior. 

18 (H) Depression and bipolar disorder. 

19 (I) Substance abuse. 

20 (4) A ‘‘sleep disparity’’ exists in that poor sleep 

21 quality is strongly associated with poverty and race. 

22 Factors such as employment, education, and health 

23 status, amongst others, significantly mediated this 

24 effect only in poor subjects, suggesting a differential 


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1 vulnerability to these factors in poor relative to non2 poor individuals in the context of sleep quality. 

3 (5) African-Americans sleep worse than Cauca4 sian Americans. African-Americans take longer to 

5 fall asleep, report poorer sleep quality, have more 

6 light and less deep sleep, and nap more often and 

7 longer. 

8 (6) African-Americans and individuals in lower 

9 socioeconomic status groups may be at an increased 

10 risk for sleep disturbances and associated health 

11 consequences. 

12 (7) Among young African-Americans, the likeli13 hood of having sleep disordered breathing and exhib14 iting risk factors for poor sleep is twice that in 

15 young Caucasians. Frequent snoring is more com16 mon among African-American and Hispanic women 

17 and Hispanic men compared to non-Hispanic Cauca18 sians, independent of other factors including obesity. 

19 (8) African-Americans with sleep disordered 

20 breathing develop symptoms at a younger age than 

21 Caucasians but appear less likely to be diagnosed 

22 and treated in a timely manner. This delay may at 

23 least in part be due to reduced access to care. 

24 (9) Sleep loss contributes to increased risk for 

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1 pertension, all of which have increased prevalence in 

2 underserved, underrepresented minorities. Racial 

3 and ethnic disparities related to obesity may also 

4 contribute to disparities in health outcomes related 

5 to sleep disordered breathing. 

6 (10) Non-Caucasian adults report an insomnia 

7 rate of 12.9 percent compared to only 6.6 percent 

8 for Caucasians. 

9 (11) African-American women have a higher in10 cidence of insomnia than African-American men, 

11 perhaps related in part to higher risk for chronic 

12 persisting symptoms. 

13 SEC. 792. SLEEP AND CIRCADIAN RHYTHM DISORDERS RE14 SEARCH ACTIVITIES OF THE NATIONAL IN15 STITUTES OF HEALTH. 

16 (a) IN GENERAL.—The Director of the National In17 stitutes of Health, acting through the Director of the Na18 tional Heart, Lung, and Blood Institute, shall— 

19 (1) continue to expand research activities ad20 dressing sleep health disparities; and 

21 (2) continue implementation of the ‘‘NIH Sleep 

22 Disorders Research Plan’’ across all institutes and 

23 centers of the National Institutes of Health to im24 prove treatment and prevention of sleep health dis25 parities. 


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1 (b) REQUIRED RESEARCH ACTIVITIES.—In con2 ducting or supporting research relating to sleep and circa3 dian rhythm, the Director of the National Heart, Lung, 

4 and Blood Institute shall— 

5 (1) advance epidemiology and clinical research 

6 to achieve a more complete understanding of dispari7 ties in domains of sleep health and across population 

8 subgroups for which cardiovascular and metabolic 

9 health disparities exist, including— 

10 (A) prevalence and severity of sleep apnea; 

11 (B) habitual sleep duration; 

12 (C) sleep timing and regularity; and 

13 (D) insomnia; 

14 (2) develop study designs and analytical ap15 proaches to explain and predict multilevel and life16 course determinants of sleep health and to elucidate 

17 the sleep-related causes of cardiovascular and meta18 bolic health disparities across the age spectrum, in19 cluding such determinants and causes that are— 

20 (A) environmental; 

21 (B) biological or genetic; 

22 (C) psychosocial; 

23 (D) societal; 

24 (E) political; or 

25 (F) economic; 


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1 (3) determine the contribution of sleep impair2 ments such as sleep apnea, insufficient sleep dura3 tion, irregular sleep schedules, and insomnia to un4 explained disparities in cardiovascular and metabolic 

5 risk and disease outcomes; 

6 (4) develop study designs, data sampling and 

7 collection tools, and analytical approaches to opti8 mize understanding of mediating and moderating 

9 factors, and feedback mechanisms coupling sleep to 

10 cardiovascular and metabolic health disparities; 

11 (5) advance research to understand cultural 

12 and linguistic barriers (on the person, provider, or 

13 system level) to access to care, medical diagnosis, 

14 and treatment of sleep disorders in diverse popu15 lation groups; 

16 (6) develop and test multilevel interventions (in17 cluding sleep health education in diverse commu18 nities) to reduce disparities in sleep health that will 

19 impact ability to improve disparities in cardio20 vascular and metabolic risk or disease; 

21 (7) create opportunities to integrate sleep and 

22 health disparity science by strategically utilizing re23 sources (existing or anticipated cohorts), exchanging 

24 scientific data and ideas (cross-over into scientific 


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1 meetings), and develop multidisciplinary investi2 gator-initiated grant applications; and 

3 (8) enhance the diversity and foster career de4 velopment of young investigators involved in sleep 

5 and health disparities science. 

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 year 2017 and 

9 each subsequent fiscal year. 

10 SEC. 793. SLEEP AND CIRCADIAN RHYTHM HEALTH DIS11 PARITIES-RELATED ACTIVITIES OF THE CEN12 TERS FOR DISEASE CONTROL AND PREVEN13 TION. 

14 (a) IN GENERAL.—The Director of the Centers for 

15 Disease Control and Prevention shall conduct, support, 

16 and expand public health strategies and prevention, diag17 nosis, surveillance, and public and professional awareness 

18 activities regarding sleep and circadian rhythm disorders. 

19 (b) FINDINGS.—The Congress finds as follows: 

20 (1) Sleep disorders and sleep deficiency unre21 lated to a primary sleep disorder are underdiagnosed 

22 and are increasingly detrimental to health status. 

23 (2) The consequences to society include addi24 tional diseases, motor vehicle accidents, decreased 

25 longevity, elevated direct medical costs, and indirect 


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1 costs related to work absenteeism and property dam2 age. 

3 (c) REQUIRED SURVEILLANCE AND EDUCATION

4 AWARENESS ACTIVITIES.—In conducting or supporting 

5 research relating to sleep and circadian rhythm disorders 

6 surveillance and education awareness activities, the Direc7 tor of the Centers for Disease Control and Prevention 

8 shall— 

9 (1) ensure that such activities are culturally 

10 and linguistically appropriate to minority patients, 

11 targeting sleep and circadian rhythm health pro12 motion and prevention programs of each major eth13 nic group, including— 

14 (A) Native Americans and Alaska Natives; 

15 (B) Asian-Americans; 

16 (C) African-Americans/Blacks; 

17 (D) Hispanic/Latino-Americans; and 

18 (E) Native Hawaiians and Pacific Island19 ers; 

20 (2) collect and compile national and State sur21 veillance data on sleep disorders health disparities; 

22 (3) continue to develop and implement new 

23 sleep questions in public health surveillance systems 

24 to increase public awareness of sleep health and 

25 sleep disorders and their impact on health; 


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1 (4) publish monthly reports highlighting geo2 graphic, racial, and ethnic disparities in sleep health, 

3 as well as relationships between insufficient sleep 

4 and chronic disease, health risk behaviors, and other 

5 outcomes as determined necessary by the Director; 

6 and 

7 (5) include public awareness campaigns that in8 form patient populations from major ethnic groups 

9 about the prevalence of sleep and circadian rhythm 

10 disorders and emphasize the importance of sleep 

11 health. 

12 (d) AUTHORIZATION OF APPROPRIATIONS.—To carry 

13 out this section, there are authorized to be appropriated 

14 such sums as may be necessary for fiscal year 2017 and 

15 each subsequent fiscal year. 

16 SEC. 794. GRANTS FOR COMPREHENSIVE SLEEP AND CIR17 CADIAN HEALTH EDUCATION WITHIN 

18 HEALTH PROFESSIONS SCHOOLS. 

19 (a) PROGRAM AUTHORIZED.—The Secretary of 

20 Health and Human Services (in this section referred to 

21 as the ‘‘Secretary’’), in coordination with the Secretary of 

22 Education, shall award grants, on a competitive basis, to 

23 academic health science centers, health professions 

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1 sive education on sleep and circadian health, particu2 larly— 

3 (1) poor sleep health; 

4 (2) sleep disorders; 

5 (3) sleep health disparities; and 

6 (4) the relationship between sleep and circadian 

7 health on metabolic activity, neurological activity, co8 morbidities, and other diseases. 

9 (b) DURATION.—Grants awarded under this section 

10 shall be for a period of 5 years. 

11 (c) APPLICATIONS.—Any academic health science 

12 center, health professions school, or other institutions of 

13 higher education seeking a grant under this section shall 

14 submit an application to the Secretary at such time, in 

15 such manner, and containing such information as the Sec16 retary may require. 

17 (d) PRIORITY.—In awarding grants under this sec18 tion, the Secretary shall give priority to an institution 

19 that— 

20 (1) has an enrollment of needy students, as de21 fined in section 318(b) of the Higher Education Act 

22 of 1965 (20 U.S.C. 1059e(b)); 

23 (2) is a Hispanic-serving institution, as defined 

24 in section 502(a) of such Act (20 U.S.C. 1101a(a)); 


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1 (3) is a Tribal College or University, as defined 

2 in section 316(b) of such Act (20 U.S.C. 1059c(b)); 

3 (4) is an Alaska Native-serving institution, as 

4 defined in section 317(b) of such Act (20 U.S.C. 

5 1059d(b)); 

6 (5) is a Native Hawaiian-serving institution, as 

7 defined in section 317(b) of such Act (20 U.S.C. 

8 1059d(b)); 

9 (6) is a Predominately Black Institution, as de10 fined in section 318(b) of such Act (20 U.S.C. 

11 1059e(b)); 

12 (7) is a Native American-serving, nontribal in13 stitution, as defined in section 319(b) of such Act 

14 (20 U.S.C. 1059f(b)); 

15 (8) is an Asian American and Native American 

16 Pacific Islander-serving institution, as defined in 

17 section 320(b) of such Act (20 U.S.C. 1059g(b)); or 

18 (9) is a minority institution, as defined in sec19 tion 365 of such Act (20 U.S.C. 1067k), with an en20 rollment of needy students, as defined in section 312 

21 of such Act (20 U.S.C. 1058). 

22 (e) USES OF FUNDS.—An institution of higher edu23 cation receiving a grant under this section may use grant 

24 funds to integrate issues relating to comprehensive sleep 

25 and circadian health into the academic or support sectors 


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1 of the institution in order to reach a large number of stu2 dents, by carrying out 1 or more of the following activities: 

3 (1) Developing educational content for issues 

4 relating to comprehensive sleep and circadian health 

5 education that will be incorporated into first-year 

6 orientation or core courses. 

7 (2) Creating innovative technology-based ap8 proaches to deliver sleep health education to stu9 dents, faculty, and staff. 

10 (3) Developing and employing peer-outreach 

11 and education programs to generate discussion, edu12 cate, and raise awareness among students about 

13 issues relating to poor quality sleep, sleep and circa14 dian disorders, and the role sleep health plays in 

15 other diseases and co-morbidities. 

16 (f) REPORT TO CONGRESS.— 

17 (1) IN GENERAL.—Not later than 1 year after 

18 the date of the enactment of this Act, and annually 

19 thereafter for a period of 5 years, the Secretary shall 

20 prepare and submit to the appropriate committees of 

21 Congress a report on the activities to provide health 

22 professions students with comprehensive sleep and 

23 circadian health education funded under this section. 

24 (2) REPORT ELEMENTS.—The report described 

25 in paragraph (1) shall include information about— 


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1 (A) the number of eligible entities and in2 stitutions of higher education that are receiving 

3 grant funds; 

4 (B) the specific activities supported by 

5 grant funds; 

6 (C) the number of students served by 

7 grant programs; and 

8 (D) the status of program evaluations. 

9 SEC. 795. REPORT ON IMPACT OF SLEEP AND CIRCADIAN 

10 HEALTH DISORDERS IN VULNERABLE & RA11 CIAL/ETHNIC POPULATIONS. 

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

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

14 Human Services shall submit to the Congress and the 

15 President a report on the impact of sleep and circadian 

16 health disorders for racial and ethnic minority commu17 nities and other vulnerable populations. 

18 (b) CONTENTS.—The report under subsection (a) 

19 shall include information on the— 

20 (1) progress that has been made in reducing 

21 the impact of sleep and circadian health disorders in 

22 such communities and populations; 

23 (2) opportunities that exist to make additional 

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1 dian health disorders in such communities and popu2 lations; 

3 (3) challenges that may impede such additional 

4 progress; and 

5 (4) Federal funding necessary to achieve sub6 stantial reductions in sleep and circadian health dis7 orders in racial and ethnic minority communities. 

8 TITLE VIII—HEALTH 

9 INFORMATION TECHNOLOGY 

10 SEC. 800. DEFINITIONS. 

11 In this title: 

12 (1) The term ‘‘certified EHR technology’’ has 

13 the meaning given to that term in section 3000 of 

14 the Public Health Service Act (42 U.S.C. 300jj). 

15 (2) The term ‘‘EHR’’ means an electronic 

16 health record. 

17 Subtitle A—Reducing Health 

18 Disparities Through Health IT 

19 SEC. 801. HRSA ASSISTANCE TO HEALTH CENTERS FOR 

20 PROMOTION OF HEALTH IT. 

21 The Secretary of Health and Human Services, acting 

22 through the Administrator of the Health Resources and 

23 Services Administration, shall expand and intensify the 

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1 ance and resources to health centers (as defined in section 

2 330(a) of the Public Health Service Act (42 U.S.C. 

3 254b(a)) to adopt and meaningfully use certified EHR 

4 technology for the management of chronic diseases and 

5 health conditions and reduction of health disparities. 

6 SEC. 802. ASSESSMENT OF IMPACT OF HEALTH IT ON RA7 CIAL AND ETHNIC MINORITY COMMUNITIES; 

8 OUTREACH AND ADOPTION OF HEALTH IT IN 

9 SUCH COMMUNITIES. 

10 (a) NATIONAL COORDINATOR FOR HEALTH INFOR11 MATION TECHNOLOGY.— 

12 (1) IN GENERAL.—The National Coordinator 

13 for Health Information Technology shall conduct an 

14 evaluation of the level of use and accessibility of 

15 electronic health records in racial and ethnic minor16 ity communities focusing on whether patients in 

17 those communities have providers with electronic 

18 health records, stratified by disparity variables. 

19 (2) CONTENT.—In conducting the evaluation 

20 under paragraph (1), the National Coordinator shall 

21 publish the results of a study regarding the 100,000 

22 providers recruited by the Regional Extension Cen23 ter established under section 3012 of the Public 

24 Health Service Act (42 U.S.C. 300jj–32), including 

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1 ulations served by such providers, with the popu2 lations stratified by disparity variables. 

3 (b) NATIONAL CENTER FOR HEALTH STATISTICS.— 

4 As soon as practicable after the date of enactment of this 

5 Act, the Director of the National Center for Health Statis6 tics shall provide to Congress a more detailed analysis of 

7 the data presented in the Data Brief 79 published by such 

8 Center in November 2011 (entitled ‘‘Electronic Health 

9 Record Systems and Intent to Apply for Meaningful Use 

10 Incentives Among Office-Based Physician Practices’’). 

11 (c) INSTITUTE OF MEDICINE.—The Secretary of 

12 Health and Human Services may enter into an agreement 

13 with the Institute of Medicine of the National Academies 

14 that provides such Institute will— 

15 (1) evaluate the impact of health information 

16 technology in racial and ethnic minority commu17 nities; and 

18 (2) publish a report regarding such evaluation. 

19 (d) CENTERS FOR MEDICARE & MEDICAID SERV20 ICES.— 

21 (1) IN GENERAL.—As part of the process of 

22 collecting information, with respect to a provider, at 

23 registration and attestation for purposes of the 

24 Medicare and Medicaid Electronic Health Records 

25 Incentive Programs, the Secretary of Health and 


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1 Human Services shall collect the race and ethnicity 

2 of such provider. 

3 (2) MEDICARE AND MEDICAID ELECTRONIC

4 HEALTH RECORDS INCENTIVE PROGRAMS DE5 FINED.—For purposes of paragraph (1), the term 

6 ‘‘Medicare and Medicaid Electronic Health Records 

7 Incentive Programs’’ means the incentive programs 

8 under section 1814(l)(3), subsections (a)(7) and (o) 

9 of section 1848, subsections (l) and (m) of section 

10 1853, subsections (b)(3)(B)(ix)(I) and (n) of section 

11 1886, and subsections (a)(3)(F) and (t) of section 

12 1903 of the Social Security Act (42 U.S.C. 

13 1395f(l)(3), 1395w–4, 1395w–23, 1395ww, and 

14 1396b). 

15 (e) NATIONAL COORDINATOR’S ASSESSMENT OF IM16 PACT OF HIT.—Section 3001(c)(6)(C) of the Public 

17 Health Service Act (42 U.S.C. 300jj–11(c)(6)(C)) is 

18 amended— 

19 (1) in the heading by inserting ‘‘, RACIAL AND

20 ETHNIC MINORITY COMMUNITIES,’’ after ‘‘HEALTH

21 DISPARITIES’’; 

22 (2) by inserting ‘‘, in communities with a high 

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1 cluding people with disabilities in these groups,’’ 

2 after ‘‘communities with health disparities’’; and 

3 (3) by adding at the end the following new sen4 tence: ‘‘In any publication under the previous sen5 tence, the National Coordinator shall include best 

6 practices for encouraging partnerships between the 

7 Federal Government, States, and private entities to 

8 expand outreach for and the adoption of certified 

9 EHR technology in communities with a high propor10 tion of individuals from racial and ethnic minority 

11 groups (as so defined), while also maintaining the 

12 accessibility requirements of section 508 of the Re13 habilitation Act to encourage patient involvement in 

14 their own health care. The National Coordinator 

15 shall— 

16 ‘‘(i) not later than 6 months after the 

17 submission to the Congress of the report 

18 required by section 832 of the Health Eq19 uity and Accountability Act of 2016, estab20 lish criteria for evaluating the impact of 

21 health information technology on commu22 nities with a high proportion of individuals 

23 from racial and ethnic minority groups (as 

24 so defined) taking into account the find25 ings in such report; and 


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1 ‘‘(ii) not later than 12 months after 

2 the submission to the Congress of such re3 ports, conduct and publish the results of 

4 an evaluation of such impact.’’. 

5 Subtitle B—Modifications To 

6 Achieve Parity in Existing Pro7 grams 

8 SEC. 811. EXTENDING FUNDING TO STRENGTHEN THE 

9 HEALTH IT INFRASTRUCTURE IN RACIAL 

10 AND ETHNIC MINORITY COMMUNITIES. 

11 Section 3011 of the Public Health Service Act (42 

12 U.S.C. 300jj–31) is amended— 

13 (1) in subsection (a), by adding at the end the 

14 following new paragraph: 

15 ‘‘(8) Activities described in the previous para16 graphs of this subsection with respect to commu17 nities with a high proportion of individuals from ra18 cial and ethnic minority groups (as defined in sec19 tion 1707(g)).’’; and 

20 (2) by adding at the end the following new sub21 section: 

22 ‘‘(e) ANNUAL REPORT ON EXPENDITURES.—The 

23 National Coordinator shall report annually to the Con24 gress on activities and expenditures under this section.’’. 


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1 SEC. 812. PRIORITIZING REGIONAL EXTENSION CENTER AS2 SISTANCE TO RACIAL AND ETHNIC MINORITY 

3 GROUPS. 

4 (a) IN GENERAL.—Section 3012(c)(4)(C) of the Pub5 lic Health Service Act (42 U.S.C. 300jj–32(c)(4)(C)) is 

6 amended by inserting ‘‘or individuals from racial and eth7 nic minority groups (as defined in section 1707(g))’’ after 

8 ‘‘medically underserved individuals’’. 

9 (b) BIENNIAL EVALUATION.—Section 3012(c)(8) of 

10 the Public Health Service Act (42 U.S.C. 300jj–32(c)(8)) 

11 is amended— 

12 (1) by inserting: ‘‘Each evaluation panel shall 

13 include at least one consumer advocate from a racial 

14 and ethnic minority community served by the center 

15 involved, at least one patient or family caregiver, 

16 and at least one representative of a minority-serving 

17 institution.’’ after ‘‘ ‘and of Federal officials.’’; and 

18 (2) by inserting ‘‘and shall determine the de19 gree to which such center provides outreach and as20 sistance to providers predominantly serving racial 

21 and ethnic minority groups (as defined in section 

22 1707(g))’’ after ‘‘specified in paragraph (3)’’. 


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1 SEC. 813. 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— 

8 (1) in paragraph (3), by striking at the end 

9 ‘‘or’’; 

10 (2) in paragraph (4), by striking the period at 

11 the end and inserting ‘‘; or’’; and 

12 (3) by adding at the end the following new 

13 paragraph: 

14 ‘‘(5) carry out any of the activities described in 

15 a previous paragraph of this subsection with respect 

16 to communities with a high proportion of individuals 

17 from racial and ethnic minority groups (as defined 

18 in section 1707(g)).’’. 

19 SEC. 814. AUTHORIZATION OF APPROPRIATIONS. 

20 Section 3018 of the Public Health Service Act (42 

21 U.S.C. 300jj–38) is amended by striking ‘‘fiscal years 

22 2009 through 2013’’ and inserting ‘‘fiscal years 2017 

23 through 2021’’. 


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1 Subtitle C—Additional Research 

2 and Studies 

3 SEC. 831. DATA COLLECTION AND ASSESSMENTS CON4 DUCTED IN COORDINATION WITH MINORITY5 SERVING INSTITUTIONS. 

6 Section 3001(c)(6) of the Public Health Service Act 

7 (42 U.S.C. 300jj–11(c)(6)) is amended by adding at the 

8 end the following new subparagraph: 

9 ‘‘(F) DATA COLLECTION AND ASSESS10 MENTS CONDUCTED IN COORDINATION WITH

11 MINORITY-SERVING INSTITUTIONS.— 

12 ‘‘(i) IN GENERAL.—In carrying out 

13 subparagraph (C) with respect to commu14 nities with a high proportion of individuals 

15 from racial and ethnic minority groups (as 

16 defined in section 1707(g)), the National 

17 Coordinator shall, to the greatest extent 

18 possible, coordinate with an entity de19 scribed in clause (ii). 

20 ‘‘(ii) MINORITY-SERVING INSTITU21 TIONS.—For purposes of clause (i), an en22 tity described in this clause is a historically 

23 Black college or university, a Hispanic24 serving institution, a tribal college or uni25 versity, or an Asian-American-, Native 


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1 American-, and Pacific Islander-serving in2 stitution with an accredited public health, 

3 health policy, or health services research 

4 program.’’. 

5 SEC. 832. STUDY OF HEALTH INFORMATION TECHNOLOGY 

6 IN MEDICALLY UNDERSERVED COMMU7 NITIES. 

8 (a) IN GENERAL.—Not later than 24 months after 

9 the date of enactment of this Act, the Secretary of Health 

10 and Human Services shall— 

11 (1) enter into an agreement with the Institute 

12 of Medicine of the National Academies (or, if the In13 stitute of Medicine declines, another appropriate 

14 public or nonprofit private entity) to conduct a study 

15 on the development, implementation, and effective16 ness of health information technology within medi17 cally underserved areas (as described in subsection 

18 (c)); and 

19 (2) submit a report to Congress describing the 

20 results of such study, including any recommenda21 tions for legislative or administrative action. 

22 (b) STUDY.—The study described in subsection 

23 (a)(1) shall— 


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1 (1) identify barriers to successful implementa2 tion of health information technology in medically 

3 underserved areas; 

4 (2) examine the impact of health information 

5 technology on providing quality care and reducing 

6 the cost of care to individuals in such areas, includ7 ing the impact of such technology on improved 

8 health outcomes for individuals, including which 

9 technology worked for which population and how it 

10 improved health outcomes for that population; 

11 (3) examine the impact of health information 

12 technology on improving health-care-related deci13 sions by both patients and providers in such areas; 

14 (4) identify specific best practices for using 

15 health information technology to foster the con16 sistent provision of physical accessibility and reason17 able policy accommodations in health care to individ18 uals with disabilities in such areas; 

19 (5) assess the feasibility and costs associated 

20 with the use of health information technology in 

21 such areas; 

22 (6) evaluate whether the adoption and use of 

23 qualified electronic health records (as described in 

24 section 3000(13) of the Public Health Service Act 

25 (42 U.S.C. 300jj(13)) is effective in reducing health 


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1 disparities, including analysis of clinical quality 

2 measures reported by Medicare and Medicaid pro3 viders pursuant to programs to encourage the adop4 tion and use of certified EHR technology; 

5 (7) identify providers in medically underserved 

6 areas that are not electing to adopt and use elec7 tronic health records and determine what barriers 

8 are preventing those providers from adopting and 

9 using such records; and 

10 (8) examine urban and rural community health 

11 systems and determine the impact that health infor12 mation technology may have on the capacity of pri13 mary health providers in those systems. 

14 (c) MEDICALLY UNDERSERVED AREA.—The term 

15 ‘‘medically underserved area’’ means— 

16 (1) a population that has been designated as a 

17 medically underserved population under section 

18 330(b)(3) of the Public Health Service Act (42 

19 U.S.C. 254b(b)(3)); 

20 (2) an area that has been designated as a 

21 health professional shortage area under section 332 

22 of the Public Health Service Act (42 U.S.C. 254e); 

23 (3) an area or population that has been des24 ignated as a medically underserved community under 


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1 section 799B(6) of the Public Health Service Act 

2 (42 U.S.C. 295p(6)); or 

3 (4) an area or population that— 

4 (A) is not described in paragraphs (1) 

5 through (3) of this subsection; 

6 (B) experiences significant barriers to ac7 cessing quality health services; and 

8 (C) has a high prevalence of diseases or 

9 conditions described in title VII of this Act, 

10 with such diseases or conditions having a dis11 proportionate impact on racial and ethnic mi12 nority groups (as defined in section 1707(g) of 

13 the Public Health Service Act (42 U.S.C. 300u14 6(g))) or a subgroup of people with disabilities 

15 who have specific functional impairments. 

16 Subtitle D—Closing Gaps in 

17 Funding To Adopt Certified EHRs 

18 SEC. 841. EXTENDING MEDICAID EHR INCENTIVE PAY19 MENTS TO REHABILITATION FACILITIES, 

20 LONG-TERM CARE FACILITIES, AND HOME 

21 HEALTH AGENCIES. 

22 Section 1903(t)(2)(B) of the Social Security Act (42 

23 U.S.C. 1396b(t)(2)(B)) is amended— 

24 (1) in clause (i), by striking ‘‘, or’’ and insert25 ing a semicolon; 


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1 (2) in clause (ii), by striking the period at the 

2 end and inserting a semicolon; and 

3 (3) by inserting after clause (ii) the following 

4 new clauses: 

5 ‘‘(iii) a rehabilitation facility (as defined in sec6 tion 1886(j)(1)) that furnishes acute or subacute re7 habilitation services; 

8 ‘‘(iv) a long-term care hospital (as defined in 

9 section 1886(d)(1)(B)(iv)(I)); or 

10 ‘‘(v) a home health agency (as defined in sec11 tion 1861(o)).’’. 

12 SEC. 842. EXTENDING PHYSICIAN ASSISTANT ELIGIBILITY 

13 FOR MEDICAID ELECTRONIC HEALTH 

14 RECORD INCENTIVE PAYMENTS. 

15 (a) IN GENERAL.—Section 1903(t)(3)(B)(v) of the 

16 Social Security Act (42 U.S.C. 1396b(t)(3)(B)(v)) is 

17 amended to read as follows: 

18 ‘‘(v) physician assistant, in the case that 

19 the assistant is a primary care provider, includ20 ing an assistant who practices in a rural health 

21 clinic that is led by a physician assistant or 

22 practices in a federally qualified health center 

23 that is so led.’’. 

24 (b) EFFECTIVE DATE.—The amendment made by 

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1 pended under section 1903(a)(3)(F) of the Social Security 

2 Act (42 U.S.C. 1396b(a)(3)(F)) for calendar quarters be3 ginning on or after the date of the enactment of this Act. 

4 TITLE IX—ACCOUNTABILITY 

5 AND EVALUATION 

6 SEC. 901. PROHIBITION ON DISCRIMINATION IN FEDERAL 

7 ASSISTED HEALTH CARE SERVICES AND RE8 SEARCH PROGRAMS ON THE BASIS OF SEX, 

9 RACE, COLOR, NATIONAL ORIGIN, MARITAL 

10 STATUS, FAMILIAL STATUS, SEXUAL ORI11 ENTATION, GENDER IDENTITY, OR DIS12 ABILITY STATUS. 

13 (a) IN GENERAL.—No person in the United States 

14 shall, on the basis of sex, race, color, national origin, mar15 ital status, familial status, sexual orientation, gender iden16 tity, or disability status, be excluded from participation 

17 in, be denied the benefits of, or be subjected to discrimina18 tion under any health program or activity, including any 

19 health research program or activity, receiving Federal fi20 nancial assistance. 

21 (b) DEFINITION.—In this section, the term ‘‘familial 

22 status’’ means, with respect to one or more individuals— 

23 (1) being domiciled with any individual related 

24 by blood or affinity whose close association with the 

25 individual is the equivalent of a family relationship; 


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1 (2) being in the process of securing legal cus2 tody of any individual; or 

3 (3) being pregnant. 

4 SEC. 902. TREATMENT OF MEDICARE PAYMENTS UNDER 

5 TITLE VI OF THE CIVIL RIGHTS ACT OF 1964. 

6 A payment to a provider of services, physician, or 

7 other supplier under part B, C, or D of title XVIII of 

8 the Social Security Act shall be deemed a grant, and not 

9 a contract of insurance or guaranty, for the purposes of 

10 title VI of the Civil Rights Act of 1964. 

11 SEC. 903. ACCOUNTABILITY AND TRANSPARENCY WITHIN 

12 THE DEPARTMENT OF HEALTH AND HUMAN 

13 SERVICES. 

14 Title XXXIV of the Public Health Service Act, as 

15 amended by titles I, II, and III of this Act, is further 

16 amended by inserting after subtitle B the following: 

17 ‘‘Subtitle C—Strengthening 

18 Accountability 

19 ‘‘SEC. 3441. ELEVATION OF THE OFFICE OF CIVIL RIGHTS. 

20 ‘‘(a) IN GENERAL.—The Secretary shall establish 

21 within the Office for Civil Rights an Office of Health Dis22 parities, which shall be headed by a director to be ap23 pointed by the Secretary. 

24 ‘‘(b) PURPOSE.—The Office of Health Disparities 

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1 ations of health entities which receive Federal financial as2 sistance are in compliance with title VI of the Civil Rights 

3 Act, which prohibits discrimination on the basis of race, 

4 color, or national origin. The activities of the Office shall 

5 include the following: 

6 ‘‘(1) The development and implementation of 

7 an action plan to address racial and ethnic health 

8 care disparities, which shall address concerns relat9 ing to the Office for Civil Rights as released by the 

10 United States Commission on Civil Rights in the re11 port entitled ‘Health Care Challenge: Acknowledging 

12 Disparity, Confronting Discrimination, and Ensur13 ing Equity’ (September 1999) in conjunction with 

14 the reports by the Institute of Medicine entitled ‘Un15 equal Treatment: Confronting Racial and Ethnic 

16 Disparities in Health Care’, ‘Crossing the Quality 

17 Chasm: A New Health System for the 21st Cen18 tury’, ‘In the Nation’s Compelling Interest: Ensur19 ing Diversity in the Health Care Workforce’, ‘The 

20 National Partnership for Action to End Health Dis21 parities’, and ‘The Health of Lesbian, Gay, Bisexual, 

22 and Transgender People’, and other related reports 

23 by the Institute of Medicine. This plan shall be pub24 licly disclosed for review and comment and the final 


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1 plan shall address any comments or concerns that 

2 are received by the Office. 

3 ‘‘(2) Investigative and enforcement actions 

4 against intentional discrimination and policies and 

5 practices that have a disparate impact on minorities. 

6 ‘‘(3) The review of racial, ethnic, gender iden7 tity, sexual orientation, sex, disability status, socio8 economic status, and primary language health data 

9 collected by Federal health agencies to assess health 

10 care disparities related to intentional discrimination 

11 and policies and practices that have a disparate im12 pact on minorities. 

13 ‘‘(4) Outreach and education activities relating 

14 to compliance with title VI of the Civil Rights Act. 

15 ‘‘(5) The provision of technical assistance for 

16 health entities to facilitate compliance with title VI 

17 of the Civil Rights Act. 

18 ‘‘(6) Coordination and oversight of activities of 

19 the civil rights compliance offices established under 

20 section 3442. 

21 ‘‘(7) Ensuring— 

22 ‘‘(A) at a minimum, compliance with the 

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1 senting Federal Data on Race and Ethnicity; 

2 and 

3 ‘‘(B) consideration of available data and 

4 language standards such as— 

5 ‘‘(i) the standards for collecting and 

6 reporting data under section 3101; and 

7 ‘‘(ii) the National Standards on Cul8 turally and Linguistically Appropriate 

9 Services of the Office of Minority Health 

10 within the Department of Health and 

11 Human Services. 

12 ‘‘(c) FUNDING AND STAFF.—The Secretary shall en13 sure the effectiveness of the Office of Health Disparities 

14 by ensuring that the Office is provided with— 

15 ‘‘(1) adequate funding to enable the Office to 

16 carry out its duties under this section; and 

17 ‘‘(2) staff with expertise in— 

18 ‘‘(A) epidemiology; 

19 ‘‘(B) statistics; 

20 ‘‘(C) health quality assurance; 

21 ‘‘(D) minority health and health dispari22 ties; 

23 ‘‘(E) cultural and linguistic competency; 

24 ‘‘(F) civil rights; and 


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1 ‘‘(G) social, behavioral, and economic de2 terminants of health. 

3 ‘‘(d) REPORT.—Not later than December 31, 2017, 

4 and annually thereafter, the Secretary, in collaboration 

5 with the Director of the Office for Civil Rights and the 

6 Deputy Assistant Secretary for Minority Health, shall 

7 submit a report to the Committee on Health, Education, 

8 Labor, and Pensions of the Senate and the Committee on 

9 Energy and Commerce of the House of Representatives 

10 that includes— 

11 ‘‘(1) the number of cases filed, broken down by 

12 category; 

13 ‘‘(2) the number of cases investigated and 

14 closed by the office; 

15 ‘‘(3) the outcomes of cases investigated; 

16 ‘‘(4) the staffing levels of the office including 

17 staff credentials; 

18 ‘‘(5) the number of other lingering and emerg19 ing cases in which civil rights inequities can be dem20 onstrated; and 

21 ‘‘(6) the number of cases remaining open and 

22 an explanation for their open status. 

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

24 are 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 2017 through 2022. 

3 ‘‘SEC. 3442. ESTABLISHMENT OF HEALTH PROGRAM OF4 FICES FOR CIVIL RIGHTS WITHIN FEDERAL 

5 HEALTH AND HUMAN SERVICES AGENCIES. 

6 ‘‘(a) IN GENERAL.—The Secretary shall establish 

7 civil rights compliance offices in each agency within the 

8 Department of Health and Human Services that admin9 isters health programs. 

10 ‘‘(b) PURPOSE OF OFFICES.—Each office established 

11 under subsection (a) shall ensure that recipients of Fed12 eral financial assistance under Federal health programs 

13 administer their programs, services, and activities in a 

14 manner that— 

15 ‘‘(1) does not discriminate, either intentionally 

16 or in effect, on the basis of race, national origin, lan17 guage, ethnicity, sex, age, disability, sexual orienta18 tion, and gender identity; and 

19 ‘‘(2) promotes the reduction and elimination of 

20 disparities in health and health care based on race, 

21 national origin, language, ethnicity, sex, age, dis22 ability, sexual orientation, and gender identity. 

23 ‘‘(c) POWERS AND DUTIES.—The offices established 

24 in subsection (a) shall have the following powers and du25 ties: 


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1 ‘‘(1) The establishment of compliance and pro2 gram participation standards for recipients of Fed3 eral financial assistance under each program admin4 istered by an agency within the Department of 

5 Health and Human Services including the establish6 ment of disparity reduction standards to encompass 

7 disparities in health and health care related to race, 

8 national origin, language, ethnicity, sex, age, dis9 ability, sexual orientation, and gender identity. 

10 ‘‘(2) The development and implementation of 

11 program-specific guidelines that interpret and apply 

12 Department of Health and Human Services guid13 ance under title VI of the Civil Rights Act of 1964 

14 and section 1557 of the Patient Protection and Af15 fordable Care Act to each Federal health program 

16 administered by the agency. 

17 ‘‘(3) The development of a disparity-reduction 

18 impact analysis methodology that shall be applied to 

19 every rule issued by the agency and published as 

20 part of the formal rulemaking process under sections 

21 555, 556, and 557 of title 5, United States Code. 

22 ‘‘(4) Oversight of data collection, analysis, and 

23 publication requirements for all recipients of Federal 

24 financial assistance under each Federal health pro25 gram administered by the agency; compliance with, 


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1 at a minimum, the 1997 Office of Management and 

2 Budget Standards for Maintaining, Collecting, and 

3 Presenting Federal Data on Race and Ethnicity; and 

4 consideration of available data and language stand5 ards such as— 

6 ‘‘(A) the standards for collecting and re7 porting data under section 3101; and 

8 ‘‘(B) the National Standards on Culturally 

9 and Linguistically Appropriate Services of the 

10 Office of Minority Health within the Depart11 ment of Health and Human Services. 

12 ‘‘(5) The conduct of publicly available studies 

13 regarding discrimination within Federal health pro14 grams administered by the agency as well as dis15 parity reduction initiatives by recipients of Federal 

16 financial assistance under Federal health programs. 

17 ‘‘(6) Annual reports to the Committee on 

18 Health, Education, Labor, and Pensions and the 

19 Committee on Finance of the Senate and the Com20 mittee on Energy and Commerce and the Committee 

21 on Ways and Means of the House of Representatives 

22 on the progress in reducing disparities in health and 

23 health care through the Federal programs adminis24 tered by the agency. 


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1 ‘‘(d) RELATIONSHIP TO OFFICE FOR CIVIL RIGHTS

2 IN THE DEPARTMENT OF JUSTICE.— 

3 ‘‘(1) DEPARTMENT OF HEALTH AND HUMAN

4 SERVICES.—The Office for Civil Rights in the De5 partment of Health and Human Services shall pro6 vide standard-setting and compliance review inves7 tigation support services to the Civil Rights Compli8 ance Office for each agency. 

9 ‘‘(2) DEPARTMENT OF JUSTICE.—The Office 

10 for Civil Rights in the Department of Justice shall 

11 continue to maintain the power to institute formal 

12 proceedings when an agency Office for Civil Rights 

13 determines that a recipient of Federal financial as14 sistance is not in compliance with the disparity re15 duction standards of the agency. 

16 ‘‘(e) DEFINITION.—In this section, the term ‘Federal 

17 health programs’ mean programs— 

18 ‘‘(1) under the Social Security Act (42 U.S.C. 

19 301 et seq.) that pay for health care and services; 

20 and 

21 ‘‘(2) under this Act that provide Federal finan22 cial assistance for health care, biomedical research, 

23 health services research, and programs designed to 

24 improve the public’s health, including health service 

25 programs.’’. 


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1 SEC. 904. UNITED STATES COMMISSION ON CIVIL RIGHTS. 

2 (a) COORDINATION WITHIN DEPARTMENT OF JUS3 TICE OF ACTIVITIES REGARDING HEALTH DISPARI4 TIES.—Section 3(a) of the Civil Rights Commission Act 

5 of 1983 (42 U.S.C. 1975a(a)) is amended— 

6 (1) in paragraph (1), by striking ‘‘and’’ at the 

7 end; 

8 (2) in paragraph (2), by striking the period at 

9 the end and inserting ‘‘; and’’; and 

10 (3) by adding at the end the following: 

11 ‘‘(3) shall, with respect to activities carried out 

12 in health care and correctional facilities toward the 

13 goal of eliminating health disparities between the 

14 general population and members of racial or ethnic 

15 minority groups, coordinate such activities of— 

16 ‘‘(A) the Office for Civil Rights within the 

17 Department of Justice; 

18 ‘‘(B) the Office of Justice Programs within 

19 the Department of Justice; 

20 ‘‘(C) the Office for Civil Rights within the 

21 Department of Health and Human Services; 

22 and 

23 ‘‘(D) the Office of Minority Health within 

24 the Department of Health and Human Services 

25 (headed by the Deputy Assistant Secretary for 

26 Minority Health).’’. 


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1 (b) AUTHORIZATION OF APPROPRIATIONS.—Section 

2 5 of the Civil Rights Commission Act of 1983 (42 U.S.C. 

3 1975c) is amended by striking the first sentence and in4 serting the following: ‘‘For the purpose of carrying out 

5 this Act, there are authorized to be appropriated 

6 $30,000,000 for fiscal year 2017, and such sums as may 

7 be necessary for each of the fiscal years 2018 through 

8 2022.’’. 

9 SEC. 905. SENSE OF CONGRESS CONCERNING FULL FUND10 ING OF ACTIVITIES TO ELIMINATE RACIAL 

11 AND ETHNIC HEALTH DISPARITIES. 

12 (a) FINDINGS.—Congress makes the following find13 ings: 

14 (1) The health status of the American populace 

15 is declining and the United States currently ranks 

16 below most industrialized nations in health status 

17 measured by longevity, sickness, and mortality. 

18 (2) Racial and ethnic minority populations tend 

19 have the poorest health status and face substantial 

20 cultural, social, and economic barriers to obtaining 

21 quality health care. 

22 (3) Lesbian, gay, bisexual, transgender, queer, 

23 and questioning (LGBTQ) populations experience 

24 significant personal and structural barriers to ob25 taining high-quality health care. 


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1 (4) Efforts to improve minority health have 

2 been limited by inadequate resources (funding, staff3 ing, and stewardship) and lack of accountability. 

4 (b) SENSE OF CONGRESS.—It is the sense of Con5 gress that— 

6 (1) funding should be doubled by fiscal year 

7 2018 for the National Institute for Minority Health 

8 Disparities, the Office of Civil Rights in the Depart9 ment of Health and Human Services, the National 

10 Institute of Nursing Research, and the Office of Mi11 nority Health; 

12 (2) adequate funding by fiscal year 2018, and 

13 subsequent funding increases, should be provided for 

14 health and human service professions training pro15 grams, the Racial and Ethnic Approaches to Com16 munity Health (REACH) Initiative at the Centers 

17 for Disease Control and Prevention, the Minority 

18 HIV/AIDS Initiative, and the Excellence Centers to 

19 Eliminate Ethnic/Racial Disparities (EXCEED) 

20 Program at the Agency for Healthcare Research and 

21 Quality; 

22 (3) funding should be fully restored to the Ra23 cial and Ethnic Approaches to Community Health 

24 (REACH) Initiative at the Centers for Disease Con25 trol and Prevention, which has been a successful 


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1 program at the community health level, and efforts 

2 should continue to place a strong emphasis on build3 ing community capacity to secure financial resources 

4 and technical assistance to eliminate health dispari5 ties; 

6 (4) adequate funding for fiscal year 2018 and 

7 increased funding for future years should be pro8 vided for the REACH Initiative’s United States Risk 

9 Factor Survey to ensure adequate data collection to 

10 track health disparities, and there should be appro11 priate avenues provided to disseminate findings to 

12 the general public; 

13 (5) current and newly created health disparity 

14 elimination incentives, programs, agencies, and de15 partments under this Act (and the amendments 

16 made by this Act) should receive adequate staffing 

17 and funding by fiscal year 2018; and 

18 (6) stewardship and accountability should be 

19 provided to the Congress and the President for 

20 measurable and sustainable progress toward health 

21 disparity elimination. 

22 SEC. 906. GAO AND NIH REPORTS. 

23 (a) GAO REPORT ON NIH GRANT RACIAL AND ETH24 NIC DIVERSITY.— 


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1 (1) IN GENERAL.—The Comptroller General of 

2 the United States shall conduct a study on the racial 

3 and ethnic diversity among the following groups: 

4 (A) All applicants for grants, contracts, 

5 and cooperative agreements awarded by the Na6 tional Institutes of Health during the period be7 ginning on January 1, 2006, and ending De8 cember 31, 2015. 

9 (B) All recipients of such grants, con10 tracts, and cooperative agreements. 

11 (C) All members of the peer review panels 

12 of such applicants and recipients, respectively. 

13 (2) REPORT.—Not later than six months after 

14 the date of the enactment of this Act, the Comp15 troller General shall complete the study under para16 graph (1) and submit to Congress a report con17 taining the results of such study. 

18 (b) NIH REPORT ON CERTAIN AUTHORITY OF NA19 TIONAL INSTITUTE ON MINORITY HEALTH AND HEALTH

20 DISPARITIES.—Not later than six months after the date 

21 of the enactment of this Act, and biennially thereafter, the 

22 Director of the National Institutes of Health, in collabora23 tion with the Director of the National Institute on Minor24 ity Health and Health Disparities, shall submit to Con25 gress a report that details and evaluates— 


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1 (1) the steps taken during the applicable report 

2 period by the Director of the National Institutes of 

3 Health to enforce the expanded planning, coordina4 tion, review, and evaluation authority provided the 

5 National Institute on Minority Health and Health 

6 Disparities under section 464z–3(h) of the Public 

7 Health Service Act (42 U.S.C. 285(h)), as added by 

8 section 10334(c) of the Patient Protection and Af9 fordable Care Act, over all minority health and 

10 health disparity research that is conducted or sup11 ported by the Institutes and Centers at the National 

12 Institutes of Health; and 

13 (2) the outcomes of such steps. 

14 (c) GAO REPORT RELATED TO RECIPIENTS OF

15 PPACA FUNDING.—Not later than one year after the 

16 date of the enactment of this Act and biennially thereafter 

17 until 2022, the Comptroller General of the United States 

18 shall submit to Congress a report that identifies— 

19 (1) the racial and ethnic diversity of commu20 nity-based organizations that applied for Federal en21 rollment funding provided pursuant to the provisions 

22 of (and amendments made by) the Patient Protec23 tion and Affordable Care Act; 

24 (2) the percentage of such organizations that 

25 were awarded such funding; and 


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1 (3) the impact of such community-based organi2 zations’ enrollment efforts on the insurance status of 

3 their communities. 

4 (d) ANNUAL REPORT ON ACTIVITIES OF NATIONAL

5 INSTITUTE ON MINORITY HEALTH AND HEALTH DIS6 PARITIES.—The Director of the National Institute on Mi7 nority Health and Health Disparities shall prepare an an8 nual report on the activities carried out or to be carried 

9 out by the Institute, and shall submit each such report 

10 to the Committee on Health, Education, Labor, and Pen11 sions of the Senate, the Committee on Energy and Com12 merce of the House of Representatives, the Secretary of 

13 Health and Human Services, and the Director of the Na14 tional Institutes of Health. With respect to the fiscal year 

15 involved, the report shall— 

16 (1) describe and evaluate the progress made in 

17 health disparities research conducted or supported 

18 by institutes and centers of the National Institutes 

19 of Health; 

20 (2) summarize and analyze expenditures made 

21 for activities with respect to health disparities re22 search conducted or supported by the National Insti23 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 TITLE X—ADDRESSING SOCIAL 

7 DETERMINANTS AND IM8 PROVING ENVIRONMENTAL 

9 JUSTICE 

10 SEC. 1001. DEFINITIONS. 

11 (a) DETERMINANTS OF HEALTH.—The term ‘‘deter12 minants of health’’— 

13 (1) refers to the range of personal, social, eco14 nomic, and environmental factors that influence 

15 health status; and 

16 (2) includes social determinants of health 

17 (which are sometimes referred to as ‘‘social and eco18 nomic determinants of health’’ or ‘‘socioeconomic de19 terminants of health’’), environmental determinants 

20 of health, and personal determinants of health. 

21 (b) ENVIRONMENTAL DETERMINANTS OF

22 HEALTH.—The term ‘‘environmental determinants of 

23 health’’ refers to the broad physical, psychological, social, 

24 and aesthetic environment. 


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1 (c) PERSONAL DETERMINANTS OF HEALTH.—The 

2 term ‘‘personal determinants of health’’ refers to an indi3 vidual’s behavior, biology, and genetics. 

4 (d) SOCIAL DETERMINANTS OF HEALTH.—The term 

5 ‘‘social determinants of health’’ refers to a subset of deter6 minants of the health of individuals and environments 

7 (such as communities, neighborhoods, and societies) that 

8 describe people’s social identity, describe the social and 

9 economic resources to which people have access, and de10 scribe the conditions in which people work, live, and play. 

11 SEC. 1002. FINDINGS. 

12 The Congress finds as follows: 

13 (1) There are more opportunities to improve 

14 health for everyone when we understand that health 

15 starts, first, not in a medical setting, but in our 

16 families, in our schools and workplaces, in our 

17 neighborhoods, and in the air we breathe and water 

18 we drink. 

19 (2) The social determinants of health are the 

20 largest predictors of health outcomes. 

21 (3) Healthy People 2020 identifies health and 

22 health care quality as a function of not only access 

23 to health care, but also the social determinants of 

24 health, categorized into the following: neighborhoods 

25 and the built environment; social and community 


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1 context; education; and economic stability. The fol2 lowing examples illustrate the nexus between the un3 equal distribution of the social determinants of 

4 health and health disparities: 

5 (A) The built environment influences resi6 dents’ level of physical activity. Neighborhoods 

7 with high levels of poverty are significantly less 

8 likely to have places where children can be 

9 physically active, such as parks, green spaces, 

10 and bike paths and lanes. Neighborhoods and 

11 communities can provide opportunities for phys12 ical activity and support active lifestyles 

13 through accessible and safe parks and open 

14 spaces and through land use policy, zoning, and 

15 healthy community design. 

16 (B) Emotional and physical health and 

17 well-being are directly impacted by perceived 

18 levels of safety, such as unlit streets at night. 

19 Community members have expressed that safety 

20 is not only a barrier to accessing programs and 

21 services that increase quality of life but they 

22 are also not able to access physical activity in 

23 their community through the built environment. 

24 (C) In many workplace environments, toxic 

25 chemicals have lasting detrimental effects on 


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1 employees’ health. The hazardous compounds 

2 found in most nail salon products affect the 

3 respiratory system, reproductive system, and 

4 central nervous system, and also cause kidney 

5 and liver damage. Recognizing the importance 

6 of addressing occupational hazards as a matter 

7 of public health, especially for Asian-American 

8 women who constitute 40 percent of nail salon 

9 technicians—with Vietnamese-American women 

10 accounting for 37 percent of this—the White 

11 House Initiative on Asian American Pacific Is12 landers has created an interagency working 

13 group to coordinate efforts by the Environ14 mental Protection Agency, Occupational and 

15 Safety Health Administration, Food and Drug 

16 Administration, and other Federal agencies to 

17 create programming, draft regulations, and con18 duct more outreach on educating workers on 

19 health and safety issues. 

20 (D) Historical and institutional discrimina21 tion against certain racial groups in the United 

22 States has shaped the way in which social and 

23 economic resources and exposure to health pro24 moting environments are distributed. Income, 

25 education, occupation, neighborhood conditions, 


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1 schools, workplaces, the use of and health and 

2 social services, and experiences with the crimi3 nal justice system are all highly patterned by 

4 race, with racial minorities (compared to 

5 Whites) experiencing more that is health harm6 ing. Finding ways to uncouple the link between 

7 race and access to resources and healthy envi8 ronments is a principal means of reducing 

9 health disparities. Additionally, the anticipation 

10 of racism itself causes higher psychological and 

11 cardiovascular stress levels that are linked to 

12 poor health outcomes. Remedying discrimina13 tory practices at the individual and systemic 

14 levels will likely reduce health disparities caused 

15 by this unequal distribution of stress. 

16 (E) Poor health among Native Americans 

17 has largely been driven by post-colonial oppres18 sion and historical trauma. The expropriation of 

19 native lands and territories to the American 

20 state had severe consequences on Native Amer21 ican health. This resulted in the deprivation of 

22 traditional food sources—and nutrients—for 

23 Native Americans and also the destruction of 

24 traditional economies and community organiza25 tion. Today, Native Americans have twice the 


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1 rate of diabetes than non-Hispanic Whites. Rec2 ognition of the origins of the diabetes as having 

3 a social and community context, rather than 

4 just individual responsibility and genetic pre5 disposition, will shape better policy to provide 

6 food security. 

7 (F) In the context of prisons, overcrowding 

8 has led to the deterioration of the physical and 

9 mental health of individuals after they leave 

10 prison. In particular, the mass incarceration of 

11 African-American males as a result of unequal 

12 contact with and treatment in the criminal jus13 tice system has contributed to an overburdening 

14 of certain infectious diseases within the African15 American community. As a social institution, 

16 incarceration amplifies existing adverse health 

17 conditions by concentrating diseases and harm 

18 health behaviors such as tobacco use, drug use, 

19 and violence. 

20 (G) Educational attainment is the strong21 est predictor of adult mortality. It is a basic 

22 component of socioeconomic status by shaping 

23 earning potential to access resources that pro24 mote health. People with more education are 

25 less likely to report that they are in poor health, 


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1 and are also less likely to have diabetes and 

2 other chronic diseases. 

3 (H) Similarly, reading ability is a strong 

4 predictor of adult health status and is often 

5 correlated with other child health issues, such 

6 as developmental problems, vision and hearing 

7 impairments, and frequent school absence due 

8 to illness. 

9 (I) Individuals with lower levels of edu10 cational attainment are much more likely to re11 port to be current smokers. In 2011, smoking 

12 prevalence was 45.3 percent among adults with 

13 a GED diploma, 34.6 percent with nine to 11 

14 years of education, and 23.8 percent with a 

15 high school diploma, while dropping signifi16 cantly to 9.3 percent among adults with an un17 dergraduate college degree and 5.0 percent with 

18 a postgraduate college degree. 

19 (J) Social class differences account for a 

20 large part of health disparities. For example, 

21 children living in poverty experience poorer 

22 housing conditions, increased exposure to in23 door allergens and toxins (such as pesticides, 

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1 periences culminate in worse adult health as 

2 compared with children with higher socio3 economic status. Specifically, children living in 

4 socioeconomic neighborhoods have higher rates 

5 of asthma due to higher rates of psychological 

6 stress resulting from higher rates of violence. 

7 (K) Lesbian, gay, bisexual, transgender, 

8 queer, and questioning (LGBTQ) individuals 

9 face health disparities linked to societal stigma, 

10 discrimination, and denial of their civil and 

11 human rights. Discrimination against LGBTQ 

12 individuals has been associated with high rates 

13 of psychiatric disorders, substance abuse, and 

14 suicide. Experiences of violence and victimiza15 tion are frequent for LGBTQ individuals, and 

16 have long-lasting effects on the individual and 

17 the community. Personal, family, and social ac18 ceptance of sexual orientation and gender iden19 tity affects the mental health and personal safe20 ty of LGBTQ individuals. 

21 (4) Laws and regulations that improve opportu22 nities to live in safe neighborhoods, with more social 

23 cohesion, attain higher education, sustain stable em24 ployment, and bridge class differences help foster 

25 the health and safety of individuals. 


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1 (5) The global public health community has 

2 reached consensus through the Rio Political Declara3 tion of Social Determinants of Health that 

4 ‘‘[c]ollaboration in coordinated and intersectoral pol5 icy actions has proven to be effective. Health in All 

6 Policies, together with intersectoral cooperation and 

7 action, is one promising approach to enhance ac8 countability in other sectors of health, as well as the 

9 promotion of health equity and more inclusive and 

10 productive societies.’’ 

11 SEC. 1003. HEALTH IMPACT ASSESSMENTS. 

12 (a) FINDINGS.—Congress makes the following find13 ings: 

14 (1) Health Impact Assessment is a tool to help 

15 planners, health officials, decisionmakers, and the 

16 public make more informed decisions about the po17 tential health effects of proposed plans, policies, pro18 grams, and projects in order to maximize health 

19 benefits and minimize harms. 

20 (2) Health Impact Assessments can be done at 

21 a fraction of the cost and time typically required for 

22 other planning and permitting reviews. 

23 (3) Health Impact Assessments can build com24 munity support and reduce opposition to a project or 

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1 ing the development of consensus regarding new de2 velopment proposals. 

3 (4) Health Impact Assessments facilitate col4 laboration across sectors. 

5 (b) PURPOSES.—It is the purpose of this section to— 

6 (1) provide more information about the poten7 tial human health effects of policy decisions and the 

8 distribution of those effects; 

9 (2) improve how health is considered in plan10 ning and decisionmaking processes; and 

11 (3) build stronger, healthier communities 

12 through the use of Health Impact Assessment. 

13 (c) HEALTH IMPACT ASSESSMENTS.—Part P of title 

14 III of the Public Health Service Act (42 U.S.C. 280g et 

15 seq.), as amended, is further amended by adding at the 

16 end the following: 

17 ‘‘SEC. 399V–9. HEALTH IMPACT ASSESSMENTS. 

18 ‘‘(a) DEFINITIONS.—In this section and section 

19 399V–10: 

20 ‘‘(1) ADMINISTRATOR.—The term ‘Adminis21 trator’ means the Administrator of the Environ22 mental Protection Agency. 

23 ‘‘(2) BUILT ENVIRONMENT.—The term ‘built 

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1 graphically defined space, that are created or modi2 fied by individuals to form the physical and social 

3 characteristics of a community or enhance quality of 

4 human life, including— 

5 ‘‘(A) homes, schools, and places of work 

6 and worship; 

7 ‘‘(B) parks, recreation areas, and green8 ways; 

9 ‘‘(C) transportation systems; 

10 ‘‘(D) business, industry, and agriculture; 

11 and 

12 ‘‘(E) land-use plans, projects, and policies 

13 that impact the physical or social characteris14 tics of a community, including access to services 

15 and amenities. 

16 ‘‘(3) DIRECTOR.—The term ‘Director’ means 

17 the Director of the Centers for Disease Control and 

18 Prevention. 

19 ‘‘(4) ELIGIBLE ENTITY.—The term ‘eligible en20 tity’ means a unit of State or tribal government the 

21 jurisdiction of which includes individuals or popu22 lations the health of which are, or will be, affected 

23 by an activity or a proposed activity. 

24 ‘‘(5) ELIGIBLE INSTITUTION.—The term ‘eligi25 ble institution’ means a public agency or private 


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1 nonprofit institution that submits to the Secretary, 

2 in consultation with the Administrator, an applica3 tion for a grant authorized under such section at 

4 such time, in such manner, and containing such 

5 agreements, assurances, and information as the Sec6 retary and Administrator may require. 

7 ‘‘(6) HEALTH IMPACT ASSESSMENT.—The term 

8 ‘Health Impact Assessment’ means a systematic 

9 process that uses an array of data sources and ana10 lytic methods and considers input from stakeholders 

11 to determine the potential effects of a proposed pol12 icy, plan, program, or project on the health of a pop13 ulation and the distribution of those effects within 

14 the population. Such term includes identifying and 

15 recommending appropriate actions on monitoring 

16 and maximizing potential benefits and minimizing 

17 the potential harms. 

18 ‘‘(7) HEALTH DISPARITIES.—The term ‘health 

19 disparities’ are a particular type of health dif20 ferences that are closely linked with social, economic, 

21 and/or environmental disadvantage. Health dispari22 ties adversely affect groups of people who have sys23 tematically experienced greater obstacles to health 

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1 nitive, sensory, or physical disability; sexual orienta2 tion or gender identity; geographic location; or other 

3 characterisitics historically linked to discrimination 

4 or exclusion. 

5 ‘‘(8) PROPOSED ACTIVITY.—The term ‘proposed 

6 activity’ means a proposed policy, program, plan, or 

7 project currently under consideration by a local, 

8 State, tribal, or Federal agency or government. 

9 ‘‘(b) ESTABLISHMENT.—The Secretary, acting 

10 through the Director and in collaboration with the Admin11 istrator, shall carry out the following: 

12 ‘‘(1) Establish a program at the National Cen13 ter for Environmental Health at the Centers for Dis14 ease Control and Prevention focused on advancing 

15 the field of Health Impact Assessment. In devel16 oping and implementing the program, the Director 

17 of the National Center for Environmental Health 

18 shall consult with the Director of the National Cen19 ter for Chronic Disease Prevention and Health Pro20 motion as well as relevant offices within the Depart21 ment of Housing and Urban Development, the De22 partment of Transportation, and the Department of 

23 Agriculture. The program shall include— 

24 ‘‘(A) collecting and disseminating best 

25 practices; 


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1 ‘‘(B) administering capacity building 

2 grants to States to support grantees in initi3 ating Health Impact Assessments, in accord4 ance with subsection (d); 

5 ‘‘(C) providing technical assistance; 

6 ‘‘(D) developing training tools and pro7 viding training on conducting Health Impact 

8 Assessment and the implementation of built en9 vironment and health indicators; 

10 ‘‘(E) making information available, as ap11 propriate, regarding the existence of other com12 munity healthy living tools, checklists, and indi13 ces that help connect public health to other sec14 tors, and tools to help examine the effect of the 

15 indoor built environment and building codes on 

16 population health; 

17 ‘‘(F) conducting research and evaluations 

18 of Health Impact Assessments; and 

19 ‘‘(G) awarding competitive extramural re20 search grants. 

21 ‘‘(2) In accordance with subsection (c), develop 

22 guidance and guidelines to conduct Health Impact 

23 Assessments. 


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1 ‘‘(3) In accordance with subsection (d), estab2 lish a grant program to allow States to fund eligible 

3 entities to conduct Health Impact Assessments. 

4 ‘‘(c) GUIDANCE.—The Director, in consultation with 

5 the Director of the National Center for Environmental 

6 Health and, the Director of the National Center for 

7 Chronic Disease Prevention and Health Promotion, and 

8 relevant offices within the Department of Housing and 

9 Urban Development, the Department of Transportation, 

10 and the Department of Agriculture, shall— 

11 ‘‘(1) develop guidance for conducting Health 

12 Impact Assessment, including— 

13 ‘‘(A) background on national and inter14 national efforts to bridge urban planning and 

15 public health institutions and disciplines, in16 cluding a review of Health Impact Assessment 

17 best practices internationally; 

18 ‘‘(B) evidence-based direct and indirect 

19 pathways that link land-use planning, transpor20 tation, and housing policy and objectives to 

21 human health outcomes; 

22 ‘‘(C) data resources and quantitative and 

23 qualitative forecasting methods to evaluate both 

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1 fects, including identification of existing pro2 grams that can disseminate these resources; 

3 ‘‘(D) best practices for inclusive public in4 volvement in conducting Health Impact Assess5 ments; and 

6 ‘‘(E) technical assistance for other agen7 cies seeking to develop their own guidelines and 

8 procedures for Health Impact Assessment; 

9 ‘‘(2) in developing the guidance, consider avail10 able international Health Impact Assessment guid11 ance, North American Health Impact Assessment 

12 Practice Standards, and recommendations from the 

13 National Academy of Science; and 

14 ‘‘(3) not later than 1 year after the date of en15 actment of this section, publish the guidance. 

16 ‘‘(d) GRANT PROGRAM.—The Secretary, acting 

17 through the Director and in collaboration with the Admin18 istrator, shall establish a program under which the Sec19 retary shall award grants to States to fund eligible entities 

20 for capacity building or to prepare Health Impact Assess21 ments, and shall ensure that States receiving a grant 

22 under this subsection further support training and tech23 nical assistance for grantees under the program by fund24 ing and overseeing appropriate local, State, tribal, Fed25 eral, university, or nonprofit Health Impact Assessment 


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1 experts to provide technical assistance. Such assessments 

2 shall— 

3 ‘‘(1) ensure that appropriate health factors are 

4 taken into consideration as early as practicable dur5 ing the planning, review, or decisionmaking proc6 esses; 

7 ‘‘(2) assess the effect on the health of individ8 uals and populations of proposed policies, projects, 

9 or plans that result in modifications to the built en10 vironment; and 

11 ‘‘(3) assess the distribution of health effects 

12 across various factors, such as race, income, eth13 nicity, age, disability status, gender, and geography. 

14 ‘‘(e) APPLICATIONS.— 

15 ‘‘(1) IN GENERAL.—To be eligible to receive a 

16 grant under this section, an eligible entity shall sub17 mit to the Secretary an application in accordance 

18 with this subsection, at such time, in such manner, 

19 and containing such additional information as the 

20 Secretary may require. 

21 ‘‘(2) INCLUSION.—An application under this 

22 subsection shall include a list of proposed activities 

23 that require or would benefit from conducting a 

24 Health Impact Assessment within six months of 

25 awarding funds. The list should be accompanied by 


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1 supporting documentation, including letters of sup2 port, from potential conductors of Health Impact 

3 Assessments for the listed proposed activities. Each 

4 application should also include an assessment by the 

5 eligible entity of the health of the population of its 

6 jurisdiction and describe potential adverse or positive 

7 effects on health that the proposed activities may 

8 create. 

9 ‘‘(3) PREFERENCE.—Preference in awarding 

10 funds under this section may be given to eligible en11 tities that demonstrate the potential to significantly 

12 improve population health or lower health care costs 

13 as a result of potential Health Impact Assessment 

14 work. 

15 ‘‘(f) USE OF FUNDS.— 

16 ‘‘(1) IN GENERAL.—An eligible entity shall use 

17 amounts provided under a grant under this section 

18 to conduct Health Impact Assessment capacity 

19 building or to conduct or fund subgrantees to con20 duct a Health Impact Assessment for a proposed ac21 tivity in accordance with this subsection. 

22 ‘‘(2) PURPOSES.—The purposes of a Health 

23 Impact Assessment under this subsection are— 

24 ‘‘(A) to facilitate the involvement of tribal, 

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1 munity planning, transportation, housing, and 

2 land use decisions and other decisions affecting 

3 the built environment to identify any potential 

4 health concern or health benefit relating to an 

5 activity or proposed activity; 

6 ‘‘(B) to provide for an investigation of any 

7 health-related issue of concern raised in a plan8 ning process, an environmental impact assess9 ment process, or policy appraisal relating to a 

10 proposed activity; 

11 ‘‘(C) to describe and compare alternatives 

12 (including no-action alternatives) to a proposed 

13 activity to provide clarification with respect to 

14 the potential health outcomes associated with 

15 the proposed activity and, where appropriate, to 

16 the related benefit-cost or cost-effectiveness of 

17 the proposed activity and alternatives; 

18 ‘‘(D) to contribute, when applicable, to the 

19 findings of a planning process, policy appraisal, 

20 or an environmental impact statement with re21 spect to the terms and conditions of imple22 menting a proposed activity or related mitiga23 tion recommendations, as necessary; 

24 ‘‘(E) to ensure that the disproportionate 

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1 able populations is minimized as much as pos2 sible; 

3 ‘‘(F) to engage affected community mem4 bers and ensure adequate opportunity for public 

5 comment on all stages of the Health Impact As6 sessment; and 

7 ‘‘(G) where appropriate, to consult with 

8 local and county health departments and appro9 priate organizations, including planning, trans10 portation, and housing organizations and pro11 viding them with information and tools regard12 ing how to conduct and integrate Health Im13 pact Assessment into their work. 

14 ‘‘(3) ELIGIBLE ACTIVITIES.— 

15 ‘‘(A) IN GENERAL.—Eligible entities fund16 ed under this subsection shall conduct an eval17 uation of any proposed activity to determine 

18 whether it will have a significant adverse or 

19 positive effect on the health of the affected pop20 ulation in the jurisdiction of the eligible entity, 

21 based on the criteria described in subparagraph 

22 (B). 

23 ‘‘(B) CRITERIA.—The criteria described in 

24 this subparagraph include, as applicable to the 

25 proposed activity, the following: 


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1 ‘‘(i) Any substantial adverse effect or 

2 significant health benefit on health out3 comes or factors known to influence health, 

4 including the following: 

5 ‘‘(I) Physical activity. 

6 ‘‘(II) Injury. 

7 ‘‘(III) Mental health. 

8 ‘‘(IV) Accessibility to health-pro9 moting goods and services. 

10 ‘‘(V) Respiratory health. 

11 ‘‘(VI) Chronic disease. 

12 ‘‘(VII) Nutrition. 

13 ‘‘(VIII) Land use changes that 

14 promote local, sustainable food 

15 sources. 

16 ‘‘(IX) Infectious disease. 

17 ‘‘(X) Health disparities. 

18 ‘‘(XI) Existing air quality, 

19 ground or surface water quality or 

20 quantity, or noise levels; and 

21 ‘‘(ii) Other factors that may be con22 sidered, including— 

23 ‘‘(I) the potential for a proposed 

24 activity to result in systems failure 


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1 that leads to a public health emer2 gency; 

3 ‘‘(II) the probability that the pro4 posed activity will result in a signifi5 cant increase in tourism, economic de6 velopment, or employment in the ju7 risdiction of the eligible entity; 

8 ‘‘(III) any other significant po9 tential hazard or enhancement to 

10 human health, as determined by the 

11 eligible entity; or 

12 ‘‘(IV) whether the evaluation of a 

13 proposed activity would duplicate an14 other analysis or study being under15 taken in conjunction with the pro16 posed activity. 

17 ‘‘(C) FACTORS FOR CONSIDERATION.—In 

18 evaluating a proposed activity under subpara19 graph (A), an eligible entity may take into con20 sideration any reasonable, direct, indirect, or 

21 cumulative effect that can be clearly related to 

22 potential health effects and that is related to 

23 the proposed activity, including the effect of 

24 any action that is— 


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1 ‘‘(i) included in the long-range plan 

2 relating to the proposed activity; 

3 ‘‘(ii) likely to be carried out in coordi4 nation with the proposed activity; 

5 ‘‘(iii) dependent on the occurrence of 

6 the proposed activity; or 

7 ‘‘(iv) likely to have a disproportionate 

8 impact on high-risk or vulnerable popu9 lations. 

10 ‘‘(4) REQUIREMENTS.—A Health Impact As11 sessment prepared with funds awarded under this 

12 subsection shall incorporate the following, after con13 ducting the screening phase (identifying projects or 

14 policies for which a Health Impact Assessment 

15 would be valuable and feasible) through the applica16 tion process: 

17 ‘‘(A) SCOPING.—Identifying which health 

18 effects to consider and the research methods to 

19 be utilized. 

20 ‘‘(B) ASSESSING RISKS AND BENEFITS.— 

21 Assessing the baseline health status and factors 

22 known to influence the health status in the af23 fected community, which may include aggre24 gating and synthesizing existing health assess25 ment evidence and data from the community. 


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1 ‘‘(C) DEVELOPING RECOMMENDATIONS.— 

2 Suggesting changes to proposals to promote 

3 positive or mitigate adverse health effects. 

4 ‘‘(D) REPORTING.—Synthesizing the as5 sessment and recommendations and commu6 nicating the results to decisionmakers. 

7 ‘‘(E) MONITORING AND EVALUATING.— 

8 Tracking the decision and implementation effect 

9 on health determinants and health status. 

10 ‘‘(5) PLAN.—An eligible entity that is awarded 

11 a grant under this section shall develop and imple12 ment a plan, to be approved by the Director, for 

13 meaningful and inclusive stakeholder involvement in 

14 all phases of the Health Impact Assessment. Stake15 holders may include community-based organizations, 

16 youth-serving organizations, planners, public health 

17 experts, State and local public health departments 

18 and officials, health care experts or officials, housing 

19 experts or officials, and transportation experts or of20 ficials. 

21 ‘‘(6) SUBMISSION OF FINDINGS.—An eligible 

22 entity that is awarded a grant under this section 

23 shall submit the findings of any funded Health Im24 pact Assessment activities to the Secretary and 

25 make these findings publicly available. 


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1 ‘‘(7) ASSESSMENT OF IMPACTS.—An eligible en2 tity that is awarded a grant under this section shall 

3 ensure the assessment of the distribution of health 

4 impacts (related to the proposed activity) across 

5 race, ethnicity, income, age, gender, disability status, 

6 and geography. 

7 ‘‘(8) CONDUCT OF ASSESSMENT.—To the great8 est extent feasible, a Health Impact Assessment 

9 shall be conducted under this section in a manner 

10 that respects the needs and timing of the decision11 making process it evaluates. 

12 ‘‘(9) METHODOLOGY.—In preparing a Health 

13 Impact Assessment under this subsection, an eligible 

14 entity or partner shall follow the guidance published 

15 under subsection (c). 

16 ‘‘(g) HEALTH IMPACT ASSESSMENT DATABASE.— 

17 The Secretary, acting through the Director and in collabo18 ration with the Administrator, shall establish, maintain, 

19 and make publicly available a Health Impact Assessment 

20 database, including— 

21 ‘‘(1) a catalog of Health Impact Assessments 

22 received under this section; 

23 ‘‘(2) an inventory of tools used by eligible enti24 ties to conduct Health Impact Assessments; and 


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1 ‘‘(3) guidance for eligible entities with respect 

2 to the selection of appropriate tools described in 

3 paragraph (2). 

4 ‘‘(h) EVALUATION OF GRANTEE ACTIVITIES.—The 

5 Secretary shall award competitive grants to Prevention 

6 Research Centers, or nonprofit organizations or academic 

7 institutions with expertise in Health Impact Assessments 

8 to— 

9 ‘‘(1) assist grantees with the provision of train10 ing and technical assistance in the conducting of 

11 Health Impact Assessments; 

12 ‘‘(2) evaluate the activities carried out with 

13 grants under subsection (d); and 

14 ‘‘(3) assist the Secretary in disseminating evi15 dence, best practices, and lessons learned from 

16 grantees. 

17 ‘‘(i) REPORT TO CONGRESS.—Not later than 1 year 

18 after the date of enactment of this section, the Secretary 

19 shall submit to Congress a report concerning the evalua20 tion of the programs under this section, including rec21 ommendations as to how lessons learned from such pro22 grams can be incorporated into future guidance docu23 ments developed and provided by the Secretary and other 

24 Federal agencies, as appropriate. 


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1 ‘‘(j) AUTHORIZATION OF APPROPRIATIONS.—There 

2 are authorized to be appropriated to carry out this section 

3 such sums as may be necessary. 

4 ‘‘SEC. 399V–10. ADDITIONAL RESEARCH ON THE RELATION5 SHIP BETWEEN THE BUILT ENVIRONMENT 

6 AND HEALTH OUTCOMES. 

7 ‘‘(a) RESEARCH GRANT PROGRAM.— 

8 ‘‘(1) GRANTS.—The Secretary, in collaboration 

9 with the Administrator, shall award grants to eligi10 ble institutions to conduct and coordinate research 

11 on the built environment and its influence on human 

12 health. Factors that influence health that may be 

13 considered include— 

14 ‘‘(A) levels of physical activity; 

15 ‘‘(B) consumption of nutritional foods; 

16 ‘‘(C) rates of crime; 

17 ‘‘(D) air, water, and soil quality; 

18 ‘‘(E) risk or rate of injury; 

19 ‘‘(F) accessibility to health-promoting 

20 goods and services; 

21 ‘‘(G) chronic disease rates; 

22 ‘‘(H) community design; 

23 ‘‘(I) housing; and 

24 ‘‘(J) other indicators as determined appro25 priate by the Secretary. 


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1 ‘‘(2) RESEARCH.—The Secretary, in consulta2 tion with the Administrator, shall support research 

3 under this section that— 

4 ‘‘(A) investigates and defines links between 

5 the built environment and human health and 

6 identifies causal relationships; 

7 ‘‘(B) examines— 

8 ‘‘(i) the scope and intensity of the im9 pact that the built environment (including 

10 the various characteristics of the built en11 vironment) has on the human health; or 

12 ‘‘(ii) the distribution of such impacts 

13 by— 

14 ‘‘(I) location; and 

15 ‘‘(II) population subgroup; 

16 ‘‘(C) is used to develop— 

17 ‘‘(i) measures and indicators to ad18 dress health impacts and the connection of 

19 health to the built environment; 

20 ‘‘(ii) efforts to link the measures to 

21 transportation, land use, and health data22 bases; and 

23 ‘‘(iii) efforts to enhance the collection 

24 of built environment surveillance data; 


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1 ‘‘(D) distinguishes carefully between per2 sonal attitudes and choices and external influ3 ences on behavior to determine how much the 

4 association between the built environment and 

5 the health of residents, versus the lifestyle pref6 erences of the people that choose to live in the 

7 neighborhood, reflects the physical characteris8 tics of the neighborhood; and 

9 ‘‘(E)(i) identifies or develops effective 

10 intervention strategies focusing on enhance11 ments to the built environment that promote in12 creased use physical activity, access to nutri13 tious foods, or other health-promoting activities 

14 by residents; and 

15 ‘‘(ii) in developing the intervention strate16 gies under clause (i), ensures that the interven17 tion strategies will reach out to high-risk or vul18 nerable populations, including low-income urban 

19 and rural communities and aging populations, 

20 in addition to the general population. 

21 ‘‘(3) SURVEYS.—The Secretary may use funds 

22 appropriated under this section to support the ex23 pansion of national surveys and data tracking sys24 tems to provide more detailed information about the 


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1 connection between the built environment and 

2 health. 

3 ‘‘(4) PRIORITY.—In providing assistance under 

4 the grant program under this section, the Secretary 

5 and the Administrator shall give priority to research 

6 that incorporates— 

7 ‘‘(A) interdisciplinary approaches; or 

8 ‘‘(B) the expertise of the public health, 

9 physical activity, urban planning, land use, and 

10 transportation research communities in the 

11 United States and abroad. 

12 ‘‘(b) AUTHORIZATION OF APPROPRIATIONS.—There 

13 are authorized to be appropriated such sums as may be 

14 necessary to carry out this section. Not to exceed 20 per15 cent of amounts appropriated for each fiscal year under 

16 this subsection may be used for the research component 

17 of the program under this section.’’. 

18 SEC. 1004. IMPLEMENTATION OF RECOMMENDATIONS BY 

19 ENVIRONMENTAL PROTECTION AGENCY. 

20 (a) INSPECTOR GENERAL RECOMMENDATIONS.—The 

21 Administrator of the Environmental Protection Agency 

22 shall, as promptly as practicable, carry out each of the 

23 following recommendations of the Inspector General of the 

24 Agency as set forth in Report No. 2006–P–00034 entitled 


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1 ‘‘EPA needs to conduct environmental justice reviews of 

2 its programs, policies and activities’’: 

3 (1) The recommendation that the Agency’s pro4 gram and regional offices identify which programs, 

5 policies, and activities need environmental justice re6 views and require these offices to establish a plan to 

7 complete the necessary reviews. 

8 (2) The recommendation that the Administrator 

9 of the Agency ensure that these reviews determine 

10 whether the programs, policies, and activities may 

11 have a disproportionately high and adverse health or 

12 environmental impact on minority and low-income 

13 populations. 

14 (3) The recommendation that each program 

15 and regional office develop specific environmental 

16 justice review guidance for conducting environmental 

17 justice reviews. 

18 (4) The recommendation that the Administrator 

19 designate a responsible office to compile results of 

20 environmental justice reviews and recommend appro21 priate actions. 

22 (b) GAO RECOMMENDATIONS.—In developing rules 

23 under laws administered by the Environmental Protection 

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1 ommendations of the Comptroller General of the United 

2 States as set forth in GAO Report numbered GAO–05– 

3 289 entitled ‘‘EPA Should Devote More Attention to En4 vironmental Justice when Developing Clean Air Rules’’: 

5 (1) The recommendation that the Administrator 

6 ensure that workgroups involved in developing a rule 

7 devote attention to environmental justice while draft8 ing and finalizing the rule. 

9 (2) The recommendation that the Administrator 

10 enhance the ability of such workgroups to identify 

11 potential environmental justice issues through such 

12 steps as providing workgroup members with guid13 ance and training to help them identify potential en14 vironmental justice problems and involving environ15 mental justice coordinators in the workgroups when 

16 appropriate. 

17 (3) The recommendation that the Administrator 

18 improve assessments of potential environmental jus19 tice impacts in economic reviews by identifying the 

20 data and developing the modeling techniques needed 

21 to assess such impacts. 

22 (4) The recommendation that the Administrator 

23 direct appropriate Agency officers and employees to 

24 respond fully when feasible to public comments on 

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1 cy’s explanation of the basis for its conclusions, to2 gether with supporting data. 

3 (c) 2004 INSPECTOR GENERAL REPORT.—The Ad4 ministrator of the Environmental Protection Agency shall, 

5 as promptly as practicable, carry out each of the following 

6 recommendations of the Inspector General of the Agency 

7 as set forth in the report entitled ‘‘EPA Needs to Consist8 ently Implement the Intent of the Executive Order on En9 vironmental Justice’’ (Report No. 2004–P–00007): 

10 (1) The recommendation that the Agency clear11 ly define the mission of the Office of Environmental 

12 Justice (OEJ) and provide Agency staff with an un13 derstanding of the roles and responsibilities of the 

14 Office. 

15 (2) The recommendation that the Agency estab16 lish (through issuing guidance or a policy statement 

17 from the Administrator) specific timeframes for the 

18 development of definitions, goals, and measurements 

19 regarding environmental justice and provide the re20 gions and program offices a standard and consistent 

21 definition for a minority and low-income community, 

22 with instructions on how the Agency will implement 

23 and put into operation environmental justice in the 

24 Agency’s daily activities. 


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1 (3) The recommendation that the Agency en2 sure the comprehensive training program currently 

3 under development includes standard and consistent 

4 definitions of the key environmental justice concepts 

5 (such as ‘‘low-income’’, ‘‘minority’’, and ‘‘dispropor6 tionately impacted’’) and instructions for implemen7 tation of those concepts. 

8 The Administrator shall submit an initial report to Con9 gress within 6 months after the enactment of this Act re10 garding the Administrator’s strategy for implementing the 

11 recommendations referred to in paragraphs (1), (2), and 

12 (3). Thereafter, the Administrator shall provide semi13 annual reports to Congress regarding the Administrator’s 

14 progress in implementing such recommendations and 

15 modifying the Administrator’s emergency management 

16 procedures to incorporate environmental justice in the 

17 Agency’s Incident Command Structure (in accordance 

18 with the December 18, 2006, letter from the Deputy Ad19 ministrator to the Acting Inspector General of the Agen20 cy). 

21 (d) FEDERAL ACTION PLAN FOR SAVING LIVES, 

22 PROTECTING PEOPLE AND THEIR FAMILIES FROM

23 RADON.— 

24 (1) IN GENERAL.—Because radon is a naturally 

25 occurring radioactive gas that is recognized as the 


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1 leading cause of lung cancer among nonsmokers and 

2 is a particular environmental threat for low-income 

3 and minority individuals because of the lack of infor4 mation about radon levels in their own homes, the 

5 Administrator of the Environmental Protection 

6 Agency shall within 6 months after the date of the 

7 enactment of this Act, implement the action plan en8 titled ‘‘Protecting People and Families from Radon: 

9 A Federal Action Plan for Saving Lives’’ (June 20, 

10 2011), working with the Secretary of Health and 

11 Human Services acting through the Director of the 

12 Centers for Disease Control and Prevention, and 

13 with the other Federal agencies mentioned in and as 

14 set forth in the action plan. 

15 (2) SPECIFIC STEPS.—In carrying out para16 graph (1), the Administrator shall take steps to 

17 achieve each of the following: 

18 (A) The recommendation that the 

19 workgroup comprised of the Federal agencies 

20 participating in the development of the action 

21 plan referred to in paragraph (1) implement 

22 specific steps within the current authority and 

23 activities of each Federal agency to reduce ex24 posure to radon. 


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1 (B) The recommendation that such 

2 workgroup meet on the 1-year anniversary of 

3 the plan to assess and recognize achievements 

4 of the plan. 

5 (3) REPORT.—The Administrator shall report 

6 to the Congress on the 1-year assessment of the 

7 plan’s implementation, including the challenges re8 maining and the progress in reducing radon expo9 sure particularly to low-income and minority fami10 lies. 

11 SEC. 1005. GRANT PROGRAM TO CONDUCT ENVIRON12 MENTAL HEALTH IMPROVEMENT ACTIVITIES 

13 AND TO IMPROVE SOCIAL DETERMINANTS OF 

14 HEALTH. 

15 (a) DEFINITIONS.—In this section: 

16 (1) DIRECTOR.—The term ‘‘Director’’ means 

17 the Director of the Centers for Disease Control and 

18 Prevention, acting in collaboration with the Adminis19 trator of the Environmental Protection Agency and 

20 the Director of the National Institute of Environ21 mental Health Sciences. 

22 (2) ELIGIBLE ENTITY.—The term ‘‘eligible enti23 ty’’ means a State or local community that— 

24 (A) bears a disproportionate burden of ex25 posure to environmental health hazards; 


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1 (B) bears a disproportionate burden of ex2 posure to unhealthy living conditions, low 

3 standard housing conditions, low socioeconomic 

4 status, poor nutrition, less opportunity for edu5 cational attainment, disproportionate unemploy6 ment rates, or lower literacy levels; 

7 (C) has established a coalition— 

8 (i) with not less than 1 community9 based organization or demonstration pro10 gram; and 

11 (ii) with not less than 1— 

12 (I) public health entity; 

13 (II) health care provider organi14 zation; 

15 (III) academic institution, includ16 ing any minority-serving institution 

17 (including a Hispanic-serving institu18 tion, a historically Black college or 

19 university, and a tribal college or uni20 versity); or 

21 (IV) child-serving institution; 

22 (D) ensures planned activities and funding 

23 streams are coordinated to improve community 

24 health; and 


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1 (E) submits an application in accordance 

2 with subsection (c). 

3 (b) ESTABLISHMENT.—The Director shall establish a 

4 grant program under which eligible entities shall receive 

5 grants to conduct environmental health improvement ac6 tivities and to improve social determinants of health. 

7 (c) APPLICATION.—To receive a grant under this sec8 tion, an eligible entity shall submit an application to the 

9 Director at such time, in such manner, and accompanied 

10 by such information as the Director may require. 

11 (d) COOPERATIVE AGREEMENTS.—An eligible entity 

12 may use a grant under this section— 

13 (1) to promote environmental health; 

14 (2) to address environmental health disparities 

15 among all populations, including children; and 

16 (3) to address racial and ethnic disparities in 

17 social determinants of health. 

18 (e) AMOUNT OF COOPERATIVE AGREEMENT.— 

19 (1) IN GENERAL.—The Director shall award 

20 grants to eligible entities at the 3 different funding 

21 levels described in this subsection. 

22 (2) LEVEL 1 COOPERATIVE AGREEMENTS.— 

23 (A) IN GENERAL.—An eligible entity 

24 awarded a grant under this paragraph shall use 


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1 the funds to identify environmental health prob2 lems and solutions by— 

3 (i) establishing a planning and 

4 prioritizing council in accordance with sub5 paragraph (B); and 

6 (ii) conducting an environmental 

7 health assessment in accordance with sub8 paragraph (C). 

9 (B) PLANNING AND PRIORITIZING COUN10 CIL.— 

11 (i) IN GENERAL.—A prioritizing and 

12 planning council established under sub13 paragraph (A)(i) (referred to in this para14 graph as a ‘‘PPC’’) shall assist the envi15 ronmental health assessment process and 

16 environmental health promotion activities 

17 of the eligible entity. 

18 (ii) MEMBERSHIP.—Membership of a 

19 PPC shall consist of representatives from 

20 various organizations within public health, 

21 planning, development, and environmental 

22 services and shall include stakeholders 

23 from vulnerable groups such as children, 

24 the elderly, disabled, and minority ethnic 


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1 groups that are often not actively involved 

2 in democratic or decisionmaking processes. 

3 (iii) DUTIES.—A PPC shall— 

4 (I) identify key stakeholders and 

5 engage and coordinate potential part6 ners in the planning process; 

7 (II) establish a formal advisory 

8 group to plan for the establishment of 

9 services; 

10 (III) conduct an in-depth review 

11 of the nature and extent of the need 

12 for an environmental health assess13 ment, including a local epidemiological 

14 profile, an evaluation of the service 

15 provider capacity of the community, 

16 and a profile of any target popu17 lations; and 

18 (IV) define the components of 

19 care and form essential programmatic 

20 linkages with related providers in the 

21 community. 

22 (C) ENVIRONMENTAL HEALTH ASSESS23 MENT.— 


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1 (i) IN GENERAL.—A PPC shall carry 

2 out an environmental health assessment to 

3 identify environmental health concerns. 

4 (ii) ASSESSMENT PROCESS.—The 

5 PPC shall— 

6 (I) define the goals of the assess7 ment; 

8 (II) generate the environmental 

9 health issue list; 

10 (III) analyze issues with a sys11 tems framework; 

12 (IV) develop appropriate commu13 nity environmental health indicators; 

14 (V) rank the environmental 

15 health issues; 

16 (VI) set priorities for action; 

17 (VII) develop an action plan; 

18 (VIII) implement the plan; and 

19 (IX) evaluate progress and plan20 ning for the future. 

21 (D) EVALUATION.—Each eligible entity 

22 that receives a grant under this paragraph shall 

23 evaluate, report, and disseminate program find24 ings and outcomes. 


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1 (E) TECHNICAL ASSISTANCE.—The Direc2 tor may provide such technical and other non3 financial assistance to eligible entities as the 

4 Director determines to be necessary. 

5 (3) LEVEL 2 COOPERATIVE AGREEMENTS.— 

6 (A) ELIGIBILITY.— 

7 (i) IN GENERAL.—The Director shall 

8 award grants under this paragraph to eli9 gible entities that have already— 

10 (I) established broad-based col11 laborative partnerships; and 

12 (II) completed environmental as13 sessments. 

14 (ii) NO LEVEL 1 REQUIREMENT.—To 

15 be eligible to receive a grant under this 

16 paragraph, an eligible entity is not re17 quired to have successfully completed a 

18 Level 1 Cooperative Agreement (as de19 scribed in paragraph (2)). 

20 (B) USE OF GRANT FUNDS.—An eligible 

21 entity awarded a grant under this paragraph 

22 shall use the funds to further activities to carry 

23 out environmental health improvement activi24 ties, including— 


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1 (i) addressing community environ2 mental health priorities in accordance with 

3 paragraph (2)(C)(ii), including— 

4 (I) geography; 

5 (II) the built environment; 

6 (III) air quality; 

7 (IV) water quality; 

8 (V) land use; 

9 (VI) solid waste; 

10 (VII) housing; 

11 (VIII) crime; 

12 (IX) socioeconomic status; 

13 (X) ethnicity, social construct 

14 and language preference; 

15 (XI) educational attainment; 

16 (XII) employment; 

17 (XIII) food safety; 

18 (XIV) nutrition; 

19 (XV) health care services; and 

20 (XVI) injuries; 

21 (ii) building partnerships between 

22 planning, public health, and other sectors, 

23 including child-serving institutions, to ad24 dress how the built environment impacts 

25 food availability and access and physical 


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1 activity to promote healthy behaviors and 

2 lifestyles and reduce overweight and obe3 sity, musculoskeletal diseases, respiratory 

4 conditions, dental, oral and mental health 

5 conditions, poverty, and related co6 morbidities; 

7 (iii) establishing programs to ad8 dress— 

9 (I) how environmental and social 

10 conditions of work and living choices 

11 influence physical activity and dietary 

12 intake; or 

13 (II) how those conditions influ14 ence the concerns and needs of people 

15 who have impaired mobility and use 

16 assistance devices, including wheel17 chairs, lower limb prostheses, and hip, 

18 knee, and other joint replacements; 

19 and 

20 (iv) convening intervention and dem21 onstration programs that examine the role 

22 of the social environment in connection 

23 with the physical and chemical environ24 ment in— 


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1 (I) determining access to nutri2 tional food; and 

3 (II) improving physical activity to 

4 reduce overweight, obesity, and co5 morbidities and increase quality of 

6 life. 

7 (4) LEVEL 3 COOPERATIVE AGREEMENTS.— 

8 (A) IN GENERAL.—An eligible entity 

9 awarded a grant under this paragraph shall use 

10 the funds to identify and address racial and 

11 ethnic disparities in social determinants of 

12 health by creating demonstration programs that 

13 assess the feasibility of establishing a federally 

14 funded comprehensive program and describe 

15 key outcomes that address racial and ethnic dis16 parities in social determinants of health. 

17 (B) PROGRAM DESIGN.— 

18 (i) EVALUATION.—No later than 1 

19 year after enactment of this Act, the Di20 rector shall evaluate the best practices of 

21 existing programs from the private, public, 

22 community based, and academically sup23 ported initiatives focused on reducing dis24 parities in the social determinants of 

25 health for racial and ethnic populations. 


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1 (ii) DEMONSTRATION PROJECTS.— 

2 Not later than two years after the date of 

3 enactment of this Act, the Director shall 

4 implement at least ten demonstration 

5 projects including at least one project for 

6 each major racial and ethnic minority 

7 group, each of which is unique to the cul8 tural and linguistic needs of each of the 

9 following groups: 

10 (I) Native Americans and Alaska 

11 Natives. 

12 (II) Asian-Americans. 

13 (III) African-Americans/Blacks. 

14 (IV) Hispanic/Latino-Americans. 

15 (V) Native Hawaiians and Pacific 

16 Islanders. 

17 (iii) REPORT TO CONGRESS.—No later 

18 than 2 years after the implementation of 

19 the initial demonstration projects, the Di20 rector shall submit to Congress a report 

21 which includes— 

22 (I) a description of each dem23 onstration project and design; 


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1 (II) an evaluation of the cost ef2 fectiveness of each project’s preven3 tion and treatment efforts; 

4 (III) an evaluation of the cultural 

5 and linguistic appropriateness of each 

6 project by racial and ethnic group; 

7 and 

8 (IV) an evaluation of the bene9 ficiary’s health status improvement 

10 under the demonstration project. 

11 (iv) ANY OTHER INFORMATION

12 DEEMED APPROPRIATE BY THE DIREC13 TOR.—The Director shall require any other 

14 information deemed appropriate to be 

15 shared by or developed by eligible entities 

16 awarded a grant under this paragraph, in17 cluding the following: 

18 (I) Developing models and evalu19 ating methods that improve the cul20 tural and linguistically appropriate 

21 services provided through the Centers 

22 for Disease Control and Prevention to 

23 target individuals impacted by health 

24 disparities based on their race, eth25 nicity, and gender. 


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1 (II) Promoting the collaboration 

2 between primary and specialty care 

3 health care providers and patients, to 

4 ensure patients impacted by health 

5 disparities based on race, ethnicity, 

6 and gender are receiving comprehen7 sive and organized treatment and 

8 care. 

9 (III) Educating health care pro10 fessionals on the causes and effects of 

11 disparities in the social determinants 

12 of health as it relates to minority and 

13 racial and ethnic communities and the 

14 need for culturally and linguistically 

15 appropriate care in the prevention and 

16 treatment of high-impact diseases. 

17 (IV) Encouraging collaboration 

18 among community and patient-based 

19 organizations which work to address 

20 disparities in the social determinants 

21 of health as it relates to high-impact 

22 diseases in minority and racial and 

23 ethnic populations. 


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1 (f) AUTHORIZATION OF APPROPRIATIONS.—There 

2 are authorized to be appropriated to carry out this sec3 tion— 

4 (1) $25,000,000 for fiscal year 2017; and 

5 (2) such sums as may be necessary for fiscal 

6 years 2018 through 2020. 

7 SEC. 1006. ADDITIONAL RESEARCH ON THE RELATIONSHIP 

8 BETWEEN THE BUILT ENVIRONMENT AND 

9 THE HEALTH OF COMMUNITY RESIDENTS. 

10 (a) DEFINITION OF ELIGIBLE INSTITUTION.—In this 

11 section, the term ‘‘eligible institution’’ means a public or 

12 private nonprofit institution that submits to the Secretary 

13 of Health and Human Services (in this section referred 

14 to as the ‘‘Secretary’’) and the Administrator of the Envi15 ronmental Protection Agency (in this section referred to 

16 as the ‘‘Administrator’’) an application for a grant under 

17 the grant program authorized under subsection (b)(2) at 

18 such time, in such manner, and containing such agree19 ments, assurances, and information as the Secretary and 

20 Administrator may require. 

21 (b) RESEARCH GRANT PROGRAM.— 

22 (1) DEFINITION OF HEALTH.—In this section, 

23 the term ‘‘health’’ includes— 

24 (A) levels of physical activity; 


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1 (B) degree of mobility due to factors such 

2 as musculoskeletal diseases, arthritis, and obe3 sity; 

4 (C) consumption of nutritional foods; 

5 (D) rates of crime; 

6 (E) air, water, and soil quality; 

7 (F) risk of injury; 

8 (G) accessibility to health care services; 

9 (H) levels of educational attainment; and 

10 (I) other indicators as determined appro11 priate by the Secretary. 

12 (2) GRANTS.—The Secretary, in collaboration 

13 with the Administrator, shall provide grants to eligi14 ble institutions to conduct and coordinate research 

15 on the built environment and its influence on indi16 vidual and population-based health. 

17 (3) RESEARCH.—The Secretary shall support 

18 research that— 

19 (A) investigates and defines the causal 

20 links between all aspects of the built environ21 ment and the health of residents; 

22 (B) examines— 

23 (i) the extent of the impact of the 

24 built environment (including the various 


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1 characteristics of the built environment) on 

2 the health of residents; 

3 (ii) the variance in the health of resi4 dents by— 

5 (I) location (such as inner cities, 

6 inner suburbs, and outer suburbs); 

7 and 

8 (II) population subgroup (includ9 ing children, the elderly, the disadvan10 taged); or 

11 (iii) the importance of the built envi12 ronment to the total health of residents, 

13 which is the primary variable of interest 

14 from a public health perspective; 

15 (C) is used to develop— 

16 (i) measures to address health and the 

17 connection of health to the built environ18 ment; and 

19 (ii) efforts to link the measures to 

20 travel and health databases; and 

21 (D) distinguishes carefully between per22 sonal attitudes and choices and external influ23 ences on observed behavior to determine how 

24 much an observed association between the built 

25 environment and the health of residents, versus 


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1 the lifestyle preferences of the people that 

2 choose to live in the neighborhood, reflects the 

3 physical characteristics of the neighborhood; 

4 and 

5 (E)(i) identifies or develops effective inter6 vention strategies to promote better health 

7 among residents with a focus on behavioral 

8 interventions and enhancements of the built en9 vironment that promote increased use by resi10 dents; and 

11 (ii) in developing the intervention strate12 gies under clause (i), ensures that the interven13 tion strategies will reach out to high-risk popu14 lations, including racial and ethnic minorities, 

15 low-income urban and rural communities, and 

16 children. 

17 (4) PRIORITY.—In providing assistance under 

18 the grant program authorized under paragraph (2), 

19 the Secretary and the Administrator shall give pri20 ority to research that incorporates— 

21 (A) minority-serving institutions as grant22 ees; 

23 (B) interdisciplinary approaches; or 

24 (C) the expertise of the public health, 

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1 cluding child health), urban planning, and 

2 transportation research communities in the 

3 United States and abroad. 

4 SEC. 1007. ENVIRONMENT AND PUBLIC HEALTH RESTORA5 TION. 

6 (a) FINDINGS.— 

7 (1) GENERAL FINDINGS.—The Congress finds 

8 as follows: 

9 (A) As human beings, we share our envi10 ronment with a wide variety of habitats and 

11 ecosystems that nurture and sustain a diversity 

12 of species. 

13 (B) The abundance of natural resources in 

14 our environment forms the basis for our econ15 omy and has greatly contributed to human de16 velopment throughout history. 

17 (C) The accelerated pace of human devel18 opment over the last several hundred years has 

19 significantly impacted our natural environment 

20 and its resources, the health and diversity of 

21 plant and animal wildlife, the availability of 

22 critical habitats, the quality of our air and our 

23 water, and our global climate. 

24 (D) The intervention of the Federal Gov25 ernment is necessary to minimize and mitigate 


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1 human impact on the environment for the ben2 efit of public health, to maintain air quality and 

3 water quality, to sustain the diversity of plants 

4 and animals, to combat global climate change, 

5 and to protect the environment. 

6 (E) Laws and regulations in the United 

7 States have been created and promulgated to 

8 minimize and mitigate human impact on the en9 vironment for the benefit of public health, to 

10 maintain air quality and water quality, to sus11 tain wildlife, and to protect the environment. 

12 (F) Such laws include the Antiquities Act 

13 of 1906 (16 U.S.C. 431 et seq.) initiated by 

14 President Theodore Roosevelt to create the na15 tional park system, the National Environmental 

16 Policy Act of 1969 (42 U.S.C. 4321 et seq.), 

17 the Clean Air Act (42 U.S.C. 7401 et seq.), the 

18 Federal Water Pollution Control Act (33 U.S.C. 

19 1251 et seq.), the Comprehensive Environ20 mental Response, Compensation, and Liability 

21 Act of 1980 (Public Law 96–510), the Endan22 gered Species Act of 1973 (Public Law 93– 

23 205), and the National Forest Management Act 

24 of 1976 (Public Law 94–588). 


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1 (G) Attempts to repeal or weaken key envi2 ronmental safeguards pose dangers to the pub3 lic health, air quality, water quality, wildlife, 

4 and the environment. 

5 (2) FINDINGS ON CHANGES AND PROPOSED

6 CHANGES IN LAW.—The Congress finds that, since 

7 2001, the following changes and proposed changes 

8 to existing law or regulations have negatively im9 pacted or will negatively impact the environment and 

10 public health: 

11 (A) CLEAN WATER.— 

12 (i) On May 9, 2002, the Environ13 mental Protection Agency (EPA) and the 

14 Army Corps of Engineers put forth a final 

15 rule that reconciled regulations imple16 menting section 404 of the Federal Water 

17 Pollution Control Act by redefining the 

18 term ‘‘fill material’’ and amending the def19 inition of the term ‘‘discharge of fill mate20 rial’’, reversing a 25-year-old regulation. 

21 The new rule fails to restrict the dumping 

22 of hardrock mining waste, construction de23 bris, and other industrial wastes into riv24 ers, streams, lakes, and wetlands. The rule 

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1 moval coal mining companies to dump 

2 waste into streams and lakes, polluting the 

3 surrounding natural habitat and poisoning 

4 plants and animals that depend on those 

5 water sources. 

6 (ii) On February 12, 2003, the Envi7 ronmental Protection Agency published the 

8 rule ‘‘National Pollutant Discharge Elimi9 nation System Permit Regulation and Ef10 fluent Limitation Guidelines and Stand11 ards for Concentrated Animal Feeding Op12 erations’’, new livestock waste regulations 

13 that aimed to control factory farm pollu14 tion but which would severely undermine 

15 existing protections under the Federal 

16 Water Pollution Control Act. This regula17 tion allows large-scale animal factories to 

18 foul the Nation’s waters with animal 

19 waste, allows livestock owners to draft 

20 their own pollution-management plans and 

21 avoid ground water monitoring, legalizes 

22 the discharge of contaminated runoff water 

23 rich in nitrogen, phosphorus, bacteria, and 

24 metals, and ensures that large factory 

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1 mental damage they cause. In a 2005 Fed2 eral court decision (‘‘Waterkeeper Alliance, 

3 et al. v. Environmental Protection Agen4 cy’’, 399 F.3d 486 (2nd Cir. 2005)), major 

5 parts of the rule were upheld, others va6 cated, and still others remanded back to 

7 the EPA. On November 20, 2008, the En8 vironmental Protection Agency published a 

9 revised final rule which undermines envi10 ronmental protection provisions by remov11 ing mandatory permitting requirements 

12 and allowing large animal farms to self13 certify the absence of pollutant discharge 

14 activity. 

15 (iii) On March 19, 2003, the Environ16 mental Protection Agency published a new 

17 rule regarding the Total Maximum Daily 

18 Load program of the Federal Water Pollu19 tion Control Act that regulates the max20 imum amount of a particular pollutant 

21 that can be present in a body of water and 

22 still meet water quality standards. The new 

23 rule withdrew the existing regulation put 

24 forth on July 13, 2000, and halted mo25 mentum in cleaning up polluted waterways 


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1 throughout the Nation. By abandoning the 

2 existing rule, the Environmental Protection 

3 Agency is undermining the effectiveness of 

4 cleanup plans and is allowing States to 

5 avoid cleaning polluted waters entirely by 

6 dropping them from their cleanup lists. 

7 Waterways play a crucial role in the lives 

8 of the people of the United States and are 

9 critical to the livelihood of fish and wildlife. 

10 The result of dropping the July 2000 rule 

11 is that the restoration of polluted rivers, 

12 shorelines, and lakes will be delayed, harm13 ing more fish and wildlife and worsening 

14 the quality of drinking water. 

15 (iv) On December 2, 2008, the Envi16 ronmental Protection Agency and the 

17 Army Corps of Engineers jointly issued a 

18 guidance document in the form of a legal 

19 memorandum, titled ‘‘Clean Water Act Ju20 risdiction Following the U.S. Supreme 

21 Court’s Decision in Rapanos v. United 

22 States & Carabell v. United States’’. This 

23 new guidance dictates enforcement actions 

24 under the Federal Water Pollution Control 

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1 case’’ analysis to determine jurisdiction for 

2 waterways that do not flow all year. Such 

3 actions endanger small streams and wet4 lands that serve as important habitats for 

5 aquatic life, which play a fundamental role 

6 in safeguarding sources of clean drinking 

7 water and mitigate the risks and effects of 

8 floods and droughts. Further, the defini9 tion provided therein for ‘‘waters of the 

10 United States’’ is applicable to the Federal 

11 Water Pollution Control Act as a whole, 

12 potentially affecting programs that control 

13 industrial pollution and sewage levels, pre14 vent oil spills, and set water quality stand15 ards for all waters in the United States 

16 protected under the Federal Water Pollu17 tion Control Act. 

18 (B) FORESTS AND LAND MANAGEMENT.— 

19 (i) On December 3, 2003, the Presi20 dent signed into law the Healthy Forests 

21 Restoration Act of 2003 (Public Law 108– 

22 148; 16 U.S.C. 6501 et seq.). Although the 

23 law attempts to reduce the risk of cata24 strophic forest fires, it provides a boon to 

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1 gressive thinning of backcountry forests 

2 that are far from at-risk communities. The 

3 law allows for increased logging of large, 

4 fire-resistant trees that are not in close 

5 proximity of homes and communities; it 

6 undermines critical protections for endan7 gered species by exempting Federal land 

8 management agencies from consulting with 

9 the United States Fish and Wildlife Serv10 ice before approving any action that could 

11 harm endangered plants or wildlife; and it 

12 limits public participation by reducing the 

13 number of environmental project reviews. 

14 (ii) On April 21, 2008, the Depart15 ment of Agriculture issued a Final Plan16 ning Rule and Record of Decision for Na17 tional Forest System Land Management 

18 Planning. Similar to rules enacted by the 

19 Administration on January 5, 2005, later 

20 remanded back to the agency in Federal 

21 district court for violating the National 

22 Environmental Policy Act of 1969, the En23 dangered Species Act of 1973, and the Ad24 ministrative Procedure Act (‘‘Citizens for 

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1 ment of Agriculture’’, 481 F. Supp. 2d 

2 1059 (N.D. Cal. 2007)), this revised rule 

3 eliminates strict forest planning standards 

4 established in 1982, and opens millions of 

5 acres of public lands to damaging and 

6 invasive logging, mining, and drilling oper7 ations. These regulations would reverse 

8 more than 20 years of protection for wild9 life and national forests by removing the 

10 overall goal of ensuring ecological sustain11 ability in managing the national forest sys12 tem, weakening the National Forest Man13 agement Act of 1976, and effectively end14 ing the review of forest management plans 

15 under the National Environmental Policy 

16 Act of 1969. 

17 (iii) On September 20, 2006, the Dis18 trict Court for the Northern District of 

19 California vacated the Protection of Inven20 toried Roadless Areas rule, enacted on May 

21 13, 2005, which gave State Governors 18 

22 months to petition the Federal Government 

23 to either restore the previous rule for their 

24 States, or submit a new management and 

25 development plan for national forest areas 


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1 inventoried under the rule. Despite the 

2 enjoinment of the Administration’s 2005 

3 rule, and the subsequent restoration of the 

4 original Roadless Area Conservation Rule, 

5 the United States Forest Service has con6 tinued to allow States to petition for a spe7 cial rule under the authority of the Admin8 istrative Procedure Act, publishing a final 

9 special rule for Idaho on October 16, 2008. 

10 As a result, 58.5 million acres of wild na11 tional forests are still vulnerable to log12 ging, road building, and other develop13 ments that may fragment natural habitats 

14 and negatively impact fish and wildlife. 

15 (iv) On November 17, 2008, the De16 partment of the Interior’s Bureau of Land 

17 Management (BLM) signed the Record of 

18 Decision (ROD) amending 12 resource 

19 management plans in Colorado, Utah, and 

20 Wyoming, opening 2,000,000 acres of pub21 lic lands to commercial tar sands and oil 

22 shale exploration and development. On No23 vember 18, 2008, the BLM published a 

24 final rule for Oil Shale Management set25 ting the policies and procedures for a comVerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00777 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475

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1 mercial leasing program for the manage2 ment of federally owned oil shale in those 

3 three States. Previously barred by a con4 gressional moratorium on the commercial 

5 leasing regulations for oil shale until Sep6 tember 30, 2008, the development of oil 

7 shale on public lands poses a serious threat 

8 to land conservation, endangered and 

9 threatened species, and critical habitat. 

10 Domestic shale oil production allowed by 

11 these regulations is highly water and en12 ergy intensive, the impacts of which will in13 tensify existing water scarcity in the arid 

14 Western Region and potentially degrade 

15 air and water quality for surrounding pop16 ulations. 

17 (C) SCIENTIFIC REVIEW.—On December 

18 16, 2008, the United States Fish and Wildlife 

19 Service of the Department of the Interior and 

20 the National Oceanic and Atmospheric Admin21 istration of the Department of Commerce joint22 ly issued a new rule amending regulations gov23 erning interagency cooperation under section 7 

24 of the Endangered Species Act of 1973 (ESA). 

25 This rule undermines the intention of the ESA 


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1 to protect species and the ecosystems upon 

2 which they depend by allowing Federal agencies 

3 to carry out, permit, or fund an action without 

4 proper environmental review and expert third5 party consultation from Federal wildlife ex6 perts. Under this new rule, Federal agencies 

7 can unilaterally circumvent the formal review 

8 process, eliminating longstanding and scientif9 ically grounded safeguards that serve to protect 

10 the biodiversity of our Nation’s ecosystems and 

11 avert harm to thousands of endangered and 

12 threatened species. 

13 (b) STATEMENT OF POLICY.—It is the policy of the 

14 United States Government to work in conjunction with 

15 States, territories, tribal governments, international orga16 nizations, and foreign governments in order to act as a 

17 steward of the environment for the benefit of public 

18 health, to maintain air quality and water quality, to sus19 tain the diversity of plant and animal species, to combat 

20 global climate change, and to protect the environment for 

21 future generations to enjoy. 

22 (c) STUDY AND REPORT ON PUBLIC HEALTH OR EN23 VIRONMENTAL IMPACT OF REVISED RULES, REGULA24 TIONS, LAWS, OR PROPOSED LAWS.— 


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1 (1) STUDY.—Not later than 30 days after the 

2 date of enactment of this Act, the President shall 

3 enter into an arrangement under which the National 

4 Academy of Sciences will conduct a study to deter5 mine the impact on public health, air quality, water 

6 quality, wildlife, and the environment of the fol7 lowing regulations, laws, and proposed laws: 

8 (A) CLEAN WATER.— 

9 (i) Final revisions to the Federal 

10 Water Pollution Control Act regulatory 

11 definitions of ‘‘fill material’’ and ‘‘dis12 charge of fill material’’, finalized and pub13 lished in the Federal Register on May 9, 

14 2002 (67 Fed. Reg. 31129), amending 

15 part 232 of title 40, Code of Federal Regu16 lations. 

17 (ii) Revised National Pollutant Dis18 charge Elimination System Permit Regula19 tion and Effluent Limitation Guidelines 

20 and Standards for Concentrated Animal 

21 Feeding Operations in response to the 

22 ‘‘Waterkeeper Alliance, et al. v. Environ23 mental Protection Agency’’ decision, final24 ized and published in the Federal Register 

25 on November 20, 2008 (73 Fed. Reg. 


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1 225), amending parts 9, 122, and 412 of 

2 title 40, Code of Federal Regulations. 

3 (iii) A March 19, 2003, rule published 

4 in the Federal Register (68 Fed. Reg. 

5 13608) withdrawing a July 13, 2000, rule 

6 revising the Total Maximum Daily Load 

7 program of the Federal Water Pollution 

8 Control Act (65 Fed. Reg. 43586), amend9 ing parts 9, 122, 123, 124, and 130 of 

10 title 40, Code of Federal Regulations. 

11 (iv) Official Guidance Document, 

12 ‘‘Clean Water Act Jurisdiction Following 

13 the United States Supreme Court’s Deci14 sion in Rapanos v. United States & 

15 Carabell v. United States’’, issued on De16 cember 2, 2008, relating to jurisdiction 

17 under section 404 of the Federal Water 

18 Pollution Control Act. 

19 (B) FORESTS AND LAND MANAGEMENT.— 

20 (i) Healthy Forests Restoration Act of 

21 2003, signed into law on December 3, 

22 2003 (Public Law 108–148; 16 U.S.C. 

23 6501 et seq.). 

24 (ii) National Forest System Land 

25 Management Planning Rule, finalized and 


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1 published in the Federal Register on April 

2 21, 2008 (73 Fed. Reg. 21468), replacing 

3 the 2005 final rule (70 Fed. Reg. 1022, 

4 Jan. 5, 2005), as amended March 3, 2006 

5 (71 Fed. Reg. 10837), and the 2000 final 

6 rule adopted on November 9, 2000 (65 

7 Fed. Reg. 67514), as amended on Sep8 tember 29, 2004 (69 Fed. Reg. 58055), 

9 amending title 36, Code of Federal Regula10 tions, part 219. 

11 (iii) The application of the Adminis12 trative Procedure Act (5 U.S.C. 551 to 

13 559, 701 to 706, et seq.), such that States 

14 may petition for a special rule for the 

15 roadless areas in all or part of said State. 

16 (iv) Record of Decision, ‘‘Oil Shale 

17 and Tar Sands Resources Resource Man18 agement Plan Amendments’’, issued on 

19 November 17, 2008, along with the Final 

20 Rule, Oil Shale Management-General, pub21 lished in the Federal Register on Novem22 ber 18, 2008 (73 Fed. Reg. 223), amend23 ing title 43, Code of Federal Regulations, 

24 parts 3900, 3910, 3920, and 3930. 


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1 (C) SCIENTIFIC REVIEW.—Final Rule, 

2 Interagency Cooperation Under the Endangered 

3 Species Act, published in the Federal Register 

4 on December 16, 2008, amending title 50, Code 

5 of Federal Regulations, part 402. 

6 (2) METHOD.—In conducting the study under 

7 paragraph (1), the National Academy of Sciences 

8 may utilize and compare existing scientific studies 

9 regarding the regulations, laws, and proposed laws 

10 listed in paragraph (1). 

11 (3) REPORT.—Under the arrangement entered 

12 into under paragraph (1), not later than 270 days 

13 after the date on which such arrangement is entered 

14 into, the National Academy of Sciences shall make 

15 publicly available and shall submit to the Congress 

16 and to the head of each department and agency of 

17 the Federal Government that issued, implements, or 

18 would implement a regulation, law, or proposed law 

19 listed in paragraph (1), a report containing— 

20 (A) a description of the impact of all such 

21 regulations, laws, and proposed laws on public 

22 health, air quality, water quality, wildlife, and 

23 the environment, compared to the impact of 

24 preexisting regulations, or laws in effect, includ25 ing— 


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1 (i) any negative impacts to air quality 

2 or water quality; 

3 (ii) any negative impacts to wildlife; 

4 (iii) any delays in hazardous waste 

5 cleanup that are projected to be hazardous 

6 to public health; and 

7 (iv) any other negative impact on pub8 lic health or the environment; and 

9 (B) any recommendations that the Na10 tional Academy of Sciences considers appro11 priate to maintain, restore, or improve in whole 

12 or in part protections for public health, air 

13 quality, water quality, wildlife, and the environ14 ment for each of the regulations, laws, and pro15 posed laws listed in paragraph (1), which may 

16 include recommendations for the adoption of 

17 any regulation or law in place or proposed prior 

18 to January 1, 2001. 

19 (d) DEPARTMENT AND AGENCY REVISION OF EXIST20 ING RULES, REGULATIONS, OR LAWS.—Not later than 

21 180 days after the date on which the report is submitted 

22 pursuant to subsection (c)(3), the head of each depart23 ment and agency that has issued or implemented a regula24 tion or law listed in subsection (c)(1) shall submit to the 

25 Congress a plan describing the steps such department or 


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1 such agency will take, or has taken, to restore or improve 

2 protections for public health and the environment in whole 

3 or in part that were in existence prior to the issuance of 

4 such regulation or law. 

5 SEC. 1008. GAO REPORT ON HEALTH EFFECTS OF DEEP6 WATER HORIZON OIL RIG EXPLOSION IN THE 

7 GULF COAST. 

8 (a) STUDY.—The Comptroller General of the United 

9 States shall conduct a study on the type and scope of 

10 health care services administered through the Department 

11 of Health and Human Services addressing the provision 

12 of health care to racial and ethnic minorities (whether 

13 residents, cleanup workers, or volunteers) affected by the 

14 explosion of the mobile offshore drilling unit Deepwater 

15 Horizon that occurred on April 20, 2010. 

16 (b) SPECIFIC COMPONENTS; REPORTING.—In car17 rying out subsection (a), the Comptroller General shall— 

18 (1) assess the type, size, and scope of programs 

19 administered by the Department of Health and 

20 Human Services that focus on provision of health 

21 care to communities in the Gulf Coast; 

22 (2) identify the merits and disadvantages asso23 ciated with each the programs; 

24 (3) perform an analysis of the costs and bene25 fits of the programs; 


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1 (4) determine whether there is any duplication 

2 of programs; and 

3 (5) not later than 180 days after the date of 

4 the enactment of this Act, report findings and rec5 ommendations for improving access to health care 

6 for racial and ethnic minorities to the Congress. 

Æ 


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