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[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[S. 1880 Engrossed in Senate (ES)]

  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
106th CONGRESS
  2d Session
                                S. 1880

_______________________________________________________________________

                                 AN ACT

 
    To amend the Public Health Service Act to improve the health of 
                         minority individuals.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Minority Health 
and Health Disparities Research and Education Act of 2000''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Findings.
  TITLE I--IMPROVING MINORITY HEALTH AND REDUCING HEALTH DISPARITIES 
THROUGH NATIONAL INSTITUTES OF HEALTH; ESTABLISHMENT OF NATIONAL CENTER

Sec. 101. Establishment of National Center on Minority Health and 
                            Health Disparities.
Sec. 102. Centers of excellence for research education and training.
Sec. 103. Extramural loan repayment program for minority health 
                            disparities research.
Sec. 104. General provisions regarding the Center.
Sec. 105. Report regarding resources of National Institutes of Health 
                            dedicated to minority and other health 
                            disparities research.
TITLE II--HEALTH DISPARITIES RESEARCH BY AGENCY FOR HEALTHCARE RESEARCH 
                              AND QUALITY

Sec. 201. Health disparities research by Agency for Healthcare Research 
                            and Quality.
        TITLE III--DATA COLLECTION RELATING TO RACE OR ETHNICITY

Sec. 301. Study and report by National Academy of Sciences.
                 TITLE IV--HEALTH PROFESSIONS EDUCATION

Sec. 401. Health professions education in health disparities.
Sec. 402. National conference on health professions education and 
                            health disparities.
Sec. 403. Advisory responsibilities in health professions education in 
                            health disparities and cultural competency.
 TITLE V--PUBLIC AWARENESS AND DISSEMINATION OF INFORMATION ON HEALTH 
                              DISPARITIES

Sec. 501. Public awareness and information dissemination.
                   TITLE VI--MISCELLANEOUS PROVISIONS

Sec. 601. Departmental definition regarding minority individuals.
Sec. 602. Conforming provision regarding definitions.
Sec. 603. Effective date.

SEC. 2. FINDINGS.

    The Congress finds as follows:
            (1) Despite notable progress in the overall health of the 
        Nation, there are continuing disparities in the burden of 
        illness and death experienced by African Americans, Hispanics, 
        Native Americans, Alaska Natives, and Asian Pacific Islanders, 
        compared to the United States population as a whole.
            (2) The largest numbers of the medically underserved are 
        white individuals, and many of them have the same health care 
        access problems as do members of minority groups. Nearly 
        20,000,000 white individuals live below the poverty line with 
        many living in non-metropolitan, rural areas such as 
        Appalachia, where the high percentage of counties designated as 
        health professional shortage areas (47 percent) and the high 
        rate of poverty contribute to disparity outcomes. However, 
        there is a higher proportion of racial and ethnic minorities in 
        the United States represented among the medically underserved.
            (3) There is a national need for minority scientists in the 
        fields of biomedical, clinical, behavioral, and health services 
        research. Ninety percent of minority physicians educated at 
        Historically Black Medical Colleges live and serve in minority 
        communities.
            (4) Demographic trends inspire concern about the Nation's 
        ability to meet its future scientific, technological and 
        engineering workforce needs. Historically, non-Hispanic white 
        males have made up the majority of the United States 
        scientific, technological, and engineering workers.
            (5) The Hispanic and Black population will increase 
        significantly in the next 50 years. The scientific, 
        technological, and engineering workforce may decrease if 
        participation by underepresented minorities remains the same.
            (6) Increasing rates of Black and Hispanic workers can help 
        ensure strong scientific, technological, and engineering 
        workforce.
            (7) Individuals such as underepresented minorities and 
        women in the scientific, technological, and engineering 
        workforce enable society to address its diverse needs.
            (8) If there had not been a substantial increase in the 
        number of science and engineering degrees awarded to women and 
        underepresented minorities over the past few decades, the 
        United States would be facing even greater shortages in 
        scientific, technological, and engineering workers.
            (9) In order to effectively promote a diverse and strong 
        21st Century scientific, technological, and engineering 
        workforce, Federal agencies should expand or add programs that 
        effectively overcome barriers such as educational transition 
        from one level to the next and student requirements for 
        financial resources.
            (10) Federal agencies should work in concert with the 
        private nonprofit sector to emphasize the recruitment and 
        retention of qualified individuals from ethnic and gender 
        groups that are currently underrepresented in the scientific, 
        technological, and engineering workforce.
            (11) Behavioral and social sciences research has increased 
        awareness and understanding of factors associated with health 
        care utilization and access, patient attitudes toward health 
        services, and risk and protective behaviors that affect health 
        and illness. These factors have the potential to then be 
        modified to help close the health disparities gap among ethnic 
        minority populations. In addition, there is a shortage of 
        minority behavioral science researchers and behavioral health 
        care professionals. According to the National Science 
        Foundation, only 15.5 percent of behavioral research-oriented 
        psychology doctorate degrees were awarded to minority students 
        in 1997. In addition, only 17.9 percent of practice-oriented 
        psychology doctorate degrees were awarded to ethnic minorities.

  TITLE I--IMPROVING MINORITY HEALTH AND REDUCING HEALTH DISPARITIES 
THROUGH NATIONAL INSTITUTES OF HEALTH; ESTABLISHMENT OF NATIONAL CENTER

SEC. 101. ESTABLISHMENT OF NATIONAL CENTER ON MINORITY HEALTH AND 
              HEALTH DISPARITIES.

    (a) In General.--Part E of title IV of the Public Health Service 
Act (42 U.S.C. 287 et seq.) is amended by adding at the end the 
following subpart:

 ``Subpart 6--National Center on Minority Health and Health Disparities

``SEC. 485E. PURPOSE OF CENTER.

    ``(a) In General.--The general purpose of the National Center on 
Minority Health and Health Disparities (in this subpart referred to as 
the `Center') is the conduct and support of research, training, 
dissemination of information, and other programs with respect to 
minority health conditions and other populations with health 
disparities.
    ``(b) Priorities.--The Director of the Center shall in expending 
amounts appropriated under this subpart give priority to conducting and 
supporting minority health disparities research.
    ``(c) Minority Health Disparities Research.--For purposes of this 
subpart:
            ``(1) The term `minority health disparities research' means 
        basic, clinical, and behavioral research on minority health 
        conditions (as defined in paragraph (2)), including research to 
        prevent, diagnose, and treat such conditions.
            ``(2) The term `minority health conditions', with respect 
        to individuals who are members of minority groups, means all 
        diseases, disorders, and conditions (including with respect to 
        mental health and substance abuse)--
                    ``(A) unique to, more serious, or more prevalent in 
                such individuals;
                    ``(B) for which the factors of medical risk or 
                types of medical intervention may be different for such 
                individuals, or for which it is unknown whether such 
                factors or types are different for such individuals; or
                    ``(C) with respect to which there has been 
                insufficient research involving such individuals as 
                subjects or insufficient data on such individuals.
            ``(3) The term `minority group' has the meaning given the 
        term `racial and ethnic minority group' in section 1707.
            ``(4) The terms `minority' and `minorities' refer to 
        individuals from a minority group.
    ``(d) Health Disparity Populations.--For purposes of this subpart:
            ``(1) A population is a health disparity population if, as 
        determined by the Director of the Center after consultation 
        with the Director of the Agency for Healthcare Research and 
        Quality, there is a significant disparity in the overall rate 
        of disease incidence, prevalence, morbidity, mortality, or 
        survival rates in the population as compared to the health 
        status of the general population.
            ``(2) The Director shall give priority consideration to 
        determining whether minority groups qualify as health disparity 
        populations under paragraph (1).
            ``(3) The term `health disparities research' means basic, 
        clinical, and behavioral research on health disparity 
        populations (including individual members and communities of 
        such populations) that relates to health disparities as defined 
        under paragraph (1), including the causes of such disparities 
        and methods to prevent, diagnose, and treat such disparities.
    ``(e) Coordination of Activities.--The Director of the Center shall 
act as the primary Federal official with responsibility for 
coordinating all minority health disparities research and other health 
disparities research conducted or supported by the National Institutes 
of Health, and--
            ``(1) shall represent the health disparities research 
        program of the National Institutes of Health, including the 
        minority health disparities research program, at all relevant 
        Executive branch task forces, committees and planning 
        activities; and
            ``(2) shall maintain communications with all relevant 
        Public Health Service agencies, including the Indian Health 
        Service, and various other departments of the Federal 
        Government to ensure the timely transmission of information 
        concerning advances in minority health disparities research and 
        other health disparities research between these various 
        agencies for dissemination to affected communities and health 
        care providers.
    ``(f) Collaborative Comprehensive Plan and Budget.--
            ``(1) In general.--Subject to the provisions of this 
        section and other applicable law, the Director of NIH, the 
        Director of the Center, and the directors of the other agencies 
        of the National Institutes of Health in collaboration (and in 
        consultation with the advisory council for the Center) shall--
                    ``(A) establish a comprehensive plan and budget for 
                the conduct and support of all minority health 
                disparities research and other health disparities 
                research activities of the agencies of the National 
                Institutes of Health (which plan and budget shall be 
                first established under this subsection not later than 
                12 months after the date of the enactment of this 
                subpart);
                    ``(B) ensure that the plan and budget establish 
                priorities among the health disparities research 
                activities that such agencies are authorized to carry 
                out;
                    ``(C) ensure that the plan and budget establish 
                objectives regarding such activities, describes the 
                means for achieving the objectives, and designates the 
                date by which the objectives are expected to be 
                achieved;
                    ``(D) ensure that, with respect to amounts 
                appropriated for activities of the Center, the plan and 
                budget give priority in the expenditure of funds to 
                conducting and supporting minority health disparities 
                research;
                    ``(E) ensure that all amounts appropriated for such 
                activities are expended in accordance with the plan and 
                budget;
                    ``(F) review the plan and budget not less than 
                annually, and revise the plan and budget as 
                appropriate;
                    ``(G) ensure that the plan and budget serve as a 
                broad, binding statement of policies regarding minority 
                health disparities research and other health 
                disparities research activities of the agencies, but do 
                not remove the responsibility of the heads of the 
                agencies for the approval of specific programs or 
                projects, or for other details of the daily 
                administration of such activities, in accordance with 
                the plan and budget; and
                    ``(H) promote coordination and collaboration among 
                the agencies conducting or supporting minority health 
                or other health disparities research.
            ``(2) Certain components of plan and budget.--With respect 
        to health disparities research activities of the agencies of 
        the National Institutes of Health, the Director of the Center 
        shall ensure that the plan and budget under paragraph (1) 
        provide for--
                    ``(A) basic research and applied research, 
                including research and development with respect to 
                products;
                    ``(B) research that is conducted by the agencies;
                    ``(C) research that is supported by the agencies;
                    ``(D) proposals developed pursuant to solicitations 
                by the agencies and for proposals developed 
                independently of such solicitations; and
                    ``(E) behavioral research and social sciences 
                research, which may include cultural and linguistic 
                research in each of the agencies.
            ``(3) Minority health disparities research.--The plan and 
        budget under paragraph (1) shall include a separate statement 
        of the plan and budget for minority health disparities 
        research.
    ``(g) Participation in Clinical Research.--The Director of the 
Center shall work with the Director of NIH and the directors of the 
agencies of the National Institutes of Health to carry out the 
provisions of section 492B that relate to minority groups.
    ``(h) Research Endowments.--
            ``(1) In general.--The Director of the Center may carry out 
        a program to facilitate minority health disparities research 
        and other health disparities research by providing for research 
        endowments at centers of excellence under section 736.
            ``(2) Eligibility.--The Director of the Center may provide 
        for a research endowment under paragraph (1) only if the 
        institution involved meets the following conditions:
                    ``(A) The institution does not have an endowment 
                that is worth in excess of an amount equal to 50 
                percent of the national average of endowment funds at 
                institutions that conduct similar biomedical research 
                or training of health professionals.
                    ``(B) The application of the institution under 
                paragraph (1) regarding a research endowment has been 
                recommended pursuant to technical and scientific peer 
                review and has been approved by the advisory council 
                under subsection (j).
    ``(i) Certain Activities.--In carrying out subsection (a), the 
Director of the Center--
            ``(1) shall assist the Director of the National Center for 
        Research Resources in carrying out section 481(c)(3) and in 
        committing resources for construction at Institutions of 
        Emerging Excellence;
            ``(2) shall establish projects to promote cooperation among 
        Federal agencies, State, local, tribal, and regional public 
        health agencies, and private entities in health disparities 
        research; and
            ``(3) may utilize information from previous health 
        initiatives concerning minorities and other health disparity 
        populations.
    ``(j) Advisory Council.--
            ``(1) In general.--The Secretary shall, in accordance with 
        section 406, establish an advisory council to advise, assist, 
        consult with, and make recommendations to the Director of the 
        Center on matters relating to the activities described in 
        subsection (a), and with respect to such activities to carry 
        out any other functions described in section 406 for advisory 
        councils under such section. Functions under the preceding 
        sentence shall include making recommendations on budgetary 
        allocations made in the plan under subsection (f), and shall 
        include reviewing reports under subsection (k) before the 
        reports are submitted under such subsection.
            ``(2) Membership.--With respect to the membership of the 
        advisory council under paragraph (1), a majority of the members 
        shall be individuals with demonstrated expertise regarding 
        minority health disparity and other health disparity issues; 
        representatives of communities impacted by minority and other 
        health disparities shall be included; and a diversity of health 
        professionals shall be represented. The membership shall in 
        addition include a representative of the Office of Behavioral 
        and Social Sciences Research under section 404A.
    ``(k) Annual Report.--The Director of the Center shall prepare an 
annual report on the activities carried out or to be carried out by the 
Center, and shall submit each such report to the Committee on Health, 
Education, Labor, and Pensions of the Senate, the Committee on Commerce 
of the House of Representatives, the Secretary, and the Director of 
NIH. With respect to the fiscal year involved, the report shall--
            ``(1) describe and evaluate the progress made in health 
        disparities research conducted or supported by the national 
        research institutes;
            ``(2) summarize and analyze expenditures made for 
        activities with respect to health disparities research 
        conducted or supported by the National Institutes of Health;
            ``(3) include a separate statement applying the 
        requirements of paragraphs (1) and (2) specifically to minority 
        health disparities research; and
            ``(4) contain such recommendations as the Director 
        considers appropriate.
    ``(l) Authorization of Appropriations.--For the purpose of carrying 
out this subpart, there are authorized to be appropriated $100,000,000 
for fiscal year 2001, and such sums as may be necessary for each of the 
fiscal years 2002 through 2005. Such authorization of appropriations is 
in addition to other authorizations of appropriations that are 
available for the conduct and support of minority health disparities 
research or other health disparities research by the agencies of the 
National Institutes of Health.''.
    (b) Conforming Amendment.--Part A of title IV of the Public Health 
Service Act (42 U.S.C. 281 et seq.) is amended--
            (1) in section 401(b)(2)--
                    (A) in subparagraph (F), by moving the subparagraph 
                two ems to the left; and
                    (B) by adding at the end the following 
                subparagraph:
            ``(G) The National Center on Minority Health and Health 
        Disparities.''; and
            (2) by striking section 404.

SEC. 102. CENTERS OF EXCELLENCE FOR RESEARCH EDUCATION AND TRAINING.

    Subpart 6 of part E of title IV of the Public Health Service Act, 
as added by section 101(a) of this Act, is amended by adding at the end 
the following section:

``SEC. 485F. CENTERS OF EXCELLENCE FOR RESEARCH EDUCATION AND TRAINING.

    ``(a) In General.--The Director of the Center shall make awards of 
grants or contracts to designated biomedical and behavioral research 
institutions under paragraph (1) of subsection (c), or to consortia 
under paragraph (2) of such subsection, for the purpose of assisting 
the institutions in supporting programs of excellence in biomedical and 
behavioral research training for individuals who are members of 
minority health disparity populations or other health disparity 
populations.
    ``(b) Required Use of Funds.--An award may be made under subsection 
(a) only if the applicant involved agrees that the grant will be 
expended--
            ``(1) to train members of minority health disparity 
        populations or other health disparity populations as 
        professionals in the area of biomedical or behavioral research 
        or both; or
            ``(2) to expand, remodel, renovate, or alter existing 
        research facilities or construct new research facilities for 
        the purpose of conducting minority health disparities research 
        and other health disparities research.
    ``(c) Centers of Excellence.--
            ``(1) In general.--For purposes of this section, a 
        designated biomedical and behavioral research institution is a 
        biomedical and behavioral research institution that--
                    ``(A) has a significant number of members of 
                minority health disparity populations or other health 
                disparity populations enrolled as students in the 
                institution (including individuals accepted for 
                enrollment in the institution);
                    ``(B) has been effective in assisting such students 
                of the institution to complete the program of education 
                or training and receive the degree involved;
                    ``(C) has made significant efforts to recruit 
                minority students to enroll in and graduate from the 
                institution, which may include providing means-tested 
                scholarships and other financial assistance as 
                appropriate; and
                    ``(D) has made significant recruitment efforts to 
                increase the number of minority or other members of 
                health disparity populations serving in faculty or 
                administrative positions at the institution.
            ``(2) Consortium.--Any designated biomedical and behavioral 
        research institution involved may, with other biomedical and 
        behavioral institutions (designated or otherwise), including 
        tribal health programs, form a consortium to receive an award 
        under subsection (a).
            ``(3) Application of criteria to other programs.--In the 
        case of any criteria established by the Director of the Center 
        for purposes of determining whether institutions meet the 
        conditions described in paragraph (1), this section may not, 
        with respect to minority health disparity populations or other 
        health disparity populations, be construed to authorize, 
        require, or prohibit the use of such criteria in any program 
        other than the program established in this section.
    ``(d) Duration of Grant.--The period during which payments are made 
under a grant under subsection (a) may not exceed 5 years. Such 
payments shall be subject to annual approval by the Director of the 
Center and to the availability of appropriations for the fiscal year 
involved to make the payments.
    ``(e) Maintenance of Effort.--
            ``(1) In general.--With respect to activities for which an 
        award under subsection (a) is authorized to be expended, the 
        Director of the Center may not make such an award to a 
        designated research institution or consortium for any fiscal 
        year unless the institution, or institutions in the consortium, 
        as the case may be, agree to maintain expenditures of non-
        Federal amounts for such activities at a level that is not less 
        than the level of such expenditures maintained by the 
        institutions involved for the fiscal year preceding the fiscal 
        year for which such institutions receive such an award.
            ``(2) Use of federal funds.--With respect to any Federal 
        amounts received by a designated research institution or 
        consortium and available for carrying out activities for which 
        an award under subsection (a) is authorized to be expended, the 
        Director of the Center may make such an award only if the 
        institutions involved agree that the institutions will, before 
        expending the award, expend the Federal amounts obtained from 
        sources other than the award.
    ``(f) Certain Expenditures.--The Director of the Center may 
authorize a designated biomedical and behavioral research institution 
to expend a portion of an award under subsection (a) for research 
endowments.
    ``(g) Definitions.--For purposes of this section:
            ``(1) The term `designated biomedical and behavioral 
        research institution' has the meaning indicated for such term 
        in subsection (c)(1). Such term includes any health professions 
        school receiving an award of a grant or contract under section 
        736.
            ``(2) The term `program of excellence' means any program 
        carried out by a designated biomedical and behavioral research 
        institution with an award under subsection (a), if the program 
        is for purposes for which the institution involved is 
        authorized in subsection (b) to expend the grant.
    ``(h) Authorization of Appropriations.--For the purpose of making 
grants under subsection (a), there are authorized to be appropriated 
such sums as may be necessary for each of the fiscal years 2001 through 
2005.''.

SEC. 103. EXTRAMURAL LOAN REPAYMENT PROGRAM FOR MINORITY HEALTH 
              DISPARITIES RESEARCH.

    Subpart 6 of part E of title IV of the Public Health Service Act, 
as amended by section 102 of this Act, is amended by adding at the end 
the following section:

``SEC. 485G. LOAN REPAYMENT PROGRAM FOR MINORITY HEALTH DISPARITIES 
              RESEARCH.

    ``(a) In General.--The Director of the Center shall establish a 
program of entering into contracts with qualified health professionals 
under which such health professionals agree to engage in minority 
health disparities research or other health disparities research in 
consideration of the Federal Government agreeing to repay, for each 
year of engaging in such research, not more than $35,000 of the 
principal and interest of the educational loans of such health 
professionals.
    ``(b) Service Provisions.--The provisions of sections 338B, 338C, 
and 338E shall, except as inconsistent with subsection (a), apply to 
the program established in such subsection to the same extent and in 
the same manner as such provisions apply to the National Health Service 
Corps Loan Repayment Program established in subpart III of part D of 
title III.
    ``(c) Requirement Regarding Health Disparity Populations.--The 
Director of the Center shall ensure that not fewer than 50 percent of 
the contracts entered into under subsection (a) are for appropriately 
qualified health professionals who are members of a health disparity 
population.
    ``(d) Priority.--With respect to minority health disparities 
research and other health disparities research under subsection (a), 
the Secretary shall ensure that priority is given to conducting 
projects of biomedical research.
    ``(e) Funding.--
            ``(1) Authorization of appropriations.--For the purpose of 
        carrying out this section, there are authorized to be 
        appropriated such sums as may be necessary for each of the 
        fiscal years 2001 through 2005.
            ``(2) Availability of appropriations.--Amounts available 
        for carrying out this section shall remain available until the 
        expiration of the second fiscal year beginning after the fiscal 
        year for which the amounts were made available.''.

SEC. 104. GENERAL PROVISIONS REGARDING THE CENTER.

    Subpart 6 of part E of title IV of the Public Health Service Act, 
as amended by section 103 of this Act, is amended by adding at the end 
the following section:

``SEC. 485H. GENERAL PROVISIONS REGARDING THE CENTER.

    ``(a) Administrative Support for Center.--The Secretary, acting 
through the Director of the National Institutes of Health, shall 
provide administrative support and support services to the Director of 
the Center and shall ensure that such support takes maximum advantage 
of existing administrative structures at the agencies of the National 
Institutes of Health.
    ``(b) Evaluation and Report.--
            ``(1) Evaluation.--Not later than 5 years after the date of 
        the enactment of this subpart, the Secretary shall conduct an 
        evaluation to--
                    ``(A) determine the effect of this subpart on the 
                planning and coordination of health disparities 
                research programs at the agencies of the National 
                Institutes of Health;
                    ``(B) evaluate the extent to which this subpart has 
                eliminated the duplication of administrative resources 
                among such Institutes, centers and divisions; and
                    ``(C) provide, to the extent determined by the 
                Secretary to be appropriate, recommendations concerning 
                future legislative modifications with respect to this 
                subpart, for both minority health disparities research 
                and other health disparities research.
            ``(2) Minority health disparities research.--The evaluation 
        under paragraph (1) shall include a separate statement that 
        applies subparagraphs (A) and (B) of such paragraph to minority 
        health disparities research.
            ``(3) Report.--Not later than 1 year after the date on 
        which the evaluation is commenced under paragraph (1), the 
        Secretary shall prepare and submit to the Committee on Health, 
        Education, Labor, and Pensions of the Senate, and the Committee 
        on Commerce of the House of Representatives, a report 
        concerning the results of such evaluation.''.

SEC. 105. REPORT REGARDING RESOURCES OF NATIONAL INSTITUTES OF HEALTH 
              DEDICATED TO MINORITY AND OTHER HEALTH DISPARITIES 
              RESEARCH.

    Not later than December 1, 2003, the Director of the National 
Center on Minority Health and Health Disparities (established by the 
amendment made by section 101(a)), after consultation with the advisory 
council for such Center, shall submit to the Congress, the Secretary of 
Health and Human Services, and the Director of the National Institutes 
of Health a report that provides the following:
            (1) Recommendations for the methodology that should be used 
        to determine the extent of the resources of the National 
        Institutes of Health that are dedicated to minority health 
        disparities research and other health disparities research, 
        including determining the amount of funds that are used to 
        conduct and support such research. With respect to such 
        methodology, the report shall address any discrepancies between 
        the methodology used by such Institutes as of the date of the 
        enactment of this Act and the methodology used by the Institute 
        of Medicine as of such date.
            (2) A determination of whether and to what extent, relative 
        to fiscal year 1999, there has been an increase in the level of 
        resources of the National Institutes of Health that are 
        dedicated to minority health disparities research, including 
        the amount of funds used to conduct and support such research. 
        The report shall include provisions describing whether and to 
        what extent there have been increases in the number and amount 
        of awards to minority serving institutions.

TITLE II--HEALTH DISPARITIES RESEARCH BY AGENCY FOR HEALTHCARE RESEARCH 
                              AND QUALITY

SEC. 201. HEALTH DISPARITIES RESEARCH BY AGENCY FOR HEALTHCARE RESEARCH 
              AND QUALITY.

    (a)  General.--Part A of title IX of the Public Health Service Act 
(42 U.S.C. 299 et seq.) is amended--
            (1) in section 902, by striking subsection (g); and
            (2) by adding at the end the following:

``SEC. 903. RESEARCH ON HEALTH DISPARITIES.

    ``(a) In General.--The Director shall--
            ``(1) conduct and support research to identify populations 
        for which there is a significant disparity in the quality, 
        outcomes, cost, or use of health care services or access to and 
        satisfaction with such services, as compared to the general 
        population;
            ``(2) conduct and support research on the causes of and 
        barriers to reducing the health disparities identified in 
        paragraph (1), taking into account such factors as 
        socioeconomic status, attitudes toward health, the language 
        spoken, the extent of formal education, the area or community 
        in which the population resides, and other factors the Director 
        determines to be appropriate;
            ``(3) conduct and support research and support 
        demonstration projects to identify, test, and evaluate 
        strategies for reducing or eliminating health disparities, 
        including development or identification of effective service 
        delivery models, and disseminate effective strategies and 
        models;
            ``(4) develop measures and tools for the assessment and 
        improvement of the outcomes, quality, and appropriateness of 
        health care services provided to health disparity populations;
            ``(5) in carrying out section 902(c), provide support to 
        increase the number of researchers who are members of health 
        disparity populations, and the health services research 
        capacity of institutions that train such researchers; and
            ``(6) beginning with fiscal year 2003, annually submit to 
        the Congress a report regarding prevailing disparities in 
        health care delivery as it relates to racial factors and 
        socioeconomic factors in priority populations.
    ``(b) Research and Demonstration Projects.--
            ``(1) In general.--In carrying out subsection (a), the 
        Director shall conduct and support research and support 
        demonstrations to--
                    ``(A) identify the clinical, cultural, 
                socioeconomic, geographic, and organizational factors 
                that contribute to health disparities, including 
                minority health disparity populations, which research 
                shall include behavioral research, such as examination 
                of patterns of clinical decisionmaking, and research on 
                access, outreach, and the availability of related 
                support services (such as cultural and linguistic 
                services);
                    ``(B) identify and evaluate clinical and 
                organizational strategies to improve the quality, 
                outcomes, and access to care for health disparity 
                populations, including minority health disparity 
                populations;
                    ``(C) test such strategies and widely disseminate 
                those strategies for which there is scientific evidence 
                of effectiveness; and
                    ``(D) determine the most effective approaches for 
                disseminating research findings to health disparity 
                populations, including minority populations.
            ``(2) Use of certain strategies.--In carrying out this 
        section, the Director shall implement research strategies and 
        mechanisms that will enhance the involvement of individuals who 
        are members of minority health disparity populations or other 
        health disparity populations, health services researchers who 
        are such individuals, institutions that train such individuals 
        as researchers, members of minority health disparity 
        populations or other health disparity populations for whom the 
        Agency is attempting to improve the quality and outcomes of 
        care, and representatives of appropriate tribal or other 
        community-based organizations with respect to health disparity 
        populations. Such research strategies and mechanisms may 
        include the use of--
                    ``(A) centers of excellence that can demonstrate, 
                either individually or through consortia, a combination 
                of multi-disciplinary expertise in outcomes or quality 
                improvement research, linkages to relevant sites of 
                care, and a demonstrated capacity to involve members 
                and communities of health disparity populations, 
                including minority health disparity populations, in the 
                planning, conduct, dissemination, and translation of 
                research;
                    ``(B) provider-based research networks, including 
                health plans, facilities, or delivery system sites of 
                care (especially primary care), that make extensive use 
                of health care providers who are members of health 
                disparity populations or who serve patients in such 
                populations and have the capacity to evaluate and 
                promote quality improvement;
                    ``(C) service delivery models (such as health 
                centers under section 330 and the Indian Health 
                Service) to reduce health disparities; and
                    ``(D) innovative mechanisms or strategies that will 
                facilitate the translation of past research investments 
                into clinical practices that can reasonably be expected 
                to benefit these populations.
    ``(c) Quality Measurement Development.--
            ``(1) In general.--To ensure that health disparity 
        populations, including minority health disparity populations, 
        benefit from the progress made in the ability of individuals to 
        measure the quality of health care delivery, the Director shall 
        support the development of quality of health care measures that 
        assess the experience of such populations with health care 
        systems, such as measures that assess the access of such 
        populations to health care, the cultural competence of the care 
        provided, the quality of the care provided, the outcomes of 
        care, or other aspects of health care practice that the 
        Director determines to be important.
            ``(2) Examination of certain practices.--The Director shall 
        examine the practices of providers that have a record of 
        reducing health disparities or have experience in providing 
        culturally competent health services to minority health 
        disparity populations or other health disparity populations. In 
        examining such practices of providers funded under the 
        authorities of this Act, the Director shall consult with the 
        heads of the relevant agencies of the Public Health Service.
            ``(3) Report.--Not later than 36 months after the date of 
        the enactment of this section, the Secretary, acting through 
        the Director, shall prepare and submit to the appropriate 
        committees of Congress a report describing the state-of-the-art 
        of quality measurement for minority and other health disparity 
        populations that will identify critical unmet needs, the 
        current activities of the Department to address those needs, 
        and a description of related activities in the private sector.
    ``(d) Definition.--For purposes of this section:
            ``(1) The term `health disparity population' has the 
        meaning given such term in section 485E, except that in 
        addition to the meaning so given, the Director may determine 
        that such term includes populations for which there is a 
        significant disparity in the quality, outcomes, cost, or use of 
        health care services or access to or satisfaction with such 
        services as compared to the general population.
            ``(2) The term `minority', with respect to populations, 
        refers to racial and ethnic minority groups as defined in 
        section 1707.''.
    (b) Funding.--Section 927 of the Public Health Service Act (42 
U.S.C. 299c-6) is amended by adding at the end the following:
    ``(d) Health Disparities Research.--For the purpose of carrying out 
the activities under section 903, there are authorized to be 
appropriated $50,000,000 for fiscal year 2001, and such sums as may be 
necessary for each of the fiscal years 2002 through 2005.''.

        TITLE III--DATA COLLECTION RELATING TO RACE OR ETHNICITY

SEC. 301. STUDY AND REPORT BY NATIONAL ACADEMY OF SCIENCES.

    (a) Study.--The National Academy of Sciences shall conduct a 
comprehensive study of the Department of Health and Human Services' 
data collection systems and practices, and any data collection or 
reporting systems required under any of the programs or activities of 
the Department, relating to the collection of data on race or 
ethnicity, including other Federal data collection systems (such as the 
Social Security Administration) with which the Department interacts to 
collect relevant data on race and ethnicity.
    (b) Report.--Not later than 1 year after the date of enactment of 
this Act, the National Academy of Sciences shall prepare and submit to 
the Committee on Health, Education, Labor, and Pensions of the Senate 
and the Committee on Commerce of the House of Representatives, a report 
that--
            (1) identifies the data needed to support efforts to 
        evaluate the effects of socioeconomic status, race and 
        ethnicity on access to health care and other services and on 
        disparity in health and other social outcomes and the data 
        needed to enforce existing protections for equal access to 
        health care;
            (2) examines the effectiveness of the systems and practices 
        of the Department of Health and Human Services described in 
        subsection (a), including pilot and demonstration projects of 
        the Department, and the effectiveness of selected systems and 
        practices of other Federal, State, and tribal agencies and the 
        private sector, in collecting and analyzing such data;
            (3) contains recommendations for ensuring that the 
        Department of Health and Human Services, in administering its 
        entire array of programs and activities, collects, or causes to 
        be collected, reliable and complete information relating to 
        race and ethnicity; and
            (4) includes projections about the costs associated with 
        the implementation of the recommendations described in 
        paragraph (3), and the possible effects of the costs on program 
        operations.
    (c) Authorization of Appropriations.--For the purpose of carrying 
out this section, there are authorized to be appropriated such sums as 
may be necessary for fiscal year 2001.

                 TITLE IV--HEALTH PROFESSIONS EDUCATION

SEC. 401. HEALTH PROFESSIONS EDUCATION IN HEALTH DISPARITIES.

    (a) In General.--Part B of title VII of the Public Health Service 
Act (42 U.S.C. 293 et seq.) is amended by inserting after section 740 
the following:

``SEC. 741. GRANTS FOR HEALTH PROFESSIONS EDUCATION.

    ``(a) Grants for Health Professions Education in Health Disparities 
and Cultural Competency.--
            ``(1) In general.--The Secretary, acting through the 
        Administrator of the Health Resources and Services 
        Administration, may make awards of grants, contracts, or 
        cooperative agreements to public and nonprofit private entities 
        (including tribal entities) for the purpose of carrying out 
        research and demonstration projects (including research and 
        demonstration projects for continuing health professions 
        education) for training and education of health professionals 
        for the reduction of disparities in health care outcomes and 
        the provision of culturally competent health care.
            ``(2) Eligible entities.--Unless specifically required 
        otherwise in this title, the Secretary shall accept 
        applications for grants or contracts under this section from 
        health professions schools, academic health centers, State or 
        local governments, or other appropriate public or private 
        nonprofit entities (or consortia of entities, including 
        entities promoting multidisciplinary approaches) for funding 
        and participation in health professions training activities. 
        The Secretary may accept applications from for-profit private 
        entities as determined appropriate by the Secretary.
    ``(b) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out subsection (a), $3,500,000 for fiscal year 
2001, $7,000,000 for fiscal year 2002, $7,000,000 for fiscal year 2003, 
and $3,500,000 for fiscal year 2004.''.
    (b) Nursing Education.--Part A of title VIII of the Public Health 
Service Act (42 U.S.C. 296 et seq.) is amended--
            (1) by redesignating section 807 as section 808; and
            (2) by inserting after section 806 the following:

``SEC. 807. GRANTS FOR HEALTH PROFESSIONS EDUCATION.

    ``(a) Grants for Health Professions Education in Health Disparities 
and Cultural Competency.--The Secretary, acting through the 
Administrator of the Health Resources and Services Administration, may 
make awards of grants, contracts, or cooperative agreements to eligible 
entities for the purpose of carrying out research and demonstration 
projects (including research and demonstration projects for continuing 
health professions education) for training and education for the 
reduction of disparities in health care outcomes and the provision of 
culturally competent health care. Grants under this section shall be 
the same as provided in section 741.''.
    ``(b) Authorization of Appropriations.--There are to be 
appropriated to carry out subsection (a) such sums as may be necessary 
for each of the fiscal years 2001 through 2004.''.

SEC. 402. NATIONAL CONFERENCE ON HEALTH PROFESSIONS EDUCATION AND 
              HEALTH DISPARITIES.

    (a) In General.--Not later than 1 year after the date of enactment 
of this Act, the Secretary of Health and Human Services (in this 
section referred to as the ``Secretary''), acting through the 
Administrator of the Health Resources and Services Administration, 
shall convene a national conference on health professions education as 
a method for reducing disparities in health outcomes.
    (b) Participants.--The Secretary shall include in the national 
conference convened under subsection (a) advocacy groups and 
educational entities as described in section 741 of the Public Health 
Service Act (as added by section 401), tribal health programs, health 
centers under section 330 of such Act, and other interested parties.
    (c) Issues.--The national conference convened under subsection (a) 
shall include, but is not limited to, issues that address the role and 
impact of health professions education on the reduction of disparities 
in health outcomes, including the role of education on cultural 
competency. The conference shall focus on methods to achieve reductions 
in disparities in health outcomes through health professions education 
(including continuing education programs) and strategies for outcomes 
measurement to assess the effectiveness of education in reducing 
disparities.
    (d) Publication of Findings.--Not later than 6 months after the 
national conference under subsection (a) has convened, the Secretary 
shall publish in the Federal Register a summary of the proceedings and 
findings of the conference.
    (e) Authorization of Appropriations.--There is authorized to be 
appropriated such sums as may be necessary to carry out this section.

SEC. 403. ADVISORY RESPONSIBILITIES IN HEALTH PROFESSIONS EDUCATION IN 
              HEALTH DISPARITIES AND CULTURAL COMPETENCY.

    Section 1707 of the Public Health Service Act (42 U.S.C. 300u-6) is 
amended--
            (1) in subsection (b), by adding at the end the following 
        paragraph:
            ``(10) Advise in matters related to the development, 
        implementation, and evaluation of health professions education 
        in decreasing disparities in health care outcomes, including 
        cultural competency as a method of eliminating health 
        disparities.'';
            (2) in subsection (c)(2), by striking ``paragraphs (1) 
        through (9)'' and inserting ``paragraphs (1) through (10)''; 
        and
            (3) in subsection (d), by amending paragraph (1) to read as 
        follows:
            ``(1) Recommendations regarding language.--
                    ``(A) Proficiency in speaking english.--The Deputy 
                Assistant Secretary shall consult with the Director of 
                the Office of International and Refugee Health, the 
                Director of the Office of Civil Rights, and the 
                Directors of other appropriate departmental entities 
                regarding recommendations for carrying out activities 
                under subsection (b)(9).
                    ``(B) Health professions education regarding health 
                disparities.--The Deputy Assistant Secretary shall 
                carry out the duties under subsection (b)(10) in 
                collaboration with appropriate personnel of the 
                Department of Health of Human Services, other Federal 
                agencies, and other offices, centers, and institutions, 
                as appropriate, that have responsibilities under the 
                Minority Health and Health Disparities Research and 
                Education Act of 2000.''.

 TITLE V--PUBLIC AWARENESS AND DISSEMINATION OF INFORMATION ON HEALTH 
                              DISPARITIES

SEC. 501. PUBLIC AWARENESS AND INFORMATION DISSEMINATION.

    (a) Public Awareness on Health Disparities.--The Secretary of 
Health and Human Services (in this section referred to as the 
``Secretary'') shall conduct a national campaign to inform the public 
and health care professionals about health disparities in minority and 
other underserved populations by disseminating information and 
materials available on specific diseases affecting these populations 
and programs and activities to address these disparities. The campaign 
shall--
            (1) have a specific focus on minority and other underserved 
        communities with health disparities; and
            (2) include an evaluation component to assess the impact of 
        the national campaign in raising awareness of health 
        disparities and information on available resources.
    (b) Dissemination of Information on Health Disparities.--The 
Secretary shall develop and implement a plan for the dissemination of 
information and findings with respect to health disparities under 
titles I, II, III, and IV of this Act. The plan shall--
            (1) include the participation of all agencies of the 
        Department of Health and Human Services that are responsible 
        for serving populations included in the health disparities 
        research; and
            (2) have agency-specific strategies for disseminating 
        relevant findings and information on health disparities and 
        improving health care services to affected communities.

                   TITLE VI--MISCELLANEOUS PROVISIONS

SEC. 601. DEPARTMENTAL DEFINITION REGARDING MINORITY INDIVIDUALS.

    Section 1707(g)(1) of the Public Health Service Act (42 U.S.C. 
300u-6) is amended--
            (1) by striking ``Asian Americans and'' and inserting 
        ``Asian Americans;''; and
            (2) by inserting ``Native Hawaiians and other'' before 
        ``Pacific Islanders;''.

SEC. 602. CONFORMING PROVISION REGARDING DEFINITIONS.

    For purposes of this Act, the term ``racial and ethnic minority 
group'' has the meaning given such term in section 1707 of the Public 
Health Service Act.

SEC. 603. EFFECTIVE DATE.

    This Act and the amendments made by this Act take effect October 1, 
2000, or upon the date of the enactment of this Act, whichever occurs 
later.

            Passed the Senate October 26 (legislative day, September 
      22), 2000.

            Attest:

                                                             Secretary.
106th CONGRESS

  2d Session

                                S. 1880

_______________________________________________________________________

                                 AN ACT

    To amend the Public Health Service Act to improve the health of 
                         minority individuals.

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