II

106TH CONGRESS

1ST SESSION S. 1880

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

individuals.

IN THE SENATE OF THE UNITED STATES

NOVEMBER 8, 1999

Mr. KENNEDY (for himself, Mr. AKAKA, Mr. INOUYE, Mrs. LINCOLN, and Mr.

WELLSTONE) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions

A BILL

To amend the Public Health Service Act to improve the

health of minority individuals.

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; TABLE OF CONTENTS.

4 (a) SHORT TITLE.—This Act may be cited as the

5 ‘‘Health Care Fairness Act of 1999’’.

6 (b) TABLE OF CONTENTS.—The table of contents of

7 this Act is as follows:

Sec. 1. Short title; table of contents.

Sec. 2. Findings.

TITLE I—IMPROVING MINORITY HEALTH THROUGH THE

NATIONAL INSTITUTES OF HEALTH
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Sec. 101. Research on minority health.

‘‘PART J—RESEARCH ON MINORITY HEALTH

‘‘Sec. 499A. Establishment of Center.

‘‘Sec. 499B. Advisory Council.

‘‘Sec. 499C. Comprehensive plan and budget.

‘‘Sec. 499D. Center funding.

‘‘Sec. 499E. Centers of excellence for research on health disparities and

training.

‘‘Sec. 499F. Loan repayment program for biomedical research.

‘‘Sec. 499G. Additional authorities.

‘‘Sec. 499H. General provisions regarding the Center.

TITLE II—MEDICAL EDUCATION

Sec. 201. Grants for health care education curricula development.

Sec. 202. National Conference on Continuing Health Professional Education

and Disparity in Health Outcomes.

Sec. 203. Advisory Committee.

Sec. 204. Cultural competency clearinghouse.

TITLE III—MINORITY HEALTH RESEARCH BY THE AGENCY FOR

HEALTH CARE POLICY AND RESEARCH

Sec. 301. Minority health research by the Agency for Health Care Policy and

Research.

TITLE IV—DATA COLLECTION RELATING TO RACE OR

ETHNICITY

Sec. 401. Study and report by National Academy of Sciences.

TITLE V—PUBLIC AWARENESS

Sec. 501. Public awareness.

1 SEC. 2. FINDINGS.

2 Congress makes the following findings:

3 (1) The United States ranks below most indus4 trialized nations in health status as measured by

5 longevity, sickness, and mortality.

6 (2) The United States ranks 24th among indus7 trialized nations in infant mortality.

8 (3) This poor rank in health status is attributed

9 in large measure to the lower health status of Amer10 ica’s minority populations.
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1 (4) Many minority groups suffer disproportion2 ately from cancer. Disparities exist in both mortality

3 and incidence rates. For men and women combined,

4 African Americans have a cancer death rate about

5 35 percent higher than that for whites. Paralleling

6 the death rate, the incidence rate for lung cancer in

7 African American men is about 50 percent higher

8 than white men. Native Hawaiian men also have ele9 vated rates of lung cancer compared with white men.

10 Alaskan Native men and women suffer from higher

11 rates of cancers of the colon and rectum than do

12 whites. Vietnamese women in the United States have

13 a cervical cancer incidence rate more than 5 times

14 greater than white women. Hispanic women also suf15 fer elevated rates of cervical cancer.

16 (5) Infant death rates among African Amer17 ican, Native Americans and Alaskan Natives, and

18 Hispanics were well above the national average. The

19 greatest disparity exists for African Americans. The

20 overall Native American rate does not reflect the di21 versity among Indian communities, some of which

22 have infant mortality rates approaching twice the

23 national rate.

24 (6) Sudden infant death syndrome (referred to

25 in this section as ‘‘SIDS’’) accounts for approxi-
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1 mately 10 percent of all infant deaths in the first

2 year of life. Minority populations are at greater risk

3 for SIDS. In addition to the greater risks among Af4 rican Americans, the rates are 3 to 4 times as high

5 for some Native American and Alaskan Native popu6 lations.

7 (7) Cardiovascular disease is the leading cause

8 of death for all racial and ethnic groups. Major dis9 parities exist among population groups, with a dis10 proportionate burden of death and disability from

11 cardiovascular disease in minority and low-income

12 populations. Stroke is the only leading cause of

13 death for which mortality is higher for Asian-Amer14 ican males than for white males.

15 (8) Racial and ethnic minorities have higher

16 rates of hypertension, tend to develop hypertension

17 at an earlier age, and are less likely to undergo

18 treatment to control their high blood pressure.

19 (9) Diabetes, the seventh leading cause of death

20 in the United States, is a serious public health prob21 lem affecting racial and ethnic communities. The

22 prevalence of diabetes in African Americans is ap23 proximately 70 percent higher than whites and the

24 prevalence in Hispanics is nearly double that of

25 whites. The prevalence rate of diabetes among Na-
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1 tive Americans and Alaskan Natives is more than

2 twice that for the total population and at least 1

3 tribe, the Pimas of Arizona, have the highest known

4 prevalence of diabetes of any population in the

5 world.

6 (10) The human immunodeficiency virus (re7 ferred to in this section as ‘‘HIV’’), which causes ac8 quired immune deficiency syndrome (referred to in

9 this section as ‘‘AIDS’’), results in disproportionate

10 suffering in minority populations. Minority persons

11 represent 25 percent of the total United States pop12 ulation, but 54 percent of all cases of AIDS.

13 (11) More than 75 percent of AIDS cases re14 ported among women and children occur in minority

15 women and children.

16 (12) Nearly 2 of 5 (38 percent) Hispanic

17 adults, 1 of 4 (24 percent) African American adults,

18 and 1 of 4 (24 percent) Asian-American adults are

19 uninsured, compared with 1 of 7 (14 percent) white

20 adults.

21 (13) Elderly minorities experience disparities in

22 access to care and health status, in part because

23 medicare covers only half the health care expenses of

24 older Americans.
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1 (14) Two of 5 Hispanic and 2 of 5 African

2 Americans age 65 and older rate their health status

3 as fair or poor, compared with less than 1 of 4 (23

4 percent) white Americans 65 and over.

5 (15) Nearly 2 of 5 (39 percent) African Amer6 ican adults and almost half (46 percent) of Hispanic

7 adults report that they do not have a regular doctor,

8 compared with 1 of 4 (26 percent) of white adults.

9 (16) Minority Americans 65 and older are less

10 likely to have a regular doctor or to see a specialist.

11 (17) Ninety percent of minority physicians pro12 duced by Historically Black Medical Colleges live

13 and serve in minority communities.

14 (18) Almost half (45 percent) of Hispanic

15 adults, 2 of 5 (41 percent) Asian-American adults,

16 and more than 1 of 3 (35 percent) African American

17 adults report difficulty paying for medical care, com18 pared with 1 of 4 (26 percent) white adults.

19 (19) Despite suffering disproportionate rates of

20 illness, death, and disability, minorities have not

21 been proportionately represented in many clinical re22 search trials, except in studies of behavioral risk fac23 tors associated with negative stereotypes.
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1 (20) Culturally sensitive approaches to research

2 are needed to encourage minority participation in re3 search studies.

4 (21) There is a national need for minority sci5 entists in the field of biomedical, clinical, and health

6 services research.

7 (22) In 1990, only 3.3 percent of all United

8 States medical school faculties were underrep9 resented minority persons.

10 (23) Only 1 percent of full professors were

11 underrepresented minority persons in 1990.

12 (24) The proportion of underrepresented mi13 norities in high academic ranks, such as professors

14 and associated professors, decreased from 1980 to

15 1990.

16 (25) African Americans with identical com17 plaints of chest pain are less likely than white Amer18 icans to be referred by physicians for sophisticated

19 cardiac tests.

20 (26) Cultural competency training in medical

21 schools and residency training programs has the po22 tential to reduce disparities in health care and

23 health outcomes.

24 (27) More detailed data on health disparities is

25 needed to—
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1 (A) evaluate the impact that race and eth2 nicity have on health status, access to care, and

3 quality of care; and

4 (B) enforce existing protections for equal

5 access to care.

6 TITLE I—IMPROVING MINORITY

7 HEALTH THROUGH THE NA8 TIONAL INSTITUTES OF

9 HEALTH

10 SEC. 101. RESEARCH ON MINORITY HEALTH.

11 Title IV of the Public Health Service Act (42 U.S.C.

12 281 et seq.) is amended by adding at the end the fol13 lowing:

14 ‘‘PART J—RESEARCH ON MINORITY HEALTH

15 ‘‘SEC. 499A. ESTABLISHMENT OF CENTER.

16 ‘‘(a) IN GENERAL.—There is established within the

17 National Institutes of Health an organization to be known

18 as the Center for Research on Minority Health and Health

19 Disparities (referred to in this part as the ‘Center’). The

20 Center shall be headed by a director, who shall be ap21 pointed by the Secretary and shall report to the Director

22 of the National Institutes of Health.

23 ‘‘(b) TASK FORCE.—The Director of the Center shall

24 chair a trans-NIH task force that is composed of Institute

25 Directors, NIH senior staff, and representatives of other
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1 public health agencies, that will establish a comprehensive

2 plan and budget estimates under section 499C for minor3 ity health that should be conducted or supported by the

4 national research institutes, and shall recommend an

5 agenda for conducting and supporting such research.

6 ‘‘(c) DUTIES.—

7 ‘‘(1) INTERAGENCY COORDINATION OF MINOR8 ITY HEALTH RESEARCH.—With respect to minority

9 health, the Director of the Center shall facilitate the

10 establishment of, and provide administrative support

11 to, the task force referred to in subsection (b) to

12 plan, coordinate, and evaluate all research conducted

13 at or funded by NIH.

14 ‘‘(2) MINORITY HEALTH RESEARCH INFORMA15 TION SYSTEM.—The Director of the Center shall es16 tablish a minority health research information sys17 tem in order to track minority-related research,

18 training, and construction. The system shall capture,

19 for each minority-related research, training, or con20 struction project year-end data.

21 ‘‘(3) CONSULTATIONS.—The Director of the

22 Center shall carry out this part (including devel23 oping and revising the plan required in section

24 499C) in consultation with the Advisory Council es25 tablished under section 499B, the heads of the agen-
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1 cies of the National Institutes of Health, and the

2 advisory councils of such agencies.

3 ‘‘(4) COORDINATION.—The Director of the Cen4 ter shall act as the primary Federal official with re5 sponsibility for monitoring all minority health re6 search conducted or supported by the National Insti7 tutes of Health, and—

8 ‘‘(A) shall serve to represent the National

9 Institutes of Health minority health research

10 program at all relevant Executive branch task

11 forces, committees and planning activities; and

12 ‘‘(B) shall maintain communications with

13 all relevant Public Health Service agencies and

14 with various other departments of the Federal

15 Government, to ensure the timely transmission

16 of information concerning advances in minority

17 health research between these various agencies

18 for dissemination to affected communities and

19 health care providers.

20 ‘‘(d) INNOVATIVE GRANTS.—

21 ‘‘(1) IN GENERAL.—The Director of the Center,

22 in consultation with the Advisory Council, shall iden23 tify areas of insufficient minority health research at

24 the Institutes and Centers, and shall provide funds

25 to the Institutes and Centers for the awarding of
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1 peer-reviewed grants for innovative projects that ad2 dress high priority areas of minority health research

3 that are not adequately addressed by other Insti4 tutes or Centers.

5 ‘‘(2) EXCEPTIONAL CIRCUMSTANCES.—

6 ‘‘(A) IN GENERAL.—If the Director of the

7 Center determines that the Institutes or Cen8 ters are unwilling or unable to award a grant

9 under paragraph (1) for the conduct of a re10 search project identified under such paragraph,

11 the Director, in consultation with the Advisory

12 Council, shall award 1 or more peer reviewed

13 grants to support such research project.

14 ‘‘(B) LIMITATION.—The total amount of

15 grants awarded under subparagraph (A) for a

16 fiscal year shall not exceed an amount equal to

17 10 percent of the total final budget for the mi18 nority health disparities comprehensive plan for

19 the National Institutes of Health for the fiscal

20 year, or $130,000,000, whichever is greater.

21 ‘‘(3) ADMINISTRATION OF RESEARCH PRO22 POSALS.—

23 ‘‘(A) REQUESTS.—The Director of the

24 Center may issue requests for research pro-
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1 posals in areas identified under paragraph

2 (2)(A).

3 ‘‘(B) DELEGATION.—The Director of the

4 Center may delegate responsibility for the re5 view and management of research proposals

6 under this subsection to another Institute or

7 Center, or to the Center for Scientific Review.

8 ‘‘(C) FINAL APPROVAL.—The Director of

9 the Center may issue a final approval of re10 search awards under paragraph (1) so long as

11 such approval is provided within 30 days of the

12 date on which the award is approved by an In13 stitute or Center.

14 ‘‘(e) DEFINITIONS.—In this part:

15 ‘‘(1) MINORITY HEALTH CONDITIONS.—The

16 term ‘minority health conditions’, with respect to in17 dividuals who are members of racial, ethnic, and in18 digenous (including Native Americans, Alaskan Na19 tives, and Native Hawaiians) minority groups,

20 means all diseases, disorders, and conditions (includ21 ing with respect to mental health)—

22 ‘‘(A) unique to, more serious, or more

23 prevalent in such individuals;
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1 ‘‘(B) for which the factors of medical risk

2 or types of medical intervention are different

3 for such individuals; or

4 ‘‘(C) which have been found to result in

5 health disparities but for which insufficient re6 search has been conducted.

7 ‘‘(2) MINORITY HEALTH RESEARCH.—The term

8 ‘minority health research’ means basic and clinical

9 research on minority health conditions, including re10 search on preventing such conditions.

11 ‘‘SEC. 499B. ADVISORY COUNCIL.

12 ‘‘(a) IN GENERAL.—The Secretary shall establish an

13 advisory council (referred to in this part as the ‘Advisory

14 Council’), pursuant to the Federal Advisory Committee

15 Act, for the purpose of providing advice to the Director

16 of the Center on carrying out this part.

17 ‘‘(b) COMPOSITION.—The Advisory Council shall be

18 composed of not less than 18, and not more than 24 indi19 viduals, who are not officers or employees of the Federal

20 Government, to be appointed by the Secretary. A majority

21 of the members of the Advisory Council shall be individ22 uals with demonstrated expertise regarding minority

23 health issues. The Advisory Council shall include rep24 resentatives of communities impacted by racial and ethnic
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1 health disparities. The Director of the Center shall serve

2 as the chairperson of the Advisory Council.

3 ‘‘SEC. 499C. COMPREHENSIVE PLAN AND BUDGET.

4 ‘‘(a) IN GENERAL.—Subject to this section and other

5 applicable law, the Director of the Center (in consultation

6 with the Advisory Council) and the members of the Task

7 Force established under section 499A, in carrying out sec8 tion 499A, shall—

9 ‘‘(1) establish a comprehensive plan and budget

10 for the conduct and support of all minority health

11 research activities of the agencies of the National In12 stitutes of Health (which plan shall be first estab13 lished under this subsection not later than 12

14 months after the date of the enactment of this part),

15 which budget shall be submitted to the Secretary,

16 the Director of the Office of Management and Budg17 et and Congress and included in the annual budget

18 justification for the National Institutes of Health;

19 ‘‘(2) ensure that the plan and budget estab20 lishes priorities, consistent with sound medical and

21 scientific judgment, among the minority health re22 search activities that such agencies are authorized to

23 carry out;

24 ‘‘(3) ensure that the plan and budget estab25 lishes objectives regarding such activities, describes
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1 the means for achieving the objectives, and des2 ignates the date by which the objectives are expected

3 to be achieved;

4 ‘‘(4) ensure that all amounts appropriated for

5 such activities are expended in accordance with the

6 plan and budget;

7 ‘‘(5) review the plan and budget not less than

8 annually, and coordinate revisions to the plan as ap9 propriate; and

10 ‘‘(6) ensure that the plan and budget serve as

11 a broad, binding statement of policies regarding mi12 nority health research activities of the agencies, but

13 does not remove the responsibility of the heads of

14 the agencies for the approval of specific programs or

15 projects, grant management, or for other details of

16 the daily administration of such activities, in accord17 ance with the plan and budget.

18 ‘‘(b) CERTAIN COMPONENTS.—With respect to mi19 nority health research activities of the agencies of the Na20 tional Institutes of Health, the plan and budget shall—

21 ‘‘(1) provide for basic research;

22 ‘‘(2) provide for clinical research;

23 ‘‘(3) provide for research that is conducted by

24 the agencies;
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1 ‘‘(4) provide for research that is supported by

2 the agencies;

3 ‘‘(5) provide for proposals developed pursuant

4 to solicitations by the agencies and for proposals de5 veloped independently of such solicitations; and

6 ‘‘(6) provide for prevention research, behavioral

7 research and social sciences research.

8 ‘‘(c) APPROVAL.—The plan and budget established

9 under this section are subject to the approval of the Direc10 tor of the Center and the Director of the National Insti11 tutes of Health.

12 ‘‘(d) BUDGET ITEMS FOR MINORITY HEALTH.—In

13 the Budget of the United States that is submitted to Con14 gress by the President, the President shall, with respect

15 to each Institute or agency of the National Institutes of

16 Health, include a separate line item account for the

17 amount that each such Institute or agency requests for

18 minority health activities.

19 ‘‘SEC. 499D. CENTER FUNDING.

20 ‘‘For the purpose of carrying out administrative func21 tions related to minority health research activities under

22 the plan under sections 499A, 499B, and 499C, there are

23 authorized to be appropriated $100,000,000 for fiscal year

24 2000, and such sums as may be necessary for each of fis25 cal years 2001 through 2004.
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1 ‘‘SEC. 499E. CENTERS OF EXCELLENCE FOR RESEARCH ON

2 HEALTH DISPARITIES AND TRAINING.

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

4 the Director of the National Institutes of Health, shall

5 make grants to, and enter into contracts with, designated

6 biomedical research institutions described in subsection

7 (c), and other public and nonprofit health or educational

8 entities, for the purpose of assisting the institutions in

9 supporting programs of excellence in biomedical research

10 education for under-represented minority individuals.

11 ‘‘(b) REQUIRED USE OF FUNDS.—

12 ‘‘(1) IN GENERAL.—The Secretary may not

13 make a grant under subsection (a) unless the des14 ignated biomedical research institution involved

15 agrees, subject to subsection (c)(1)(B), to expend

16 the grant—

17 ‘‘(A) to conduct minority health research

18 and research into the nature of health dispari19 ties that affect racial, ethnic, and indigenous

20 minorities, the causes of such disparities, and

21 remedies for such disparities;

22 ‘‘(B) to train minorities as professionals in

23 the area of biomedical research;

24 ‘‘(C) to expand, remodel, renovate, or alter

25 existing research facilities or construct new re26 search facilities for the purpose of conducting
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1 biomedical research related to health dispari2 ties; or

3 ‘‘(D) to establish or increase an endow4 ment fund in accordance with paragraph (2).

5 ‘‘(2) ENDOWMENT FUNDS.—

6 ‘‘(A) IN GENERAL.—Except as provided in

7 subparagraph (B), an institution that meets the

8 requirements of subparagraph (B) may utilize

9 not to exceed 35 percent of the amounts re10 ceived under a grant under subsection (a) to es11 tablish or increase an endowment fund at the

12 institution. Amounts used under this subpara13 graph shall be dedicated exclusively to the sup14 port of biomedical research and the associated

15 costs of such research.

16 ‘‘(B) REQUIREMENTS.—To be eligible to

17 use funds as provided for under subparagraph

18 (A), an institution shall not have a endowment

19 fund that is worth in excess of an amount equal

20 to 50 percent of the national average of all en21 dowment funds at all institutions that are of

22 the same biomedical research discipline.

23 ‘‘(c) CENTERS OF EXCELLENCE.—
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1 ‘‘(1) GENERAL CONDITIONS.—The conditions

2 specified in this paragraph are that a designated

3 biomedical research institution—

4 ‘‘(A) has a significant number of under5 represented minority individuals enrolled in the

6 institution, including individuals accepted for

7 enrollment in the institution;

8 ‘‘(B) has been effective in assisting under9 represented minority students of the institution

10 to complete the program of education and re11 ceive the degree involved;

12 ‘‘(C) has been effective in recruiting under13 represented minority individuals to enroll in and

14 graduate from the institution, including pro15 viding scholarships and other financial assist16 ance to such individuals and encouraging

17 under-represented minority students from all

18 levels of the educational pipeline to pursue bio19 medical research careers; and

20 ‘‘(D) has made significant recruitment ef21 forts to increase the number of under-rep22 resented minority individuals serving in faculty

23 or administrative positions at the institution.

24 ‘‘(2) CONSORTIUM.—Any designated biomedical

25 research institution involved may, with other bio-
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1 medical institutions (designated or otherwise) form a

2 consortium to carry out the purposes described in

3 subsection (b) at the institutions of the consortium.

4 ‘‘(3) APPLICATION OF CRITERIA TO OTHER

5 PROGRAMS.—In the case of any criteria established

6 by the Secretary for purposes of determining wheth7 er institutions meet the conditions described in para8 graph (1), this section may not, with respect to ra9 cial, ethnic, and indigenous minorities, be construed

10 to authorize, require, or prohibit the use of such cri11 teria in any program other than the program estab12 lished in this section.

13 ‘‘(d) DURATION OF GRANT.—The period during

14 which payments are made under a grant under subsection

15 (a) may not exceed 5 years. Such payments shall be sub16 ject to annual approval by the Secretary and to the avail17 ability of appropriations for the fiscal year involved to

18 make the payments.

19 ‘‘(e) DEFINITIONS.—In this section:

20 ‘‘(1) MINORITY.—The term ‘minority’ means an

21 individual from a racial or ethnic group that is

22 under-represented in health research.

23 ‘‘(2) PROGRAM OF EXCELLENCE.—The term

24 ‘program of excellence’ means any program carried

25 out by a designated biomedical research institution
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1 with a grant made under subsection (a), if the pro2 gram is for purposes for which the institution in3 volved is authorized in subsection (b) or (c) to ex4 pend the grant.

5 ‘‘(f) FUNDING.—

6 ‘‘(1) AUTHORIZATION OF APPROPRIATIONS.—

7 For the purpose of making grants under subsection

8 (a), there are authorized to be appropriated such

9 sums as may be necessary for each of the fiscal

10 years 2000 through 2004.

11 ‘‘(2) NO LIMITATION.—Nothing in this sub12 section shall be construed as limiting the centers of

13 excellence referred to in this section to the des14 ignated amount, or to preclude such entities from

15 competing for other grants under this section.

16 ‘‘(3) MAINTENANCE OF EFFORT.—

17 ‘‘(A) IN GENERAL.—With respect to activi18 ties for which a grant made under this part are

19 authorized to be expended, the Secretary may

20 not make such a grant to a center of excellence

21 for any fiscal year unless the center agrees to

22 maintain expenditures of non-Federal amounts

23 for such activities at a level that is not less

24 than the level of such expenditures maintained

25 by the center for the fiscal year preceding the
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1 fiscal year for which the institution receives

2 such a grant.

3 ‘‘(B) USE OF FEDERAL FUNDS.—With re4 spect to any Federal amounts received by a cen5 ter of excellence and available for carrying out

6 activities for which a grant under this part is

7 authorized to be expended, the Secretary may

8 not make such a grant to the center for any fis9 cal year unless the center agrees that the center

10 will, before expending the grant, expend the

11 Federal amounts obtained from sources other

12 than the grant.

13 ‘‘SEC. 499F. LOAN REPAYMENT PROGRAM FOR BIOMEDICAL

14 RESEARCH.

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

16 the Director of the National Institutes of Health, shall es17 tablish a program of entering into contracts with qualified

18 health professionals under which such health professionals

19 agree to engage in minority health research or research

20 into the nature of health disparities that affect racial, eth21 nic, and indigenous populations, in consideration of the

22 Federal Government agreeing to repay, for each year of

23 such service, not more than $35,000 of the principal and

24 interest of the educational loans of such health profes25 sionals.
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1 ‘‘(b) SERVICE PROVISIONS.—The provisions of sec2 tions 338B, 338C, and 338E shall, except as inconsistent

3 with subsection (a), apply to the program established in

4 such subsection (a) to the same extent and in the same

5 manner as such provisions apply to the National Health

6 Service Corps Loan Repayment Program established in

7 subpart III of part D of title III.

8 ‘‘(c) AVAILABILITY OF APPROPRIATIONS.—Amounts

9 available for carrying out this section shall remain avail10 able until the expiration of the second fiscal year begin11 ning after the fiscal year for which the amounts were made

12 available.

13 ‘‘(d) HEALTH DISPARITIES.—In carrying out this

14 section, the Secretary shall take steps sufficient to ensure

15 the active participation of appropriately qualified minority

16 heath professionals, including extensive outreach and re17 cruitment efforts. In complying with this subsection, the

18 Secretary shall waive the requirement that the recipients

19 of loan repayment assistance agree to engage in minority

20 health research or research into the nature of health dis21 parities that affect racial, ethnic and indigenous popu22 lations.

23 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—For the

24 purpose of carrying out this section, there are authorized
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1 to be appropriated such sums as may be necessary for

2 each of the fiscal years 2000 through 2004.

3 ‘‘SEC. 499G. ADDITIONAL AUTHORITIES.

4 ‘‘(a) IN GENERAL.—In overseeing and supporting mi5 nority health research, the Director of the Center—

6 ‘‘(1) shall assist the Director of the National

7 Center for Research Resources in carrying out sec8 tion 481(c)(3) and in committing resources for con9 struction at Institutions of Emerging Excellence;

10 ‘‘(2) shall assist in the administration of section

11 492B with respect to the inclusion of members of

12 minority groups as subjects in clinical research; and

13 ‘‘(3) subject to section 405(b)(2) and without

14 regard to section 3324 of title 31, United States

15 Code, and section 3709 of the Revised Statutes (41

16 U.S.C. 5), may enter into such contracts and cooper17 ative agreements with any public agency, or with

18 any person, firm, association, corporation, or edu19 cational institution, as may be necessary to expedite

20 and coordinate minority health research.

21 ‘‘(b) REPORT TO CONGRESS AND THE SECRETARY.—

22 The Director of the Center shall each fiscal year prepare

23 and submit to the appropriate committees of Congress and

24 the Secretary a report—
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1 ‘‘(1) describing and evaluating the progress

2 made in such fiscal year in minority health research

3 conducted or supported by the Institutes;

4 ‘‘(2) summarizing and analyzing expenditures

5 made in such fiscal year for activities with respect

6 to minority health research conducted or supported

7 by the National Institutes of Health; and

8 ‘‘(3) containing such recommendations as the

9 Director considers appropriate.

10 ‘‘(c) PROJECTS FOR COOPERATION AMONG PUBLIC

11 AND PRIVATE HEALTH ENTITIES.—In carrying out sub12 section (a), the Director of the Center shall establish

13 projects to promote cooperation among Federal agencies,

14 State, local, and regional public health agencies, and pri15 vate entities, in minority health research.

16 ‘‘SEC. 499H. GENERAL PROVISIONS REGARDING THE

17 CENTER.

18 ‘‘(a) ADMINISTRATIVE SUPPORT FOR CENTER.—The

19 Secretary, acting through the Director of the National In20 stitutes of Health, shall provide administrative support

21 and support services to the Director of the Center and

22 shall ensure that such support takes maximum advantage

23 of existing administrative structures at the agencies of the

24 National Institutes of Health.
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1 ‘‘(b) REQUIRED EXPERTISE.—The Director of the

2 Center, in consultation with the Advisory Council and the

3 Center for Scientific Review, shall ensure that scientists

4 with appropriate expertise in research on minority health

5 are incorporated into the review, oversight, and manage6 ment processes of all research projects in the National In7 stitutes of Health minority health research program and

8 other activities under such program.

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

10 Center, in consultation with the directors of the national

11 research institutes and centers, shall ensure that appro12 priate technical assistance is available to applicants for all

13 research projects and other activities supported by the Na14 tional Institutes of Health minority health research pro15 gram.

16 ‘‘(d) EVALUATION AND REPORT.—

17 ‘‘(1) EVALUATION.—Not later than 5 years

18 after the date of the enactment of this part, the Sec19 retary shall conduct an evaluation to—

20 ‘‘(A) determine the effect of this section on

21 the planning and coordination of the minority

22 health research programs at the institutes, cen23 ters and divisions of the National Institutes of

24 Health;
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1 ‘‘(B) evaluate the extent to which this part

2 has eliminated the duplication of administrative

3 resources among such Institutes, centers and

4 divisions; and

5 ‘‘(C) provide recommendations concerning

6 future alterations with respect to this part.

7 ‘‘(2) REPORT.—Not later than 1 year after the

8 date on which the evaluation is commenced under

9 paragraph (1), the Secretary shall prepare and sub10 mit to the Committee on Health, Education, Labor,

11 and Pensions of the Senate, and the Committee on

12 Commerce of the House of Representatives, a report

13 concerning the results of such evaluation.’’.

14 TITLE II—MEDICAL EDUCATION

15 SEC. 201. GRANTS FOR HEALTH CARE EDUCATION CUR16 RICULA DEVELOPMENT.

17 Part F of title VII of the Public Health Service Act

18 (42 U.S.C. 295j et seq.) is amended by inserting after sec19 tion 791 the following:

20 ‘‘SEC. 791A. GRANTS FOR HEALTH PROFESSIONS EDU21 CATION CURRICULA DEVELOPMENT.

22 ‘‘(a) GRANTS FOR GRADUATE EDUCATION CUR23 RICULA DEVELOPMENT.—

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

25 through the Administrator for the Health Resources
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1 and Services Administration and in collaboration

2 with the Administrator for Health Care Policy and

3 Research and the Deputy Assistant Secretary for

4 Minority Health, may make awards of grants, con5 tracts, or cooperative agreements to public and non6 profit private entities for the purpose of carrying out

7 research projects and demonstration projects to de8 velop curricula to reduce disparity in health care

9 outcomes, including curricula and faculty develop10 ment for cultural competency in graduate and un11 dergraduate health professions education.

12 ‘‘(2) ELIGIBILITY.—To be eligible to receive a

13 grant, contract or cooperative agreements under

14 paragraph (1), an entity shall—

15 ‘‘(A) be a school of medicine, school of os16 teopathic medicine, school of dentistry, school of

17 public health, school of nursing, school of phar18 macy, school of allied health, or other recog19 nized health profession school; and

20 ‘‘(B) prepare and submit to the Secretary

21 an application at such time, in such manner,

22 and containing such information as the Sec23 retary may require.

24 ‘‘(3) USE OF FUNDS.—An entity shall use

25 amounts received under a grant under paragraph (1)
29

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1 to carry out research projects and demonstration

2 projects to develop curricula to reduce disparity in

3 health care outcomes, including curricula for cultural

4 competency in graduate medical education. Such

5 curricula shall focus on the need to remove bias

6 from health care at a personal level as well as at

7 a systematic level.

8 ‘‘(4) NUMBER OF GRANTS AND GRANT TERM.—

9 The Secretary shall award not to exceed 20 grants,

10 contracts or cooperative agreements (or combination

11 thereof) under paragraph (1) in each of the first and

12 second fiscal years for which funds are available

13 under subsection (f). The term of each such grant,

14 contract or cooperative agreement shall be 3 years.

15 ‘‘(b) GRANTS FOR CONTINUING HEALTH PROFES16 SIONAL EDUCATION CURRICULA DEVELOPMENT.—

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

18 through the Health Resources and Services Adminis19 tration and the Agency for Health Care Policy and

20 Research and in collaboration with the Office of Mi21 nority Health, shall award grants, contracts or coop22 erative agreements to eligible entities for the estab23 lishment of demonstration projects to develop cur24 ricula to reduce disparity in health care and health
30

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1 outcomes, including curricula for cultural com2 petency, in continuing medical education.

3 ‘‘(2) ELIGIBILITY.—To be eligible to receive a

4 grant, contract, or cooperative agreement under

5 paragraph (1) an entity shall—

6 ‘‘(A) be a school of medicine, school of os7 teopathic medicine, school of dentistry, school of

8 public health, school of nursing, school of phar9 macy, school of allied health, or other recog10 nized health profession school; and

11 ‘‘(B) prepare and submit to the Secretary

12 an application at such time, in such manner,

13 and containing such information as the Sec14 retary may require.

15 ‘‘(3) USE OF FUNDS.—An entity shall use

16 amounts received under a grant, contract, or cooper17 ative agreement under paragraph (1) to develop and

18 evaluate the effect and impact of curricula for con19 tinuing medical education courses or programs to

20 provide education concerning issues relating to dis21 parity in health care and health outcomes, including

22 cultural competency of health professionals. Such

23 curricula shall focus on the need to remove bias

24 from health care at a personal level as well as at a

25 systemic level.
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1 ‘‘(4) NUMBER OF GRANTS AND GRANT TERM.—

2 The Secretary shall award not to exceed 20 grants,

3 contracts, or cooperative under paragraph (1) in

4 each of the first and second fiscal years for which

5 funds are available under subsection (f). The term of

6 each such grant shall be 3 years.

7 ‘‘(c) DISTRIBUTION OF PROJECTS.—The Secretary

8 shall ensure that, to the extent practicable, projects under

9 subsections (a) and (b) are carried out in each of the prin10 cipal geographic regions of the United States and address

11 issues associated with different minority groups and

12 health professions.

13 ‘‘(d) MONITORING.—An entity that receives a grant,

14 contract or cooperative agreement under subsection (a) or

15 (b) shall ensure that procedures are in place to monitor

16 activities undertaken using grant, contract or cooperative

17 agreement funds. Such entity shall annually prepare and

18 submit to the Secretary a report concerning the effective19 ness of curricula developed under the grant contract or

20 cooperative agreement.

21 ‘‘(e) REPORT TO CONGRESS.—Not later than Janu22 ary 1, 2002, the Secretary shall prepare and submit to

23 the appropriate committees of Congress, a report con24 cerning the effectiveness of programs funded under this

25 section and a plan to encourage the implementation and
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1 utilization of curricula to reduce disparity in health care

2 and health outcomes. A final report shall be submitted by

3 the Secretary not later than January 1, 2004.

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

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

6 $3,500,000 for fiscal year 2000, $7,000,000 for fiscal year

7 2001, $7,000,000 for fiscal year 2002, and $3,500,000

8 for fiscal year 2003.’’.

9 SEC. 202. NATIONAL CONFERENCE ON CONTINUING

10 HEALTH PROFESSIONAL EDUCATION AND

11 DISPARITY IN HEALTH OUTCOMES.

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 convene a national conference on

15 continuing health professions education as a method for

16 reducing disparity in health care and health outcomes, in17 cluding continuing medical education on cultural com18 petency. The conference shall include sessions to address

19 measurements of outcomes to assess the effectiveness of

20 curricula in reducing disparity.

21 (b) PARTICIPANTS.—The Secretary of Health and

22 Human Services shall invite minority health advocacy

23 groups, health education entities described in section

24 741(b)(1) of the Public Health Service Act (as added by
33

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1 section 201), and other interested parties to attend the

2 conference under subsection (a).

3 (c) ISSUES.—The national conference convened under

4 subsection (a) shall address issues relating to the role of

5 continuing medical education in the effort to reduce dis6 parity in health care and health outcomes, including the

7 role of continuing medical education in improving the cul8 tural competency of health professionals and health pro9 fessions faculty. The conference shall focus on methods

10 to achieve reductions in the disparities in health care and

11 health outcomes through continuing medical education

12 courses or programs and on strategies for measuring the

13 effectiveness of curricula to reduce disparities.

14 (d) PUBLICATION OF FINDINGS.—Not later than 6

15 months after the convening of the national conference

16 under subsection (a), the Secretary of Health and Human

17 Services shall publish in the Federal Register a summary

18 of the proceedings and the findings of the conference.

19 (e) AUTHORIZATION OF APPROPRIATIONS.—There is

20 authorized to be appropriated such sums as may be nec21 essary to carry out this section.

22 SEC. 203. ADVISORY COMMITTEE.

23 (a) ESTABLISHMENT.—The Secretary of Health and

24 Human Services shall establish an advisory committee to

25 provide advice to the Secretary on matters related to the
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1 development, implementation, and evaluation of graduate

2 and continuing education curricula for health care profes3 sionals to decrease the disparity in health care and health

4 outcomes, including curricula on cultural competency as

5 a method of eliminating health disparity.

6 (b) MEMBERSHIP.—Not later than 3 months after

7 the date on which amounts are appropriated to carry out

8 this section, the Secretary of Health and Human Services

9 shall appoint the members of the advisory committee.

10 Such members shall be appointed from among individuals

11 who—

12 (1) unless otherwise specified, are not officers

13 or employees of the Federal Government;

14 (2) are experienced in issues relating to health

15 disparity; and

16 (3) meet such other requirements as the Sec17 retary determines appropriate;

18 and shall include a representative of the Office of Minority

19 Health under section 1707 of the Public Health Service

20 Act (42 U.S.C. 300u–6) and such other representatives

21 of offices and agencies of the Public Health Service as the

22 Secretary determines to be appropriate. The Secretary

23 shall ensure that members of minority communities are

24 well represented on the advisory committee. Such rep25 resentatives shall include 1 or more individuals who serve
35

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1 on the advisory committee under section 1707(c) of such

2 Act.

3 (c) COLLABORATION.—The advisory committee shall

4 carry out its duties under this section in collaboration with

5 the Office of Minority Health of the Department of Health

6 and Human Services, and other offices, centers, and insti7 tutes of the Department of Health and Human Services,

8 and other Federal agencies.

9 (d) TERMINATION.—The advisory committee shall

10 terminate on the date that is 4 years after the date on

11 which the first member of the committee is appointed.

12 (e) EXISTING COMMITTEE.—The Secretary may des13 ignate an existing advisory committee operating under the

14 authority of the Office of Minority Health of the Depart15 ment of Health and Human Services to serve as the advi16 sory committee under this section.

17 SEC. 204. CULTURAL COMPETENCY CLEARINGHOUSE.

18 (a) ESTABLISHMENT.—The Director of the Office of

19 Minority Health of the Department of Health and Human

20 Services shall establish within the Resource Center of the

21 Office of Minority Health, or through the awarding of a

22 contract provide for the establishment of, an information

23 clearinghouse for curricula to reduce racial and ethnic dis24 parity in health care and health outcomes. The clearing25 house shall facilitate and enhance, through the effective
36

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1 dissemination of information, knowledge and under2 standing of practices that lead to decreases in the dis3 parity of health across minority and ethnic groups, includ4 ing curricula for continuing medical education to develop

5 cultural competency in health care professionals.

6 (b) AVAILABILITY OF INFORMATION.—Information

7 contained in the clearinghouse shall be made available to

8 minority health advocacy groups, health education entities

9 described in section 791A(b)(2)(A) of the Public Health

10 Service Act (as added by section 201), health maintenance

11 organizations, and other interested parties.

12 (c) AUTHORIZATION OF APPROPRIATIONS.—There is

13 authorized to be appropriated such sums as may be nec14 essary to carry out this section.

15 TITLE III—MINORITY HEALTH

16 RESEARCH BY THE AGENCY

17 FOR HEALTH CARE POLICY

18 AND RESEARCH

19 SEC. 301. MINORITY HEALTH RESEARCH BY THE AGENCY

20 FOR HEALTH CARE POLICY AND RESEARCH.

21 (a) IN GENERAL.—Part A of title IX of the Public

22 Health Service Act (42 U.S.C. 299 et seq.) is amended

23 by adding at the end the following:
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1 ‘‘SEC. 906. RESEARCH ON MINORITY HEALTH DISPARITIES.

2 ‘‘(a) IN GENERAL.—The Administrator of the Agen3 cy for Health Care Policy and Research shall—

4 ‘‘(1) conduct and support research to identify

5 how to improve the quality and outcomes of health

6 care services for minority populations and the causes

7 of health disparities for minority populations, includ8 ing barriers to health care access;

9 ‘‘(2) conduct and support research and support

10 demonstration projects to identify, test, and evaluate

11 strategies for eliminating the disparities described in

12 paragraph (1) and promoting effective interventions;

13 ‘‘(3) develop measures for the assessment and

14 improvement of the quality and appropriateness of

15 health care services provided to minority popu16 lations; and

17 ‘‘(4) in carrying out 902(c), provide support to

18 increase the number of minority health care re19 searchers and the health services research capacity

20 of institutions that train minority health care re21 searchers.

22 ‘‘(b) RESEARCH AND DEMONSTRATION PROJECTS.—

23 ‘‘(1) IN GENERAL.—In carrying out subsection

24 (a), the Administrator shall conduct and support re25 search to—
38

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1 ‘‘(A) identify the clinical, cultural, socio2 economic, and organizational factors that con3 tribute to health disparities for minority popu4 lations (including examination of patterns of

5 clinical decisionmaking and of the availability of

6 support services);

7 ‘‘(B) identify and evaluate clinical and or8 ganizational strategies to improve the quality,

9 outcomes, and access to care for minority popu10 lations;

11 ‘‘(C) support demonstrations to test such

12 strategies; and

13 ‘‘(D) widely disseminate strategies for

14 which there is scientific evidence of effective15 ness.

16 ‘‘(2) USE OF CERTAIN STRATEGIES.—In car17 rying out this section the Administrator shall imple18 ment research strategies and mechanisms that will

19 enhance the involvement of minority health services

20 researchers, institutions that train minority re21 searchers, and members of minority populations for

22 whom the Agency is attempting to improve the qual23 ity and outcomes of care, including—

24 ‘‘(A) centers of excellence that can dem25 onstrate, either individually or through con-
39

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1 sortia, a combination of multi-disciplinary ex2 pertise in outcomes or quality improvement re3 search and a demonstrated capacity to engage

4 minority populations in the planning, conduct

5 and translation of research, with linkages to

6 relevant sites of care;

7 ‘‘(B) provider-based research networks, in8 cluding health plans, facilities, or delivery sys9 tem sites of care (especially primary care), that

10 make extensive use of minority health care pro11 viders or serve minority patient populations and

12 have the capacity to evaluate and promote qual13 ity improvement; and

14 ‘‘(C) other innovative mechanisms or strat15 egies that will facilitate the translation of past

16 research investments into clinical practices that

17 can reasonably be expected to benefit these pop18 ulations.

19 ‘‘(c) QUALITY MEASUREMENT DEVELOPMENT.—

20 ‘‘(1) IN GENERAL.—To ensure that minority

21 populations benefit from the progress made in the

22 ability of individuals to measure the quality of health

23 care delivery, the Administrator of the Agency for

24 Health Care Policy and Research shall support the

25 development of quality of health care measures that
40

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1 assess the experience of minority populations with

2 health care systems, such as measures that assess

3 the access of minority populations to health care, the

4 cultural competence of the care provided, the quality

5 of the care provided, the outcomes of care, or other

6 aspects of health care practice that the Adminis7 trator determines to be important.

8 ‘‘(2) REPORT.—Not later than 24 months after

9 the date of enactment of this section, the Secretary,

10 acting through the Administrator, shall prepare and

11 submit to the appropriate committees of Congress a

12 report describing the state-of-the-art of quality

13 measurement for minority populations which will

14 identify critical unmet needs, the current activities

15 of the Department to address those needs, and a de16 scription of related activities in the private sector.’’.

17 (b) FUNDING.—Section 926 of the Public Health

18 Service Act (42 U.S.C. 299c–5) is amended by adding at

19 the end the following:

20 ‘‘(f) MINORITY HEALTH DISPARITIES RESEARCH.—

21 For the purpose of carrying out the activities under sec22 tion 906, there are authorized to be appropriated such

23 sums as may be necessary for each of the fiscal years 2000

24 through 2004.’’.
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1 TITLE IV—DATA COLLECTION

2 RELATING TO RACE OR ETH3 NICITY

4 SEC. 401. STUDY AND REPORT BY NATIONAL ACADEMY OF

5 SCIENCES.

6 (a) STUDY.—The Secretary of Health and Human

7 Services shall enter into a contract with the National

8 Academy of Sciences for the conduct of a comprehensive

9 study of the Department of Health and Human Services’

10 data collection systems and practices, and any data collec11 tion or reporting systems required under any of the pro12 grams or activities of the Department, relating to the col13 lection of data on race or ethnicity, including other Fed14 eral data collection systems (such as the Social Security

15 Administration) with which the Department interacts to

16 collect relevant data on race and ethnicity.

17 (b) REPORT.—Not later than 1 year after the date

18 of enactment of this Act, the National Academy of

19 Sciences shall prepare and submit to the Committee on

20 Health, Education, Labor, and Pensions of the Senate and

21 the Committee on Commerce of the House of Representa22 tives, a report that—

23 (1) identifies the data needed to support efforts

24 to evaluate the effects of race and ethnicity on ac25 cess to and quality of health care and other services
42

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1 and on disparity in health and other social outcomes,

2 the data needed to define appropriate quality of care

3 measures to assess the equivalence of health care

4 outcomes in health care payer systems, and the data

5 needed to enforce existing protections for equal ac6 cess to health care;

7 (2) examines the effectiveness of the systems

8 and practices of the Department of Health and

9 Human Services described in subsection (a), includ10 ing demonstration projects of the Department, and

11 the effectiveness of selected systems and practices of

12 other Federal and State agencies and the private

13 sector, in collecting and analyzing such data;

14 (3) contains recommendations for ensuring that

15 the Department of Health and Human Services, in

16 administering its entire array of programs and ac17 tivities, collects, or causes to be collected, accurate

18 and complete information relating to race and eth19 nicity as may be necessary to monitor access to and

20 quality of health care and to ensure the capability to

21 monitor and enforce civil rights laws; and

22 (4) includes projections about the costs associ23 ated with the implementation of the recommenda24 tions described in paragraph (3), and the possible ef25 fects of the costs on program operations.
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1 (c) AUTHORIZATION OF APPROPRIATIONS.—There

2 are authorized to be appropriated such sums as may be

3 necessary for fiscal year 2000 to carry out this section.

4 TITLE V—PUBLIC AWARENESS

5 SEC. 501. PUBLIC AWARENESS.

6 (a) PUBLIC AWARENESS CAMPAIGN.—The Secretary

7 of Health and Human Services, acting through the Sur8 geon General and the Director of the Office for Civil

9 Rights, shall conduct a national media campaign for the

10 purpose of informing the public about racial and ethnic

11 disparities in health care and health outcomes.

12 (b) AUTHORIZATION OF APPROPRIATIONS.—For the

13 purpose of carrying out subsection (a), there are author14 ized to be appropriated such sums as may be necessary

15 for fiscal year 2000.

Æ