106TH CONGRESS

2D SESSION S. 1880

AN ACT

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 ‘‘Minority Health and Health Disparities Research and

6 Education Act of 2000’’.
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1 (b) TABLE OF CONTENTS.—The table of contents of

2 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.

3 SEC. 2. FINDINGS.

4 The Congress finds as follows:

5 (1) Despite notable progress in the overall

6 health of the Nation, there are continuing disparities
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1 in the burden of illness and death experienced by Af2 rican Americans, Hispanics, Native Americans, Alas3 ka Natives, and Asian Pacific Islanders, compared

4 to the United States population as a whole.

5 (2) The largest numbers of the medically under6 served are white individuals, and many of them have

7 the same health care access problems as do members

8 of minority groups. Nearly 20,000,000 white individ9 uals live below the poverty line with many living in

10 non-metropolitan, rural areas such as Appalachia,

11 where the high percentage of counties designated as

12 health professional shortage areas (47 percent) and

13 the high rate of poverty contribute to disparity out14 comes. However, there is a higher proportion of ra15 cial and ethnic minorities in the United States rep16 resented among the medically underserved.

17 (3) There is a national need for minority sci18 entists in the fields of biomedical, clinical, behav19 ioral, and health services research. Ninety percent of

20 minority physicians educated at Historically Black

21 Medical Colleges live and serve in minority commu22 nities.

23 (4) Demographic trends inspire concern about

24 the Nation’s ability to meet its future scientific,

25 technological and engineering workforce needs. His-
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1 torically, non-Hispanic white males have made up

2 the majority of the United States scientific, techno3 logical, and engineering workers.

4 (5) The Hispanic and Black population will in5 crease significantly in the next 50 years. The sci6 entific, technological, and engineering workforce may

7 decrease if participation by underepresented minori8 ties remains the same.

9 (6) Increasing rates of Black and Hispanic

10 workers can help ensure strong scientific, techno11 logical, and engineering workforce.

12 (7) Individuals such as underepresented minori13 ties and women in the scientific, technological, and

14 engineering workforce enable society to address its

15 diverse needs.

16 (8) If there had not been a substantial increase

17 in the number of science and engineering degrees

18 awarded to women and underepresented minorities

19 over the past few decades, the United States would

20 be facing even greater shortages in scientific, techno21 logical, and engineering workers.

22 (9) In order to effectively promote a diverse and

23 strong 21st Century scientific, technological, and en24 gineering workforce, Federal agencies should expand

25 or add programs that effectively overcome barriers
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1 such as educational transition from one level to the

2 next and student requirements for financial re3 sources.

4 (10) Federal agencies should work in concert

5 with the private nonprofit sector to emphasize the

6 recruitment and retention of qualified individuals

7 from ethnic and gender groups that are currently

8 underrepresented in the scientific, technological, and

9 engineering workforce.

10 (11) Behavioral and social sciences research has

11 increased awareness and understanding of factors

12 associated with health care utilization and access,

13 patient attitudes toward health services, and risk

14 and protective behaviors that affect health and ill15 ness. These factors have the potential to then be

16 modified to help close the health disparities gap

17 among ethnic minority populations. In addition,

18 there is a shortage of minority behavioral science re19 searchers and behavioral health care professionals.

20 According to the National Science Foundation, only

21 15.5 percent of behavioral research-oriented psy22 chology doctorate degrees were awarded to minority

23 students in 1997. In addition, only 17.9 percent of

24 practice-oriented psychology doctorate degrees were

25 awarded to ethnic minorities.
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1 TITLE I—IMPROVING MINORITY

2 HEALTH AND REDUCING

3 HEALTH DISPARITIES

4 THROUGH NATIONAL INSTI5 TUTES OF HEALTH; ESTAB6 LISHMENT OF NATIONAL

7 CENTER

8 SEC. 101. ESTABLISHMENT OF NATIONAL CENTER ON MI9 NORITY HEALTH AND HEALTH DISPARITIES.

10 (a) IN GENERAL.—Part E of title IV of the Public

11 Health Service Act (42 U.S.C. 287 et seq.) is amended

12 by adding at the end the following subpart:

13 ‘‘Subpart 6—National Center on Minority Health and

14 Health Disparities

15 ‘‘SEC. 485E. PURPOSE OF CENTER.

16 ‘‘(a) IN GENERAL.—The general purpose of the Na17 tional Center on Minority Health and Health Disparities

18 (in this subpart referred to as the ‘Center’) is the conduct

19 and support of research, training, dissemination of infor20 mation, and other programs with respect to minority

21 health conditions and other populations with health dis22 parities.

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

24 in expending amounts appropriated under this subpart
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1 give priority to conducting and supporting minority health

2 disparities research.

3 ‘‘(c) MINORITY HEALTH DISPARITIES RESEARCH.—

4 For purposes of this subpart:

5 ‘‘(1) The term ‘minority health disparities re6 search’ means basic, clinical, and behavioral research

7 on minority health conditions (as defined in para8 graph (2)), including research to prevent, diagnose,

9 and treat such conditions.

10 ‘‘(2) The term ‘minority health conditions’, with

11 respect to individuals who are members of minority

12 groups, means all diseases, disorders, and conditions

13 (including with respect to mental health and sub14 stance abuse)—

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

16 prevalent in such individuals;

17 ‘‘(B) for which the factors of medical risk

18 or types of medical intervention may be dif19 ferent for such individuals, or for which it is

20 unknown whether such factors or types are dif21 ferent for such individuals; or

22 ‘‘(C) with respect to which there has been

23 insufficient research involving such individuals

24 as subjects or insufficient data on such individ25 uals.
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1 ‘‘(3) The term ‘minority group’ has the mean2 ing given the term ‘racial and ethnic minority group’

3 in section 1707.

4 ‘‘(4) The terms ‘minority’ and ‘minorities’ refer

5 to individuals from a minority group.

6 ‘‘(d) HEALTH DISPARITY POPULATIONS.—For pur7 poses of this subpart:

8 ‘‘(1) A population is a health disparity popu9 lation if, as determined by the Director of the Cen10 ter after consultation with the Director of the Agen11 cy for Healthcare Research and Quality, there is a

12 significant disparity in the overall rate of disease in13 cidence, prevalence, morbidity, mortality, or survival

14 rates in the population as compared to the health

15 status of the general population.

16 ‘‘(2) The Director shall give priority consider17 ation to determining whether minority groups qual18 ify as health disparity populations under paragraph

19 (1).

20 ‘‘(3) The term ‘health disparities research’

21 means basic, clinical, and behavioral research on

22 health disparity populations (including individual

23 members and communities of such populations) that

24 relates to health disparities as defined under para25 graph (1), including the causes of such disparities
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1 and methods to prevent, diagnose, and treat such

2 disparities.

3 ‘‘(e) COORDINATION OF ACTIVITIES.—The Director

4 of the Center shall act as the primary Federal official with

5 responsibility for coordinating all minority health dispari6 ties research and other health disparities research con7 ducted or supported by the National Institutes of Health,

8 and—

9 ‘‘(1) shall represent the health disparities re10 search program of the National Institutes of Health,

11 including the minority health disparities research

12 program, at all relevant Executive branch task

13 forces, committees and planning activities; and

14 ‘‘(2) shall maintain communications with all rel15 evant Public Health Service agencies, including the

16 Indian Health Service, and various other depart17 ments of the Federal Government to ensure the

18 timely transmission of information concerning ad19 vances in minority health disparities research and

20 other health disparities research between these var21 ious agencies for dissemination to affected commu22 nities and health care providers.

23 ‘‘(f) COLLABORATIVE COMPREHENSIVE PLAN AND

24 BUDGET.—
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1 ‘‘(1) IN GENERAL.—Subject to the provisions of

2 this section and other applicable law, the Director of

3 NIH, the Director of the Center, and the directors

4 of the other agencies of the National Institutes of

5 Health in collaboration (and in consultation with the

6 advisory council for the Center) shall—

7 ‘‘(A) establish a comprehensive plan and

8 budget for the conduct and support of all mi9 nority health disparities research and other

10 health disparities research activities of the

11 agencies of the National Institutes of Health

12 (which plan and budget shall be first estab13 lished under this subsection not later than 12

14 months after the date of the enactment of this

15 subpart);

16 ‘‘(B) ensure that the plan and budget es17 tablish priorities among the health disparities

18 research activities that such agencies are au19 thorized to carry out;

20 ‘‘(C) ensure that the plan and budget es21 tablish objectives regarding such activities, de22 scribes the means for achieving the objectives,

23 and designates the date by which the objectives

24 are expected to be achieved;
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1 ‘‘(D) ensure that, with respect to amounts

2 appropriated for activities of the Center, the

3 plan and budget give priority in the expenditure

4 of funds to conducting and supporting minority

5 health disparities research;

6 ‘‘(E) ensure that all amounts appropriated

7 for such activities are expended in accordance

8 with the plan and budget;

9 ‘‘(F) review the plan and budget not less

10 than annually, and revise the plan and budget

11 as appropriate;

12 ‘‘(G) ensure that the plan and budget serve

13 as a broad, binding statement of policies re14 garding minority health disparities research and

15 other health disparities research activities of the

16 agencies, but do not remove the responsibility of

17 the heads of the agencies for the approval of

18 specific programs or projects, or for other de19 tails of the daily administration of such activi20 ties, in accordance with the plan and budget;

21 and

22 ‘‘(H) promote coordination and collabora23 tion among the agencies conducting or sup24 porting minority health or other health dispari25 ties research.
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1 ‘‘(2) CERTAIN COMPONENTS OF PLAN AND

2 BUDGET.—With respect to health disparities re3 search activities of the agencies of the National In4 stitutes of Health, the Director of the Center shall

5 ensure that the plan and budget under paragraph

6 (1) provide for—

7 ‘‘(A) basic research and applied research,

8 including research and development with re9 spect to products;

10 ‘‘(B) research that is conducted by the

11 agencies;

12 ‘‘(C) research that is supported by the

13 agencies;

14 ‘‘(D) proposals developed pursuant to so15 licitations by the agencies and for proposals de16 veloped independently of such solicitations; and

17 ‘‘(E) behavioral research and social

18 sciences research, which may include cultural

19 and linguistic research in each of the agencies.

20 ‘‘(3) MINORITY HEALTH DISPARITIES RE21 SEARCH.—The plan and budget under paragraph (1)

22 shall include a separate statement of the plan and

23 budget for minority health disparities research.

24 ‘‘(g) PARTICIPATION IN CLINICAL RESEARCH.—The

25 Director of the Center shall work with the Director of
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1 NIH and the directors of the agencies of the National In2 stitutes of Health to carry out the provisions of section

3 492B that relate to minority groups.

4 ‘‘(h) RESEARCH ENDOWMENTS.—

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

6 may carry out a program to facilitate minority

7 health disparities research and other health dispari8 ties research by providing for research endowments

9 at centers of excellence under section 736.

10 ‘‘(2) ELIGIBILITY.—The Director of the Center

11 may provide for a research endowment under para12 graph (1) only if the institution involved meets the

13 following conditions:

14 ‘‘(A) The institution does not have an en15 dowment that is worth in excess of an amount

16 equal to 50 percent of the national average of

17 endowment funds at institutions that conduct

18 similar biomedical research or training of health

19 professionals.

20 ‘‘(B) The application of the institution

21 under paragraph (1) regarding a research en22 dowment has been recommended pursuant to

23 technical and scientific peer review and has

24 been approved by the advisory council under

25 subsection (j).
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1 ‘‘(i) CERTAIN ACTIVITIES.—In carrying out sub2 section (a), the Director of the Center—

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

4 Center for Research Resources in carrying out sec5 tion 481(c)(3) and in committing resources for con6 struction at Institutions of Emerging Excellence;

7 ‘‘(2) shall establish projects to promote coopera8 tion among Federal agencies, State, local, tribal, and

9 regional public health agencies, and private entities

10 in health disparities research; and

11 ‘‘(3) may utilize information from previous

12 health initiatives concerning minorities and other

13 health disparity populations.

14 ‘‘(j) ADVISORY COUNCIL.—

15 ‘‘(1) IN GENERAL.—The Secretary shall, in ac16 cordance with section 406, establish an advisory

17 council to advise, assist, consult with, and make rec18 ommendations to the Director of the Center on mat19 ters relating to the activities described in subsection

20 (a), and with respect to such activities to carry out

21 any other functions described in section 406 for ad22 visory councils under such section. Functions under

23 the preceding sentence shall include making rec24 ommendations on budgetary allocations made in the

25 plan under subsection (f), and shall include review-
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1 ing reports under subsection (k) before the reports

2 are submitted under such subsection.

3 ‘‘(2) MEMBERSHIP.—With respect to the mem4 bership of the advisory council under paragraph (1),

5 a majority of the members shall be individuals with

6 demonstrated expertise regarding minority health

7 disparity and other health disparity issues; rep8 resentatives of communities impacted by minority

9 and other health disparities shall be included; and a

10 diversity of health professionals shall be represented.

11 The membership shall in addition include a rep12 resentative of the Office of Behavioral and Social

13 Sciences Research under section 404A.

14 ‘‘(k) ANNUAL REPORT.—The Director of the Center

15 shall prepare an annual report on the activities carried out

16 or to be carried out by the Center, and shall submit each

17 such report to the Committee on Health, Education,

18 Labor, and Pensions of the Senate, the Committee on

19 Commerce of the House of Representatives, the Secretary,

20 and the Director of NIH. With respect to the fiscal year

21 involved, the report shall—

22 ‘‘(1) describe and evaluate the progress made in

23 health disparities research conducted or supported

24 by the national research institutes;
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1 ‘‘(2) summarize and analyze expenditures made

2 for activities with respect to health disparities re3 search conducted or supported by the National Insti4 tutes of Health;

5 ‘‘(3) include a separate statement applying the

6 requirements of paragraphs (1) and (2) specifically

7 to minority health disparities research; and

8 ‘‘(4) contain such recommendations as the Di9 rector considers appropriate.

10 ‘‘(l) AUTHORIZATION OF APPROPRIATIONS.—For the

11 purpose of carrying out this subpart, there are authorized

12 to be appropriated $100,000,000 for fiscal year 2001, and

13 such sums as may be necessary for each of the fiscal years

14 2002 through 2005. Such authorization of appropriations

15 is in addition to other authorizations of appropriations

16 that are available for the conduct and support of minority

17 health disparities research or other health disparities re18 search by the agencies of the National Institutes of

19 Health.’’.

20 (b) CONFORMING AMENDMENT.—Part A of title IV

21 of the Public Health Service Act (42 U.S.C. 281 et seq.)

22 is amended—

23 (1) in section 401(b)(2)—

24 (A) in subparagraph (F), by moving the

25 subparagraph two ems to the left; and
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1 (B) by adding at the end the following sub2 paragraph:

3 ‘‘(G) The National Center on Minority Health

4 and Health Disparities.’’; and

5 (2) by striking section 404.

6 SEC. 102. CENTERS OF EXCELLENCE FOR RESEARCH EDU7 CATION AND TRAINING.

8 Subpart 6 of part E of title IV of the Public Health

9 Service Act, as added by section 101(a) of this Act, is

10 amended by adding at the end the following section:

11 ‘‘SEC. 485F. CENTERS OF EXCELLENCE FOR RESEARCH

12 EDUCATION AND TRAINING.

13 ‘‘(a) IN GENERAL.—The Director of the Center shall

14 make awards of grants or contracts to designated bio15 medical and behavioral research institutions under para16 graph (1) of subsection (c), or to consortia under para17 graph (2) of such subsection, for the purpose of assisting

18 the institutions in supporting programs of excellence in

19 biomedical and behavioral research training for individuals

20 who are members of minority health disparity populations

21 or other health disparity populations.

22 ‘‘(b) REQUIRED USE OF FUNDS.—An award may be

23 made under subsection (a) only if the applicant involved

24 agrees that the grant will be expended—
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1 ‘‘(1) to train members of minority health dis2 parity populations or other health disparity popu3 lations as professionals in the area of biomedical or

4 behavioral research or both; or

5 ‘‘(2) to expand, remodel, renovate, or alter ex6 isting research facilities or construct new research

7 facilities for the purpose of conducting minority

8 health disparities research and other health dispari9 ties research.

10 ‘‘(c) CENTERS OF EXCELLENCE.—

11 ‘‘(1) IN GENERAL.—For purposes of this sec12 tion, a designated biomedical and behavioral re13 search institution is a biomedical and behavioral re14 search institution that—

15 ‘‘(A) has a significant number of members

16 of minority health disparity populations or

17 other health disparity populations enrolled as

18 students in the institution (including individuals

19 accepted for enrollment in the institution);

20 ‘‘(B) has been effective in assisting such

21 students of the institution to complete the pro22 gram of education or training and receive the

23 degree involved;

24 ‘‘(C) has made significant efforts to recruit

25 minority students to enroll in and graduate
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1 from the institution, which may include pro2 viding means-tested scholarships and other fi3 nancial assistance as appropriate; and

4 ‘‘(D) has made significant recruitment ef5 forts to increase the number of minority or

6 other members of health disparity populations

7 serving in faculty or administrative positions at

8 the institution.

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

10 and behavioral research institution involved may,

11 with other biomedical and behavioral institutions

12 (designated or otherwise), including tribal health

13 programs, form a consortium to receive an award

14 under subsection (a).

15 ‘‘(3) APPLICATION OF CRITERIA TO OTHER

16 PROGRAMS.—In the case of any criteria established

17 by the Director of the Center for purposes of deter18 mining whether institutions meet the conditions de19 scribed in paragraph (1), this section may not, with

20 respect to minority health disparity populations or

21 other health disparity populations, be construed to

22 authorize, require, or prohibit the use of such cri23 teria in any program other than the program estab24 lished in this section.
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1 ‘‘(d) DURATION OF GRANT.—The period during

2 which payments are made under a grant under subsection

3 (a) may not exceed 5 years. Such payments shall be sub4 ject to annual approval by the Director of the Center and

5 to the availability of appropriations for the fiscal year in6 volved to make the payments.

7 ‘‘(e) MAINTENANCE OF EFFORT.—

8 ‘‘(1) IN GENERAL.—With respect to activities

9 for which an award under subsection (a) is author10 ized to be expended, the Director of the Center may

11 not make such an award to a designated research in12 stitution or consortium for any fiscal year unless the

13 institution, or institutions in the consortium, as the

14 case may be, agree to maintain expenditures of non15 Federal amounts for such activities at a level that is

16 not less than the level of such expenditures main17 tained by the institutions involved for the fiscal year

18 preceding the fiscal year for which such institutions

19 receive such an award.

20 ‘‘(2) USE OF FEDERAL FUNDS.—With respect

21 to any Federal amounts received by a designated re22 search institution or consortium and available for

23 carrying out activities for which an award under

24 subsection (a) is authorized to be expended, the Di25 rector of the Center may make such an award only
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1 if the institutions involved agree that the institutions

2 will, before expending the award, expend the Federal

3 amounts obtained from sources other than the

4 award.

5 ‘‘(f) CERTAIN EXPENDITURES.—The Director of the

6 Center may authorize a designated biomedical and behav7 ioral research institution to expend a portion of an award

8 under subsection (a) for research endowments.

9 ‘‘(g) DEFINITIONS.—For purposes of this section:

10 ‘‘(1) The term ‘designated biomedical and be11 havioral research institution’ has the meaning indi12 cated for such term in subsection (c)(1). Such term

13 includes any health professions school receiving an

14 award of a grant or contract under section 736.

15 ‘‘(2) The term ‘program of excellence’ means

16 any program carried out by a designated biomedical

17 and behavioral research institution with an award

18 under subsection (a), if the program is for purposes

19 for which the institution involved is authorized in

20 subsection (b) to expend the grant.

21 ‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—For the

22 purpose of making grants under subsection (a), there are

23 authorized to be appropriated such sums as may be nec24 essary for each of the fiscal years 2001 through 2005.’’.
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1 SEC. 103. EXTRAMURAL LOAN REPAYMENT PROGRAM FOR

2 MINORITY HEALTH DISPARITIES RESEARCH.

3 Subpart 6 of part E of title IV of the Public Health

4 Service Act, as amended by section 102 of this Act, is

5 amended by adding at the end the following section:

6 ‘‘SEC. 485G. LOAN REPAYMENT PROGRAM FOR MINORITY

7 HEALTH DISPARITIES RESEARCH.

8 ‘‘(a) IN GENERAL.—The Director of the Center shall

9 establish a program of entering into contracts with quali10 fied health professionals under which such health profes11 sionals agree to engage in minority health disparities re12 search or other health disparities research in consideration

13 of the Federal Government agreeing to repay, for each

14 year of engaging in such research, not more than $35,000

15 of the principal and interest of the educational loans of

16 such health professionals.

17 ‘‘(b) SERVICE PROVISIONS.—The provisions of sec18 tions 338B, 338C, and 338E shall, except as inconsistent

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

20 such subsection to the same extent and in the same man21 ner as such provisions apply to the National Health Serv22 ice Corps Loan Repayment Program established in sub23 part III of part D of title III.

24 ‘‘(c) REQUIREMENT REGARDING HEALTH DISPARITY

25 POPULATIONS.—The Director of the Center shall ensure

26 that not fewer than 50 percent of the contracts entered
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1 into under subsection (a) are for appropriately qualified

2 health professionals who are members of a health disparity

3 population.

4 ‘‘(d) PRIORITY.—With respect to minority health dis5 parities research and other health disparities research

6 under subsection (a), the Secretary shall ensure that pri7 ority is given to conducting projects of biomedical re8 search.

9 ‘‘(e) FUNDING.—

10 ‘‘(1) AUTHORIZATION OF APPROPRIATIONS.—

11 For the purpose of carrying out this section, there

12 are authorized to be appropriated such sums as may

13 be necessary for each of the fiscal years 2001

14 through 2005.

15 ‘‘(2) AVAILABILITY OF APPROPRIATIONS.—

16 Amounts available for carrying out this section shall

17 remain available until the expiration of the second

18 fiscal year beginning after the fiscal year for which

19 the amounts were made available.’’.

20 SEC. 104. GENERAL PROVISIONS REGARDING THE CENTER.

21 Subpart 6 of part E of title IV of the Public Health

22 Service Act, as amended by section 103 of this Act, is

23 amended by adding at the end the following section:
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1 ‘‘SEC. 485H. GENERAL PROVISIONS REGARDING THE CEN2 TER.

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

4 Secretary, acting through the Director of the National In5 stitutes of Health, shall provide administrative support

6 and support services to the Director of the Center and

7 shall ensure that such support takes maximum advantage

8 of existing administrative structures at the agencies of the

9 National Institutes of Health.

10 ‘‘(b) EVALUATION AND REPORT.—

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

12 after the date of the enactment of this subpart, the

13 Secretary shall conduct an evaluation to—

14 ‘‘(A) determine the effect of this subpart

15 on the planning and coordination of health dis16 parities research programs at the agencies of

17 the National Institutes of Health;

18 ‘‘(B) evaluate the extent to which this sub19 part has eliminated the duplication of adminis20 trative resources among such Institutes, centers

21 and divisions; and

22 ‘‘(C) provide, to the extent determined by

23 the Secretary to be appropriate, recommenda24 tions concerning future legislative modifications

25 with respect to this subpart, for both minority
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1 health disparities research and other health dis2 parities research.

3 ‘‘(2) MINORITY HEALTH DISPARITIES RE4 SEARCH.—The evaluation under paragraph (1) shall

5 include a separate statement that applies subpara6 graphs (A) and (B) of such paragraph to minority

7 health disparities research.

8 ‘‘(3) REPORT.—Not later than 1 year after the

9 date on which the evaluation is commenced under

10 paragraph (1), the Secretary shall prepare and sub11 mit to the Committee on Health, Education, Labor,

12 and Pensions of the Senate, and the Committee on

13 Commerce of the House of Representatives, a report

14 concerning the results of such evaluation.’’.

15 SEC. 105. REPORT REGARDING RESOURCES OF NATIONAL

16 INSTITUTES OF HEALTH DEDICATED TO MI17 NORITY AND OTHER HEALTH DISPARITIES

18 RESEARCH.

19 Not later than December 1, 2003, the Director of the

20 National Center on Minority Health and Health Dispari21 ties (established by the amendment made by section

22 101(a)), after consultation with the advisory council for

23 such Center, shall submit to the Congress, the Secretary

24 of Health and Human Services, and the Director of the
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1 National Institutes of Health a report that provides the

2 following:

3 (1) Recommendations for the methodology that

4 should be used to determine the extent of the re5 sources of the National Institutes of Health that are

6 dedicated to minority health disparities research and

7 other health disparities research, including deter8 mining the amount of funds that are used to con9 duct and support such research. With respect to

10 such methodology, the report shall address any dis11 crepancies between the methodology used by such

12 Institutes as of the date of the enactment of this Act

13 and the methodology used by the Institute of Medi14 cine as of such date.

15 (2) A determination of whether and to what ex16 tent, relative to fiscal year 1999, there has been an

17 increase in the level of resources of the National In18 stitutes of Health that are dedicated to minority

19 health disparities research, including the amount of

20 funds used to conduct and support such research.

21 The report shall include provisions describing wheth22 er and to what extent there have been increases in

23 the number and amount of awards to minority serv24 ing institutions.
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1 TITLE II—HEALTH DISPARITIES

2 RESEARCH BY AGENCY FOR

3 HEALTHCARE RESEARCH

4 AND QUALITY

5 SEC. 201. HEALTH DISPARITIES RESEARCH BY AGENCY FOR

6 HEALTHCARE RESEARCH AND QUALITY.

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

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

9 (1) in section 902, by striking subsection (g);

10 and

11 (2) by adding at the end the following:

12 ‘‘SEC. 903. RESEARCH ON HEALTH DISPARITIES.

13 ‘‘(a) IN GENERAL.—The Director shall—

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

15 populations for which there is a significant disparity

16 in the quality, outcomes, cost, or use of health care

17 services or access to and satisfaction with such serv18 ices, as compared to the general population;

19 ‘‘(2) conduct and support research on the

20 causes of and barriers to reducing the health dis21 parities identified in paragraph (1), taking into ac22 count such factors as socioeconomic status, attitudes

23 toward health, the language spoken, the extent of

24 formal education, the area or community in which
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1 the population resides, and other factors the Direc2 tor determines to be appropriate;

3 ‘‘(3) conduct and support research and support

4 demonstration projects to identify, test, and evaluate

5 strategies for reducing or eliminating health dispari6 ties, including development or identification of effec7 tive service delivery models, and disseminate effec8 tive strategies and models;

9 ‘‘(4) develop measures and tools for the assess10 ment and improvement of the outcomes, quality, and

11 appropriateness of health care services provided to

12 health disparity populations;

13 ‘‘(5) in carrying out section 902(c), provide

14 support to increase the number of researchers who

15 are members of health disparity populations, and the

16 health services research capacity of institutions that

17 train such researchers; and

18 ‘‘(6) beginning with fiscal year 2003, annually

19 submit to the Congress a report regarding prevailing

20 disparities in health care delivery as it relates to ra21 cial factors and socioeconomic factors in priority

22 populations.

23 ‘‘(b) RESEARCH AND DEMONSTRATION PROJECTS.—
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1 ‘‘(1) IN GENERAL.—In carrying out subsection

2 (a), the Director shall conduct and support research

3 and support demonstrations to—

4 ‘‘(A) identify the clinical, cultural, socio5 economic, geographic, and organizational fac6 tors that contribute to health disparities, in7 cluding minority health disparity populations,

8 which research shall include behavioral re9 search, such as examination of patterns of clin10 ical decisionmaking, and research on access,

11 outreach, and the availability of related support

12 services (such as cultural and linguistic serv13 ices);

14 ‘‘(B) identify and evaluate clinical and or15 ganizational strategies to improve the quality,

16 outcomes, and access to care for health dis17 parity populations, including minority health

18 disparity populations;

19 ‘‘(C) test such strategies and widely dis20 seminate those strategies for which there is sci21 entific evidence of effectiveness; and

22 ‘‘(D) determine the most effective ap23 proaches for disseminating research findings to

24 health disparity populations, including minority

25 populations.
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1 ‘‘(2) USE OF CERTAIN STRATEGIES.—In car2 rying out this section, the Director shall implement

3 research strategies and mechanisms that will en4 hance the involvement of individuals who are mem5 bers of minority health disparity populations or

6 other health disparity populations, health services re7 searchers who are such individuals, institutions that

8 train such individuals as researchers, members of

9 minority health disparity populations or other health

10 disparity populations for whom the Agency is at11 tempting to improve the quality and outcomes of

12 care, and representatives of appropriate tribal or

13 other community-based organizations with respect to

14 health disparity populations. Such research strate15 gies and mechanisms may include the use of—

16 ‘‘(A) centers of excellence that can dem17 onstrate, either individually or through con18 sortia, a combination of multi-disciplinary ex19 pertise in outcomes or quality improvement re20 search, linkages to relevant sites of care, and a

21 demonstrated capacity to involve members and

22 communities of health disparity populations, in23 cluding minority health disparity populations, in

24 the planning, conduct, dissemination, and

25 translation of research;
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1 ‘‘(B) provider-based research networks, in2 cluding health plans, facilities, or delivery sys3 tem sites of care (especially primary care), that

4 make extensive use of health care providers who

5 are members of health disparity populations or

6 who serve patients in such populations and have

7 the capacity to evaluate and promote quality

8 improvement;

9 ‘‘(C) service delivery models (such as

10 health centers under section 330 and the Indian

11 Health Service) to reduce health disparities;

12 and

13 ‘‘(D) innovative mechanisms or strategies

14 that will facilitate the translation of past re15 search investments into clinical practices that

16 can reasonably be expected to benefit these pop17 ulations.

18 ‘‘(c) QUALITY MEASUREMENT DEVELOPMENT.—

19 ‘‘(1) IN GENERAL.—To ensure that health dis20 parity populations, including minority health dis21 parity populations, benefit from the progress made

22 in the ability of individuals to measure the quality

23 of health care delivery, the Director shall support

24 the development of quality of health care measures

25 that assess the experience of such populations with
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1 health care systems, such as measures that assess

2 the access of such populations to health care, the

3 cultural competence of the care provided, the quality

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

5 aspects of health care practice that the Director de6 termines to be important.

7 ‘‘(2) EXAMINATION OF CERTAIN PRACTICES.—

8 The Director shall examine the practices of pro9 viders that have a record of reducing health dispari10 ties or have experience in providing culturally com11 petent health services to minority health disparity

12 populations or other health disparity populations. In

13 examining such practices of providers funded under

14 the authorities of this Act, the Director shall consult

15 with the heads of the relevant agencies of the Public

16 Health Service.

17 ‘‘(3) REPORT.—Not later than 36 months after

18 the date of the enactment of this section, the Sec19 retary, acting through the Director, shall prepare

20 and submit to the appropriate committees of Con21 gress a report describing the state-of-the-art of qual22 ity measurement for minority and other health dis23 parity populations that will identify critical unmet

24 needs, the current activities of the Department to
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1 address those needs, and a description of related ac2 tivities in the private sector.

3 ‘‘(d) DEFINITION.—For purposes of this section:

4 ‘‘(1) The term ‘health disparity population’ has

5 the meaning given such term in section 485E, except

6 that in addition to the meaning so given, the Direc7 tor may determine that such term includes popu8 lations for which there is a significant disparity in

9 the quality, outcomes, cost, or use of health care

10 services or access to or satisfaction with such serv11 ices as compared to the general population.

12 ‘‘(2) The term ‘minority’, with respect to popu13 lations, refers to racial and ethnic minority groups

14 as defined in section 1707.’’.

15 (b) FUNDING.—Section 927 of the Public Health

16 Service Act (42 U.S.C. 299c–6) is amended by adding at

17 the end the following:

18 ‘‘(d) HEALTH DISPARITIES RESEARCH.—For the

19 purpose of carrying out the activities under section 903,

20 there are authorized to be appropriated $50,000,000 for

21 fiscal year 2001, and such sums as may be necessary for

22 each of the fiscal years 2002 through 2005.’’.
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1 TITLE III—DATA COLLECTION

2 RELATING TO RACE OR ETH3 NICITY

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

5 SCIENCES.

6 (a) STUDY.—The National Academy of Sciences shall

7 conduct a comprehensive study of the Department of

8 Health and Human Services’ data collection systems and

9 practices, and any data collection or reporting systems re10 quired under any of the programs or activities of the De11 partment, relating to the collection of data on race or eth12 nicity, including other Federal data collection systems

13 (such as the Social Security Administration) with which

14 the Department interacts to collect relevant data on race

15 and ethnicity.

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

17 of enactment of this Act, the National Academy of

18 Sciences shall prepare and submit to the Committee on

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

20 the Committee on Commerce of the House of Representa21 tives, a report that—

22 (1) identifies the data needed to support efforts

23 to evaluate the effects of socioeconomic status, race

24 and ethnicity on access to health care and other

25 services and on disparity in health and other social
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1 outcomes and the data needed to enforce existing

2 protections for equal access to health care;

3 (2) examines the effectiveness of the systems

4 and practices of the Department of Health and

5 Human Services described in subsection (a), includ6 ing pilot and demonstration projects of the Depart7 ment, and the effectiveness of selected systems and

8 practices of other Federal, State, and tribal agencies

9 and the private sector, in collecting and analyzing

10 such data;

11 (3) contains recommendations for ensuring that

12 the Department of Health and Human Services, in

13 administering its entire array of programs and ac14 tivities, collects, or causes to be collected, reliable

15 and complete information relating to race and eth16 nicity; and

17 (4) includes projections about the costs associ18 ated with the implementation of the recommenda19 tions described in paragraph (3), and the possible ef20 fects of the costs on program operations.

21 (c) AUTHORIZATION OF APPROPRIATIONS.—For the

22 purpose of carrying out this section, there are authorized

23 to be appropriated such sums as may be necessary for fis24 cal year 2001.
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1 TITLE IV—HEALTH

2 PROFESSIONS EDUCATION

3 SEC. 401. HEALTH PROFESSIONS EDUCATION IN HEALTH

4 DISPARITIES.

5 (a) IN GENERAL.—Part B of title VII of the Public

6 Health Service Act (42 U.S.C. 293 et seq.) is amended

7 by inserting after section 740 the following:

8 ‘‘SEC. 741. GRANTS FOR HEALTH PROFESSIONS EDU9 CATION.

10 ‘‘(a) GRANTS FOR HEALTH PROFESSIONS EDU11 CATION IN HEALTH DISPARITIES AND CULTURAL COM12 PETENCY.—

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

14 through the Administrator of the Health Resources

15 and Services Administration, may make awards of

16 grants, contracts, or cooperative agreements to pub17 lic and nonprofit private entities (including tribal en18 tities) for the purpose of carrying out research and

19 demonstration projects (including research and dem20 onstration projects for continuing health professions

21 education) for training and education of health pro22 fessionals for the reduction of disparities in health

23 care outcomes and the provision of culturally com24 petent health care.
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1 ‘‘(2) ELIGIBLE ENTITIES.—Unless specifically

2 required otherwise in this title, the Secretary shall

3 accept applications for grants or contracts under

4 this section from health professions schools, aca5 demic health centers, State or local governments, or

6 other appropriate public or private nonprofit entities

7 (or consortia of entities, including entities promoting

8 multidisciplinary approaches) for funding and par9 ticipation in health professions training activities.

10 The Secretary may accept applications from for11 profit private entities as determined appropriate by

12 the Secretary.

13 ‘‘(b) AUTHORIZATION OF APPROPRIATIONS.—There

14 are authorized to be appropriated to carry out subsection

15 (a), $3,500,000 for fiscal year 2001, $7,000,000 for fiscal

16 year 2002, $7,000,000 for fiscal year 2003, and

17 $3,500,000 for fiscal year 2004.’’.

18 (b) NURSING EDUCATION.—Part A of title VIII of

19 the Public Health Service Act (42 U.S.C. 296 et seq.) is

20 amended—

21 (1) by redesignating section 807 as section 808;

22 and

23 (2) by inserting after section 806 the following:
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1 ‘‘SEC. 807. GRANTS FOR HEALTH PROFESSIONS EDU2 CATION.

3 ‘‘(a) GRANTS FOR HEALTH PROFESSIONS EDU4 CATION IN HEALTH DISPARITIES AND CULTURAL COM5 PETENCY.—The Secretary, acting through the Adminis6 trator of the Health Resources and Services Administra7 tion, may make awards of grants, contracts, or cooperative

8 agreements to eligible entities for the purpose of carrying

9 out research and demonstration projects (including re10 search and demonstration projects for continuing health

11 professions education) for training and education for the

12 reduction of disparities in health care outcomes and the

13 provision of culturally competent health care. Grants

14 under this section shall be the same as provided in section

15 741.’’.

16 ‘‘(b) AUTHORIZATION OF APPROPRIATIONS.—There

17 are to be appropriated to carry out subsection (a) such

18 sums as may be necessary for each of the fiscal years 2001

19 through 2004.’’.

20 SEC. 402. NATIONAL CONFERENCE ON HEALTH PROFES21 SIONS EDUCATION AND HEALTH DISPARI22 TIES.

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

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

25 Human Services (in this section referred to as the ‘‘Sec26 retary’’), acting through the Administrator of the Health
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1 Resources and Services Administration, shall convene a

2 national conference on health professions education as a

3 method for reducing disparities in health outcomes.

4 (b) PARTICIPANTS.—The Secretary shall include in

5 the national conference convened under subsection (a) ad6 vocacy groups and educational entities as described in sec7 tion 741 of the Public Health Service Act (as added by

8 section 401), tribal health programs, health centers under

9 section 330 of such Act, and other interested parties.

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

11 subsection (a) shall include, but is not limited to, issues

12 that address the role and impact of health professions edu13 cation on the reduction of disparities in health outcomes,

14 including the role of education on cultural competency.

15 The conference shall focus on methods to achieve reduc16 tions in disparities in health outcomes through health pro17 fessions education (including continuing education pro18 grams) and strategies for outcomes measurement to assess

19 the effectiveness of education in reducing disparities.

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

21 months after the national conference under subsection (a)

22 has convened, the Secretary shall publish in the Federal

23 Register a summary of the proceedings and findings of

24 the conference.
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1 (e) AUTHORIZATION OF APPROPRIATIONS.—There is

2 authorized to be appropriated such sums as may be nec3 essary to carry out this section.

4 SEC. 403. ADVISORY RESPONSIBILITIES IN HEALTH PRO5 FESSIONS EDUCATION IN HEALTH DISPARI6 TIES AND CULTURAL COMPETENCY.

7 Section 1707 of the Public Health Service Act (42

8 U.S.C. 300u–6) is amended—

9 (1) in subsection (b), by adding at the end the

10 following paragraph:

11 ‘‘(10) Advise in matters related to the develop12 ment, implementation, and evaluation of health pro13 fessions education in decreasing disparities in health

14 care outcomes, including cultural competency as a

15 method of eliminating health disparities.’’;

16 (2) in subsection (c)(2), by striking ‘‘para17 graphs (1) through (9)’’ and inserting ‘‘paragraphs

18 (1) through (10)’’; and

19 (3) in subsection (d), by amending paragraph

20 (1) to read as follows:

21 ‘‘(1) RECOMMENDATIONS REGARDING LAN22 GUAGE.—

23 ‘‘(A) PROFICIENCY IN SPEAKING

24 ENGLISH.—The Deputy Assistant Secretary

25 shall consult with the Director of the Office of
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1 International and Refugee Health, the Director

2 of the Office of Civil Rights, and the Directors

3 of other appropriate departmental entities re4 garding recommendations for carrying out ac5 tivities under subsection (b)(9).

6 ‘‘(B) HEALTH PROFESSIONS EDUCATION

7 REGARDING HEALTH DISPARITIES.—The Dep8 uty Assistant Secretary shall carry out the du9 ties under subsection (b)(10) in collaboration

10 with appropriate personnel of the Department

11 of Health of Human Services, other Federal

12 agencies, and other offices, centers, and institu13 tions, as appropriate, that have responsibilities

14 under the Minority Health and Health Dispari15 ties Research and Education Act of 2000.’’.

16 TITLE V—PUBLIC AWARENESS

17 AND DISSEMINATION OF IN18 FORMATION ON HEALTH DIS19 PARITIES

20 SEC. 501. PUBLIC AWARENESS AND INFORMATION DISSEMI21 NATION.

22 (a) PUBLIC AWARENESS ON HEALTH DISPARI23 TIES.—The Secretary of Health and Human Services (in

24 this section referred to as the ‘‘Secretary’’) shall conduct

25 a national campaign to inform the public and health care
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1 professionals about health disparities in minority and

2 other underserved populations by disseminating informa3 tion and materials available on specific diseases affecting

4 these populations and programs and activities to address

5 these disparities. The campaign shall—

6 (1) have a specific focus on minority and other

7 underserved communities with health disparities;

8 and

9 (2) include an evaluation component to assess

10 the impact of the national campaign in raising

11 awareness of health disparities and information on

12 available resources.

13 (b) DISSEMINATION OF INFORMATION ON HEALTH

14 DISPARITIES.—The Secretary shall develop and imple15 ment a plan for the dissemination of information and find16 ings with respect to health disparities under titles I, II,

17 III, and IV of this Act. The plan shall—

18 (1) include the participation of all agencies of

19 the Department of Health and Human Services that

20 are responsible for serving populations included in

21 the health disparities research; and

22 (2) have agency-specific strategies for dissemi23 nating relevant findings and information on health

24 disparities and improving health care services to af25 fected communities.
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1 TITLE VI—MISCELLANEOUS

2 PROVISIONS

3 SEC. 601. DEPARTMENTAL DEFINITION REGARDING MINOR4 ITY INDIVIDUALS.

5 Section 1707(g)(1) of the Public Health Service Act

6 (42 U.S.C. 300u–6) is amended—

7 (1) by striking ‘‘Asian Americans and’’ and in8 serting ‘‘Asian Americans;’’; and

9 (2) by inserting ‘‘Native Hawaiians and other’’

10 before ‘‘Pacific Islanders;’’.

11 SEC. 602. CONFORMING PROVISION REGARDING DEFINI12 TIONS.

13 For purposes of this Act, the term ‘‘racial and ethnic

14 minority group’’ has the meaning given such term in sec15 tion 1707 of the Public Health Service Act.

16 SEC. 603. EFFECTIVE DATE.

17 This Act and the amendments made by this Act take

18 effect October 1, 2000, or upon the date of the enactment

19 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.