I 

113TH CONGRESS 

2D SESSION H. R. 5294 

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

IN THE HOUSE OF REPRESENTATIVES 

JULY 30, 2014 

Ms. ROYBAL-ALLARD (for herself, Ms. LEE of California, Mrs. CHRISTENSEN, 

Ms. BORDALLO, Ms. BROWN of Florida, Mr. BUTTERFIELD, Ms. CHU, 

Ms. CLARKE of New York, Mr. CA ́RDENAS, Mr. CARSON of Indiana, Ms. 

CASTOR of Florida, Mr. CONYERS, Mr. CROWLEY, Mr. CUMMINGS, Mr. 

DANNY K. DAVIS of Illinois, Ms. DEGETTE, Ms. DELAURO, Ms. 

EDWARDS, Mr. ELLISON, Mr. FALEOMAVAEGA, Mr. FARR, Mr. FATTAH, 

Ms. FUDGE, Mr. GARCIA, Mr. GRIJALVA, Ms. MICHELLE LUJAN GRISHAM of New Mexico, Mr. GUTIE ́RREZ, Ms. HAHN, Mr. HINOJOSA, Mr. 

HONDA, Ms. JACKSON LEE, Ms. EDDIE BERNICE JOHNSON of Texas, 

Mr. JOHNSON of Georgia, Mr. LEWIS, Ms. LOFGREN, Mrs. LOWEY, Mr. 

BEN RAY LUJA ́N of New Mexico, Ms. MATSUI, Ms. MCCOLLUM, Mr. 

MCGOVERN, Mrs. NEGRETE MCLEOD, Mr. MEEKS, Ms. MENG, Mrs. 

NAPOLITANO, Ms. NORTON, Mr. PASTOR of Arizona, Mr. PIERLUISI, Mr. 

RANGEL, Mr. RICHMOND, Mr. RUSH, Mr. SABLAN, Ms. LINDA T. 

SA ́NCHEZ of California, Ms. LORETTA SANCHEZ of California, Ms. SCHAKOWSKY, Mr. SCHIFF, Mr. DAVID SCOTT of Georgia, Mr. SCOTT of Virginia, Mr. SERRANO, Mr. SIRES, Ms. SLAUGHTER, Mr. TAKANO, Mr. 

TONKO, Mr. VARGAS, Mr. VELA, Ms. VELA ́ZQUEZ, and Ms. WATERS) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and 

Means, Agriculture, Education and the Workforce, the Budget, Veterans’ 

Affairs, Armed Services, the Judiciary, and Natural Resources, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned 


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A BILL 

To improve the health of minority individuals, and for other 

purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Health Equity and 

5 Accountability Act of 2014’’. 

6 SEC. 2. TABLE OF CONTENTS. 

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

Sec. 1. Short title. 

Sec. 2. Table of contents. 

Sec. 3. Findings. 

TITLE I—DATA COLLECTION AND REPORTING 

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

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

and analysis. 

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

Sec. 104. Revision of HIPAA claims standards. 

Sec. 105. National Center for Health Statistics. 

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

surveys. 

Sec. 107. Geo-access study. 

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

Government. 

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

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

collection of health data. 

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

data. 

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

background. 

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

Islanders. 

Sec. 114. Clarification of simplified administrative reporting requirement. 

TITLE II—CULTURALLY AND LINGUISTICALLY APPROPRIATE 

HEALTH CARE 

Sec. 201. Definitions. 


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

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

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

Sec. 205. Federal reimbursement for culturally and linguistically appropriate 

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

Health Insurance Programs. 

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

Sec. 207. Assurances for receiving Federal funds. 

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

Sec. 209. English for speakers of other languages. 

Sec. 210. Implementation. 

Sec. 211. Language access services. 

TITLE III—HEALTH WORKFORCE DIVERSITY 

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

Sec. 302. Hispanic-serving health professions schools. 

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

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

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

Sec. 306. Scholarship and fellowship programs. 

Sec. 307. McNair Postbaccalaureate Achievement Program. 

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

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

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

Sec. 311. Health Professions Workforce Fund. 

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

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

TITLE IV—IMPROVEMENT OF HEALTH CARE SERVICES 

Subtitle A—Health Empowerment Zones 

Sec. 401. Short title. 

Sec. 402. Findings. 

Sec. 403. Designation of health empowerment zones. 

Sec. 404. Assistance to those seeking designation. 

Sec. 405. Benefits of designation. 

Sec. 406. Definition. 

Sec. 407. Authorization of appropriations. 

Subtitle B—Other Improvements of Health Care Services 

CHAPTER 1—EXPANSION OF COVERAGE

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

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

health care under the ACA. 

Sec. 413. Study on the uninsured. 


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Sec. 414. Medicaid payment parity for the territories. 

Sec. 415. Extension of Medicare secondary payer. 

Sec. 416. Border health grants. 

Sec. 417. Removing Medicare barrier to health care. 

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

health centers. 

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

Hawaiian health care system under the Medicaid program. 

CHAPTER 2—EXPANSION OF ACCESS

Sec. 421. Grants for racial and ethnic approaches to community health. 

Sec. 422. Critical access hospital improvements. 

Sec. 423. Establishment of Rural Community Hospital (RCH) Program. 

Sec. 424. Medicare remote monitoring pilot projects. 

Sec. 425. Rural health quality advisory commission and demonstration projects. 

Sec. 426. Rural health care services. 

Sec. 427. Community health center collaborative access expansion. 

Sec. 428. Facilitating the provision of telehealth services across State lines. 

Sec. 429. Scoring of preventive health savings. 

Sec. 430. Sense of Congress. 

Sec. 431. Repeal of requirement for documentation evidencing citizenship or 

nationality under the Medicaid program. 

Sec. 432. Office of Minority Health in Veterans Health Administration of Department of Veterans Affairs. 

Sec. 433. Indian defined in PPACA. 

Sec. 434. Study of DSH payments to ensure hospital access for low-income patients. 

Sec. 435. Assistant Secretary of the Indian Health Service. 

Sec. 436. Reauthorization of the Native Hawaiian Health Care Improvement 

Act. 

TITLE V—IMPROVING HEALTH OUTCOMES FOR WOMEN, 

CHILDREN, AND FAMILIES 

Sec. 501. Grants to promote positive health behaviors in women and children. 

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

Sec. 503. Repeal of denial of benefits. 

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

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

Sec. 506. Eliminating disparities in maternity health outcomes. 

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

sudden unexplained death in childhood. 

Sec. 508. Reducing unintended teenage pregnancies. 

Sec. 509. Gestational diabetes. 

Sec. 510. Emergency contraception education and information programs. 

Sec. 511. Supporting healthy adolescent development. 

Sec. 512. Compassionate assistance for rape emergencies. 

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

FDA-approved contraception. 

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

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


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Sec. 516. Consumer education campaign. 

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

women and newborns. 

Sec. 518. Maternity care health professional shortage areas. 

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

centers on optimal maternity outcomes. 

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

Medicaid Innovation to include maternity care models. 

Sec. 521. Development of interprofessional maternity care educational models 

and tools. 

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

furnished by certain students, interns, and residents supervised 

by certified nurse midwives. 

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

care professionals. 

TITLE VI—MENTAL HEALTH 

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

counselor services, and substance abuse counselor services 

under part B of the Medicare program. 

Sec. 602. Minority Fellowship Program. 

Sec. 603. Integrated Health Care Demonstration Program. 

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

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

mental health disparities. 

TITLE VII—ADDRESSING HIGH IMPACT MINORITY DISEASES 

Subtitle A—Cancer 

Sec. 701. Lung cancer mortality reduction. 

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

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

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

minorities. 

Sec. 705. Reducing cancer disparities within Medicare. 

Subtitle B—Viral Hepatitis and Liver Cancer Control and Prevention 

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

Subtitle C—Acquired Bone Marrow Failure Diseases 

Sec. 721. Acquired bone marrow failure diseases. 

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

Issues 

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

Sec. 732. CDC Wisewoman Screening Program. 

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

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

Sec. 735. Clinical research funding for oral health. 

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


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Subtitle E—HIV/AIDS 

Sec. 741. Statement of policy. 

Sec. 742. Findings. 

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

Sec. 744. Enhancing the national HIV surveillance system. 

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

appropriate care. 

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

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

Sec. 748. Minority AIDS initiative. 

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

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

Sec. 751. Dental education loan repayment program. 

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

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

programs. 

Sec. 754. Elimination of abstinence-only education program. 

Sec. 755. Report on impact of HIV/AIDS in vulnerable populations. 

Sec. 756. National HIV/AIDS observance days. 

Sec. 757. Review of all Federal and State laws, policies, and regulations regarding the criminal prosecution of individuals for HIV-related offenses. 

Sec. 758. Repeal of limitation against use of funds for education or information 

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

Sec. 759. Expanding support for condoms in prisons. 

Sec. 760. Automatic reinstatement or enrollment in Medicaid for people who 

test positive for HIV before reentering communities. 

Sec. 761. Stop AIDS in prison. 

Sec. 762. Support data system review and indicators for monitoring HIV care. 

Sec. 763. Transfer of funds for implementation of national HIV/AIDS strategy. 

Sec. 764. HIV integrated services delivery model demonstration. 

Sec. 765. Report on the implementation of goal 4 (improved coordination) of 

the national HIV/AIDS strategy. 

Subtitle F—Diabetes 

Sec. 771. Research, treatment, and education. 

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

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

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

Sec. 775. Updated report on health disparities. 

Subtitle G—Lung Disease 

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

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

Sec. 778. Influenza and pneumonia vaccination campaign. 

Sec. 779. Chronic obstructive pulmonary disease action plan. 

Subtitle H—Osteoarthritis and Musculoskeletal Diseases 


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Sec. 781. Findings. 

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

the Centers for Disease Control and Prevention. 

Subtitle I—Sleep and Circadian Rhythm Disorders 

Sec. 791. Short title; findings. 

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

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

Centers for Disease Control and Prevention. 

TITLE VIII—HEALTH INFORMATION TECHNOLOGY 

Sec. 800. Definitions. 

Subtitle A—Reducing Health Disparities Through Health IT 

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

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

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

Subtitle B—Modifications To Achieve Parity in Existing Programs 

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

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

minority groups. 

Sec. 813. Extending competitive grants for the development of loan programs 

to facilitate adoption of certified EHR technology by providers 

serving racial and ethnic minority groups. 

Sec. 814. Authorization of appropriations. 

Subtitle C—Additional Research and Studies 

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

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

Subtitle D—Closing Gaps in Funding To Adopt Certified EHRs 

Sec. 841. Application of Medicare HITECH payments to hospitals in Puerto 

Rico. 

Sec. 842. Extending Medicaid EHR incentive payments to rehabilitation facilities, long-term care facilities, and home health agencies. 

Sec. 843. Extending physician assistant eligibility for Medicaid electronic health 

record incentive payments. 

TITLE IX—ACCOUNTABILITY AND EVALUATION 

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

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

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

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

Act of 1964. 


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

and Human Services. 

Sec. 904. United States Commission on Civil Rights. 

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

racial and ethnic health disparities. 

Sec. 906. GAO and NIH reports. 

TITLE X—ADDRESSING SOCIAL DETERMINANTS AND IMPROVING 

ENVIRONMENTAL JUSTICE 

Sec. 1001. Definitions. 

Sec. 1002. Findings. 

Sec. 1003. Health impact assessments. 

Sec. 1004. Implementation of recommendations by Environmental Protection 

Agency. 

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

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

Sec. 1007. Environment and public health restoration. 

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

in the Gulf Coast. 

1 SEC. 3. FINDINGS. 

2 The Congress finds as follows: 

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

8 health care. 

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

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

12 physical structure of communities, nutrition and 

13 food options, educational attainment, employment, 

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

15 immigrant or citizenship status, sexual orientation, 


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1 gender identity, socioeconomic status, or disability 

2 status—that directly and indirectly affect the health, 

3 health care, and wellness of individuals and commu4 nities. 

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

6 health care providers and allied health workers and 

7 this shortage disproportionately affects health pro8 fessional shortage areas where many racial and eth9 nic minority populations reside. 

10 (4) All efforts to reduce health disparities and 

11 barriers to quality health services require better and 

12 more consistent data. 

13 (5) A full range of culturally and linguistically 

14 appropriate health care and public health services 

15 must be available and accessible in every community. 

16 (6) Racial and ethnic minorities and under17 served populations must be included early and equi18 tably in health reform innovations. 

19 (7) Efforts to improve minority health have 

20 been limited by inadequate resources in funding, 

21 staffing, stewardship, and accountability. Targeted 

22 investments that are focused on disparities elimi23 nation must be made in providing care and services 

24 that are community-based, including prevention and 

25 policies addressing social determinants of health. 


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

2 Human Services developed the HHS Action Plan to 

3 Reduce Racial and Ethnic Health Disparities and 

4 the National Stakeholder Strategy for Achieving 

5 Health Equity, two strategic plans that represent 

6 the country’s first coordinated roadmap to reducing 

7 health disparities. Along with the National Preven8 tion Strategy, Healthy People 2020, and the Na9 tional Health Care Quality Strategy, as well as crit10 ical resources such as the 2012 National Healthcare 

11 Quality and Disparities Reports, these comprehen12 sive plans will work to increase the number of Amer13 icans who are healthy at every stage of life. 

14 (9) The Department of Health and Human 

15 Services also developed other strategic planning doc16 uments to combat disease disparities with a high im17 pact on minority populations including the National 

18 HIV/AIDS Strategy, and the Action Plan for the 

19 Prevention, Care and Treatment of Viral Hepatitis. 

20 (10) The Patient Protection and Affordable 

21 Care Act, as amended by the Health Care and Edu22 cation Reconciliation Act, represents the biggest ad23 vancement for minority health in the last 40 years. 


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1 TITLE I—DATA COLLECTION 

2 AND REPORTING 

3 SEC. 101. AMENDMENT TO THE PUBLIC HEALTH SERVICE 

4 ACT. 

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

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

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

9 among federally supported health programs. 

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

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

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

13 the following: 

14 ‘‘Subtitle B—Strengthening Data 

15 Collection, Improving Data 

16 Analysis, and Expanding Data 

17 Reporting 

18 ‘‘SEC. 3431. HEALTH DISPARITY DATA. 

19 ‘‘(a) REQUIREMENTS.— 

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

24 Services shall— 


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

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

7 program— 

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

10 sex, primary language, sexual orientation, 

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

13 3101; 

14 ‘‘(ii) collecting data for additional 

15 population groups if such groups can be 

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

18 under section 3101; 

19 ‘‘(iii) additionally referring, where 

20 practicable, to the standards developed by 

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


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1 ‘‘(iv) where practicable, through self2 reporting; 

3 ‘‘(B) with respect to the collection of the 

4 data described in subparagraph (A), for appli5 cants and recipients who are minors, require 

6 communication assistance in speech or writing, 

7 and for applicants and recipients who are other8 wise legally incapacitated, require that— 

9 ‘‘(i) such data be collected from the 

10 parent or legal guardian of such an appli11 cant or recipient; and 

12 ‘‘(ii) the primary language of the par13 ent or legal guardian of such an applicant 

14 or recipient be collected; 

15 ‘‘(C) systematically analyze such data 

16 using the smallest appropriate units of analysis 

17 feasible to detect racial and ethnic disparities, 

18 as well as disparities along the lines of primary 

19 language, sex, disability status, sexual orienta20 tion, gender identity, and socioeconomic status 

21 in health and health care, and report the results 

22 of such analysis to the Secretary, the Director 

23 of the Office for Civil Rights, each agency listed 

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

25 Health, Education, Labor, and Pensions and 


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1 the Committee on Finance of the Senate, and 

2 the Committee on Energy and Commerce and 

3 the Committee on Ways and Means of the 

4 House of Representatives; 

5 ‘‘(D) provide such data to the Secretary on 

6 at least an annual basis; and 

7 ‘‘(E) ensure that the provision of assist8 ance to an applicant or recipient of assistance 

9 is not denied or otherwise adversely affected be10 cause of the failure of the applicant or recipient 

11 to provide race, ethnicity, primary language, 

12 sex, sexual orientation, disability status, gender 

13 identity, and socioeconomic status data. 

14 ‘‘(2) RULES OF CONSTRUCTION.—Nothing in 

15 this subsection shall be construed to— 

16 ‘‘(A) permit the use of information col17 lected under this subsection in a manner that 

18 would adversely affect any individual providing 

19 any such information; or 

20 ‘‘(B) diminish existing or future require21 ments on health care providers to collect data. 

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

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

25 disclosure of any data collected under this title. The 


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

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

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

6 protected— 

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

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

10 Health Insurance Portability and Accountability Act 

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

13 health information and other protections; and 

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

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

18 from other inappropriate uses, as defined by the 

19 Secretary. 

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

21 Secretary shall develop and implement a national plan to 

22 ensure the collection of data in a culturally appropriate 

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

24 and reporting of racial, ethnic, sex, primary language, sex25 ual orientation, disability status, gender identity, and soVerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00015 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294

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

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

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

4 carried out under this section are in compliance with the 

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

7 consultation with the National Committee on Vital Health 

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

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

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

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

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

18 States, territories, Indian tribes, health providers, 

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

25 care services; 


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

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

4 identity, and socioeconomic status identifiers and 

5 that such identifiers can be retrieved from clinical 

6 records, including records transmitted electronically; 

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

9 groups can be aggregated into the minimum race 

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

12 racial and ethnic groups that comprise a significant 

13 proportion of the population of the State; 

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

15 racial, ethnic, primary language, sexual orientation, 

16 disability status, gender identity, and socioeconomic 

17 status data, subject to privacy and confidentiality 

18 regulations; and 

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

20 collected under subsection (a). 

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

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

25 3101. 


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1 ‘‘(e) TECHNICAL ASSISTANCE FOR THE COLLECTION

2 AND REPORTING OF DATA.— 

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

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

6 an entity operating under such program to comply 

7 with the requirements of this section. 

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

10 to— 

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

13 language, sexual orientation, disability status, 

14 gender identity, and socioeconomic status data 

15 collection and analysis; 

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

19 into the race and ethnicity categories outlined 

20 by the standards developed under section 3101; 

21 ‘‘(C) develop mechanisms for submitting 

22 collected data subject to existing privacy and 

23 confidentiality regulations; and 

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


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1 health providers, health-related agencies, and 

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

4 sexual orientation, disability status, gender 

5 identity, and socioeconomic status are legal and 

6 essential for eliminating health and health care 

7 disparities. 

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

9 Secretary, acting through the Director of the Agency for 

10 Healthcare Research and Quality and in coordination with 

11 the Administrator of the Centers for Medicare & Medicaid 

12 Services, shall provide technical assistance to agencies of 

13 the Department of Health and Human Services in meeting 

14 Federal standards for health disparity data collection and 

15 for analysis of racial and ethnic disparities in health and 

16 health care in public programs by— 

17 ‘‘(1) identifying appropriate quality assurance 

18 mechanisms to monitor for health disparities; 

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

21 ‘‘(3) developing new quality measures relating 

22 to racial and ethnic disparities and their overlap 

23 with other disparity factors in health and health 

24 care; 


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

2 should be conducted; and 

3 ‘‘(5) sharing data with external organizations 

4 for research and quality improvement purposes. 

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

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

8 and written primary language data; and 

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

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

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

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

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

18 and 

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

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

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

24 are authorized to be appropriated to carry out this section 


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

2 2015 through 2020. 

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

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

8 the date of the enactment of the Health Equity and Ac9 countability Act of 2014 may be operated under a grant 

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

11 grant shall not be divisible. 

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

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

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

16 with respect to such service area— 

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

18 progress made toward meeting, each of the health 

19 status objectives of the service, the Indian tribes, 

20 tribal organizations, and urban Indian organizations 

21 in the service area; 

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

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


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

2 and urban Indian organizations in identifying their 

3 highest priority health status objectives and the 

4 services needed to achieve such objectives, based on 

5 epidemiological data; 

6 ‘‘(4) make recommendations for the targeting 

7 of services needed by the populations served; 

8 ‘‘(5) make recommendations to improve health 

9 care delivery systems for Indians and urban Indians; 

10 ‘‘(6) provide requested technical assistance to 

11 Indian tribes, tribal organizations, and urban Indian 

12 organizations in the development of local health 

13 service priorities and incidence and prevalence rates 

14 of disease and other illness in the community; and 

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

17 organizations to promote public health. 

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

19 Centers for Disease Control and Prevention shall provide 

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

22 ‘‘(d) GRANTS FOR STUDIES.— 

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

24 grants to Indian tribes, tribal organizations, urban 

25 Indian organizations, and eligible intertribal conVerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00022 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294

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1 sortia to conduct epidemiological studies of Indian 

2 communities. 

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

4 intertribal consortium is eligible to receive a grant 

5 under this subsection if— 

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

8 Indian health; and 

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

11 communities in which the intertribal consortium 

12 is located. 

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

14 grant under this subsection shall be submitted in 

15 such manner and at such time as the Secretary shall 

16 prescribe. 

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

18 grant under this subsection shall— 

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

21 carry out the functions described in paragraph 

22 (5); 

23 ‘‘(B) consult and cooperate with providers 

24 of related health and social services in order to 

25 avoid duplication of existing services; and 


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1 ‘‘(C) demonstrate cooperation from Indian 

2 tribes or urban Indian organizations in the area 

3 to be served. 

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

5 paragraph (1) may be used— 

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

7 in subsection (b); 

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

9 with tribal leaders, urban Indian community 

10 leaders, and related health staff on health care 

11 and health service management issues; and 

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

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

15 regarding ways to improve the health status of 

16 Indians. 

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

18 center operated by a grantee pursuant to a grant awarded 

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

20 authority for purposes of the Health Insurance Portability 

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

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

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

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


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1 delivery systems, and other protected health information 

2 in the possession of the Secretary.’’. 

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

5 ANALYSIS. 

6 Section 3101 of the Public Health Service Act (42 

7 U.S.C. 300kk) is amended— 

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

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

10 (h). 

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

12 THE SOCIAL SECURITY ADMINISTRATION. 

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

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

15 the following: 

16 ‘‘SEC. 1150C. COLLECTION OF RACE AND ETHNICITY DATA 

17 BY THE SOCIAL SECURITY ADMINISTRATION. 

18 ‘‘(a) REQUIREMENT.—The Commissioner of Social 

19 Security, in consultation with the Administrator of the 

20 Centers for Medicare & Medicaid Services, shall— 

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

22 ethnicity, primary language, and disability status of 

23 all applicants for Social Security account numbers or 

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

25 all individuals with respect to whom the CommisVerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00025 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294

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

3 the Commissioner or the Secretary of the Treas4 ury— 

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

6 for data collection on race, ethnicity, primary 

7 language, and disability status developed under 

8 section 3101 of the Public Health Service Act; 

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

10 additional population groups if such groups can 

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

13 under section 3101 of the Public Health Service 

14 Act; and 

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

19 Quality Improvement’ (released August 31, 

20 2009); 

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

22 described in paragraph (1) for applicants who are 

23 under 18 years of age or otherwise legally incapaci24 tated, require that— 


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1 ‘‘(A) such data be collected from the par2 ent or legal guardian of such an applicant; and 

3 ‘‘(B) the primary language of the parent 

4 or legal guardian of such an applicant or recipi5 ent be used; 

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

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

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

12 Medicare & Medicaid Services and other Federal 

13 health agencies; 

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

15 least an annual basis; and 

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

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

20 status data. 

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

22 Social Security shall ensure (through the promulgation of 

23 regulations or otherwise) that all data collected pursuant 

24 to subsection (a) are protected— 


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

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

4 Health Insurance Portability and Accountability Act 

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

7 health information and other protections; and 

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

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

12 from other inappropriate uses, as defined by the 

13 Secretary. 

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

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

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

20 either directly or by grant or contract, provide technical 

21 assistance to enable any health entity to comply with the 

22 requirements of this section. 

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

24 are authorized to be appropriated to carry out this section 


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

2 2015 through 2020.’’. 

3 SEC. 104. REVISION OF HIPAA CLAIMS STANDARDS. 

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

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

6 Human Services shall revise the regulations promulgated 

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

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

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

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

12 data collection on race, ethnicity, primary language, 

13 disability, and sex developed under section 3101 of 

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

15 and 

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

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

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

22 subject to the regulations described in such subsection and 

23 provide technical assistance with respect to the collection 

24 of the data involved. 


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

2 Human Services shall require that health entities comply 

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

4 later than 2 years after the final promulgation of such 

5 standards. 

6 SEC. 105. NATIONAL CENTER FOR HEALTH STATISTICS. 

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

8 U.S.C. 242k(n)) is amended— 

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

10 inserting ‘‘2020’’; 

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

12 striking ‘‘2003’’ and inserting ‘‘2020’’; and 

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

14 inserting ‘‘2020’’. 

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

16 HAWAIIANS, OR PACIFIC ISLANDERS AND 

17 OTHER UNDERREPRESENTED GROUPS IN 

18 FEDERAL HEALTH SURVEYS. 

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

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


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

2 HAWAIIANS, OR PACIFIC ISLANDERS AND 

3 OTHER UNDERREPRESENTED GROUPS IN 

4 FEDERAL HEALTH SURVEYS. 

5 ‘‘(a) NATIONAL STRATEGY.— 

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

7 and Human Services, acting through the Director of 

8 the National Center for Health Statistics (referred 

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

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

13 develop and implement an ongoing and sustainable 

14 national strategy for oversampling Asian-Americans, 

15 Native Hawaiians, or Pacific Islanders, and other 

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

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

21 the enactment of the this section, the Secretary— 

22 ‘‘(A) shall consult with representatives of 

23 community groups, nonprofit organizations, 

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


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1 Native Hawaiians, or Pacific Islanders, and 

2 other underrepresented populations; and 

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

5 and agencies. 

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

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

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

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

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

14 2015 through 2020.’’. 

15 SEC. 107. GEO-ACCESS STUDY. 

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

18 (1) conduct a study to— 

19 (A) determine which geographic areas of 

20 the United States have shortages of specialty 

21 mental health providers; and 

22 (B) assess the preparedness of speciality 

23 mental health providers to deliver culturally and 

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


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

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

4 COLLECTED BY THE FEDERAL GOVERNMENT. 

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

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

8 and office of the Federal Government that has collected 

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

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

13 Not later than April 30, 2015, and each April 30 there14 after, the Secretary of Health and Human Services, acting 

15 through the Director of the National Institute on Minority 

16 Health and Health Disparities and the Deputy Assistant 

17 Secretary for Minority Health, shall— 

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

19 primary language data submitted under subsection 

20 (a) for the preceding calendar year; 

21 (2) make publicly available such data and the 

22 results of such analysis; and 

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

24 data and analysis. 


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

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

4 Human Services, acting through the National Institute on 

5 Minority Health and Health Disparities and the Office of 

6 Minority Health, may award grants to access and analyze 

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

9 and eliminate disparities in health and health care. 

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

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

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

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

18 OF HEALTH DATA. 

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

20 U.S.C. 300kk(a)) is amended— 

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

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

23 status’’; 

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

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

26 status’’; and 


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

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

3 status’’. 

4 SEC. 111. STANDARDS FOR MEASURING SOCIOECONOMIC 

5 STATUS IN COLLECTION OF HEALTH DATA. 

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

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

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

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

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

14 SEC. 112. SAFETY AND EFFECTIVENESS OF DRUGS WITH 

15 RESPECT TO RACIAL AND ETHNIC BACK16 GROUND. 

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

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

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

21 RESPECT TO RACIAL AND ETHNIC BACK22 GROUND. 

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

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


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1 ethnic background as to the safety or effectiveness of a 

2 drug, then— 

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

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

7 of the Public Health Service Act for approval of a 

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

10 the disparity; and 

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

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

14 ‘‘(b) POSTMARKET STUDIES.— 

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

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

17 ethnic background as to the safety or effectiveness 

18 of a drug for which there is an approved application 

19 under section 505 or a license under section 351 of 

20 the Public Health Service Act, the Secretary may by 

21 order require the holder of the approved application 

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


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

2 that the postmarket studies confirm that there is a 

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

4 the drug shall include appropriate information about 

5 the disparity. 

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

7 specify all aspects of study design, including the 

8 number of studies and study participants, and the 

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

11 studies of the drug. 

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

13 Secretary may by order modify any aspect of the 

14 study design as necessary after issuing an order 

15 under paragraph (1). 

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

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

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

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

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

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

25 basis of racial or ethnic background as to safety or 


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1 effectiveness of a drug in the same chemical class as 

2 the drug; 

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

4 basis of racial or ethnic background in the way the 

5 drug is metabolized; and 

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

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

9 AND 505(j).— 

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

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

13 under that section or misbranded under section 502 

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

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

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

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

24 require that the labeling of a drug approved under 

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


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1 disparity on the basis of racial or ethnic background 

2 as to the safety or effectiveness of the drug include 

3 a statement of any appropriate contraindications, 

4 warnings, or precautions related to the disparity 

5 that the Secretary considers necessary.’’. 

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

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

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

10 application under section 505 or license under section 351 

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

12 to complete the investigations or studies, or comply with 

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

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

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

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

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

18 SEC. 113. IMPROVING HEALTH DATA REGARDING NATIVE 

19 HAWAIIANS AND OTHER PACIFIC ISLANDERS. 

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

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

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

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


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

4 church group, social service group, national advocacy 

5 organization, or cultural group. 

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

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

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

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

16 ‘‘(4) GOVERNMENT REPRESENTATIVES.—The 

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

21 Palau, and the Republic of the Marshall Islands. 

22 ‘‘(5) NATIVE HAWAIIANS AND OTHER PACIFIC

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

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


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

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

5 island. 

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

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

9 Virgin Islands, the Federated States of Micronesia, 

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

12 ‘‘(b) NATIONAL STRATEGY.— 

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

14 through the Director of the National Center for 

15 Health Statistics (referred to in this section as 

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

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

22 and health care needs of NHOPI populations living 

23 in the continental United States, Hawaii, American 

24 Samoa, the Commonwealth of the Northern Mariana 

25 Islands, the Federated States of Micronesia, Guam, 


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

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

6 enactment of the Health Equity and Accountability 

7 Act of 2014, the Secretary— 

8 ‘‘(A) shall consult with representatives of 

9 community groups, designated organizations, 

10 and nonprofit, nongovernmental organizations 

11 and with government representatives of NHOPI 

12 populations; and 

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

15 ‘‘(c) PRELIMINARY HEALTH SURVEY.— 

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

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

19 areas and regions in the continental United States, 

20 Hawaii, American Samoa, the Commonwealth of the 

21 Northern Mariana Islands, the Federated States of 

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

23 Republic of the Marshall Islands in which NHOPI 

24 people reside. 


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

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

3 other data the Secretary determines to be— 

4 ‘‘(A) useful in determining health status 

5 and health care needs; or 

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

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

9 health survey described in paragraph (1), including 

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

14 government representatives of NHOPI populations, 

15 as determined by the Secretary. 

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

17 this subsection shall be completed not later than 18 

18 months after the date of enactment of the Health 

19 Equity and Accountability Act of 2014. 

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

21 after the date of enactment of the Health Equity and Ac22 countability Act of 2014, the Secretary shall submit to 

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

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


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

2 into an agreement with the Institute of Medicine to 

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

5 ‘‘(A) The standards and definitions of 

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

8 standards and definitions. 

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

10 care systems in insular areas, evaluated based 

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

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

16 ‘‘(D) The progress toward implementation 

17 of recommendations of the Committee on 

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

22 Course for the 21st Century’. 

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

24 paragraph (1) shall require the Institute of Medicine 

25 to submit to the Secretary and to Congress, not 


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1 later than 2 years after the date of the enactment 

2 of the Health Equity and Accountability Act of 

3 2014, a report containing a description of the results 

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

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

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

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

12 2015 through 2020.’’. 

13 SEC. 114. CLARIFICATION OF SIMPLIFIED ADMINISTRATIVE 

14 REPORTING REQUIREMENT. 

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

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

17 following: 

18 ‘‘(5) SIMPLIFIED ADMINISTRATIVE REPORTING

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

21 Responsibility and Work Opportunity Reconciliation 

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

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

24 aggregate number of exceptions granted under such 

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


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1 TITLE II—CULTURALLY AND LIN2 GUISTICALLY APPROPRIATE 

3 HEALTH CARE 

4 SEC. 201. DEFINITIONS. 

5 In this title, the definitions contained in section 3400 

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

7 shall apply. 

8 SEC. 202. AMENDMENT TO THE PUBLIC HEALTH SERVICE 

9 ACT. 

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

11 (1) Effective communication is essential to 

12 meaningful access to quality physical and mental 

13 health care. 

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

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

18 limited-English-proficient individuals and individuals 

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

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

22 residents in the United States who speak English 

23 less than very well and, therefore, cannot effectively 

24 communicate with health and social service providers 

25 continues to increase significantly. 


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1 (4) The responsibility to fund language services 

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

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

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

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

10 prohibits discrimination based on the grounds of 

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

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

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

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

18 with equal access to benefits and services for which 

19 such persons qualify. 

20 (6) Linguistic diversity in the health care and 

21 health-care-related-services workforce is important 

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

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


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

3 issues and help them identify resources to improve 

4 access to quality care for limited-English-proficient 

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

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

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

12 health care. 

13 (9) Competent language services in health care 

14 settings should be available as a matter of course. 

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

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

17 the following: 

18 ‘‘TITLE XXXIV—CULTURALLY 

19 AND LINGUISTICALLY APPRO20 PRIATE HEALTH CARE 

21 ‘‘SEC. 3400. DEFINITIONS. 

22 ‘‘In this title: 

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


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

2 ‘community health worker’ includes a community 

3 health advocate, a lay health educator, a community 

4 health representative, a peer health promoter, a 

5 community health outreach worker, and in Spanish, 

6 promotores de salud. 

7 ‘‘(3) COMPETENT INTERPRETER SERVICES.— 

8 The term ‘competent interpreter services’ means a 

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

11 ‘‘(A) comprehends the source language and 

12 can communicate comprehensively in the target 

13 language to convey the meaning intended in the 

14 source language; and 

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

17 by choosing equivalent expressions that convey 

18 the best matching and meaning to the source 

19 language and capture, to the greatest possible 

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

22 ‘‘(4) COMPETENT TRANSLATION SERVICES.— 

23 The term ‘competent translation services’ means a 

24 translanguage rendition of a written document in 

25 which the translator— 


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1 ‘‘(A) comprehends the source language and 

2 can write or sign comprehensively in the target 

3 language to convey the meaning intended in the 

4 source language; and 

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

7 choosing equivalent expressions that convey the 

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

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

15 system, agency, or among professionals that enables 

16 effective work in cross-cultural situations. In the 

17 preceding sentence— 

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

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

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

24 intersex individuals, and individuals with phys25 ical and mental disabilities; and 


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

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

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

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

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

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

10 services who is limited in English proficiency, or has 

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

13 understanding, and benefit from health care or 

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

15 the development of their treatment plan. 

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

17 term ‘grievance resolution process’ means all aspects 

18 of dispute resolution including filing complaints, 

19 grievance and appeal procedures, and court action. 

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

21 care group’ means a group of physicians organized, 

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

25 other individual or entity furnishing services covered 


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1 under the Medicaid, SCHIP, or Medicare programs 

2 that is affiliated with the health care group. 

3 ‘‘(9) HEALTHCARE SERVICES.—The term 

4 ‘health care services’ means services that address 

5 physical as well as mental health conditions in all 

6 care settings. 

7 ‘‘(10) HEALTH-CARE-RELATED SERVICES.—The 

8 term ‘health-care-related services’ means human or 

9 social services programs or activities that provide ac10 cess, referrals or links to health care. 

11 ‘‘(11) INDIAN TRIBE.—The term ‘Indian tribe’ 

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

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

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

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

21 ‘‘(12) INTEGRATED HEALTH CARE DELIVERY

22 SYSTEM.—The term ‘integrated health care delivery 

23 system’ means an interdisciplinary system that 

24 brings together providers from the primary health, 

25 mental health, substance use and related disciplines 


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1 to improve the health outcomes of an individual. 

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

4 and providers, home health agencies, ambulatory 

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

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

9 terms ‘interpreting’ and ‘interpretation’ mean the 

10 transmission of a spoken, written, or signed message 

11 from one language or format into another, faithfully, 

12 accurately, and objectively. 

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

14 access’ means the provision of language services to 

15 an LEP individual or individual with communication 

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

18 care or health-care-related services. 

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

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


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

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

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

5 respective programs under titles XVIII, XIX, and 

6 XXI of the Social Security Act. 

7 ‘‘(18) MINORITY.— 

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

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

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

12 with respect to populations, refers to racial and 

13 ethnic minority groups. 

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

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

16 ethnic minority group’. 

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

18 The term ‘racial and ethnic minority group’ means 

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

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

23 Pacific Islanders. 

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

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1 preting or interpretation for which the interpreter is 

2 in the physical presence of the provider of health 

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

4 of such services who is limited in English proficiency 

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

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

8 means the Secretary of Health and Human Services. 

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

10 translation’ means the transmission of a written 

11 message in one language into a spoken or signed 

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

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

15 the several States, the District of Columbia, the 

16 Commonwealth of Puerto Rico, the Indian tribes, 

17 the United States Virgin Islands, Guam, American 

18 Samoa, and the Commonwealth of the Northern 

19 Mariana Islands. 

20 ‘‘(25) TELEPHONIC INTERPRETATION.—The 

21 term ‘telephonic interpretation’ (also known as over 

22 the phone interpretation or OPI) means a method of 

23 interpreting/interpretation for which the interpreter 

24 is not in the physical presence of the provider of 

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1 English-proficient recipient of such services but is 

2 connected via telephone. 

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

4 means the transmission of a written message in one 

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

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

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

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

12 not in the physical presence of the provider of health 

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

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

16 transmission. 

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

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

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

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1 taining to the reduction, denial, or termination of 

2 services or benefits, notices of the right to appeal 

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

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

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

11 13166, it is the purpose of this section— 

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

14 assisted programs and activities for individuals who 

15 are limited in their English proficiency; 

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

17 the services it provides and develop and implement 

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

20 access to those services consistent with, and without 

21 substantially burdening, the fundamental mission of 

22 the agency; 

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

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


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

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

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

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

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

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

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

14 provision of services. 

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

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

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

23 limited-English-proficient individuals. Not later than 

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


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1 each such Federal agency shall ensure that such 

2 plan is fully implemented. 

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

4 paragraph (1) shall include— 

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

7 have access to the agency’s federally conducted 

8 health care and health-care-related programs 

9 and activities; 

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

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

14 federally conducted programs and activities; 

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

16 federally conducted programs and activities to 

17 improve cultural competence to provide a range 

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

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

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


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

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

8 federally assisted programs and activities for 

9 such a limited-English-proficient individual; 

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

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

13 health care or health-care-related programs and 

14 activities for limited-English-proficient individ15 uals; 

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

17 to ensure that competent language assistance is 

18 provided to limited-English-proficient patients 

19 by interpreters or trained bilingual staff; and 

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

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

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


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1 obtaining a competent interpreter would 

2 jeopardize the health of the patient; or 

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

4 has been informed in his or her preferred 

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

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

11 agency that is required to prepare a plan under 

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

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

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

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

19 exempt from legal or regulatory requirements related 

20 to competent interpreter services. 

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

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

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1 nancial assistance shall ensure that the guidance for 

2 recipients of Federal financial assistance developed 

3 by the agency to ensure compliance with title VI of 

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

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

6 assistance. Each agency shall send a copy of such 

7 guidance to the Department of Justice which shall 

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

9 After approval by the Department of Justice, each 

10 agency shall publish its guidance document in the 

11 Federal Register for public comment. 

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

13 guidance developed under paragraph (1) shall take 

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

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

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

19 that has developed a guidance for purposes of title 

20 VI of the Civil Rights Act of 1964 shall examine 

21 such existing guidance, as well as the programs and 

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

24 comply with this subsection. 


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

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

4 ‘‘(d) CONSULTATIONS.— 

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

7 care and health-care-related activities shall ensure 

8 that stakeholders, such as limited-English-proficient 

9 individuals and their representative organizations, 

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

13 of the agency. 

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

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

18 agency; 

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

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

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

25 its recipients. 


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

2 LINGUISTICALLY APPROPRIATE SERVICES IN 

3 HEALTH CARE. 

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

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

6 Federal financial assistance, including credits, subsidies, 

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

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

11 programs, activities, agencies, and entities are described 

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

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

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

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

19 and linguistically appropriate health care to patient 

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

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

23 and workforce at all levels and across all disciplines 

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

25 culturally and linguistically appropriate policies and 

26 practices on an ongoing basis; 


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

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

6 of operation, to facilitate timely access to all health 

7 care and services; 

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

9 manner, of their right to receive language assistance 

10 services in their primary language, verbally and in 

11 writing; 

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

14 by interpreters and bilingual staff, and ensure that 

15 family, particularly minor children, and friends are 

16 not used to provide interpretation services— 

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

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

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

21 services if the health care services provider has 

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

24 section 3400; 


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

2 constitutes 5 percent or 500 individuals, whichever 

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

4 served or likely to be affected or encountered in the 

5 service area of the organization, make available— 

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

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

11 ‘‘(C) signage; 

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

17 and operations; 

18 ‘‘(8) conduct initial and ongoing organizational 

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

21 linguistic, competence-related National Standards 

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


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

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

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

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

11 needs, are— 

12 ‘‘(A) collected in health records; 

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

14 management information systems; and 

15 ‘‘(C) periodically updated; 

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

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

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

20 and implement services that respond to the cultural 

21 and linguistic characteristics of the service area of 

22 the organization; 

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

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

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

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

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

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

16 the head of each Federal entity from which Federal 

17 funds are received, information about their progress 

18 and successful innovations in implementing the 

19 standards under this section as required by the head 

20 of such entity. 

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

22 AND LINGUISTIC COMPETENCE IN HEALTH 

23 CARE. 

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

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1 search and Quality, shall establish and support a center 

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

3 and Linguistic Competence in Health Care’ (referred to 

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

5 activities: 

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

7 shall provide resources via the Internet to identify 

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

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

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

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

14 health care and health-care-related services at 

15 no cost to such providers. Materials may be 

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

18 in a timely and reasonable manner. The quality 

19 of such translation services shall be monitored 

20 and reported publicly. 

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

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

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1 guages in the United States according to the 

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

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

6 the Office of Management and Budget. 

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

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

10 for LEP individuals— 

11 ‘‘(A) to obtain information about federally 

12 conducted or funded health programs, including 

13 Medicare, Medicaid, and SCHIP; 

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

15 or accessing these programs and understanding 

16 Federal notices written in English; and 

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

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

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

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


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1 improve medical outcomes, to improve cultural 

2 competence, reduce health care costs caused by 

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

8 Such information shall include the information 

9 described in the succeeding provisions of this 

10 paragraph. 

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

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

17 following: 

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

20 ‘‘(I) intake forms; 

21 ‘‘(II) Medicare, Medicaid, and 

22 SCHIP forms, including eligibility in23 formation; 

24 ‘‘(III) forms informing patient of 

25 HIPAA compliance and consent; and 


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

3 and waivers of rights. 

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

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

7 prevention and treatment instructions. 

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

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

11 notices. 

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

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

17 ‘‘(i) ensure that the documents posted 

18 in English and non-English languages are 

19 culturally appropriate; 

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


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1 ‘‘(iii) allow health care providers to 

2 customize the documents for their use; 

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

5 ‘‘(v) provide technical assistance with 

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

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

9 Secretary determines to be useful to fulfill 

10 the purposes of the clearinghouse. 

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

15 and strategies to improve language services for 

16 LEP individuals, including case studies using 

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

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

23 populations residing in the United States to all 

24 health care providers and health-care-related 


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

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

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

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

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

11 types of providers of health care and 

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

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

18 ‘‘(F) INFORMATION ABOUT PROGRESS.— 

19 The Center shall regularly collect and make 

20 publicly available information about the 

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

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


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1 communities about the availability of this infor2 mation. 

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

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

5 to, the Director of the Agency for Healthcare Research 

6 and Quality. 

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

14 by the Center. 

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

16 through contract, shall undertake a national education 

17 campaign to inform providers, LEP individuals, health 

18 professionals, graduate schools, and community health 

19 centers about— 

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

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

23 the risks associated with using family members, 

24 friends, minors, and untrained bilingual staff; 


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

3 ‘‘(4) promising practices to effectively provide 

4 language services. 

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

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

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

9 of fiscal years 2015 through 2019. 

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

11 COMPETENCE GRANTS. 

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

13 the Director of the Agency for Healthcare Research and 

14 Quality, shall award grants to eligible entities to enable 

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

18 with limited-English proficiency. The Director of the 

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

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

24 of Minority Health, regarding the design and evaluation 

25 of the grants program. 


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

2 under subsection (a) an entity shall— 

3 ‘‘(1) be— 

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

5 territory, or subdivision thereof; 

6 ‘‘(B) an organization described in section 

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

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

9 such Code; 

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

11 or substance use center or clinic; 

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

13 ‘‘(E) an integrated health care delivery 

14 system; 

15 ‘‘(F) a public hospital; 

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

17 college; or 

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

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

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

23 Secretary may require. 

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


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

2 providing competent interpretation services through 

3 onsite interpretation, telephonic interpretation, or 

4 video interpretation; 

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

6 promote individuals at all levels of the organization 

7 to maintain a diverse staff and leadership that can 

8 promote and provide language services to patient 

9 populations of the service area of the organization; 

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

11 that identifies the current demographic, cultural, 

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

14 needed in service area of the organization; 

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

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

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

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

23 sensitive and capable of identifying, preventing, and 

24 resolving complaints by LEP individuals; or 


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

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

4 in the workplace; 

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

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

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

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

16 ‘‘(11) develop other language assistance services 

17 as determined appropriate by the Secretary; 

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

19 of improving cultural competence; and 

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

21 protections provided for under the regulations pro22 mulgated under section 264(c) of the Health Insur23 ance Portability and Accountability Act of 1996 (42 

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1 ent’s race, ethnicity, and primary language are col2 lected (and periodically updated) in health records 

3 and integrated into the organization’s information 

4 management systems or any similar system used to 

5 store and retrieve data. 

6 ‘‘(d) PRIORITY.—In awarding grants under this sec7 tion, the Secretary shall give priority to entities that pri8 marily engage in providing direct care and that have devel9 oped partnerships with community organizations or with 

10 agencies with experience in improving language access. 

11 ‘‘(e) EVALUATION.— 

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

13 grant under this section shall submit to the Sec14 retary an evaluation that describes, in the manner 

15 and to the extent required by the Secretary, the ac16 tivities carried out with funds received under the 

17 grant, and how such activities improved access to 

18 health and health-care-related services and the qual19 ity of health care for individuals with limited-English 

20 proficiency. Such evaluation shall be collected and 

21 disseminated through the Robert T. Matsui Center 

22 for Cultural and Linguistic Competence in Health 

23 Care established under section 3403. The Director 

24 of the Agency for Healthcare Research and Quality 

25 shall notify grantees of the availability of technical 


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1 assistance for the evaluation and provide such assist2 ance upon request. 

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

4 Agency for Healthcare Research and Quality shall 

5 evaluate or arrange with other individuals or organi6 zations to evaluate projects funded under this sec7 tion. 

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

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

10 $5,000,000 for each of fiscal years 2015 through 2019. 

11 ‘‘SEC. 3405. RESEARCH ON CULTURAL AND LANGUAGE COM12 PETENCE. 

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

14 the Director of the Agency for Healthcare Research and 

15 Quality, shall expand research concerning language access 

16 in the provision of health care. 

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

18 Healthcare Research and Quality may conduct the re19 search described in subsection (a) or enter into contracts 

20 with other individuals or organizations to do so. 

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

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

23 ‘‘(1) To identify the barriers to mental and be24 havioral services that are faced by LEP individuals. 


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

2 health administrators’ attitudes, knowledge, and 

3 awareness of the barriers to quality health care serv4 ices that are faced by LEP individuals. 

5 ‘‘(3) To identify optimal approaches for deliv6 ering language access. 

7 ‘‘(4) To identify best practices for data collec8 tion, including— 

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

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

11 the race, ethnicity, and primary language of re12 cipients of such services, taking into account ex13 isting research conducted by the Government or 

14 private sector; 

15 ‘‘(B) the development and implementation 

16 of data collection and reporting systems; and 

17 ‘‘(C) effective privacy safeguards for col18 lected data. 

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

20 for primary language. 

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

22 which the Department can create or coordinate, and 

23 then subsidize or otherwise fund telephonic interpre24 tation providers for health care providers, taking 

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1 bility necessary for such a system to accommodate 

2 variations in— 

3 ‘‘(A) provider type; 

4 ‘‘(B) languages needed and their frequency 

5 of use; 

6 ‘‘(C) type of encounter; 

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

8 business hours and after hours; and 

9 ‘‘(E) location of encounter. 

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

11 are authorized to be appropriated to carry out this section 

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

13 2015 through 2019.’’. 

14 SEC. 203. PILOT PROGRAM FOR IMPROVEMENT AND DE15 VELOPMENT OF STATE MEDICAL INTER16 PRETING SERVICES. 

17 (a) GRANTS AUTHORIZED.—The Secretary shall 

18 award one grant in accordance with this section to each 

19 of three States to assist each such State in designing, im20 plementing, and evaluating a statewide program to provide 

21 onsite interpreter services under Medicaid. 

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

23 section is authorized for a period of three fiscal years be24 ginning on October 1, 2014. 


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

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

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

4 enrollees, as determined by the Secretary; 

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

6 enrollees, as determined by the Secretary; 

7 (3) that has a high growth rate of the popu8 lation of LEP individuals, as determined by the Sec9 retary; and 

10 (4) that has a population of qualified LEP en11 rollees that is linguistically diverse, requiring inter12 preter services in at least 200 non-English lan13 guages. 

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

15 this section shall use the grant funds to— 

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

17 State participating in the State plan under Medicaid 

18 have access to onsite interpreter services, for the 

19 purpose of enabling effective communication between 

20 such providers and qualified LEP enrollees during 

21 the furnishing of items and services and administra22 tive interactions; 

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

24 (A) a statewide health care information 

25 technology system that is designed to achieve 


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1 efficiencies and economies of scale with respect 

2 to onsite interpreter services provided to health 

3 care providers in the State participating in the 

4 State plan under Medicaid; and 

5 (B) an entity to administer such system, 

6 the duties of which shall include— 

7 (i) procuring and scheduling inter8 preter services for qualified LEP enrollees; 

9 (ii) procuring and scheduling inter10 preter services for LEP individuals seeking 

11 to enroll in the State plan under Medicaid; 

12 (iii) ensuring that interpreters receive 

13 payment for interpreter services rendered 

14 under the system; and 

15 (iv) consulting regularly with organi16 zations representing consumers, inter17 preters, and health care providers; and 

18 (3) develop mechanisms to establish, improve, 

19 and strengthen the competency of the medical inter20 pretation workforce that serves qualified LEP enroll21 ees in the State, including a national certification 

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

23 (e) APPLICATION.—To receive a grant under this sec24 tion, a State shall submit an application at such time and 


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1 containing such information as the Secretary may require, 

2 which shall include the following: 

3 (1) A description of the language access needs 

4 of individuals in the State enrolled in the State plan 

5 under Medicaid. 

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

7 program will— 

8 (A) use the grant funds for the purposes 

9 described in subsection (d); 

10 (B) meet the health care needs of rural 

11 populations of the State; and 

12 (C) collect information that accurately 

13 tracks the language services requested by con14 sumers as compared to the language services 

15 provided by health care providers in the State 

16 participating in the State plan under Medicaid. 

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

18 evaluated, including a proposal for collaboration with 

19 organizations representing interpreters, consumers, 

20 and LEP individuals. 

21 (f) DEFINITIONS.—In this section: 

22 (1) QUALIFIED LEP ENROLLEE.—The term 

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

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


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

2 Medicaid. 

3 (2) STATE.—The term ‘‘State’’ has the mean4 ing given the term in section 1101(a)(1) of the So5 cial Security Act (42 U.S.C. 1301(a)(1)), for pur6 poses of title XIX of such Act. 

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

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

9 1101(a)(2) of the Social Security Act (42 U.S.C. 

10 1301(a)(2)), for purposes of title XIX of such Act. 

11 (g) FUNDING.— 

12 (1) AUTHORIZATION OF APPROPRIATIONS.— 

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

14 to carry out this section. 

15 (2) AVAILABILITY OF FUNDS.—The funds au16 thorized by paragraph (1) shall be available without 

17 fiscal year limitation. 

18 (3) INCREASED FEDERAL FINANCIAL PARTICI19 PATION.—Section 1903(a)(2)(E) of the Social Secu20 rity Act (42 U.S.C. 1396b(a)(2)(E)), as amended by 

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

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

23 grant under section 203 of the Health Equity and 

24 Accountability Act of 2014, 100 percent for each 


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1 quarter occurring during the grant period)’’ after 

2 ‘‘90 percent’’. 

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

5 location outside the United States. 

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

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

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

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

17 for purposes of this subsection, all the time that 

18 is spent by an intern or resident in an approved 

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

21 linguistically appropriate service delivery shall 

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

24 (b) INDIRECT MEDICAL EDUCATION.—Section 

25 1886(d)(5)(B) of the Social Security Act (42 U.S.C. 


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1 1395ww(d)(5)(B)) is amended by adding at the end the 

2 following new clause: 

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

4 of subsection (h)(4) shall apply under this sub5 paragraph in the same manner as they apply 

6 under such subsection.’’. 

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

8 subsections (a) and (b) shall apply with respect to pay9 ments made to hospitals on or after the date that is one 

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

11 SEC. 205. FEDERAL REIMBURSEMENT FOR CULTURALLY 

12 AND LINGUISTICALLY APPROPRIATE SERV13 ICES UNDER THE MEDICARE, MEDICAID, AND 

14 STATE CHILDREN’S HEALTH INSURANCE 

15 PROGRAMS. 

16 (a) LANGUAGE ACCESS GRANTS FOR MEDICARE

17 PROVIDERS.— 

18 (1) ESTABLISHMENT.— 

19 (A) IN GENERAL.—Not later than 6 

20 months after the date of the enactment of this 

21 Act, the Secretary of Health and Human Serv22 ices, acting through the Centers for Medicare & 

23 Medicaid Services and in consultation with the 

24 Center for Medicare and Medicaid Innovation, 

25 shall establish a demonstration program under 


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1 which the Secretary shall award grants to eligi2 ble Medicare service providers to improve com3 munication between such providers and limited4 English-proficient Medicare beneficiaries, in5 cluding beneficiaries who live in diverse and un6 derserved communities. 

7 (B) APPLICATION OF INNOVATION

8 RULES.—The demonstration project under sub9 paragraph (A) shall be conducted in a manner 

10 that is consistent with the applicable provisions 

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

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

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

14 practicable, the Secretary shall award not less 

15 than 24 grants under this subsection. 

16 (D) GRANT PERIOD.—Except as provided 

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

18 under this subsection shall be for a 3-year pe19 riod. 

20 (2) ELIGIBILITY REQUIREMENTS.—To be eligi21 ble for a grant under this subsection, an entity must 

22 meet the following requirements: 

23 (A) MEDICARE PROVIDER.—The entity 

24 must be— 


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1 (i) a provider of services under part A 

2 of title XVIII of the Social Security Act; 

3 (ii) a provider of services under part 

4 B of such title; 

5 (iii) a Medicare Advantage organiza6 tion offering a Medicare Advantage plan 

7 under part C of such title; or 

8 (iv) a PDP sponsor offering a pre9 scription drug plan under part D of such 

10 title. 

11 (B) UNDERSERVED COMMUNITIES.—The 

12 entity must serve a community that, with re13 spect to necessary language services for improv14 ing access and utilization of health care among 

15 limited-English-proficient individuals, is 

16 disproportionally underserved. 

17 (C) APPLICATION.—The entity must pre18 pare and submit to the Secretary an applica19 tion, at such time, in such manner, and accom20 panied by such additional information as the 

21 Secretary may require. 

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

23 that received a grant under this subsection in 

24 a previous year, such grantee is only eligible for 

25 continued payments under a grant under this 


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1 subsection if the grantee met the reporting re2 quirements under paragraph (9) for such year. 

3 If a grantee fails to meet the requirement of 

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

5 Secretary may terminate the grant and solicit 

6 applications from new grantees to participate in 

7 the demonstration program. 

8 (3) DISTRIBUTION.—To the extent feasible, the 

9 Secretary shall award— 

10 (A) at least 6 grants to providers of serv11 ices described in paragraph (2)(A)(i); 

12 (B) at least 6 grants to service providers 

13 described in paragraph (2)(A)(ii); 

14 (C) at least 6 grants to organizations de15 scribed in paragraph (2)(A)(iii); and 

16 (D) at least 6 grants to sponsors described 

17 in paragraph (2)(A)(iv). 

18 (4) CONSIDERATIONS IN AWARDING GRANTS.— 

19 (A) VARIATION IN GRANTEES.—In award20 ing grants under this subsection, the Secretary 

21 shall select grantees to ensure the following: 

22 (i) The grantees provide many dif23 ferent types of language services. 

24 (ii) The grantees serve Medicare bene25 ficiaries who speak different languages, 


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1 and who, as a population, have differing 

2 needs for language services. 

3 (iii) The grantees serve Medicare 

4 beneficiaries in both urban and rural set5 tings. 

6 (iv) The grantees serve Medicare 

7 beneficiaries in at least two geographic re8 gions, as defined by the Secretary. 

9 (v) The grantees serve Medicare bene10 ficiaries in at least two large metropolitan 

11 statistical areas with racial, ethnic, and 

12 economically diverse populations. 

13 (B) PRIORITY FOR PARTNERSHIPS WITH

14 COMMUNITY ORGANIZATIONS AND AGENCIES.— 

15 In awarding grants under this subsection, the 

16 Secretary shall give priority to eligible entities 

17 that have a partnership with— 

18 (i) a community organization; or 

19 (ii) a consortia of community organi20 zations, State agencies, and local agencies, 

21 that has experience in providing language serv22 ices. 

23 (5) USE OF FUNDS FOR COMPETENT LANGUAGE

24 SERVICES.— 


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1 (A) IN GENERAL.—Subject to subpara2 graph (E), a grantee may only use grant funds 

3 received under this subsection to pay for the 

4 provision of competent language services to 

5 Medicare beneficiaries who are limited-English6 proficient. 

7 (B) COMPETENT LANGUAGE SERVICES DE8 FINED.—For purposes of this subsection, the 

9 term ‘‘competent language services’’ means— 

10 (i) interpreter and translation services 

11 that— 

12 (I) subject to the exceptions 

13 under subparagraph (C)— 

14 (aa) if the grantee operates 

15 in a State that has statewide 

16 health care interpreter standards, 

17 meet the State standards cur18 rently in effect; or 

19 (bb) if the grantee operates 

20 in a State that does not have 

21 statewide health care interpreter 

22 standards, utilizes competent in23 terpreters who follow the Na24 tional Council on Interpreting in 


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1 Health Care’s Code of Ethics and 

2 Standards of Practice; and 

3 (II) that, in the case of inter4 preter services, are provided 

5 through— 

6 (aa) onsite interpretation; 

7 (bb) telephonic interpreta8 tion; or 

9 (cc) video interpretation; 

10 and 

11 (ii) the direct provision of health care 

12 or health-care-related services by a com13 petent bilingual health care provider. 

14 (C) EXCEPTIONS.—The requirements of 

15 subparagraph (B)(i)(I) do not apply, with re16 spect to interpreter and translation services and 

17 a grantee— 

18 (i) in the case of a Medicare bene19 ficiary who is limited-English-proficient 

20 if— 

21 (I) such beneficiary has been in22 formed, in the beneficiary’s primary 

23 language, of the availability of free in24 terpreter and translation services and 

25 the beneficiary instead requests that a 


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1 family member, friend, or other per2 son provide such services; and 

3 (II) the grantee documents such 

4 request in the beneficiary’s medical 

5 record; or 

6 (ii) in the case of a medical emergency 

7 where the delay directly associated with ob8 taining a competent interpreter or trans9 lation services would jeopardize the health 

10 of the patient. 

11 Subparagraph (C)(ii) shall not be construed to 

12 exempt emergency rooms or similar entities 

13 that regularly provide health care services in 

14 medical emergencies to limited-English-pro15 ficient patients from any applicable legal or reg16 ulatory requirements related to providing com17 petent interpreter and translation services with18 out undue delay. 

19 (D) MEDICARE ADVANTAGE ORGANIZA20 TIONS AND PDP SPONSORS.—If a grantee is a 

21 Medicare Advantage organization offering a 

22 Medicare Advantage plan under part C of title 

23 XVIII of the Social Security Act or a PDP 

24 sponsor offering a prescription drug plan under 

25 part D of such title, such entity must provide 


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1 at least 50 percent of the grant funds that the 

2 entity receives under this subsection directly to 

3 the entity’s network providers (including all 

4 health providers and pharmacists) for the pur5 pose of providing support for such providers to 

6 provide competent language services to Medi7 care beneficiaries who are limited-English-pro8 ficient. 

9 (E) ADMINISTRATIVE AND REPORTING

10 COSTS.—A grantee may use up to 10 percent of 

11 the grant funds to pay for administrative costs 

12 associated with the provision of competent lan13 guage services and for reporting required under 

14 paragraph (9). 

15 (6) DETERMINATION OF AMOUNT OF GRANT

16 PAYMENTS.— 

17 (A) IN GENERAL.—Payments to grantees 

18 under this subsection shall be calculated based 

19 on the estimated numbers of limited-English20 proficient Medicare beneficiaries in a grantee’s 

21 service area utilizing— 

22 (i) data on the numbers of limited23 English-proficient individuals who speak 

24 English less than ‘‘very well’’ from the 

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1 reau of the Census or other State-based 

2 study the Secretary determines likely to 

3 yield accurate data regarding the number 

4 of such individuals in such service area; or 

5 (ii) data provided by the grantee, if 

6 the grantee routinely collects data on the 

7 primary language of the Medicare bene8 ficiaries that the grantee serves and the 

9 Secretary determines that the data is accu10 rate and shows a greater number of lim11 ited-English-proficient individuals than 

12 would be estimated using the data under 

13 clause (i). 

14 (B) DISCRETION OF SECRETARY.—Subject 

15 to subparagraph (C), the amount of payment 

16 made to a grantee under this subsection may be 

17 modified annually at the discretion of the Sec18 retary, based on changes in the data under sub19 paragraph (A) with respect to the service area 

20 of a grantee for the year. 

21 (C) LIMITATION ON AMOUNT.—The 

22 amount of a grant made under this subsection 

23 to a grantee may not exceed $500,000 for the 

24 period under paragraph (1)(D). 


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1 (7) ASSURANCES.—Grantees under this sub2 section shall, as a condition of receiving a grant 

3 under this subsection— 

4 (A) ensure that clinical and support staff 

5 receive appropriate ongoing education and 

6 training in linguistically appropriate service de7 livery; 

8 (B) ensure the linguistic competence of bi9 lingual providers; 

10 (C) offer and provide appropriate language 

11 services at no additional charge to each patient 

12 with limited-English proficiency for all points of 

13 contact between the patient and the grantee, in 

14 a timely manner during all hours of operation; 

15 (D) notify Medicare beneficiaries of their 

16 right to receive language services in their pri17 mary language; 

18 (E) post signage in the primary languages 

19 commonly used by the patient population in the 

20 service area of the organization; and 

21 (F) ensure that— 

22 (i) primary language data are col23 lected for recipients of language services 

24 and such data are consistent with stand25 ards developed under title XXXIV of the 


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1 Public Health Service Act, as added by 

2 section 202 of this Act, to the extent such 

3 standards are available upon the initiation 

4 of the demonstration program; and 

5 (ii) consistent with the privacy protec6 tions provided under the regulations pro7 mulgated pursuant to section 264(c) of the 

8 Health Insurance Portability and Account9 ability Act of 1996 (42 U.S.C. 1320d–2 

10 note), if the recipient of language services 

11 is a minor or is incapacitated, primary lan12 guage data are collected on the parent or 

13 legal guardian of such recipient. 

14 (8) NO COST-SHARING.—Limited-English-pro15 ficient Medicare beneficiaries shall not have to pay 

16 cost-sharing or co-payments for competent language 

17 services provided under this demonstration program. 

18 (9) REPORTING REQUIREMENTS FOR GRANT19 EES.—Not later than the end of each calendar year, 

20 a grantee that receives funds under this subsection 

21 in such year shall submit to the Secretary a report 

22 that includes the following information: 

23 (A) The number of Medicare beneficiaries 

24 to whom competent language services are pro25 vided. 


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1 (B) The primary languages of those Medi2 care beneficiaries. 

3 (C) The types of language services pro4 vided to such beneficiaries. 

5 (D) Whether such language services were 

6 provided by employees of the grantee or 

7 through a contract with external contractors or 

8 agencies. 

9 (E) The types of interpretation services 

10 provided to such beneficiaries, and the approxi11 mate length of time such service is provided to 

12 such beneficiaries. 

13 (F) The costs of providing competent lan14 guage services. 

15 (G) An account of the training or accredi16 tation of bilingual staff, interpreters, and trans17 lators providing services funded by the grant 

18 under this subsection. 

19 (10) EVALUATION AND REPORT TO CON20 GRESS.—Not later than 1 year after the completion 

21 of a 3-year grant under this subsection, the Sec22 retary shall conduct an evaluation of the demonstra23 tion program under this subsection and shall submit 

24 to the Congress a report that includes the following: 


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1 (A) An analysis of the patient outcomes 

2 and the costs of furnishing care to the limited3 English-proficient Medicare beneficiaries par4 ticipating in the project as compared to such 

5 outcomes and costs for limited-English-pro6 ficient Medicare beneficiaries not participating, 

7 based on the data provided under paragraph (9) 

8 and any other information available to the Sec9 retary. 

10 (B) The effect of delivering language serv11 ices on— 

12 (i) Medicare beneficiary access to care 

13 and utilization of services; 

14 (ii) the efficiency and cost effective15 ness of health care delivery; 

16 (iii) patient satisfaction; 

17 (iv) health outcomes; and 

18 (v) the provision of culturally appro19 priate services provided to such bene20 ficiaries. 

21 (C) The extent to which bilingual staff, in22 terpreters, and translators providing services 

23 under such demonstration were trained or ac24 credited and the nature of accreditation or 

25 training needed by type of provider, service, or 


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1 other category as determined by the Secretary 

2 to ensure the provision of high-quality interpre3 tation, translation, or other language services to 

4 Medicare beneficiaries if such services are ex5 panded pursuant to subsection (c) of section 

6 1907 of this Act. 

7 (D) Recommendations, if any, regarding 

8 the extension of such project to the entire Medi9 care program, subject to the provisions of sec10 tion 1115A(c) of the Social Security Act. 

11 (11) APPROPRIATIONS.—There is appropriated 

12 to carry out this subsection, in equal parts from the 

13 Federal Hospital Insurance Trust Fund under sec14 tion 1817 of the Social Security Act (42 U.S.C. 

15 1395i) and the Federal Supplementary Medical In16 surance Trust Fund under section 1841 of such Act 

17 (42 U.S.C. 1395t), $16,000,000 for each fiscal year 

18 of the demonstration program. 

19 (b) LANGUAGE SERVICES UNDER THE MEDICARE

20 PROGRAM.— 

21 (1) INCLUSION AS RURAL HEALTH CLINIC

22 SERVICES.—Section 1861 of the Social Security Act 

23 (42 U.S.C. 1395x) is amended— 

24 (A) in subsection (aa)(1)— 


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1 (i) in subparagraph (B), by striking 

2 the ‘‘and’’ at the end; 

3 (ii) in subparagraph (C), by inserting 

4 ‘‘and’’ after the comma at the end; and 

5 (iii) by inserting after subparagraph 

6 (C) the following: 

7 ‘‘(D) language services as defined in sub8 section (iii)(1),’’; and 

9 (B) by adding at the end the following new 

10 subsection: 

11 ‘‘Language Services and Related Terms 

12 ‘‘(iii)(1) LANGUAGE SERVICES DEFINED.—The term 

13 ‘language services’ has the same meaning given ‘language 

14 or language access services’ in section 3400 of the Public 

15 Health Service Act. 

16 ‘‘(2) INTERPRETER SERVICES DEFINED.—For the 

17 purposes of this subsection, the term ‘interpreter services’ 

18 has the meaning given ‘competent interpreter services’ 

19 under section 3400(3) of the Public Health Service Act. 

20 ‘‘(3) INTERPRETER DEFINED.—The term ‘inter21 preter’— 

22 ‘‘(A) means an individual— 

23 ‘‘(i) who faithfully, accurately, and objec24 tively transmits a spoken message from one lan25 guage into another language; and 


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1 ‘‘(ii) who knows health and health-related 

2 terminology in both languages; and 

3 ‘‘(B) includes individuals who provide in-person, 

4 telephonic, and video interpretation. 

5 ‘‘(4) TRANSLATION DEFINED.—The term ‘trans6 lation’ means the transmission of a written message in one 

7 language into a written message in another language that 

8 retains the intended meaning of the original message. 

9 ‘‘(5) LIMITED-ENGLISH-PROFICIENT AND LEP DE10 FINED.—The terms ‘limited-English-proficient’ and ‘LEP’ 

11 have the meaning given the term ‘limited english pro12 ficient’ under section 9101(25) of the Elementary and 

13 Secondary Education Act of 1965, except that subpara14 graphs (A), (B), and (D) of such section not apply.’’. 

15 (2) COVERAGE.—Section 1832(a)(2) of such 

16 Act (42 U.S.C. 1395k(a)(2)) is amended— 

17 (A) by striking ‘‘and’’ at the end of sub18 paragraph (I); 

19 (B) by striking the period at the end of 

20 subparagraph (J) and inserting ‘‘; and’’; and 

21 (C) by adding at the end of subparagraph 

22 (J) the following: 

23 ‘‘(K) language services (as defined in para24 graph (1) of section 1861(iii)) furnished by an 


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1 interpreter (as defined in paragraph (3) of such 

2 section) or translator.’’. 

3 (3) PAYMENT.—Section 1833(a) of the Social 

4 Security Act (42 U.S.C. 1395l(a)) is amended— 

5 (A) by striking ‘‘and’’ at the end of para6 graph (8); 

7 (B) by redesignating paragraph (9) as 

8 paragraph (10); and 

9 (C) by inserting after paragraph (8) the 

10 following new paragraph: 

11 ‘‘(9) in the case of language services described 

12 in section 1861(iii)(1), 100 percent of the reasonable 

13 charges for such services, as determined in consulta14 tion with the Medicare Payment Advisory Commis15 sion; and’’. 

16 (4) WAIVER OF BUDGET NEUTRALITY.—For 

17 the 3-year period beginning on the date of enact18 ment of this section, the budget neutrality provision 

19 of section 1848(c)(2)(B)(ii) of the Social Security 

20 Act (42 U.S.C. 1395w–4(c)(2)(B)(ii)) shall not 

21 apply with respect to language services (as such 

22 term is defined in section 1861(iii)(1) of such Act). 

23 (c) MEDICARE PARTS C AND D.— 

24 (1) IN GENERAL.—Medicare Advantage plans 

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1 scription drug plans under part D of such Act shall 

2 comply with title VI of the Civil Rights Act of 1964 

3 and section 1557 of the Patient Protection and Af4 fordable Care Act to provide effective language serv5 ices to enrollees of such plans. 

6 (2) MEDICARE ADVANTAGE PLANS AND PRE7 SCRIPTION DRUG PLANS REPORTING REQUIRE8 MENT.—Section 1857(e) of the Social Security Act 

9 (42 U.S.C. 1395w–27(e)) is amended by adding at 

10 the end the following new paragraph: 

11 ‘‘(5) REPORTING REQUIREMENTS RELATING TO

12 EFFECTIVE LANGUAGE SERVICES.—A contract under 

13 this part shall require a Medicare Advantage organi14 zation (and, through application of section 1860D– 

15 12(b)(3)(D), a contract under section 1860D–12 

16 shall require a PDP sponsor) to annually submit 

17 (for each year of the contract) a report that contains 

18 information on the plan’s internal policies and proce19 dures related to recruitment and retention efforts di20 rected to workforce diversity and linguistically and 

21 culturally appropriate provision of services in each of 

22 the following contexts: 

23 ‘‘(A) The collection of data in a manner 

24 that meets the requirements of title I of the 


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1 Health Equity and Accountability Act of 2014, 

2 regarding the enrollee population. 

3 ‘‘(B) Education of staff and contractors 

4 who have routine contact with enrollees regard5 ing the various needs of the diverse enrollee 

6 population. 

7 ‘‘(C) Evaluation of the health plan’s lan8 guage services programs and services with re9 spect to the plan’s enrollee population, such as 

10 through analysis of complaints or satisfaction 

11 survey results. 

12 ‘‘(D) Methods by which the plan provides 

13 to the Secretary information regarding the eth14 nic diversity of the plan’s enrollee population. 

15 ‘‘(E) The periodic provision of educational 

16 information to plan enrollees on the plan’s lan17 guage services and programs.’’. 

18 (d) IMPROVING LANGUAGE SERVICES IN MEDICAID

19 AND CHIP.— 

20 (1) PAYMENTS TO STATES.—Section 

21 1903(a)(2)(E) of the Social Security Act (42 U.S.C. 

22 1396b(a)(2)(E)) is amended by— 

23 (A) striking ‘‘75’’ and inserting ‘‘90’’; 


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1 (B) striking ‘‘translation or interpretation 

2 services’’ and inserting ‘‘language services’’; 

3 and 

4 (C) striking ‘‘children of families’’ and in5 serting ‘‘individuals’’. 

6 (2) STATE PLAN REQUIREMENTS.—Section 

7 1902(a)(10)(A) of the Social Security Act (42 

8 U.S.C. 1396a(a)(10)(A)) is amended by striking 

9 ‘‘and (28)’’ and inserting ‘‘(28), and (29)’’. 

10 (3) DEFINITION OF MEDICAL ASSISTANCE.— 

11 Section 1905(a) of the Social Security Act (42 

12 U.S.C. 1396d(a)) is amended by— 

13 (A) in paragraph (28), by striking ‘‘and’’ 

14 at the end; 

15 (B) by redesignating paragraph (29) as 

16 paragraph (30); and 

17 (C) by inserting after paragraph (28) the 

18 following new paragraph: 

19 ‘‘(29) language services, as such term is defined 

20 in section 1861(iii)(1), provided in a timely manner 

21 to limited-English-proficient individuals who need 

22 such services; and’’. 

23 (4) USE OF DEDUCTIONS AND COST SHAR24 ING.—Section 1916(a)(2) of the Social Security Act 

25 (42 U.S.C. 1396o(2)) is amended by— 


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1 (A) by striking ‘‘or’’ at the end of subpara2 graph (D); 

3 (B) by striking ‘‘; and’’ at the end of sub4 paragraph (E) and inserting ‘‘, or’’; and 

5 (C) by adding at the end the following new 

6 subparagraph: 

7 ‘‘(F) language services described in section 

8 1905(a)(29); and’’. 

9 (5) CHIP COVERAGE REQUIREMENTS.—Section 

10 2103 of the Social Security Act (42 U.S.C. 1397cc) 

11 is amended— 

12 (A) in subsection (a), in the matter before 

13 paragraph (1), by striking ‘‘and (7)’’ and in14 serting ‘‘(7), and (9)’’; and 

15 (B) in subsection (c), by adding at the end 

16 the following new paragraph: 

17 ‘‘(9) LANGUAGE SERVICES.—The child health 

18 assistance provided to a targeted low-income child 

19 shall include coverage of language services, as such 

20 term is defined in section 1861(iii)(1), provided in a 

21 timely manner to limited-English-proficient individ22 uals who need such services.’’; and 

23 (C) in subsection (e)(2)— 

24 (i) in the heading, by striking ‘‘PRE25 VENTIVE’’ and inserting ‘‘CERTAIN’’; and 


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1 (ii) by inserting ‘‘, subsection (c)(9),’’ 

2 after ‘‘subsection (c)(1)(C)’’. 

3 (6) DEFINITION OF CHILD HEALTH ASSIST4 ANCE.—Section 2110(a)(27) of the Social Security 

5 Act (42 U.S.C. 1397jj) is amended by striking 

6 ‘‘translation’’ and inserting ‘‘language services as 

7 described in section 2103(c)(9)’’. 

8 (7) STATE DATA COLLECTION.—Pursuant to 

9 the reporting requirement described in section 

10 2107(b)(1) of the Social Security Act (42 U.S.C. 

11 1397gg(b)(1)), the Secretary of Health and Human 

12 Services shall require that States collect data on— 

13 (A) the primary language of individuals re14 ceiving child health assistance under title XXI 

15 of the Social Security Act; and 

16 (B) in the case of such individuals who are 

17 minors or incapacitated, the primary language 

18 of the individual’s parent or guardian. 

19 (8) CHIP PAYMENTS TO STATES.—Section 

20 2105 of the Social Security Act (42 U.S.C. 

21 1397ee(c)) is amended— 

22 (A) in subsection (a)(1) by striking ‘‘75’’ 

23 and inserting ‘‘90’’; and 

24 (B) in subsection (c)(2)(A), by inserting 

25 before the period ‘‘, except that expenditures 


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1 pursuant to clause (iv) of subparagraph (D) of 

2 such paragraph shall not count towards this 

3 total’’. 

4 (e) FUNDING LANGUAGE SERVICES FURNISHED BY

5 PROVIDERS OF HEALTH CARE AND HEALTH-CARE-RE6 LATED SERVICES THAT SERVE HIGH RATES OF UNIN7 SURED LEP INDIVIDUALS.— 

8 (1) PAYMENT OF COSTS.— 

9 (A) IN GENERAL.—Subject to subpara10 graph (B), the Secretary of Health and Human 

11 Services shall make payments (on a quarterly 

12 basis) directly to eligible entities to support the 

13 provision of language services to limited14 English-proficient individuals in an amount 

15 equal to an eligible entity’s eligible costs for 

16 such services for the quarter. 

17 (B) FUNDING.—Out of any funds in the 

18 Treasury not otherwise appropriated, there are 

19 appropriated to the Secretary of Health and 

20 Human Services such sums as may be nec21 essary for each of fiscal years 2012 through 

22 2016. 

23 (C) RELATION TO MEDICAID DSH.—Pay24 ments under this subsection shall not offset or 

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1 cial Security Act, nor shall payments under 

2 such section be considered when determining 

3 uncompensated costs associated with the provi4 sion of language services. 

5 (2) METHODOLOGY FOR PAYMENT OF

6 CLAIMS.— 

7 (A) IN GENERAL.—The Secretary shall es8 tablish a methodology to determine the average 

9 per person cost of language services. 

10 (B) DIFFERENT ENTITIES.—In estab11 lishing such methodology, the Secretary may es12 tablish different methodologies for different 

13 types of eligible entities. 

14 (C) NO INDIVIDUAL CLAIMS.—The Sec15 retary may not require eligible entities to sub16 mit individual claims for language services for 

17 individual patients as a requirement for pay18 ment under this subsection. 

19 (3) DATA COLLECTION INSTRUMENT.—For pur20 poses of this subsection, the Secretary shall create a 

21 standard data collection instrument that is con22 sistent with any existing reporting requirements by 

23 the Secretary or relevant accrediting organizations 

24 regarding the number of individuals to whom lan25 guage access are provided. 


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1 (4) GUIDELINES.—Not later than 6 months 

2 after the date of enactment of this Act, the Sec3 retary of Health and Human Services shall establish 

4 and distribute guidelines concerning the implementa5 tion of this subsection. 

6 (5) REPORTING REQUIREMENTS.— 

7 (A) REPORT TO SECRETARY.—Entities re8 ceiving payment under this subsection shall pro9 vide the Secretary with a quarterly report on 

10 how the entity used such funds. Such report 

11 shall contain aggregate (and may not contain 

12 individualized) data collected using the instru13 ment under paragraph (3) and shall otherwise 

14 be in a form and manner determined by the 

15 Secretary. 

16 (B) REPORT TO CONGRESS.—Not later 

17 than 2 years after the date of enactment of this 

18 Act, and every 2 years thereafter, the Secretary 

19 shall submit a report to Congress concerning 

20 the implementation of this subsection. 

21 (6) DEFINITIONS.—In this subsection: 

22 (A) ELIGIBLE COSTS.—The term ‘‘eligible 

23 costs’’ means, with respect to an eligible entity 

24 that provides language services to limited25 English-proficient individuals, the product of— 


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1 (i) the average per person cost of lan2 guage services, determined according to 

3 the methodology devised under paragraph 

4 (2); and 

5 (ii) the number of limited-English-pro6 ficient individuals who are provided lan7 guage services by the entity and for whom 

8 no reimbursement is available for such 

9 services under the amendments made by 

10 subsections (a), (b), (c), or (d) or by pri11 vate health insurance. 

12 (B) ELIGIBLE ENTITY.—The term ‘‘eligible 

13 entity’’ means an entity that— 

14 (i) is a Medicaid provider that is— 

15 (I) a physician; 

16 (II) a hospital with a low-income 

17 utilization rate (as defined in section 

18 1923(b)(3) of the Social Security Act 

19 (42 U.S.C. 1396r–4(b)(3))) of greater 

20 than 25 percent; or 

21 (III) a federally qualified health 

22 center (as defined in section 

23 1905(l)(2)(B) of the Social Security 

24 Act (42 U.S.C. 1396d(l)(2)(B))); 


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1 (ii) provide language services to at 

2 least 8 percent of the entity’s total number 

3 of patients, not later than 6 months after 

4 the date of the enactment of the Act; and 

5 (iii) prepare and submit an applica6 tion to the Secretary, at such time, in such 

7 manner, and accompanied by such infor8 mation as the Secretary may require to as9 certain the entity’s eligibility for funding 

10 under this subsection. 

11 (C) LANGUAGE SERVICES.—The term 

12 ‘‘language services’’ has the meaning given such 

13 term in section 1861(iii)(1) of the Social Secu14 rity Act. 

15 (f) APPLICATION OF CIVIL RIGHTS ACT OF 1964 AND

16 OTHER LAWS.—Nothing in this section shall be construed 

17 to limit otherwise existing obligations of recipients of Fed18 eral financial assistance under title VI of the Civil Rights 

19 Act of 1964 (42 U.S.C. 2000(d) et seq.) or other laws 

20 that protect the civil rights of individuals. 

21 (g) EFFECTIVE DATE.— 

22 (1) IN GENERAL.—Except as otherwise pro23 vided and subject to paragraph (2), the amendments 

24 made by this section shall take effect on January 1, 

25 2013. 


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1 (2) EXCEPTION IF STATE LEGISLATION RE2 QUIRED.—In the case of a State plan for medical as3 sistance under title XIX of the Social Security Act 

4 which the Secretary of Health and Human Services 

5 determines requires State legislation (other than leg6 islation appropriating funds) in order for the plan to 

7 meet the additional requirement imposed by the 

8 amendments made by this section, the State plan 

9 shall not be regarded as failing to comply with the 

10 requirements of such title solely on the basis of its 

11 failure to meet this additional requirement before 

12 the first day of the first calendar quarter beginning 

13 after the close of the first regular session of the 

14 State legislature that begins after the date of the en15 actment of this Act. For purposes of the previous 

16 sentence, in the case of a State that has a 2-year 

17 legislative session, each year of such session shall be 

18 deemed to be a separate regular session of the State 

19 legislature. 

20 SEC. 206. INCREASING UNDERSTANDING OF AND IMPROV21 ING HEALTH LITERACY. 

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

23 Director of the Agency for Healthcare Research and Qual24 ity and the Administrator of the Health Resources and 

25 Services Administration, in consultation with the Director 


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1 of the National Institute on Minority Health and Health 

2 Disparities and the Office of Minority Health, shall award 

3 grants to eligible entities to improve health care for pa4 tient populations that have low functional health literacy. 

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

6 under subsection (a), an entity shall— 

7 (1) be a hospital, health center or clinic, health 

8 plan, or other health entity (including a nonprofit 

9 minority health organization or association); and 

10 (2) prepare and submit to the Secretary an ap11 plication at such time, in such manner, and con12 taining such information as the Secretary may re13 quire. 

14 (c) USE OF FUNDS.— 

15 (1) AGENCY FOR HEALTHCARE RESEARCH AND

16 QUALITY.—Grants awarded under subsection (a) 

17 through the Agency for Healthcare Research and 

18 Quality shall be used— 

19 (A) to define and increase the under20 standing of health literacy; 

21 (B) to investigate the correlation between 

22 low health literacy and health and health care; 

23 (C) to clarify which aspects of health lit24 eracy have an effect on health outcomes; and 


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1 (D) for any other activity determined ap2 propriate by the Director of the Agency. 

3 (2) HEALTH RESOURCES AND SERVICES ADMIN4 ISTRATION.—Grants awarded under subsection (a) 

5 through the Health Resources and Services Adminis6 tration shall be used to conduct demonstration 

7 projects for interventions for patients with low 

8 health literacy that may include— 

9 (A) the development of new disease man10 agement programs for patients with low health 

11 literacy; 

12 (B) the tailoring of existing disease man13 agement programs addressing mental, physical, 

14 oral, and behavioral health conditions for pa15 tients with low health literacy; 

16 (C) the translation of written health mate17 rials for patients with low health literacy; 

18 (D) the identification, implementation, and 

19 testing of low health literacy screening tools; 

20 (E) the conduct of educational campaigns 

21 for patients and providers about low health lit22 eracy; and 

23 (F) other activities determined appropriate 

24 by the Administrator of the Health Resources 

25 and Services Administration. 


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1 (d) DEFINITIONS.—In this section, the term ‘‘low 

2 health literacy’’ means the inability of an individual to ob3 tain, process, and understand basic health information 

4 and services needed to make appropriate health decisions. 

5 (e) AUTHORIZATION OF APPROPRIATIONS.—There 

6 are authorized to be appropriated to carry out this section, 

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

8 2015 through 2019. 

9 SEC. 207. ASSURANCES FOR RECEIVING FEDERAL FUNDS. 

10 (a) IN GENERAL.—Any health program or activity, 

11 any part of which is receiving Federal financial assistance, 

12 including credits, subsidies, or contracts of insurance, and 

13 any program or activity that is administered by an execu14 tive agency or any entity established under title I of the 

15 Patient Protection and Affordable Care Act (or amend16 ments made thereby), as such programs, activities, agen17 cies, and entities are described in section 1557(a) of the 

18 Patient Protection and Affordable Care Act (42 U.S.C. 

19 18116), in order to ensure the right of LEP individuals 

20 to receive access to quality health care, shall— 

21 (1) ensure that appropriate clinical and support 

22 staff receive ongoing education and training in lin23 guistically appropriate service delivery; 

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1 ited-English-proficiency at all points of contact, in a 

2 timely manner during all hours of operation; 

3 (3) notify patients of their right to receive lan4 guage services in their primary language; and 

5 (4) utilize only competent interpreter or trans6 lation services, as defined in section 3400 of the 

7 Public Health Service Act. 

8 (b) EXEMPTIONS.—The requirements of subsection 

9 (a)(4) shall not apply as follows: 

10 (1) When a patient (who has been informed in 

11 his or her primary language of the availability of 

12 free interpreter and translation services) requests 

13 the use of family, friends, or other persons untrained 

14 in interpretation or translation if the following con15 ditions are met: 

16 (A) The interpreter requested by the pa17 tient is over the age of 18. 

18 (B) The recipient informs the patient that 

19 he or she has the option of having the recipient 

20 provide an interpreter for him or her without 

21 charge, or of using his or her own interpreter. 

22 (C) The recipient informs the patient that 

23 the recipient may not require an LEP person to 

24 use a family member or friend as an inter25 preter. 


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1 (D) The recipient evaluates whether the 

2 person the patient wishes to use as an inter3 preter is competent. If the recipient has reason 

4 to believe that the interpreter is not competent, 

5 the recipient provides the recipient’s own inter6 preter to protect the recipient from liability if 

7 the patient’s interpreter is later found not com8 petent. 

9 (E) If the recipient has reason to believe 

10 that there is a conflict of interest between the 

11 interpreter and patient, the recipient may not 

12 use the patient’s interpreter. 

13 (F) The recipient has the patient sign a 

14 waiver, witnessed by at least 1 individual not 

15 related to the patient, that includes the infor16 mation stated in subparagraphs (A) through 

17 (E) and is translated into the patient’s lan18 guage. 

19 (2) When a medical emergency exists and the 

20 delay directly associated with obtaining competent 

21 interpreter or translation services would jeopardize 

22 the health of the patient, but only until a competent 

23 interpreter or translation service is available. 

24 (c) RULE OF CONSTRUCTION.—Subsection (b)(2) 

25 shall not be construed to mean that emergency rooms or 


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1 similar entities that regularly provide health care services 

2 in medical emergencies are exempt from legal or regu3 latory requirements related to competent interpreter serv4 ices. 

5 SEC. 208. REPORT ON FEDERAL EFFORTS TO PROVIDE CUL6 TURALLY AND LINGUISTICALLY APPRO7 PRIATE HEALTH CARE SERVICES. 

8 (a) REPORT.—Not later than 1 year after the date 

9 of enactment of this Act and annually thereafter, the Sec10 retary of Health and Human Services shall enter into a 

11 contract with the Institute of Medicine for the preparation 

12 and publication of a report that describes Federal efforts 

13 to ensure that all individuals with limited-English pro14 ficiency have meaningful access culturally competent to 

15 health care and health-care-related services. Such report 

16 shall include— 

17 (1) a description and evaluation of the activities 

18 carried out under this Act; 

19 (2) a description and analysis of best practices, 

20 model programs, guidelines, and other effective 

21 strategies for providing access to culturally and lin22 guistically appropriate health care services; 

23 (3) recommendations on the development and 

24 implementation of policies and practices by providers 


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1 of health care and health-care-related services for 

2 limited-English-proficient individuals; 

3 (4) a description of the effect of providing lan4 guage services on quality of health care and access 

5 to care; and 

6 (5) a description of the costs associated with or 

7 savings related to the provision of language services. 

8 (b) AUTHORIZATION OF APPROPRIATIONS.—There 

9 are authorized to be appropriated to carry out this section 

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

11 2015 through 2019. 

12 SEC. 209. ENGLISH FOR SPEAKERS OF OTHER LANGUAGES. 

13 (a) GRANTS AUTHORIZED.—The Secretary of Edu14 cation is authorized to provide grants to eligible entities 

15 for the provision of English as a second language (here16 after referred to as ‘‘ESL’’) instruction and shall deter17 mine, after consultation with appropriate stakeholders, the 

18 mechanism for administering and distributing such 

19 grants. 

20 (b) ELIGIBLE ENTITY DEFINED.—For purposes of 

21 this section, the term ‘‘eligible entity’’ means a State or 

22 community-based organization that employs, and serves, 

23 minority populations. 

24 (c) APPLICATION.—An eligible entity may apply for 

25 a grant under this section by submitting such information 


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1 as the Secretary may require and in such form and man2 ner as the Secretary may require. 

3 (d) USE OF GRANT.—As a condition of receiving a 

4 grant under this section, an eligible entity shall— 

5 (1) develop and implement a plan for assuring 

6 the availability of ESL instruction that effectively 

7 integrates information about the nature of the 

8 United States health care system, how to access 

9 care, and any special language skills that may be re10 quired for them to access and regularly negotiate the 

11 system effectively; 

12 (2) develop a plan, including, where appro13 priate, public-private partnerships, for making ESL 

14 instruction progressively available to all individuals 

15 seeking instruction; and 

16 (3) maintain current ESL instruction efforts by 

17 using the additional funds to supplement rather 

18 than supplant any funds expended for ESL instruc19 tion in the State as of January 1, 2015. 

20 (e) ADDITIONAL DUTIES OF THE SECRETARY.—The 

21 Secretary of Education shall— 

22 (1) collect and publicize annual data on how 

23 much Federal, State, and local governments spend 

24 on ESL instruction; 


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1 (2) collect data from State and local govern2 ments to identify the unmet needs of English lan3 guage learners for appropriate ESL instruction, in4 cluding— 

5 (A) the preferred written and spoken lan6 guage of such English language learners; 

7 (B) the extent of waiting lists including 

8 how many programs maintain waiting lists and, 

9 for programs that do not have waiting lists, the 

10 reasons why not; 

11 (C) the availability of programs to geo12 graphically isolated communities; 

13 (D) the impact of course enrollment poli14 cies, including open enrollment, on the avail15 ability of ESL instruction; 

16 (E) the number individuals in the State 

17 and each participating locality; 

18 (F) the effectiveness of the instruction in 

19 meeting the needs of individuals receiving in20 struction and those needing instruction; 

21 (G) as assessment of the need for pro22 grams that integrate job training and ESL in23 struction, to assist individuals to obtain better 

24 jobs; and 


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1 (H) the availability of ESL slots by State 

2 and locality; 

3 (3) determine the cost and most appropriate 

4 methods of making ESL instruction available to all 

5 English language learners seeking instruction; and 

6 (4) within 1 year of the date of enactment of 

7 this Act, issue a report to Congress that assesses the 

8 information collected in paragraphs (1), (2), and (3) 

9 and makes recommendations on steps that should be 

10 taken to progressively realize the goal of making 

11 ESL instruction available to all English language 

12 learners seeking instruction. 

13 (f) AUTHORIZATION OF APPROPRIATIONS.—There 

14 are authorized to be appropriated to the Secretary of Edu15 cation for each of fiscal years 2015 through 2018 

16 $250,000,000 to carry out this section. 

17 SEC. 210. IMPLEMENTATION. 

18 (a) GENERAL PROVISIONS.— 

19 (1) A State shall not be immune under the 

20 Eleventh Amendment of the Constitution of the 

21 United States from suit in Federal court for failing 

22 to provide the language access funded pursuant to 

23 this title. 

24 (2) In a suit against a State for a violation of 

25 this title, remedies (including remedies at both at 


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1 law and in equity) are available for such a violation 

2 to the same extent as such remedies are available for 

3 such a violation in the suit against any public or pri4 vate entity other than a State. 

5 (b) RULE OF CONSTRUCTION.—Nothing in this title 

6 shall be construed to limit otherwise existing obligations 

7 of recipients of Federal financial assistance under title VI 

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

9 seq.) or any other statute. 

10 SEC. 211. LANGUAGE ACCESS SERVICES. 

11 (a) ESSENTIAL BENEFITS.—Section 1302(b)(1) of 

12 the Patient Protection and Affordable Care Act (42 

13 U.S.C. 18022(b)(1)) is amended by adding at the end the 

14 following: 

15 ‘‘(K) Language access services, including 

16 oral interpretation and written translations.’’. 

17 (b) EMPLOYER-SPONSORED MINIMUM ESSENTIAL

18 COVERAGE.—Section 36B(c)(2)(C) of the Internal Rev19 enue Code of 1986 is amended by adding at the end the 

20 following: 

21 ‘‘(v) COVERAGE MUST INCLUDE LAN22 GUAGE ACCESS AND SERVICES.—Except as 

23 provided in clause (iii), an employee shall 

24 not be treated as eligible for minimum es25 sential coverage if such coverage consists 


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1 of an eligible employer-sponsored plan (as 

2 defined in section 5000A(f)(2)) and the 

3 plan does not provide coverage for lan4 guage access services, including oral inter5 pretation and written translations.’’. 

6 (c) QUALITY REPORTING.—Section 2717(a)(1) of the 

7 Public Health Service Act (42 U.S.C. 300gg–17(a)(1)) is 

8 amended— 

9 (1) by striking ‘‘and’’ at the end of subpara10 graph (C); 

11 (2) by striking the period at the end of sub12 paragraph (D) and inserting ‘‘; and’’; and 

13 (3) by adding at the end the following new sub14 paragraph: 

15 ‘‘(E) reduce health disparities through the 

16 provision of language access services, including 

17 oral interpretation and written translations.’’. 

18 (d) REGULATIONS REGARDING INTERNAL CLAIMS

19 AND APPEALS AND EXTERNAL REVIEW PROCESSES FOR

20 HEALTH PLANS AND HEALTH INSURANCE ISSUERS.— 

21 The Secretary of the Treasury, the Secretary of Labor, 

22 and the Secretary of Health and Human Services shall 

23 amend the regulations in section 54.9815–2719T(e) of 

24 title 26, Code of Federal Regulations, section 2590.715– 

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1 tion 147.136(e) of title 45, Code of Federal Regulations, 

2 respectively, to require group health plans and health in3 surance issuers offering group or individual health insur4 ance coverage to which such sections apply— 

5 (1) to provide oral interpretation services with6 out any threshold requirements; 

7 (2) to provide in the English versions of all no8 tices a statement prominently displayed in not less 

9 than 15 non-English languages clearly indicating 

10 how to access the language services provided by the 

11 plan or issuer; and 

12 (3) with respect to written translations of no13 tices, to apply a threshold that 5 percent of the pop14 ulation or at least 500 individuals per service area 

15 are literate only in the same non-English language 

16 in lieu of 10 percent or more residing in a county. 

17 (e) DATA COLLECTION AND REPORTING.—The Sec18 retary of Health and Human Services shall— 

19 (1) amend the single streamlined application 

20 form developed pursuant to section 1413 of the Pa21 tient Protection and Affordable Care Act (42 U.S.C. 

22 18083) to collect the preferred spoken and written 

23 language for each household member applying for 

24 coverage under a qualified health plan through an 


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1 Exchange under title I of the Patient Protection and 

2 Affordable Care Act; 

3 (2) require navigators, certified application 

4 counselors, and other enrollment assisters to collect 

5 and report requests for language assistance; and 

6 (3) require the Federal and State call centers 

7 established pursuant to section 1311(d)(4)(b) of the 

8 Patient Protection and Affordable Care Act (42 

9 U.S.C. 18031(d)(4)(b)) to submit an annual report 

10 documenting the number of language assistance re11 quests, the types of languages requested, the range 

12 and average wait time for a consumer to speak with 

13 an interpreter, and any steps the call center and lan14 guage line have taken to actively address some of 

15 the consumer complaints. 

16 (f) EFFECTIVE DATE.—The amendments made by 

17 this section shall apply to plan years beginning after the 

18 date of the enactment of this Act. 

19 TITLE III—HEALTH WORKFORCE 

20 DIVERSITY 

21 SEC. 301. AMENDMENT TO THE PUBLIC HEALTH SERVICE 

22 ACT. 

23 Title XXXIV of the Public Health Service Act, as 

24 added by section 202, is amended by adding at the end 

25 the following: 


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1 ‘‘Subtitle A—Diversifying the 

2 Health Care Workplace 

3 ‘‘SEC. 3411. NATIONAL WORKING GROUP ON WORKFORCE 

4 DIVERSITY. 

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

6 the Bureau of Health Workforce within the Health Re7 sources and Services Administration, shall award a grant 

8 to an entity determined appropriate by the Secretary for 

9 the establishment of a national working group on work10 force diversity. 

11 ‘‘(b) REPRESENTATION.—In establishing the national 

12 working group under subsection (a): 

13 ‘‘(1) The grantee shall ensure that the group 

14 has representatives of the following: 

15 ‘‘(A) The Health Resources and Services 

16 Administration. 

17 ‘‘(B) The Department of Health and 

18 Human Services Data Council. 

19 ‘‘(C) The Office of Minority Health of the 

20 Department of Health and Human Services. 

21 ‘‘(D) The Substance Abuse and Mental 

22 Health Services Administration. 

23 ‘‘(E) The Bureau of Labor Statistics of 

24 the Department of Labor. 


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1 ‘‘(F) The Public Health Practice Program 

2 Office—Office of Workforce Policy and Plan3 ning. 

4 ‘‘(G) The National Institute on Minority 

5 Health and Health Disparities. 

6 ‘‘(H) The Agency for Healthcare Research 

7 and Quality. 

8 ‘‘(I) The Institute of Medicine Study Com9 mittee for the 2004 workforce diversity report. 

10 ‘‘(J) The Indian Health Service. 

11 ‘‘(K) Minority-serving academic institu12 tions. 

13 ‘‘(L) Consumer organizations. 

14 ‘‘(M) Health professional associations, in15 cluding those that represent underrepresented 

16 minority populations. 

17 ‘‘(N) Researchers in the area of health 

18 workforce. 

19 ‘‘(O) Health workforce accreditation enti20 ties. 

21 ‘‘(P) Private foundations that have spon22 sored workforce diversity initiatives. 

23 ‘‘(Q) Local and State health departments. 

24 ‘‘(R) Representatives of community mem25 bers to be included on admissions committees 


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1 for health profession schools pursuant to sub2 section (c)(8). 

3 ‘‘(S) Other entities determined appropriate 

4 by the Secretary. 

5 ‘‘(2) The grantee shall ensure that, in addition 

6 to the representatives under paragraph (1), the 

7 group has not less than 5 health professions stu8 dents representing various health profession fields 

9 and levels of training. 

10 ‘‘(c) ACTIVITIES.—The working group established 

11 under subsection (a) shall convene at least twice each year 

12 to complete the following activities: 

13 ‘‘(1) Review current public and private health 

14 workforce diversity initiatives. 

15 ‘‘(2) Identify successful health workforce diver16 sity programs and practices. 

17 ‘‘(3) Examine challenges relating to the devel18 opment and implementation of health workforce di19 versity initiatives. 

20 ‘‘(4) Draft a national strategic work plan for 

21 health workforce diversity, including recommenda22 tions for public and private sector initiatives. 

23 ‘‘(5) Develop a framework and methods for the 

24 evaluation of current and future health workforce di25 versity initiatives. 


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1 ‘‘(6) Develop recommended standards for work2 force diversity that could be applicable to all health 

3 professions programs and programs funded under 

4 this Act. 

5 ‘‘(7) Develop guidelines to train health profes6 sionals to care for a diverse population. 

7 ‘‘(8) Develop a strategy for the inclusion of 

8 community members on admissions committees for 

9 health profession schools. 

10 ‘‘(9) Other activities determined appropriate by 

11 the Secretary. 

12 ‘‘(d) ANNUAL REPORT.—Not later than 1 year after 

13 the establishment of the working group under subsection 

14 (a), and annually thereafter, the working group shall pre15 pare and make available to the general public for com16 ment, an annual report on the activities of the working 

17 group. Such report shall include the recommendations of 

18 the working group for improving health workforce diver19 sity. 

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

21 is authorized to be appropriated to carry out this section 

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

23 2015 through 2020. 


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1 ‘‘SEC. 3412. TECHNICAL CLEARINGHOUSE FOR HEALTH 

2 WORKFORCE DIVERSITY. 

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

4 the Deputy Assistant Secretary for Minority Health, and 

5 in collaboration with the Bureau of Health Workforce 

6 within the Health Resources and Services Administration, 

7 the National Institute on Minority Health and Health Dis8 parities, shall establish a technical clearinghouse on health 

9 workforce diversity within the Office of Minority Health 

10 and coordinate current and future clearinghouses. 

11 ‘‘(b) INFORMATION AND SERVICES.—The clearing12 house established under subsection (a) shall offer the fol13 lowing information and services: 

14 ‘‘(1) Information on the importance of health 

15 workforce diversity. 

16 ‘‘(2) Statistical information relating to under17 represented minority representation in health and al18 lied health professions and occupations. 

19 ‘‘(3) Model health workforce diversity practices 

20 and programs, including integrated models of care. 

21 ‘‘(4) Admissions policies that promote health 

22 workforce diversity and are in compliance with Fed23 eral and State laws. 

24 ‘‘(5) Retainment policies that promote comple25 tion of health profession degrees for underserved 

26 populations. 


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1 ‘‘(6) Lists of scholarship, loan repayment, and 

2 loan cancellation grants as well as fellowship infor3 mation for underserved populations for health pro4 fessions schools. 

5 ‘‘(7) Foundation and other large organizational 

6 initiatives relating to health workforce diversity. 

7 ‘‘(c) CONSULTATION.—In carrying out this section, 

8 the Secretary shall consult with non-Federal entities which 

9 may include minority health professional associations and 

10 minority sections of major health professional associations 

11 to ensure the adequacy and accuracy of information. 

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

13 is authorized to be appropriated to carry out this section 

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

15 2015 through 2020. 

16 ‘‘SEC. 3413. SUPPORT FOR INSTITUTIONS COMMITTED TO 

17 WORKFORCE DIVERSITY. 

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

19 the Administrator of the Health Resources and Services 

20 Administration and the Centers for Disease Control and 

21 Prevention, shall award grants to eligible entities that 

22 demonstrate a commitment to health workforce diversity. 

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

24 under subsection (a), an entity shall— 


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1 ‘‘(1) be an educational institution or entity that 

2 historically produces or trains meaningful numbers 

3 of underrepresented minority health professionals, 

4 including— 

5 ‘‘(A) historically Black colleges and univer6 sities; 

7 ‘‘(B) Hispanic-serving health professions 

8 schools; 

9 ‘‘(C) Hispanic-serving institutions; 

10 ‘‘(D) tribal colleges and universities; 

11 ‘‘(E) Asian-American, Native American, 

12 and Pacific Islander-serving institutions; 

13 ‘‘(F) institutions that have programs to re14 cruit and retain underrepresented minority 

15 health professionals, in which a significant 

16 number of the enrolled participants are under17 represented minorities; 

18 ‘‘(G) health professional associations, 

19 which may include underrepresented minority 

20 health professional associations; and 

21 ‘‘(H) institutions— 

22 ‘‘(i) located in communities with pre23 dominantly underrepresented minority pop24 ulations; 


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1 ‘‘(ii) with whom partnerships have 

2 been formed for the purpose of increasing 

3 workforce diversity; and 

4 ‘‘(iii) in which at least 20 percent of 

5 the enrolled participants are underrep6 resented minorities; and 

7 ‘‘(2) submit to the Secretary an application at 

8 such time, in such manner, and containing such in9 formation as the Secretary may require. 

10 ‘‘(c) USE OF FUNDS.—Amounts received under a 

11 grant under subsection (a) shall be used to expand existing 

12 workforce diversity programs, implement new workforce 

13 diversity programs, or evaluate existing or new workforce 

14 diversity programs, including with respect to mental 

15 health care professions. Such programs shall enhance di16 versity by considering minority status as part of an indi17 vidualized consideration of qualifications. Possible activi18 ties may include— 

19 ‘‘(1) educational outreach programs relating to 

20 opportunities in the health professions; 

21 ‘‘(2) scholarship, fellowship, grant, loan repay22 ment, and loan cancellation programs; 

23 ‘‘(3) postbaccalaureate programs; 


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1 ‘‘(4) academic enrichment programs, particu2 larly targeting those who would not be competitive 

3 for health professions schools; 

4 ‘‘(5) kindergarten through 12th grade and 

5 other health pipeline programs; 

6 ‘‘(6) mentoring programs; 

7 ‘‘(7) internship or rotation programs involving 

8 hospitals, health systems, health plans, and other 

9 health entities; 

10 ‘‘(8) community partnership development for 

11 purposes relating to workforce diversity; or 

12 ‘‘(9) leadership training. 

13 ‘‘(d) REPORTS.—Not later than 1 year after receiving 

14 a grant under this section, and annually for the term of 

15 the grant, a grantee shall submit to the Secretary a report 

16 that summarizes and evaluates all activities conducted 

17 under the grant. 

18 ‘‘(e) DEFINITION.—In this section, the term ‘Asian19 American, Native American, and Pacific Islander-serving 

20 institutions’ has the same meaning as the term ‘Asian 

21 American and Native American Pacific Islander-serving 

22 institution’ as defined in section 371(c) of the Higher 

23 Education Act of 1965 (20 U.S.C. 1067q(c)). 

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

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


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

2 2015 through 2020. 

3 ‘‘SEC. 3414. CAREER DEVELOPMENT FOR SCIENTISTS AND 

4 RESEARCHERS. 

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

6 the Director of the National Institutes of Health, the Di7 rector of the Centers for Disease Control and Prevention, 

8 the Commissioner of Food and Drugs, the Director of the 

9 Agency for Healthcare Research and Quality, and the Ad10 ministrator of the Health Resources and Services Admin11 istration, shall award grants that expand existing opportu12 nities for scientists and researchers and promote the inclu13 sion of underrepresented minorities in the health profes14 sions. 

15 ‘‘(b) RESEARCH FUNDING.—The head of each entity 

16 within the Department of Health and Human Services 

17 shall establish or expand existing programs to provide re18 search funding to scientists and researchers in training. 

19 Under such programs, the head of each such entity shall 

20 give priority in allocating research funding to support 

21 health research in traditionally underserved communities, 

22 including underrepresented minority communities, and re23 search classified as community or participatory. 

24 ‘‘(c) DATA COLLECTION.—The head of each entity 

25 within the Department of Health and Human Services 


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1 shall collect data on the number (expressed as an absolute 

2 number and a percentage) of underrepresented minority 

3 and nonminority applicants who receive and are denied 

4 agency funding at every stage of review. Such data shall 

5 be reported annually to the Secretary and the appropriate 

6 committees of Congress. 

7 ‘‘(d) STUDENT LOAN REIMBURSEMENT.—The Sec8 retary shall establish a student loan reimbursement pro9 gram to provide student loan reimbursement assistance to 

10 researchers who focus on racial and ethnic disparities in 

11 health. The Secretary shall promulgate regulations to de12 fine the scope and procedures for the program under this 

13 subsection. 

14 ‘‘(e) STUDENT LOAN CANCELLATION.—The Sec15 retary shall establish a student loan cancellation program 

16 to provide student loan cancellation assistance to research17 ers who focus on racial and ethnic disparities in health. 

18 Students participating in the program shall make a min19 imum 5-year commitment to work at an accredited health 

20 profession school. The Secretary shall promulgate addi21 tional regulations to define the scope and procedures for 

22 the program under this subsection. 

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

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


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

2 2015 through 2020. 

3 ‘‘SEC. 3415. CAREER SUPPORT FOR NONRESEARCH HEALTH 

4 PROFESSIONALS. 

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

6 the Director of the Centers for Disease Control and Pre7 vention, the Administrator of the Substance Abuse and 

8 Mental Health Services Administration, the Administrator 

9 of the Health Resources and Services Administration, and 

10 the Administrator of the Centers for Medicare & Medicaid 

11 Services, shall establish a program to award grants to eli12 gible individuals for career support in nonresearch-related 

13 health and wellness professions. 

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

15 under subsection (a), an individual shall— 

16 ‘‘(1) be a student in a health professions school, 

17 a graduate of such a school who is working in a 

18 health profession, an individual working in a health 

19 or wellness profession (including mental and behav20 ioral health), or a faculty member of such a school; 

21 and 

22 ‘‘(2) submit to the Secretary an application at 

23 such time, in such manner, and containing such in24 formation as the Secretary may require. 


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1 ‘‘(c) USE OF FUNDS.—An individual shall use 

2 amounts received under a grant under this section to— 

3 ‘‘(1) support the individual’s health activities or 

4 projects that involve underserved communities, in5 cluding racial and ethnic minority communities; 

6 ‘‘(2) support health-related career advancement 

7 activities; 

8 ‘‘(3) to pay, or as reimbursement for payments 

9 of, student loans or training or credentialing costs 

10 for individuals who are health professionals and are 

11 focused on health issues affecting underserved com12 munities, including racial and ethnic minority com13 munities; and 

14 ‘‘(4) to establish and promote leadership train15 ing programs to decrease health disparities and to 

16 increase cultural competence with the goal of in17 creasing diversity in leadership positions. 

18 ‘‘(d) DEFINITION.—In this section, the term ‘career 

19 in nonresearch-related health and wellness professions’ 

20 means employment or intended employment in the field 

21 of public health, health policy, health management, health 

22 administration, medicine, nursing, pharmacy, psychology, 

23 social work, psychiatry, other mental and behavioral 

24 health, allied health, community health, social work, or 


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1 other fields determined appropriate by the Secretary, 

2 other than in a position that involves research. 

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

4 is authorized to be appropriated to carry out this section 

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

6 2015 through 2020. 

7 ‘‘SEC. 3416. RESEARCH ON THE EFFECT OF WORKFORCE DI8 VERSITY ON QUALITY. 

9 ‘‘(a) IN GENERAL.—The Director of the Agency for 

10 Healthcare Research and Quality, in collaboration with 

11 the Deputy Assistant Secretary for Minority Health and 

12 the Director of the National Institute on Minority Health 

13 and Health Disparities, shall award grants to eligible enti14 ties to expand research on the link between health work15 force diversity and quality health care. 

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

17 under subsection (a), an entity shall— 

18 ‘‘(1) be a clinical, public health, or health serv19 ices research entity or other entity determined ap20 propriate by the Director; and 

21 ‘‘(2) submit to the Secretary an application at 

22 such time, in such manner, and containing such in23 formation as the Secretary may require. 

24 ‘‘(c) USE OF FUNDS.—Amounts received under a 

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1 port research that investigates the effect of health work2 force diversity on— 

3 ‘‘(1) language access; 

4 ‘‘(2) cultural competence; 

5 ‘‘(3) patient satisfaction; 

6 ‘‘(4) timeliness of care; 

7 ‘‘(5) safety of care; 

8 ‘‘(6) effectiveness of care; 

9 ‘‘(7) efficiency of care; 

10 ‘‘(8) patient outcomes; 

11 ‘‘(9) community engagement; 

12 ‘‘(10) resource allocation; 

13 ‘‘(11) organizational structure; 

14 ‘‘(12) compliance of care; or 

15 ‘‘(13) other topics determined appropriate by 

16 the Director. 

17 ‘‘(d) PRIORITY.—In awarding grants under sub18 section (a), the Director shall give individualized consider19 ation to all relevant aspects of the applicant’s background. 

20 Consideration of prior research experience involving the 

21 health of underserved communities shall be such a factor. 

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

23 is authorized to be appropriated to carry out this section 

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

25 2015 through 2020. 


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1 ‘‘SEC. 3417. HEALTH DISPARITIES EDUCATION PROGRAM. 

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

3 through the National Institute on Minority Health and 

4 Health Disparities and in collaboration with the Office of 

5 Minority Health, the Office for Civil Rights, the Centers 

6 for Disease Control and Prevention, the Centers for Medi7 care & Medicaid Services, the Health Resources and Serv8 ices Administration, and other appropriate public and pri9 vate entities, shall establish and coordinate a health and 

10 health care disparities education program to support, de11 velop, and implement educational initiatives and outreach 

12 strategies that inform health care professionals and the 

13 public about the existence of and methods to reduce racial 

14 and ethnic disparities in health and health care. 

15 ‘‘(b) ACTIVITIES.—The Secretary, through the edu16 cation program established under subsection (a), shall, 

17 through the use of public awareness and outreach cam18 paigns targeting the general public and the medical com19 munity at large— 

20 ‘‘(1) disseminate scientific evidence for the ex21 istence and extent of racial and ethnic disparities in 

22 health care, including disparities that are not other23 wise attributable to known factors such as access to 

24 care, patient preferences, or appropriateness of 

25 intervention, as described in the 2002 Institute of 

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1 fronting Racial and Ethnic Disparities in Health 

2 Care’, as well as the impact of disparities related to 

3 age, disability status, socioeconomic status, sex, gen4 der identity, and sexual orientation on racial and 

5 ethnic minorities; 

6 ‘‘(2) disseminate new research findings to 

7 health care providers and patients to assist them in 

8 understanding, reducing, and eliminating health and 

9 health care disparities; 

10 ‘‘(3) disseminate information about the impact 

11 of linguistic and cultural barriers on health care 

12 quality and the obligation of health providers who 

13 receive Federal financial assistance to ensure that 

14 people with limited-English proficiency have access 

15 to language access services; 

16 ‘‘(4) disseminate information about the impor17 tance and legality of racial, ethnic, disability status, 

18 socioeconomic status, sex, gender identity, and sex19 ual orientation, and primary language data collec20 tion, analysis, and reporting; 

21 ‘‘(5) design and implement specific educational 

22 initiatives to health care providers relating to health 

23 and health care disparities; and 

24 ‘‘(6) assess the impact of the programs estab25 lished under this section in raising awareness of 


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1 health and health care disparities and providing in2 formation on available resources. 

3 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 

4 is authorized to be appropriated to carry out this section 

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

6 2015 through 2020.’’. 

7 SEC. 302. HISPANIC-SERVING HEALTH PROFESSIONS 

8 SCHOOLS. 

9 Part B of title VII of the Public Health Service Act 

10 (42 U.S.C. 293 et seq.) is amended by adding at the end 

11 the following: 

12 ‘‘SEC. 742. HISPANIC-SERVING HEALTH PROFESSIONS 

13 SCHOOLS. 

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

15 the Administrator of the Health Resources and Services 

16 Administration, shall award grants to Hispanic-serving 

17 health professions schools for the purpose of carrying out 

18 programs to recruit Hispanic individuals to enroll in and 

19 graduate from such schools, which may include providing 

20 scholarships and other financial assistance as appropriate. 

21 ‘‘(b) ELIGIBILITY.—In subsection (a), the term ‘His22 panic-serving health professions school’ means an entity 

23 that— 

24 ‘‘(1) is a school or program under section 

25 799B; 


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1 ‘‘(2) has an enrollment of full-time equivalent 

2 students that is made up of at least 9 percent His3 panic students; 

4 ‘‘(3) has been effective in carrying out pro5 grams to recruit Hispanic individuals to enroll in 

6 and graduate from the school; 

7 ‘‘(4) has been effective in recruiting and retain8 ing Hispanic faculty members; 

9 ‘‘(5) has a significant number of graduates who 

10 are providing health services to medically under11 served populations or to individuals in health profes12 sional shortage areas; and 

13 ‘‘(6) is a Regional Hispanic Center of Excel14 lence.’’. 

15 SEC. 303. LOAN REPAYMENT PROGRAM OF CENTERS FOR 

16 DISEASE CONTROL AND PREVENTION. 

17 Section 317F(c) of the Public Health Service Act (42 

18 U.S.C. 247b–7(c)) is amended— 

19 (1) by striking ‘‘and’’ after ‘‘1994,’’; and 

20 (2) by inserting before the period at the end the 

21 following: ‘‘$750,000 for fiscal year 2015, and such 

22 sums as may be necessary for each of the fiscal 

23 years 2016 through 2020’’. 


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1 SEC. 304. COOPERATIVE AGREEMENTS FOR ONLINE DE2 GREE PROGRAMS AT SCHOOLS OF PUBLIC 

3 HEALTH AND SCHOOLS OF ALLIED HEALTH. 

4 Part B of title VII of the Public Health Service Act 

5 (42 U.S.C. 293 et seq.), as amended by section 302, is 

6 further amended by adding at the end the following: 

7 ‘‘SEC. 743. COOPERATIVE AGREEMENTS FOR ONLINE DE8 GREE PROGRAMS. 

9 ‘‘(a) COOPERATIVE AGREEMENTS.—The Secretary, 

10 acting through the Administrator of the Health Resources 

11 and Services Administration, in consultation with the Di12 rector of the Centers for Disease Control and Prevention, 

13 the Director of the Agency for Healthcare Research and 

14 Quality, and the Deputy Assistant Secretary for Minority 

15 Health, shall award cooperative agreements to schools of 

16 public health and schools of allied health to design and 

17 implement online degree programs. 

18 ‘‘(b) PRIORITY.—In awarding cooperative agreements 

19 under this section, the Secretary shall give priority to any 

20 school of public health or school of allied health that has 

21 an established track record of serving medically under22 served communities. 

23 ‘‘(c) REQUIREMENTS.—Recipients of cooperative 

24 agreements under this section shall design and implement 

25 an online degree program that meets the following restric26 tions: 


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1 ‘‘(1) Enrollment of individuals who have ob2 tained a secondary school diploma or its recognized 

3 equivalent. 

4 ‘‘(2) Maintaining a significant enrollment of 

5 underrepresented minority or disadvantaged stu6 dents. 

7 ‘‘(3) Achieving a high completion rate of en8 rolled underrepresented minority or disadvantaged 

9 students. 

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

11 are authorized to be appropriated to carry out this section 

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

13 2015 through 2020.’’. 

14 SEC. 305. SENSE OF CONGRESS ON THE MISSION OF THE 

15 NATIONAL HEALTH CARE WORKFORCE COM16 MISSION. 

17 It is the sense of Congress that the National Health 

18 Care Workforce Commission established by section 5101 

19 of the Patient Protection and Affordable Care Act (42 

20 U.S.C. 294q) should, in carrying out its assigned duties 

21 under that section, give attention to the needs of racial 

22 and ethnic minorities, individuals with lower socio23 economic status, individuals with mental, developmental, 

24 and physical disabilities, lesbian, gay, bisexual, and 


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1 transgender populations, and individuals who are members 

2 of multiple minority or special population groups. 

3 SEC. 306. SCHOLARSHIP AND FELLOWSHIP PROGRAMS. 

4 Subtitle A of title XXXIV of the Public Health Serv5 ice Act, as added by section 301, is further amended by 

6 inserting after section 3417 the following: 

7 ‘‘SEC. 3418. DAVID SATCHER PUBLIC HEALTH AND HEALTH 

8 SERVICES CORPS. 

9 ‘‘(a) IN GENERAL.—The Administrator of the Health 

10 Resources and Services Administration and the Director 

11 of the Centers for Disease Control and Prevention, in col12 laboration with the Deputy Assistant Secretary for Minor13 ity Health, shall award grants to eligible entities to in14 crease awareness among postprimary and postsecondary 

15 students of career opportunities in the health professions. 

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

17 under subsection (a), an entity shall— 

18 ‘‘(1) be a clinical, public health, or health serv19 ices organization, community-based or nonprofit en20 tity, or other entity determined appropriate by the 

21 Director of the Centers for Disease Control and Pre22 vention; 

23 ‘‘(2) serve a health professional shortage area, 

24 as determined by the Secretary; 


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1 ‘‘(3) work with students, including those from 

2 racial and ethnic minority backgrounds, that have 

3 expressed an interest in the health professions; and 

4 ‘‘(4) submit to the Secretary an application at 

5 such time, in such manner, and containing such in6 formation as the Secretary may require. 

7 ‘‘(c) USE OF FUNDS.—Grant awards under sub8 section (a) shall be used to support internships that will 

9 increase awareness among students of non-research-based, 

10 career opportunities in the following health professions: 

11 ‘‘(1) Medicine. 

12 ‘‘(2) Nursing. 

13 ‘‘(3) Public Health. 

14 ‘‘(4) Pharmacy. 

15 ‘‘(5) Health administration and management. 

16 ‘‘(6) Health policy. 

17 ‘‘(7) Psychology. 

18 ‘‘(8) Dentistry. 

19 ‘‘(9) International health. 

20 ‘‘(10) Social work. 

21 ‘‘(11) Allied health. 

22 ‘‘(12) Psychiatry. 

23 ‘‘(13) Hospice care. 


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1 ‘‘(14) Other professions deemed appropriate by 

2 the Director of the Centers for Disease Control and 

3 Prevention. 

4 ‘‘(d) PRIORITY.—In awarding grants under sub5 section (a), the Director of the Centers for Disease Con6 trol and Prevention shall give priority to those entities 

7 that— 

8 ‘‘(1) serve a high proportion of individuals from 

9 disadvantaged backgrounds; 

10 ‘‘(2) have experience in health disparity elimi11 nation programs; 

12 ‘‘(3) facilitate the entry of disadvantaged indi13 viduals into institutions of higher education; and 

14 ‘‘(4) provide counseling or other services de15 signed to assist disadvantaged individuals in success16 fully completing their education at the postsecondary 

17 level. 

18 ‘‘(e) STIPENDS.—The Secretary may approve sti19 pends under this section for individuals for any period of 

20 education in student-enhancement programs (other than 

21 regular courses) at health professions schools, programs, 

22 or entities, except that such a stipend may not be provided 

23 to an individual for more than 6 months, and such a sti24 pend may not exceed $20 per day (notwithstanding any 

25 other provision of law regarding the amount of stipends). 


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

2 is authorized to be appropriated to carry out this section 

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

4 2015 through 2020. 

5 ‘‘SEC. 3419. LOUIS STOKES PUBLIC HEALTH SCHOLARS 

6 PROGRAM. 

7 ‘‘(a) IN GENERAL.—The Director of the Centers for 

8 Disease Control and Prevention, in collaboration with the 

9 Deputy Assistant Secretary for Minority Health, shall 

10 award scholarships to postsecondary students who seek a 

11 career in public health. 

12 ‘‘(b) ELIGIBILITY.—To be eligible to receive a schol13 arship under subsection (a), an individual shall— 

14 ‘‘(1) have interest, knowledge, or skill in public 

15 health research or public health practice, or other 

16 health professions as determined appropriate by the 

17 Director of the Centers for Disease Control and Pre18 vention; 

19 ‘‘(2) reside in a health professional shortage 

20 area as determined by the Secretary; 

21 ‘‘(3) demonstrate promise for becoming a leader 

22 in public health; 

23 ‘‘(4) secure admission to a 4-year institution of 

24 higher education; 

25 ‘‘(5) comply with subsection (e); and 


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1 ‘‘(6) submit to the Secretary an application at 

2 such time, in such manner, and containing such in3 formation as the Secretary may require. 

4 ‘‘(c) USE OF FUNDS.—Amounts received under an 

5 award under subsection (a) shall be used to support oppor6 tunities for students to become public health professionals. 

7 ‘‘(d) PRIORITY.—In awarding grants under sub8 section (a), the Director shall give priority to those stu9 dents that— 

10 ‘‘(1) are from disadvantaged backgrounds; 

11 ‘‘(2) have secured admissions to a minority12 serving institution; and 

13 ‘‘(3) have identified a health professional as a 

14 mentor at their school or institution and an aca15 demic advisor to assist in the completion of their 

16 baccalaureate degree. 

17 ‘‘(e) SCHOLARSHIPS.—The Secretary may approve 

18 payment of scholarships under this section for such indi19 viduals for any period of education in student under20 graduate tenure, except that such a scholarship may not 

21 be provided to an individual for more than 4 years, and 

22 such scholarships may not exceed $10,000 per academic 

23 year (notwithstanding any other provision of law regard24 ing the amount of scholarship). 


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

2 is authorized to be appropriated to carry out this section 

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

4 2015 through 2020. 

5 ‘‘SEC. 3420. PATSY MINK HEALTH AND GENDER RESEARCH 

6 FELLOWSHIP PROGRAM. 

7 ‘‘(a) IN GENERAL.—The Director of the Centers for 

8 Disease Control and Prevention, in collaboration with the 

9 Deputy Assistant Secretary for Minority Health, the Ad10 ministrator of the Substance Abuse and Mental Health 

11 Services Administration, and the Director of the Indian 

12 Health Services, shall award research fellowships to post13 baccalaureate students to conduct research that will exam14 ine gender and health disparities and to pursue a career 

15 in the health professions. 

16 ‘‘(b) ELIGIBILITY.—To be eligible to receive a fellow17 ship under subsection (a) an individual shall— 

18 ‘‘(1) have experience in health research or pub19 lic health practice; 

20 ‘‘(2) reside in a health professional shortage 

21 area as determined by the Secretary; 

22 ‘‘(3) have expressed an interest in the health 

23 professions; 

24 ‘‘(4) demonstrate promise for becoming a leader 

25 in the field of women’s health; 


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1 ‘‘(5) secure admission to a health professions 

2 school or graduate program with an emphasis in 

3 gender studies; 

4 ‘‘(6) comply with subsection (f); and 

5 ‘‘(7) submit to the Secretary an application at 

6 such time, in such manner, and containing such in7 formation as the Secretary may require. 

8 ‘‘(c) USE OF FUNDS.—Amounts received under an 

9 award under subsection (a) shall be used to support oppor10 tunities for students to become researchers and advance 

11 the research base on the intersection between gender and 

12 health. 

13 ‘‘(d) PRIORITY.—In awarding grants under sub14 section (a), the Director of the Centers for Disease Con15 trol and Prevention shall give priority to those applicants 

16 that— 

17 ‘‘(1) are from disadvantaged backgrounds; and 

18 ‘‘(2) have identified a mentor and academic ad19 visor who will assist in the completion of their grad20 uate or professional degree and have secured a re21 search assistant position with a researcher working 

22 in the area of gender and health. 

23 ‘‘(e) FELLOWSHIPS.—The Director of the Centers for 

24 Disease Control and Prevention may approve fellowships 

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1 cation in the student’s graduate or health profession ten2 ure, except that such a fellowship may not be provided 

3 to an individual for more than 3 years, and such a fellow4 ship may not exceed $18,000 per academic year (notwith5 standing any other provision of law regarding the amount 

6 of fellowship). 

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

8 is authorized to be appropriated to carry out this section 

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

10 2015 through 2020. 

11 ‘‘SEC. 3420A. PAUL DAVID WELLSTONE INTERNATIONAL 

12 HEALTH FELLOWSHIP PROGRAM. 

13 ‘‘(a) IN GENERAL.—The Director of the Agency for 

14 Healthcare Research and Quality, in collaboration with 

15 the Deputy Assistant Secretary for Minority Health, shall 

16 award research fellowships to college students or recent 

17 graduates to advance their understanding of international 

18 health. 

19 ‘‘(b) ELIGIBILITY.—To be eligible to receive a fellow20 ship under subsection (a) an individual shall— 

21 ‘‘(1) have educational experience in the field of 

22 international health; 

23 ‘‘(2) reside in a health professional shortage 

24 area as determined by the Secretary; 


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1 ‘‘(3) demonstrate promise for becoming a leader 

2 in the field of international health; 

3 ‘‘(4) be a college senior or recent graduate of 

4 a four-year higher education institution; 

5 ‘‘(5) comply with subsection (e); and 

6 ‘‘(6) submit to the Secretary an application at 

7 such time, in such manner, and containing such in8 formation as the Secretary may require. 

9 ‘‘(c) USE OF FUNDS.—Amounts received under an 

10 award under subsection (a) shall be used to support oppor11 tunities for students to become health professionals and 

12 to advance their knowledge about international issues re13 lating to health care access and quality. 

14 ‘‘(d) PRIORITY.—In awarding grants under sub15 section (a), the Director shall give priority to those appli16 cants that— 

17 ‘‘(1) are from a disadvantaged background; and 

18 ‘‘(2) have identified a mentor at a health pro19 fessions school or institution, an academic advisor to 

20 assist in the completion of their graduate or profes21 sional degree, and an advisor from an international 

22 health non-governmental organization, private volun23 teer organization, or other international institution 

24 or program that focuses on increasing health care 


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1 access and quality for residents in developing coun2 tries. 

3 ‘‘(e) FELLOWSHIPS.—The Secretary shall approve 

4 fellowships for college seniors or recent graduates, except 

5 that such a fellowship may not be provided to an indi6 vidual for more than 6 months, may not be awarded to 

7 a graduate that has not been enrolled in school for more 

8 than 1 year, and may not exceed $4,000 per academic year 

9 (notwithstanding any other provision of law regarding the 

10 amount of fellowship). 

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

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

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

14 2015 through 2020. 

15 ‘‘SEC. 3420B. EDWARD R. ROYBAL HEALTH SCHOLAR PRO16 GRAM. 

17 ‘‘(a) IN GENERAL.—The Director of the Agency for 

18 Healthcare Research and Quality, the Director of the Cen19 ters for Medicare and Medicaid Services, and the Adminis20 trator for Health Resources and Services Administration, 

21 in collaboration with the Deputy Assistant Secretary for 

22 Minority Health, shall award grants to eligible entities to 

23 expose entering graduate students to the health profes24 sions. 


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

2 under subsection (a), an entity shall— 

3 ‘‘(1) be a clinical, public health, or health serv4 ices organization, community-based, academic, or 

5 nonprofit entity, or other entity determined appro6 priate by the Director of the Agency for Healthcare 

7 Research and Quality; 

8 ‘‘(2) serve in a health professional shortage 

9 area as determined by the Secretary; 

10 ‘‘(3) work with students obtaining a degree in 

11 the health professions; and 

12 ‘‘(4) submit to the Secretary an application at 

13 such time, in such manner, and containing such in14 formation as the Secretary may require. 

15 ‘‘(c) USE OF FUNDS.—Amounts received under a 

16 grant awarded under subsection (a) shall be used to sup17 port opportunities that expose students to non-research18 based health professions, including— 

19 ‘‘(1) public health policy; 

20 ‘‘(2) health care and pharmaceutical policy; 

21 ‘‘(3) health care administration and manage22 ment; 

23 ‘‘(4) health economics; and 

24 ‘‘(5) other professions determined appropriate 

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1 search and Quality, the Director of the Centers for 

2 Medicare and Medicaid Services, and the Adminis3 trator for Health Resources and Services Adminis4 tration. 

5 ‘‘(d) PRIORITY.—In awarding grants under sub6 section (a), the Director of the Agency for Healthcare Re7 search and Quality shall give priority to those entities 

8 that— 

9 ‘‘(1) have experience with health disparity elimi10 nation programs; 

11 ‘‘(2) facilitate training in the fields described in 

12 subsection (c); and 

13 ‘‘(3) provide counseling or other services de14 signed to assist such individuals in successfully com15 pleting their education at the postsecondary level. 

16 ‘‘(e) STIPENDS.—The Secretary may approve the 

17 payment of stipends for individuals under this section for 

18 any period of education in student-enhancement programs 

19 (other than regular courses) at health professions schools 

20 or entities, except that such a stipend may not be provided 

21 to an individual for more than 2 months, and such a sti22 pend may not exceed $100 per day (notwithstanding any 

23 other provision of law regarding the amount of stipends). 

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

25 is authorized to be appropriated to carry out this section 


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

2 2015 through 2020.’’. 

3 SEC. 307. MCNAIR POSTBACCALAUREATE ACHIEVEMENT 

4 PROGRAM. 

5 Section 402E of the Higher Education Act of 1965 

6 (20 U.S.C. 1070a–15) is amended by striking subsection 

7 (g) and inserting the following: 

8 ‘‘(g) COLLABORATION IN HEALTH PROFESSION DI9 VERSITY TRAINING PROGRAMS.—The Secretary shall co10 ordinate with the Secretary of Health and Human Serv11 ices to ensure that there is collaboration between the goals 

12 of the program under this section and programs of the 

13 Health Resources and Services Administration that pro14 mote health workforce diversity. The Secretary of Edu15 cation shall take such measures as may be necessary to 

16 encourage students participating in projects assisted 

17 under this section to consider health profession careers. 

18 ‘‘(h) FUNDING.—From amounts appropriated pursu19 ant to the authority of section 402A(g), the Secretary 

20 shall, to the extent practicable, allocate funds for projects 

21 authorized by this section in an amount which is not less 

22 than $31,000,000 for each of the fiscal years 2015 

23 through 2021.’’. 


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1 SEC. 308. RULES FOR DETERMINATION OF FULL-TIME 

2 EQUIVALENT RESIDENTS FOR COST-REPORT3 ING PERIODS. 

4 (a) DGME DETERMINATIONS.—Section 1886(h)(4) 

5 of the Social Security Act (42 U.S.C. 1395ww(h)(4)) is 

6 amended— 

7 (1) in subparagraph (E), by striking ‘‘Subject 

8 to subparagraphs (J) and (K), such rules’’ and in9 serting ‘‘Subject to subparagraphs (J), (K), and (L), 

10 such rules’’; 

11 (2) in subparagraph (J), by striking ‘‘Such 

12 rules’’ and inserting ‘‘Subject to subparagraph (L), 

13 such rules’’; 

14 (3) in subparagraph (K), by striking ‘‘In deter15 mining’’ and inserting ‘‘Subject to subparagraph 

16 (L), in determining’’; and 

17 (4) by adding at the end the following new sub18 paragraph: 

19 ‘‘(L) For purposes of cost-reporting peri20 ods beginning on or after October 1, 2014, in 

21 determining the hospital’s number of full-time 

22 equivalent residents for purposes of this para23 graph, all the time spent by an intern or resi24 dent in an approved medical residency training 

25 program shall be counted toward the determina26 tion of full-time equivalency if the hospital— 


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1 ‘‘(i) is recognized as a subsection (d) 

2 hospital; 

3 ‘‘(ii) is recognized as a subsection (d) 

4 Puerto Rico hospital; 

5 ‘‘(iii) is reimbursed under a reim6 bursement system authorized under section 

7 1814(b)(3); or 

8 ‘‘(iv) is a provider-based hospital out9 patient department.’’. 

10 (b) IME DETERMINATIONS.—Section 

11 1886(d)(5)(B)(x) of the Social Security Act (42 U.S.C. 

12 1395ww(d)(5)(B)(x)) is amended— 

13 (1) in subclause (II), by striking ‘‘In deter14 mining’’ and inserting ‘‘Subject to subclause (x)(IV), 

15 in determining’’; 

16 (2) in subclause (III), by striking ‘‘In deter17 mining’’ and inserting ‘‘Subject to subclause (x)(IV), 

18 in determining’’; and 

19 (3) by adding at the end the following new sub20 clause: 

21 ‘‘(IV) The provisions of subpara22 graph (L) of subsection (h)(4) shall 

23 apply under this subparagraph in the 

24 same manner as they apply under 

25 such subsection.’’. 


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1 SEC. 309. DEVELOPING AND IMPLEMENTING STRATEGIES 

2 FOR LOCAL HEALTH EQUITY. 

3 (a) GRANTS.—The Secretaries of Health and Human 

4 Services, Education, and Labor, acting jointly, shall make 

5 grants to academic institutions for the purposes of— 

6 (1) in accordance with subsection (b), devel7 oping capacity— 

8 (A) to build an evidence base for successful 

9 strategies for increasing local health equity; and 

10 (B) to serve as national models of driving 

11 local health equity; 

12 (2) in accordance with subsection (c), devel13 oping a strategic partnership with the community in 

14 which the academic institution is located; and 

15 (3) collecting data on, and periodically evalu16 ating, the effectiveness of the institution’s programs 

17 funded through this section to enable the institution 

18 to adapt accordingly for maximum efficiency and 

19 success. 

20 (b) DEVELOPING CAPACITY FOR INCREASING LOCAL

21 HEALTH EQUITY.—As a condition on receipt of a grant 

22 under subsection (a), an academic institution shall agree 

23 to use the grant to build an evidence base for successful 

24 strategies for increasing local health equity, and to serve 

25 as a national model of driving local health equity, by sup26 porting— 


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1 (1) resources to strengthen institutional metrics 

2 and capacity to execute institutionwide health work3 force goals that can serve as models for increasing 

4 health equity in communities across the country; 

5 (2) collaborations among a cohort of institu6 tions in implementing systemic change, partnership 

7 development, and programmatic efforts supportive of 

8 health equity goals across disciplines and popu9 lations; and 

10 (3) enhanced or newly developed data systems 

11 and research infrastructure capable of informing 

12 current and future workforce efforts and building a 

13 foundation for a broader research agenda targeting 

14 urban health disparities. 

15 (c) STRATEGIC PARTNERSHIPS.—As a condition on 

16 receipt of a grant under subsection (a), an academic insti17 tution shall agree to use the grant to develop a strategic 

18 partnership with the community in which the institution 

19 is located for the purposes of— 

20 (1) strengthening connections between the insti21 tution and the community— 

22 (A) to improve evaluation of and address 

23 the community’s health and health workforce 

24 needs; and 


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1 (B) to engage the community in health 

2 workforce development; 

3 (2) developing, enhancing, or accelerating inno4 vative undergraduate and graduate programs in the 

5 biomedical sciences and health professions; and 

6 (3) strengthening pipeline programs in the bio7 medical sciences and health professions, including by 

8 developing partnerships between institutions of high9 er education and elementary and secondary schools 

10 to recruit the next generation of health professionals 

11 earlier in the pipeline to a health care career. 

12 SEC. 310. LOAN FORGIVENESS FOR MENTAL AND BEHAV13 IORAL HEALTH SOCIAL WORKERS. 

14 Section 455 of the Higher Education Act of 1965 (20 

15 U.S.C. 1087e) is amended by adding at the end the fol16 lowing new subsection: 

17 ‘‘(r) REPAYMENT PLAN FOR MENTAL AND BEHAV18 IORAL HEALTH SOCIAL WORKERS.— 

19 ‘‘(1) IN GENERAL.—The Secretary shall cancel 

20 the balance of interest and principal due on any eli21 gible Federal Direct Loan not in default for a bor22 rower who— 

23 ‘‘(A) has made 120 monthly payments on 

24 the eligible Federal Direct Loan after October 


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1 1, 2014, pursuant to any one or a combination 

2 of the following— 

3 ‘‘(i) payments under an income-based 

4 repayment plan under section 493C; 

5 ‘‘(ii) payments under a standard re6 payment plan under subsection (d)(1)(A), 

7 based on a 10-year repayment period; 

8 ‘‘(iii) monthly payments under a re9 payment plan under subsection (d)(1) or 

10 (g) of not less than the monthly amount 

11 calculated under subsection (d)(1)(A), 

12 based on a 10-year repayment period; or 

13 ‘‘(iv) payments under an income con14 tingent repayment plan under subsection 

15 (d)(1)(D); and 

16 ‘‘(B)(i) is employed as a mental health or 

17 behavioral health social worker, as defined by 

18 the Secretary by regulation, at the time of such 

19 forgiveness; and 

20 ‘‘(ii) has been employed as such a mental 

21 health or behavioral health social worker during 

22 the period in which the borrower makes each of 

23 the 120 payments as described in subparagraph 

24 (A). 


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1 ‘‘(2) LOAN CANCELLATION AMOUNT.—After the 

2 conclusion of the employment period described in 

3 paragraph (1), the Secretary shall cancel the obliga4 tion to repay the balance of principal and interest 

5 due as of the time of such cancellation, on the eligi6 ble Federal Direct Loans made to the borrower 

7 under this part. 

8 ‘‘(3) INELIGIBILITY FOR DOUBLE BENEFITS.— 

9 No borrower may, for the same employment as a 

10 mental heath or behavioral health social worker, re11 ceive a reduction of loan obligations under both this 

12 subsection and section 455(m), 428J, 428K, 428L, 

13 or 460. 

14 ‘‘(4) DEFINITION OF ELIGIBLE FEDERAL DI15 RECT LOAN.—In this subsection, the term ‘eligible 

16 Federal Direct Loan’ means a Federal Direct Staf17 ford Loan, Federal Direct PLUS Loan, Federal Di18 rect Unsubsidized Stafford Loan, or a Federal Di19 rect Consolidation Loan.’’. 

20 SEC. 311. HEALTH PROFESSIONS WORKFORCE FUND. 

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

22 establish a Health Professions Workforce Fund to be ad23 ministered through the Health Resources and Services Ad24 ministration within the Department of Health and Human 

25 Services to provide for expanded and sustained national 


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1 investment in the health professions and nursing work2 force development programs under title VII and title VIII 

3 of the Public Health Service Act. 

4 (b) ESTABLISHING THE HEALTH PROFESSIONS

5 WORKFORCE FUND.—There is authorized to be appro6 priated, and there is appropriated, out of any monies in 

7 the Treasury not otherwise appropriated, to the Health 

8 Professions Workforce Fund— 

9 (1) $355,000,000 for fiscal year 2015; 

10 (2) $375,000,000 for fiscal year 2016; 

11 (3) $392,000,000 for fiscal year 2017; 

12 (4) $412,000,000 for fiscal year 2018; 

13 (5) $432,000,000 for fiscal year 2019; 

14 (6) $454,000,000 for fiscal year 2020; 

15 (7) $476,000,000 for fiscal year 2021; 

16 (8) $500,000,000 for fiscal year 2022; 

17 (9) $525,000,000 for fiscal year 2023; and 

18 (10) $552,000,000 for fiscal year 2024. 

19 (c) FUNDING.— 

20 (1) For the purpose of carrying out health pro21 fessions education programs authorized under title 

22 VII of the Public Health Service Act, in addition to 

23 any other amounts authorized to be appropriated for 

24 such purpose, there is authorized to be appropriated 


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1 out of any monies in the Health Professions Work2 force Fund, the following: 

3 (A) $240,000,000 for fiscal year 2015. 

4 (B) $253,000,000 for fiscal year 2016. 

5 (C) $265,000,000 for fiscal year 2017. 

6 (D) $278,000,000 for fiscal year 2018. 

7 (E) $292,000,000 for fiscal year 2019. 

8 (F) $307,000,000 for fiscal year 2020. 

9 (G) $322,000,000 for fiscal year 2021. 

10 (H) $338,000,000 for fiscal year 2022. 

11 (I) $355,000,000 for fiscal year 2023. 

12 (J) $373,000,000 for fiscal year 2024. 

13 (2) For the purpose of carrying out nursing 

14 workforce development programs authorized under 

15 Title VIII of the Public Health Service Act, in addi16 tion to any other amounts authorized to be appro17 priated for such purpose, there is authorized to be 

18 appropriated out of any monies in the Health Pro19 fessions Workforce Fund, the following: 

20 (A) $115,000,000 for fiscal year 2015. 

21 (B) $122,000,000 for fiscal year 2016. 

22 (C) $127,000,000 for fiscal year 2017. 

23 (D) $134,000,000 for fiscal year 2018. 

24 (E) $140,000,000 for fiscal year 2019. 

25 (F) $147,000,000 for fiscal year 2020. 


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1 (G) $154,000,000 for fiscal year 2021. 

2 (H) $162,000,000 for fiscal year 2022. 

3 (I) $170,000,000 for fiscal year 2023. 

4 (J) $179,000,000 for fiscal year 2024. 

5 SEC. 312. FINDINGS; SENSE OF CONGRESS RELATING TO 

6 GRADUATE MEDICAL EDUCATION. 

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

8 (1) Projections by the Association of American 

9 Medical Colleges (AAMC) and other expert entities, 

10 such as the Health Resources and Services Adminis11 tration (HRSA), have indicated a nationwide short12 age of up to 130,600 physicians, split evenly be13 tween primary care and specialists, by 2025. 

14 (2) The coverage of an additional 25 million 

15 uninsured Americans under the Patient Protection 

16 and Affordable Care Act is expected to increase the 

17 projected shortage by 25 percent. 

18 (3) The United States Census projects that the 

19 Nation’s population will grow from 310 million in 

20 2010 to 400 million in 2044, with the Nation be21 coming majority-minority in 2043, and the number 

22 of Medicare beneficiaries increasing from 50.7 mil23 lion in 2012 to 90 million in 2045. 


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1 (4) One-third of currently practicing physicians 

2 are over 55 years of age and likely to retire in the 

3 next 20 years. 

4 (5) A nationwide physician shortage will result 

5 in many Americans waiting longer and traveling far6 ther for health care; seeking nonemergent care in 

7 emergency departments; and delaying treatment 

8 until their health care needs become more serious, 

9 complex, and costly. 

10 (6) Changing demographics (such as an aging 

11 population), new health care delivery models (such 

12 as medical homes), and other factors (such as dis13 aster preparedness) are contributing to a shortage of 

14 both generalist and specialist physicians. 

15 (7) These shortages will have the most severe 

16 impact on vulnerable and underserved populations, 

17 including racial/ethnic minorities and the approxi18 mately 20 percent of Americans who live in rural or 

19 inner-city locations designated as health professional 

20 shortage areas. 

21 (8) United States medical schools have com22 mitted to and have initiated a 30 percent increase 

23 in enrollment by 2017 to help reduce the Nation’s 

24 shortage of quality physicians. 


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1 (9) An increase in United States medical school 

2 graduates must be accompanied by an increase of 

3 4,000 graduate medical education (GME) training 

4 positions each year. 

5 (10) Graduate medical education programs and 

6 teaching hospitals provide venues in which the next 

7 generation of physicians learns to work collabo8 ratively with other physicians and health profes9 sionals, adopt more efficient care delivery models 

10 (such as care coordination and medical homes), in11 corporate health information technology and elec12 tronic health records in every aspect of their work, 

13 apply new methods of assuring quality and safety, 

14 and participate in groundbreaking clinical and public 

15 health research. 

16 (11) The Medicare Program under title XVIII 

17 of the Social Security Act (having more beneficiaries 

18 than any other health care program), supports its 

19 ‘‘fair share’’ of the costs associated with graduate 

20 medical education (GME). 

21 (12) In general, the level of support of graduate 

22 medical education by the Medicare Program has 

23 been capped since 1997 and has not been increased 

24 to support the expansion of graduate medical edu25 cation programs needed to avert the projected physiVerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00177 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294

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1 cian shortage or to accommodate the increase in 

2 United States medical school graduates. 

3 (b) SENSE OF CONGRESS.—It is the sense of Con4 gress that eliminating the limit of the number of residency 

5 positions that receive some level of Medicare support 

6 under section 1886(h) of the Social Security Act (42 

7 U.S.C. 1395ww(h)), also referred to as the Medical grad8 uate medical education cap, is critical to— 

9 (1) ensuring an appropriate supply of physi10 cians to meet the Nation’s health care needs; 

11 (2) facilitating equitable access for all who seek 

12 health care; and 

13 (3) mitigating disparities in health and health 

14 care. 

15 SEC. 313. CAREER SUPPORT FOR SKILLED INTERNATION16 ALLY EDUCATED HEALTH PROFESSIONALS. 

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

18 (1) According to the Association of Schools of 

19 Public Health, projections indicate a nationwide 

20 shortage of up to 250,000 public health workers 

21 needed by 2020. 

22 (2) Similar trends are projected for other health 

23 professions indicating shortages across disciplines, 

24 including within the fields of nursing, dentistry, 


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1 pharmacy, mental and behavioral health, primary 

2 care, and community and allied health. 

3 (3) A nationwide health workforce shortage will 

4 result in serious health threats and more severe and 

5 costly health care needs, due to, in part, a delayed 

6 response to food-borne outbreaks, emerging infec7 tious diseases, and natural disasters, fewer cancer 

8 screenings and delayed treatment. 

9 (4) Vulnerable and underserved populations and 

10 health professional shortage areas will be most se11 verely impacted by the health workforce shortage. 

12 (5) According to the Migration Policy Institute, 

13 over 2 million college-educated immigrants in the 

14 United States today are unemployed or under15 employed in low- or semi-skilled jobs that fail to 

16 draw on their education and expertise. 

17 (6) Approximately two out of every five inter18 nationally educated immigrants are unemployed or 

19 underemployed. 

20 (7) According to Drexel University Center for 

21 Labor Markets and Policy, underemployment for 

22 internationally educated immigrant women is 28 per23 cent higher than for their male counterparts. 

24 (8) According to the Drexel University Center 

25 for Labor Markets and Policy, the mean annual 


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1 earnings of underemployed immigrants were 

2 $32,000, or 43 percent less than U.S.-born college 

3 graduates employed in the college labor market. 

4 (9) According to Upwardly Global and the Wel5 come Back Initiative, with proper guidance and sup6 port underemployed skilled immigrants typically in7 crease their income by 215 percent to 900 percent. 

8 (10) According to the Brookings Institution and 

9 the Partnership for a New American Economy, im10 migrants working in the health workforce are, on av11 erage, better-educated than U.S.-born workers in the 

12 health workforce. 

13 (b) GRANTS TO ELIGIBLE ENTITIES.— 

14 (1) AUTHORITY TO PROVIDE GRANTS.—The 

15 Secretary of Health and Human Services, acting 

16 through the Bureau of Health Workforce within the 

17 Health Resources and Services Administration, the 

18 National Institute on Minority Health and Health 

19 Disparities, or the Office of Minority Health (in this 

20 section referred to as the ‘‘Secretary’’), may award 

21 grants to eligible entities to carry out activities de22 scribed in subsection (c). 

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

24 grant under this section, an entity shall— 


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1 (A) be a clinical, public health, or health 

2 services organization, a community-based or 

3 nonprofit entity, an academic institution, a 

4 faith-based organization, a State, county, or 

5 local government, a National Area Health Edu6 cation Center, or another entity determined ap7 propriate by the Secretary; and 

8 (B) submit to the Secretary an application 

9 at such time, in such manner, and containing 

10 such information as the Secretary may require. 

11 (c) AUTHORIZED ACTIVITIES.—A grant awarded 

12 under this section shall be used— 

13 (1) to provide services to assist unemployed and 

14 underemployed skilled immigrants, residing in the 

15 United States, who have legal, permanent work au16 thorization and who are internationally educated 

17 health professions, enter into the American health 

18 workforce with employment matching their health 

19 professional skills and education, and advance in em20 ployment to positions that better match their health 

21 professional education and expertise; 

22 (2) to reduce disparities in incomes between 

23 skilled health professional immigrants and other 

24 workers in the health workforce; 


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1 (3) to reduce barriers to entry and advance2 ment in the health workforce for internationally edu3 cated skilled immigrants; and 

4 (4) to educate employers regarding the abilities 

5 and capacities of internationally educated health 

6 professionals. 

7 (d) DEFINITIONS.—In this section: 

8 (1) The term ‘‘health professional’’ means an 

9 individual trained for employment or intended em10 ployment in the field of public health, health man11 agement, dentistry, health administration, medicine, 

12 nursing, pharmacy, psychology, social work, psychi13 atry, other mental and behavioral health, allied 

14 health, community health, social work, or wellness 

15 work, including fitness and nutrition, or other fields 

16 as determined appropriate by the Secretary. 

17 (2) The term ‘‘underemployed’’ means being 

18 employed at less skilled tasks than an employee’s 

19 training or abilities would otherwise permit. 

20 (e) AUTHORIZATION OF APPROPRIATIONS.—There is 

21 authorized to be appropriated to carry out this section 

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

23 2015 through 2019. 


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1 TITLE IV—IMPROVEMENT OF 

2 HEALTH CARE SERVICES 

3 Subtitle A—Health Empowerment 

4 Zones 

5 SEC. 401. SHORT TITLE. 

6 This subtitle may be cited as the ‘‘Health Empower7 ment Zone Act of 2014’’. 

8 SEC. 402. FINDINGS. 

9 The Congress finds the following: 

10 (1) Numerous studies and reports, including 

11 the 2012 National Healthcare Disparities Report of 

12 the Administration on Healthcare Research and 

13 Quality and the 2002 Unequal Treatment Report of 

14 the Institute of Medicine, document the extensive15 ness to which health disparities exist across the 

16 country. 

17 (2) These studies have found that, on average, 

18 racial and ethnic minorities are disproportionately 

19 afflicted with chronic and acute conditions—such as 

20 cancer, diabetes, musculoskeletal disease, obesity, 

21 and hypertension—and suffer worse health out22 comes, worse health status, and higher mortality 

23 rates than their White counterparts. 

24 (3) Several recent studies also show that health 

25 disparities are a function of not only access to health 


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1 care, but also the social determinants of health—in2 cluding the environment, the physical structure of 

3 communities, nutrition and food options, educational 

4 attainment, employment, race, ethnicity, geography, 

5 and language preference—that directly and indi6 rectly affect the health, health care, and wellness of 

7 individuals and communities. 

8 (4) Integrally involving and fully supporting the 

9 communities most affected by health inequities in 

10 the assessment, planning, launch, and evaluation of 

11 health disparity elimination efforts are among the 

12 leading recommendations made to adequately ad13 dress and ultimately reduce health disparities. 

14 (5) Recommendations also include supporting 

15 the efforts of community stakeholders from a broad 

16 cross section—including, but not limited to local 

17 businesses, local departments of commerce, edu18 cation, labor, urban planning, and transportation, 

19 and community-based and other nonprofit organiza20 tions—to find areas of common ground around 

21 health disparity elimination and collaborate to im22 prove the overall health and wellness of a community 

23 and its residents. 


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1 SEC. 403. DESIGNATION OF HEALTH EMPOWERMENT 

2 ZONES. 

3 (a) IN GENERAL.—At the request of an eligible com4 munity partnership, the Secretary may designate an eligi5 ble area as a health empowerment zone. 

6 (b) ELIGIBILITY CRITERIA.— 

7 (1) ELIGIBLE COMMUNITY PARTNERSHIP.—A 

8 community partnership is eligible to submit a re9 quest under this section if the partnership— 

10 (A) demonstrates widespread public sup11 port from key individuals and entities in the eli12 gible area, including members of the target 

13 community, State and local governments, non14 profit organizations, and community and indus15 try leaders, for designation of the eligible area 

16 as a health empowerment zone; and 

17 (B) includes representatives of— 

18 (i) a broad cross section of stake19 holders and residents from communities in 

20 the eligible area experiencing dispropor21 tionate disparities in health status and 

22 health care; and 

23 (ii) organizations, facilities, and insti24 tutions that have a history of working 

25 within and serving such communities. 


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1 (2) ELIGIBLE AREA.—An area is eligible to be 

2 designated as a health empowerment zone under this 

3 section if one or more communities in the area expe4 rience disproportionate disparities in health status 

5 and health care. In determining whether a commu6 nity experiences such disparities, the Secretary shall 

7 consider the data collected by the Department of 

8 Health and Human Services focusing on the fol9 lowing areas: 

10 (A) Access to affordable, high-quality 

11 health services. 

12 (B) The prevalence of disproportionate 

13 rates of certain illnesses or diseases including 

14 the following: 

15 (i) Arthritis, osteoporosis, chronic 

16 back conditions, and other musculoskeletal 

17 diseases. 

18 (ii) Cancer. 

19 (iii) Chronic kidney disease. 

20 (iv) Diabetes. 

21 (v) Injury (intentional and uninten22 tional). 

23 (vi) Violence (intimate and non24 intimate). 


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1 (vii) Maternal and paternal illnesses 

2 and diseases. 

3 (viii) Infant mortality. 

4 (ix) Mental illness and other disabil5 ities. 

6 (x) Substance abuse treatment and 

7 prevention, including underage drinking. 

8 (xi) Nutrition, obesity, and overweight 

9 conditions. 

10 (xii) Heart disease. 

11 (xiii) Hypertension. 

12 (xiv) Cerebrovascular disease or 

13 stroke. 

14 (xv) Tuberculosis. 

15 (xvi) HIV/AIDS and other sexually 

16 transmitted diseases. 

17 (xvii) Viral hepatitis. 

18 (xviii) Asthma. 

19 (xix) Tooth decay and other oral 

20 health issues. 

21 (C) Within the target community, the his22 torical and persistent presence of conditions 

23 that have been found to contribute to health 

24 disparities including any such conditions re25 specting the following: 


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1 (i) Poverty. 

2 (ii) Educational status and the quality 

3 of community schools. 

4 (iii) Income. 

5 (iv) Access to high-quality affordable 

6 health care. 

7 (v) Work and work environment. 

8 (vi) Environmental conditions in the 

9 community, including with respect to clean 

10 water, clean air, and the presence or ab11 sence of pollutants. 

12 (vii) Language and English pro13 ficiency. 

14 (viii) Access to affordable healthy 

15 food. 

16 (ix) Access to ethnically and culturally 

17 diverse health and human service providers 

18 and practitioners. 

19 (x) Access to culturally and linguis20 tically competent health and human serv21 ices and health and human service pro22 viders. 

23 (xi) Health-supporting infrastructure. 

24 (xii) Health insurance that is ade25 quate and affordable. 


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1 (xiii) Race, racism, and bigotry (con2 scious and unconscious). 

3 (xiv) Sexual orientation. 

4 (xv) Health literacy. 

5 (xvi) Place of residence (such as 

6 urban areas, rural areas, and tribal res7 ervations). 

8 (xvii) Stress. 

9 (c) PROCEDURE.— 

10 (1) REQUEST.—A request under subsection (a) 

11 shall— 

12 (A) describe the bounds of the area to be 

13 designated as a health empowerment zone and 

14 the process used to select those bounds; 

15 (B) demonstrate that the partnership sub16 mitting the request is an eligible community 

17 partnership described in subsection (b)(1); 

18 (C) demonstrate that the area is an eligible 

19 area described in subsection (b)(2); 

20 (D) include a comprehensive assessment of 

21 disparities in health status and health care ex22 perience by one or more communities in the 

23 area; 

24 (E) set forth— 


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1 (i) a vision and a set of values for the 

2 area; and 

3 (ii) a comprehensive and holistic set of 

4 goals to be achieved in the area through 

5 designation as a health empowerment zone; 

6 and 

7 (F) include a strategic plan and an action 

8 plan for achieving the goals described in sub9 paragraph (E)(ii). 

10 (2) APPROVAL.—Not later than 60 days after 

11 the receipt of a request for designation of an area 

12 as a health empowerment zone under this section, 

13 the Secretary shall approve or disapprove the re14 quest. 

15 (d) MINIMUM NUMBER.—The Secretary— 

16 (1) shall designate not more than 110 health 

17 empowerment zones under this section; and 

18 (2) shall designate at least one health empower19 ment zone in each of the several States, the District 

20 of Columbia, and each territory or possession of the 

21 United States. 

22 SEC. 404. ASSISTANCE TO THOSE SEEKING DESIGNATION. 

23 At the request of any organization or entity seeking 

24 to submit a request under section 403(a), the Secretary 


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1 shall provide technical assistance, and may award a grant, 

2 to assist such organization or entity— 

3 (1) to form an eligible community partnership 

4 described in section 403(b)(1); 

5 (2) to complete a health assessment, including 

6 an assessment of health disparities under section 

7 403(c)(1)(D); or 

8 (3) to prepare and submit a request, including 

9 a strategic plan, in accordance with section 403. 

10 SEC. 405. BENEFITS OF DESIGNATION. 

11 (a) PRIORITY.—In awarding any competitive grant, 

12 a Federal official shall give priority to any applicant 

13 that— 

14 (1) meets the eligibility criteria for the grant; 

15 (2) proposes to use the grant for activities in a 

16 health empowerment zone; and 

17 (3) demonstrates that such activities will di18 rectly and significantly further the goals of the stra19 tegic plan approved for such zone under section 403. 

20 (b) GRANTS FOR INITIAL IMPLEMENTATION OF

21 STRATEGIC PLAN.— 

22 (1) IN GENERAL.—Upon designating an eligible 

23 area as a health empowerment zone at the request 

24 of an eligible community partnership, the Secretary 

25 shall, subject to the availability of appropriations, 


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1 make a grant to the community partnership for im2 plementation of the strategic plan for such zone. 

3 (2) GRANT PERIOD.—A grant under paragraph 

4 (1) for a health empowerment zone shall be for a pe5 riod of 2 years and may be renewed, except that the 

6 total period of grants under paragraph (1) for such 

7 zone may not exceed 10 years. 

8 (3) LIMITATION.—In awarding grants under 

9 this subsection, the Secretary shall not give less pri10 ority to an applicant or reduce the amount of a 

11 grant because the Secretary rendered technical as12 sistance or made a grant to the same applicant 

13 under section 404. 

14 (4) REPORTING.—The Secretary shall require 

15 each recipient of a grant under this subsection to re16 port to the Secretary not less than every 6 months 

17 on the progress in implementing the strategic plan 

18 for the health empowerment zone. 

19 SEC. 406. DEFINITION. 

20 In this subtitle, the term ‘‘Secretary’’ means the Sec21 retary of Health and Human Services, acting through the 

22 Administrator of the Health Resources and Services Ad23 ministration and the Deputy Assistant Secretary for Mi24 nority Health, and in cooperation with the Director of the 

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1 tional Institute for Minority Health and Health Dispari2 ties. 

3 SEC. 407. AUTHORIZATION OF APPROPRIATIONS. 

4 To carry out this subtitle, there is authorized to be 

5 appropriated $100,000,000 for fiscal year 2015. 

6 Subtitle B—Other Improvements of 

7 Health Care Services 

8 CHAPTER 1—EXPANSION OF COVERAGE 

9 SEC. 411. AMENDMENT TO THE PUBLIC HEALTH SERVICE 

10 ACT. 

11 Title XXXIV of the Public Health Service Act, as 

12 amended by titles I, II, III, and IX of this Act, is further 

13 amended by inserting after subtitle C the following: 

14 ‘‘Subtitle D—Reconstruction and 

15 Improvement Grants for Public 

16 Health Care Facilities Serving 

17 Pacific Islanders and the Insu18 lar Areas 

19 ‘‘SEC. 3451. GRANT SUPPORT FOR QUALITY IMPROVEMENT 

20 INITIATIVES. 

21 ‘‘(a) IN GENERAL.—The Secretary, in collaboration 

22 with the Administrator of the Health Resources and Serv23 ices Administration, the Director of the Agency for 

24 Healthcare Research and Quality, and the Administrator 

25 of the Centers for Medicare & Medicaid Services, shall 


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1 award grants to eligible entities for the conduct of dem2 onstration projects to improve the quality of and access 

3 to health care. 

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

5 under subsection (a), an entity shall— 

6 ‘‘(1) be a health center, hospital, health plan, 

7 health system, community clinic. or other health en8 tity determined appropriate by the Secretary— 

9 ‘‘(A) that, by legal mandate or explicitly 

10 adopted mission, provides patients with access 

11 to services regardless of their ability to pay; 

12 ‘‘(B) that provides care or treatment for a 

13 substantial number of patients who are unin14 sured, are receiving assistance under a State 

15 program under title XIX of the Social Security 

16 Act, or are members of vulnerable populations, 

17 as determined by the Secretary; and 

18 ‘‘(C)(i) with respect to which, not less than 

19 50 percent of the entity’s patient population is 

20 made up of racial and ethnic minorities; or 

21 ‘‘(ii) that— 

22 ‘‘(I) serves a disproportionate percent23 age of local, minority racial and ethnic pa24 tients, or that has a patient population, at 


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1 least 50 percent of which is limited2 English-proficient; and 

3 ‘‘(II) provides an assurance that 

4 amounts received under the grant will be 

5 used only to support quality improvement 

6 activities in the racial and ethnic popu7 lation served; and 

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

9 application at such time, in such manner, and con10 taining such information as the Secretary may re11 quire. 

12 ‘‘(c) PRIORITY.—In awarding grants under sub13 section (a), the Secretary shall give priority to applicants 

14 under subsection (b)(2) that— 

15 ‘‘(1) demonstrate an intent to operate as part 

16 of a health care partnership, network, collaborative, 

17 coalition, or alliance where each member entity con18 tributes to the design, implementation, and evalua19 tion of the proposed intervention; or 

20 ‘‘(2) intend to use funds to carry out system21 wide changes with respect to health care quality im22 provement, including— 

23 ‘‘(A) improved systems for data collection 

24 and reporting; 


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1 ‘‘(B) innovative collaborative or similar 

2 processes; 

3 ‘‘(C) group programs with behavioral or 

4 self-management interventions; 

5 ‘‘(D) case management services; 

6 ‘‘(E) physician or patient reminder sys7 tems; 

8 ‘‘(F) educational interventions; or 

9 ‘‘(G) other activities determined appro10 priate by the Secretary. 

11 ‘‘(d) USE OF FUNDS.—An entity shall use amounts 

12 received under a grant under subsection (a) to support 

13 the implementation and evaluation of health care quality 

14 improvement activities or minority health and health care 

15 disparity reduction activities that include— 

16 ‘‘(1) with respect to health care systems, activi17 ties relating to improving— 

18 ‘‘(A) patient safety; 

19 ‘‘(B) timeliness of care; 

20 ‘‘(C) effectiveness of care; 

21 ‘‘(D) efficiency of care; 

22 ‘‘(E) patient centeredness; and 

23 ‘‘(F) health information technology; and 

24 ‘‘(2) with respect to patients, activities relating 

25 to— 


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1 ‘‘(A) staying healthy; 

2 ‘‘(B) getting well, mentally and physically; 

3 ‘‘(C) living effectively with illness or dis4 ability; and 

5 ‘‘(D) coping with end-of-life issues. 

6 ‘‘(e) COMMON DATA SYSTEMS.—The Secretary shall 

7 provide financial and other technical assistance to grant8 ees under this section for the development of common data 

9 systems. 

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

11 are authorized to be appropriated to carry out this section 

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

13 2015 through 2020. 

14 ‘‘SEC. 3452. CENTERS OF EXCELLENCE. 

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

16 the Administrator of the Health Resources and Services 

17 Administration, shall designate centers of excellence at 

18 public hospitals, and other health systems serving large 

19 numbers of minority patients, that— 

20 ‘‘(1) meet the requirements of section 

21 3451(b)(1); 

22 ‘‘(2) demonstrate excellence in providing care to 

23 minority populations; and 

24 ‘‘(3) demonstrate excellence in reducing dispari25 ties in health and health care. 


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1 ‘‘(b) REQUIREMENTS.—A hospital or health system 

2 that serves as a center of excellence under subsection (a) 

3 shall— 

4 ‘‘(1) design, implement, and evaluate programs 

5 and policies relating to the delivery of care in ra6 cially, ethnically, and linguistically diverse popu7 lations; 

8 ‘‘(2) provide training and technical assistance 

9 to other hospitals and health systems relating to the 

10 provision of quality health care to minority popu11 lations; and 

12 ‘‘(3) develop activities for graduate or con13 tinuing medical education that institutionalize a 

14 focus on cultural competence training for health care 

15 providers. 

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

17 are authorized to be appropriated to carry out this section, 

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

19 2015 through 2020. 

20 ‘‘SEC. 3453. RECONSTRUCTION AND IMPROVEMENT GRANTS 

21 FOR PUBLIC HEALTH CARE FACILITIES SERV22 ING PACIFIC ISLANDERS AND THE INSULAR 

23 AREAS. 

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1 viders and community health centers in American Samoa, 

2 Guam, the Commonwealth of the Northern Mariana Is3 lands, the United States Virgin Islands, Puerto Rico, and 

4 Hawaii for the purposes of reconstructing and improving 

5 health care facilities and services in a culturally competent 

6 and sustainable manner. 

7 ‘‘(b) ELIGIBILITY.—To be eligible to receive direct fi8 nancial assistance under subsection (a), an entity shall be 

9 a public health facility or community health center located 

10 in American Samoa, Guam, the Commonwealth of the 

11 Northern Mariana Islands, the United States Virgin Is12 lands, Puerto Rico, or Hawaii that— 

13 ‘‘(1) is owned or operated by— 

14 ‘‘(A) the Government of American Samoa, 

15 Guam, the Commonwealth of the Northern 

16 Mariana Islands, the United States Virgin Is17 lands, Puerto Rico, or Hawaii or a unit of local 

18 government; or 

19 ‘‘(B) a nonprofit organization; and 

20 ‘‘(2)(A) provides care or treatment for a sub21 stantial number of patients who are uninsured, re22 ceiving assistance under a State program under a 

23 title XVIII of the Social Security Act, or a State 

24 program under title XIX of such Act, or who are 


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1 members of a vulnerable population, as determined 

2 by the Secretary; or 

3 ‘‘(B) serves a disproportionate percentage of 

4 local, minority racial and ethnic patients. 

5 ‘‘(c) REPORT.—Not later than 180 days after the 

6 date of enactment of this title and annually thereafter, the 

7 Secretary shall submit to the Congress and the President 

8 a report that includes an assessment of health resources 

9 and facilities serving populations in American Samoa, 

10 Guam, the Commonwealth of the Northern Mariana Is11 lands, the United States Virgin Islands, Puerto Rico, and 

12 Hawaii. In preparing such report, the Secretary shall— 

13 ‘‘(1) consult with and obtain information on all 

14 health care facilities needs from the entities de15 scribed in subsection (b); 

16 ‘‘(2) include all amounts of Federal assistance 

17 received by each entity in the preceding fiscal year; 

18 ‘‘(3) review the total unmet needs of each juris19 diction for health care facilities, including needs for 

20 renovation and expansion of existing facilities; 

21 ‘‘(4) include a strategic plan for addressing the 

22 needs of each jurisdiction identified in the report; 

23 and 


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1 ‘‘(5) evaluate the effectiveness of the care pro2 vided by measuring patient outcomes and cost meas3 ures. 

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

5 are authorized to be appropriated such sums as necessary 

6 to carry out this section.’’. 

7 SEC. 412. REMOVING CITIZENSHIP AND IMMIGRATION BAR8 RIERS TO ACCESS TO AFFORDABLE HEALTH 

9 CARE UNDER THE ACA. 

10 (a) IN GENERAL.— 

11 (1) PREMIUM TAX CREDITS.—Section 36B of 

12 the Internal Revenue Code of 1986 is amended— 

13 (A) in subsection (c)(1)(B)— 

14 (i) by amending the subparagraph 

15 heading to read as follows: ‘‘SPECIAL RULE

16 FOR CERTAIN INDIVIDUALS INELIGIBLE

17 FOR MEDICAID DUE TO STATUS’’, and 

18 (ii) in clause (ii), by striking ‘‘lawfully 

19 present in the United States, but’’ and in20 serting ‘‘who’’, and 

21 (B) by striking subsection (e). 

22 (2) COST-SHARING REDUCTIONS.—Section 1402 

23 of the Patient Protection and Affordable Care Act 

24 (42 U.S.C. 18071) is amended by striking sub25 section (e). 


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1 (3) PREEXISTING CONDITION INSURANCE

2 PLAN.—Section 1101(d) of the Patient Protection 

3 and Affordable Care Act (42 U.S.C. 18001(d)) is 

4 amended by striking paragraph (1) and redesig5 nating paragraphs (2) and (3) as paragraphs (1) 

6 and (2), respectively. 

7 (4) BASIC HEALTH PROGRAM ELIGIBILITY.— 

8 Section 1331(e)(1)(B) of the Patient Protection and 

9 Affordable Care Act (42 U.S.C. 18051(e)(1)(B)) is 

10 amended by striking ‘‘lawfully present in the United 

11 States,’’. 

12 (5) RESTRICTIONS ON FEDERAL PAYMENTS.— 

13 Section 1412 of the Patient Protection and Afford14 able Care Act (42 U.S.C. 18082) is amended by 

15 striking subsection (d). 

16 (6) REQUIREMENT TO MAINTAIN MINIMUM ES17 SENTIAL COVERAGE.—Subsection (d) of section 

18 5000A of the Internal Revenue Code of 1986 is 

19 amended by striking paragraph (3) and by redesig20 nating paragraph (4) as paragraph (3). 

21 (b) CONFORMING AMENDMENT.— 

22 (1) Section 1411(a) of the Patient Protection 

23 and Affordable Care Act (42 U.S.C. 18081(a)) is 

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1 nating paragraphs (2), (3), and (4) as paragraphs 

2 (1), (2), and (3), respectively. 

3 (2) Section 1312(f) of the Patient Protection 

4 and Affordable Care Act (42 U.S.C. 18032(f)) is 

5 amended— 

6 (A) in the subsection heading, by striking 

7 ‘‘employers;’’ and all that follows through ‘‘resi8 dents’’; and 

9 (B) by striking paragraph (3). 

10 SEC. 413. STUDY ON THE UNINSURED. 

11 (a) IN GENERAL.—The Secretary of Health and 

12 Human Services (in this section referred to as the ‘‘Sec13 retary’’) shall— 

14 (1) conduct a study, in accordance with the 

15 standards under section 3101 of the Public Health 

16 Service Act (42 U.S.C. 300kk), on the demographic 

17 characteristics of the population of individuals who 

18 do not have health insurance coverage; and 

19 (2) predict, based on such study, the demo20 graphic characteristics of the population of individ21 uals who would remain without health insurance cov22 erage after the end of open enrollment or any special 

23 enrollment period. 

24 (b) REPORTING REQUIREMENTS.— 


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1 (1) IN GENERAL.—Not later than 12 months 

2 after the date of the enactment of this Act, the Sec3 retary shall submit to the Congress the results of 

4 the study under subsection (a)(1) and the prediction 

5 made under subsection (a)(2). 

6 (2) REPORTING OF DEMOGRAPHIC CHARACTER7 ISTICS.—The Secretary shall report the demographic 

8 characteristics under paragraphs (1) and (2) of sub9 section (a) on the basis of racial and ethnic group, 

10 and shall stratify the reporting on each racial and 

11 ethnic group by other demographic characteristics 

12 that can impact access to health insurance coverage, 

13 such as sexual orientation, gender identity, primary 

14 language, disability status, sex, socioeconomic sta15 tus, age group, and citizenship and immigration sta16 tus, in a manner consistent with title I of this Act. 

17 SEC. 414. MEDICAID PAYMENT PARITY FOR THE TERRI18 TORIES. 

19 (a) ELIMINATION OF FUNDING LIMITATIONS FOR

20 PUERTO RICO, THE UNITED STATES VIRGIN ISLANDS, 

21 GUAM, THE COMMONWEALTH OF THE NORTHERN MAR22 IANA ISLANDS, AND AMERICAN SAMOA.— 

23 (1) IN GENERAL.—Section 1108 of the Social 

24 Security Act (42 U.S.C. 1308) is amended— 


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1 (A) in subsection (f), in the matter pre2 ceding paragraph (1), by striking ‘‘subsection 

3 (g)’’ and inserting ‘‘subsections (g) and (h)’’; 

4 (B) in subsection (g)(2), in the matter pre5 ceding subparagraph (A)— 

6 (i) by striking ‘‘Notwithstanding sub7 section (f) and subject to and’’ and insert8 ing ‘‘Notwithstanding subsection (f) and 

9 subject to’’; and 

10 (ii) by striking ‘‘paragraphs (3) and 

11 (5)’’ and inserting ‘‘, paragraphs (3) and 

12 (5) of this subsection, and subsection (h)’’. 

13 (C) by adding at the end the following new 

14 subsection: 

15 ‘‘(h) SUNSET OF FUNDING LIMITATIONS FOR PUER16 TO RICO, THE UNITED STATES VIRGIN ISLANDS, GUAM, 

17 THE COMMONWEALTH OF THE NORTHERN MARIANA IS18 LANDS, AND AMERICAN SAMOA.—Subsections (f) and (g) 

19 shall not apply to Puerto Rico, the United States Virgin 

20 Islands, Guam, the Commonwealth of the Northern Mar21 iana Islands, and American Samoa for any fiscal year 

22 after fiscal year 2015.’’. 

23 (2) CONFORMING AMENDMENT.—Section 

24 1903(u) of such Act (42 U.S.C. 1396c(u)) is amend25 ed by striking paragraph (4). 


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1 (3) EFFECTIVE DATE.—The amendments made 

2 by this subsection shall apply beginning with fiscal 

3 year 2016. 

4 (b) PARITY IN FMAP.— 

5 (1) IN GENERAL.—Section 1905(b) of such Act 

6 (42 U.S.C. 1396d(b)) is amended by inserting after 

7 ‘‘and American Samoa shall be 55 percent,’’ the fol8 lowing: ‘‘(except that, beginning with fiscal year 

9 2018, the Federal medical assistance percentage for 

10 Puerto Rico, the United States Virgin Islands, 

11 Guam, the Commonwealth of the Northern Mariana 

12 Islands, and American Samoa shall be the Federal 

13 medical assistance percentage determined by the 

14 Secretary in consultation (for the United States Vir15 gin Islands, Guam, the Commonwealth of the North16 ern Mariana Islands, and American Samoa) with the 

17 Secretary of the Interior)’’. 

18 (2) 2-FISCAL-YEAR TRANSITION.—Notwith19 standing any other provision of law, during fiscal 

20 years 2016 and 2017, the Federal medical assist21 ance percentage established under section 1905(b) of 

22 the Social Security Act (42 U.S.C. 1396d(b)) for 

23 Puerto Rico, the United States Virgin Islands, 

24 Guam, the Commonwealth of the Northern Mariana 

25 Islands, and American Samoa shall be the highest 


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1 such Federal medical assistance percentage applica2 ble to any of the 50 States or the District of Colum3 bia for the fiscal year involved. 

4 (3) PER CAPITA INCOME DATA.— 

5 (A) REPORT TO CONGRESS.—Not later 

6 than October 1, 2016, the Secretary of Health 

7 and Human Services shall submit to Congress 

8 a report that describes the per capita income 

9 data used to promulgate the Federal medical 

10 assistance percentage in the territories and how 

11 such data differ from the per capita income 

12 data used to promulgate Federal medical assist13 ance percentages for the 50 States and the Dis14 trict of Columbia. The report should include 

15 recommendations on how the Federal medical 

16 assistance percentages can be calculated for the 

17 territories to ensure parity with the 50 States 

18 and the District of Columbia. 

19 (B) APPLICATION.—Section 1101(a)(8)(B) 

20 of the Social Security Act (42 U.S.C. 

21 1308(a)(8)(B)) is amended— 

22 (i) by striking ‘‘(other than Puerto 

23 Rico, the United States Virgin Islands, and 

24 Guam)’’ and inserting ‘‘(including Puerto 

25 Rico, the United States Virgin Islands, 


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1 Guam, the Commonwealth of the Northern 

2 Mariana Islands, and American Samoa)’’; 

3 and 

4 (ii) by inserting ‘‘(or, if such satisfac5 tory data are not available in the case of 

6 the United States Virgin Islands, Guam, 

7 the Northern Mariana Islands, or Amer8 ican Samoa, satisfactory data available 

9 from the Department of the Interior for 

10 the same period, or if such satisfactory 

11 data are not available in the case of Puerto 

12 Rico, satisfactory data available from the 

13 government of the Commonwealth of Puer14 to Rico for the same period)’’ after ‘‘De15 partment of Commerce’’. 

16 SEC. 415. EXTENSION OF MEDICARE SECONDARY PAYER. 

17 (a) IN GENERAL.—Section 1862(b)(1)(C) of the So18 cial Security Act (42 U.S.C. 1395y(b)(1)(C)) is amend19 ed— 

20 (1) in the last sentence, by inserting ‘‘, and be21 fore January 1, 2015’’ after ‘‘prior to such date)’’; 

22 and 

23 (2) by adding at the end the following new sen24 tence: ‘‘Effective for items and services furnished on 

25 or after January 1, 2015 (with respect to periods 


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1 beginning on or after the date that is 42 months 

2 prior to such date), clauses (i) and (ii) shall be ap3 plied by substituting ‘42-month’ for ‘12-month’ each 

4 place it appears in the first sentence.’’. 

5 (b) EFFECTIVE DATE.—The amendments made by 

6 this section shall take effect on the date of enactment of 

7 this Act. For purposes of determining an individual’s sta8 tus under section 1862(b)(1)(C) of the Social Security Act 

9 (42 U.S.C. 1395y(b)(1)(C)), as amended by subsection 

10 (a), an individual who is within the coordinating period 

11 as of the date of enactment of this Act shall have that 

12 period extended to the full 42 months described in the last 

13 sentence of such section, as added by the amendment 

14 made by subsection (a)(2). 

15 SEC. 416. BORDER HEALTH GRANTS. 

16 (a) ELIGIBLE ENTITY DEFINED.—In this section, 

17 the term ‘‘eligible entity’’ means a State, public institution 

18 of higher education, local government, tribal government, 

19 nonprofit health organization, community health center, or 

20 community clinic receiving assistance under section 330 

21 of the Public Health Service Act (42 U.S.C. 254b), that 

22 is located in the border area. 

23 (b) AUTHORIZATION.—From funds appropriated 

24 under subsection (f), the Secretary of Health and Human 

25 Services (in this section referred to as the ‘‘Secretary’’), 


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1 acting through the United States members of the United 

2 States-Mexico Border Health Commission, shall award 

3 grants to eligible entities to address priorities and rec4 ommendations to improve the health of border area resi5 dents that are established by— 

6 (1) the United States members of the United 

7 States-Mexico Border Health Commission; 

8 (2) the State border health offices; and 

9 (3) the Secretary. 

10 (c) APPLICATION.—An eligible entity that desires a 

11 grant under subsection (b) shall submit an application to 

12 the Secretary at such time, in such manner, and con13 taining such information as the Secretary may require. 

14 (d) USE OF FUNDS.—An eligible entity that receives 

15 a grant under subsection (b) shall use the grant funds 

16 for— 

17 (1) programs relating to— 

18 (A) maternal and child health; 

19 (B) primary care and preventative health; 

20 (C) public health and public health infra21 structure; 

22 (D) musculoskeletal health and obesity; 

23 (E) health education and promotion; 

24 (F) oral health; 

25 (G) mental and behavioral health; 


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1 (H) substance abuse; 

2 (I) health conditions that have a high prev3 alence in the border area; 

4 (J) medical and health services research; 

5 (K) workforce training and development; 

6 (L) community health workers or 

7 promotoras; 

8 (M) health care infrastructure problems in 

9 the border area (including planning and con10 struction grants); 

11 (N) health disparities in the border area; 

12 (O) environmental health; and 

13 (P) outreach and enrollment services with 

14 respect to Federal programs (including pro15 grams authorized under titles XIX and XXI of 

16 the Social Security Act (42 U.S.C. 1396 and 

17 1397aa)); and 

18 (2) other programs determined appropriate by 

19 the Secretary. 

20 (e) SUPPLEMENT, NOT SUPPLANT.—Amounts pro21 vided to an eligible entity awarded a grant under sub22 section (b) shall be used to supplement and not supplant 

23 other funds available to the eligible entity to carry out the 

24 activities described in subsection (d). 


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1 (f) AUTHORIZATION OF APPROPRIATIONS.—There 

2 are authorized to be appropriated to carry out this section, 

3 $200,000,000 for fiscal year 2015, and such sums as may 

4 be necessary for each succeeding fiscal year. 

5 SEC. 417. REMOVING MEDICARE BARRIER TO HEALTH 

6 CARE. 

7 (a) PART A.—Section 1818(a)(3) of the Social Secu8 rity Act (42 U.S.C. 1395i–2(a)(3)) is amended by striking 

9 ‘‘(B)’’ and all that follows through ‘‘under this section’’ 

10 and inserting ‘‘(B) an individual who is lawfully present 

11 in the United States’’. 

12 (b) PART B.—Section 1836(2) of the Social Security 

13 Act (42 U.S.C. 1395o(2)) is amended by striking ‘‘(B)’’ 

14 and all that follows through ‘‘under this part’’ and insert15 ing ‘‘(B) an individual who is lawfully present in the 

16 United States’’. 

17 SEC. 418. 100 PERCENT FMAP FOR MEDICAL ASSISTANCE 

18 PROVIDED BY URBAN INDIAN HEALTH CEN19 TERS. 

20 (a) IN GENERAL.—The third sentence of section 

21 1905(b) of the Social Security Act (42 U.S.C. 1396(b)), 

22 as amended by section 415(c), is further amended by in23 serting ‘‘or are received through a program operated by 

24 an urban Indian organization through a grant or contract 


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1 under title V of such Act’’ after ‘‘(as defined in section 

2 4 of the Indian Health Care Improvement Act)’’. 

3 (b) EFFECTIVE DATE.—The amendment made by 

4 this section shall apply to medical assistance provided on 

5 or after the date of enactment of this Act. 

6 SEC. 419. 100 PERCENT FMAP FOR MEDICAL ASSISTANCE 

7 PROVIDED TO A NATIVE HAWAIIAN THROUGH 

8 A FEDERALLY QUALIFIED HEALTH CENTER 

9 OR A NATIVE HAWAIIAN HEALTH CARE SYS10 TEM UNDER THE MEDICAID PROGRAM. 

11 (a) IN GENERAL.—The third sentence of section 

12 1905(b) of the Social Security Act (42 U.S.C. 1396d(b)), 

13 as amended by section 419, is amended by inserting ‘‘; 

14 and, with respect to medical assistance provided to a Na15 tive Hawaiian (as defined in section 12(2) of the Native 

16 Hawaiian Health Care Improvement Act) through a feder17 ally qualified health center or a Native Hawaiian health 

18 care system (as defined in section 12(6) of such Act), 

19 whether directly, by referral, or under contract or other 

20 arrangement between such federally qualified health cen21 ter or Native Hawaiian health care system and another 

22 health care provider’’ before the period. 

23 (b) EFFECTIVE DATE.—The amendment made by 

24 this section shall apply to medical assistance provided on 

25 or after the date of enactment of this Act. 


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1 CHAPTER 2—EXPANSION OF ACCESS 

2 SEC. 421. GRANTS FOR RACIAL AND ETHNIC APPROACHES 

3 TO COMMUNITY HEALTH. 

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

5 provide for the awarding of grants to assist communities 

6 in mobilizing and organizing resources in support of effec7 tive and sustainable programs that will reduce or eliminate 

8 disparities in health and health care experienced by racial 

9 and ethnic minority individuals. 

10 (b) AUTHORITY TO AWARD GRANTS.—The Secretary 

11 of Health and Human Services, acting through the Ad12 ministrator of the Health Resources and Services Admin13 istration, shall award grants to eligible entities to assist 

14 in designing, implementing, and evaluating culturally and 

15 linguistically appropriate, science-based, and community16 driven sustainable strategies to eliminate racial and ethnic 

17 health and health care disparities. 

18 (c) ELIGIBLE ENTITIES.—To be eligible to receive a 

19 grant under this section, an entity shall— 

20 (1) represent a coalition— 

21 (A) whose principal purpose is to develop 

22 and implement interventions to reduce or elimi23 nate a health or health care disparity in a tar24 geted racial or ethnic minority group in the 

25 community served by the coalition; and 


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1 (B) that includes— 

2 (i) members selected from among— 

3 (I) public health departments; 

4 (II) community-based organiza5 tions; 

6 (III) university and research or7 ganizations; 

8 (IV) American Indian tribal or9 ganizations, national American Indian 

10 organizations, Indian Health Service, 

11 or organizations serving Alaska Na12 tives; and 

13 (V) interested public or private 

14 health care providers or organizations 

15 as deemed appropriate by the Sec16 retary; and 

17 (ii) at least 1 member from a commu18 nity-based organization that represents the 

19 targeted racial or ethnic minority group; 

20 and 

21 (2) submit to the Secretary an application at 

22 such time, in such manner, and containing such in23 formation as the Secretary may require, which shall 

24 include— 


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1 (A) a description of the targeted racial or 

2 ethnic populations in the community to be 

3 served under the grant; 

4 (B) a description of at least 1 health dis5 parity that exists in the racial or ethnic tar6 geted populations, including health issues such 

7 as infant mortality, breast and cervical cancer 

8 screening and management, musculoskeletal 

9 diseases and obesity, prostate cancer screening 

10 and management, cardiovascular disease, diabe11 tes, child and adult immunization levels, or 

12 other health priority areas as designated by the 

13 Secretary; and 

14 (C) a demonstration of a proven record of 

15 accomplishment of the coalition members in 

16 serving and working with the targeted commu17 nity. 

18 (d) SUSTAINABILITY.—The Secretary shall give pri19 ority to an eligible entity under this section if the entity 

20 agrees that, with respect to the costs to be incurred by 

21 the entity in carrying out the activities for which the grant 

22 was awarded, the entity (and each of the participating 

23 partners in the coalition represented by the entity) will 

24 maintain its expenditures of non-Federal funds for such 

25 activities at a level that is not less than the level of such 


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1 expenditures during the fiscal year immediately preceding 

2 the first fiscal year for which the grant is awarded. 

3 (e) NONDUPLICATION.—Funds provided through this 

4 grant program should supplement, not supplant, existing 

5 Federal funding, and the funds should not be used to du6 plicate the activities of the other health disparity grant 

7 programs in this Act. 

8 (f) TECHNICAL ASSISTANCE.—The Secretary may, 

9 either directly or by grant or contract, provide any entity 

10 that receives a grant under this section with technical and 

11 other nonfinancial assistance necessary to meet the re12 quirements of this section. 

13 (g) DISSEMINATION.—The Secretary shall encourage 

14 and enable grantees to share best practices, evaluation re15 sults, and reports with communities not affiliated with 

16 grantees using the Internet, conferences, and other perti17 nent information regarding the projects funded by this 

18 section, including the outreach efforts of the Office of Mi19 nority Health and Health Disparity Elimination and the 

20 Centers for Disease Control and Prevention. 

21 (h) ADMINISTRATIVE BURDENS.—The Secretary 

22 shall make every effort to minimize duplicative or unneces23 sary administrative burdens on grantees. 


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1 (i) DEFINITION.—In this section, the term ‘‘Sec2 retary’’ means the Secretary of Health and Human Serv3 ices. 

4 (j) AUTHORIZATION OF APPROPRIATIONS.—There 

5 are authorized to be appropriated such sums as may be 

6 necessary to carry out this section. 

7 SEC. 422. CRITICAL ACCESS HOSPITAL IMPROVEMENTS. 

8 (a) ELIMINATION OF ISOLATION TEST FOR COST9 BASED AMBULANCE REIMBURSEMENT.— 

10 (1) IN GENERAL.—Section 1834(l)(8) of the 

11 Social Security Act (42 U.S.C. 1395m(l)(8)) is 

12 amended— 

13 (A) in subparagraph (B)— 

14 (i) by striking ‘‘owned and’’; and 

15 (ii) by inserting ‘‘(including when 

16 such services are provided by the entity 

17 under an arrangement with the hospital)’’ 

18 after ‘‘hospital’’; and 

19 (B) by striking the comma at the end of 

20 subparagraph (B) and all that follows and in21 serting a period. 

22 (2) EFFECTIVE DATE.—The amendments made 

23 by this subsection shall apply to services furnished 

24 on or after January 1, 2015. 


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1 (b) PROVISION OF A MORE FLEXIBLE ALTERNATIVE

2 TO THE CAH DESIGNATION 25 INPATIENT BED LIMIT

3 REQUIREMENT.— 

4 (1) IN GENERAL.—Section 1820(c)(2) of the 

5 Social Security Act (42 U.S.C. 1395i–4(c)(2)) is 

6 amended— 

7 (A) in subparagraph (B)(iii), by striking 

8 ‘‘provides not more than’’ and inserting ‘‘sub9 ject to subparagraph (F), provides not more 

10 than’’; and 

11 (B) by adding at the end the following new 

12 subparagraph: 

13 ‘‘(F) ALTERNATIVE TO 25 INPATIENT BED

14 LIMIT REQUIREMENT.— 

15 ‘‘(i) IN GENERAL.—A State may elect 

16 to treat a facility, with respect to the des17 ignation of the facility for a cost-reporting 

18 period, as satisfying the requirement of 

19 subparagraph (B)(iii) relating to a max20 imum number of acute care inpatient beds 

21 if the facility elects, in accordance with a 

22 method specified by the Secretary and be23 fore the beginning of the cost reporting pe24 riod, to meet the requirement under clause 

25 (ii). 


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1 ‘‘(ii) ALTERNATE REQUIREMENT.— 

2 The requirement under this clause, with 

3 respect to a facility and a cost-reporting 

4 period, is that the total number of inpa5 tient bed days described in subparagraph 

6 (B)(iii) during such period will not exceed 

7 7,300. For purposes of this subparagraph, 

8 an individual who is an inpatient in a bed 

9 in the facility for a single day shall be 

10 counted as one inpatient bed day. 

11 ‘‘(iii) WITHDRAWAL OF ELECTION.— 

12 The option described in clause (i) shall not 

13 apply to a facility for a cost-reporting pe14 riod if the facility (for any two consecutive 

15 cost-reporting periods during the previous 

16 5 cost-reporting periods) was treated under 

17 such option and had a total number of in18 patient bed days for each of such two cost19 reporting periods that exceeded the num20 ber specified in such clause.’’. 

21 (2) EFFECTIVE DATE.—The amendments made 

22 by paragraph (1) shall apply to cost-reporting peri23 ods beginning on or after the date of the enactment 

24 of this Act. 


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1 SEC. 423. ESTABLISHMENT OF RURAL COMMUNITY HOS2 PITAL (RCH) PROGRAM. 

3 (a) IN GENERAL.—Section 1861 of the Social Secu4 rity Act (42 U.S.C. 1395x), as amended by section 

5 203(b)(1), is amended by adding at the end of the fol6 lowing new subsection: 

7 ‘‘Rural Community Hospital; Rural Community Hospital 

8 Services 

9 ‘‘(jjj)(1) The term ‘rural community hospital’ means 

10 a hospital (as defined in subsection (e)) that— 

11 ‘‘(A) is located in a rural area (as defined in 

12 section 1886(d)(2)(D)) or treated as being so lo13 cated pursuant to section 1886(d)(8)(E); 

14 ‘‘(B) subject to paragraph (2), has less than 51 

15 acute care inpatient beds, as reported in its most re16 cent cost report; 

17 ‘‘(C) makes available 24-hour emergency care 

18 services; 

19 ‘‘(D) subject to paragraph (3), has a provider 

20 agreement in effect with the Secretary and is open 

21 to the public as of January 1, 2010; and 

22 ‘‘(E) applies to the Secretary for such designa23 tion. 

24 ‘‘(2) For purposes of paragraph (1)(B), beds in a 

25 psychiatric or rehabilitation unit of the hospital which is 

26 a distinct part of the hospital shall not be counted. 


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1 ‘‘(3) Paragraph (1)(D) shall not be construed to pro2 hibit any of the following from qualifying as a rural com3 munity hospital: 

4 ‘‘(A) A replacement facility (as defined by the 

5 Secretary in regulations in effect on January 1, 

6 2012) with the same service area (as defined by the 

7 Secretary in regulations in effect on such date). 

8 ‘‘(B) A facility obtaining a new provider num9 ber pursuant to a change of ownership. 

10 ‘‘(C) A facility which has a binding written 

11 agreement with an outside, unrelated party for the 

12 construction, reconstruction, lease, rental, or financ13 ing of a building as of January 1, 2012. 

14 ‘‘(4) Nothing in this subsection shall be construed as 

15 prohibiting a critical access hospital from qualifying as a 

16 rural community hospital if the critical access hospital 

17 meets the conditions otherwise applicable to hospitals 

18 under subsection (e) and section 1866. 

19 ‘‘(5) Nothing in this subsection shall be construed as 

20 prohibiting a rural community hospital participating in 

21 the demonstration program under section 410A of the 

22 Medicare Prescription Drug, Improvement, and Mod23 ernization Act of 2003 (Public Law 108–173; 117 Stat. 

24 2313) from qualifying as a rural community hospital if 

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1 wise applicable to hospitals under subsection (e) and sec2 tion 1866.’’. 

3 (b) PAYMENT.— 

4 (1) INPATIENT HOSPITAL SERVICES.—Section 

5 1814 of the Social Security Act (42 U.S.C. 1395f) 

6 is amended by adding at the end the following new 

7 subsection: 

8 ‘‘Payment for Inpatient Services Furnished in Rural 

9 Community Hospitals 

10 ‘‘(m) The amount of payment under this part for in11 patient hospital services furnished in a rural community 

12 hospital, other than such services furnished in a psy13 chiatric or rehabilitation unit of the hospital which is a 

14 distinct part, is, at the election of the hospital in the appli15 cation referred to in section 1861(jjj)(1)(E)— 

16 ‘‘(1) 101 percent of the reasonable costs of pro17 viding such services, without regard to the amount 

18 of the customary or other charge, or 

19 ‘‘(2) the amount of payment provided for under 

20 the prospective payment system for inpatient hos21 pital services under section 1886(d).’’. 

22 (2) OUTPATIENT SERVICES.—Section 1834 of 

23 such Act (42 U.S.C. 1395m) is amended by adding 

24 at the end the following new subsection: 


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1 ‘‘(p) PAYMENT FOR OUTPATIENT SERVICES FUR2 NISHED IN RURAL COMMUNITY HOSPITALS.—The 

3 amount of payment under this part for outpatient services 

4 furnished in a rural community hospital is, at the election 

5 of the hospital in the application referred to in section 

6 1861(jjj)(1)(E)— 

7 ‘‘(1) 101 percent of the reasonable costs of pro8 viding such services, without regard to the amount 

9 of the customary or other charge and any limitation 

10 under section 1861(v)(1)(U), or 

11 ‘‘(2) the amount of payment provided for under 

12 the prospective payment system for covered OPD 

13 services under section 1833(t).’’. 

14 (3) EXEMPTION FROM 30-PERCENT REDUCTION

15 IN REIMBURSEMENT FOR BAD DEBT.—Section 

16 1861(v)(1)(T) of such Act (42 U.S.C. 

17 1395x(v)(1)(T)) is amended by inserting ‘‘(other 

18 than for a rural community hospital)’’ after ‘‘In de19 termining such reasonable costs for hospitals’’. 

20 (c) BENEFICIARY COST-SHARING FOR OUTPATIENT

21 SERVICES.—Section 1834(p) of such Act (as added by 

22 subsection (b)(2)) is amended— 

23 (1) by redesignating paragraphs (1) and (2) as 

24 subparagraphs (A) and (B), respectively; 

25 (2) by inserting ‘‘(1)’’ after ‘‘(p)’’; and 


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1 (3) by adding at the end the following: 

2 ‘‘(2) The amounts of beneficiary cost-sharing for out3 patient services furnished in a rural community hospital 

4 under this part shall be as follows: 

5 ‘‘(A) For items and services that would have 

6 been paid under section 1833(t) if provided by a 

7 hospital, the amount of cost-sharing determined 

8 under paragraph (8) of such section. 

9 ‘‘(B) For items and services that would have 

10 been paid under section 1833(h) if furnished by a 

11 provider or supplier, no cost-sharing shall apply. 

12 ‘‘(C) For all other items and services, the 

13 amount of cost-sharing that would apply to the item 

14 or service under the methodology that would be used 

15 to determine payment for such item or service if pro16 vided by a physician, provider, or supplier, as the 

17 case may be.’’. 

18 (d) CONFORMING AMENDMENTS.— 

19 (1) PART A PAYMENT.—Section 1814(b) of 

20 such Act (42 U.S.C. 1395f(b)) is amended in the 

21 matter preceding paragraph (1) by inserting ‘‘other 

22 than inpatient hospital services furnished by a rural 

23 community hospital,’’ after ‘‘critical access hospital 

24 services,’’. 


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1 (2) PART B PAYMENT.—Section 1833(a) of 

2 such Act (42 U.S.C. 1395l(a)), as amended by sec3 tion 203(b)(2), is amended— 

4 (A) in paragraph (2), in the matter before 

5 subparagraph (A), by striking ‘‘and (I)’’ and in6 serting ‘‘(I), and (K)’’; 

7 (B) by striking ‘‘and’’ at the end of para8 graph (9); 

9 (C) by striking the period at the end of 

10 paragraph (10) and inserting ‘‘; and’’; and 

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

12 ‘‘(11) in the case of outpatient services fur13 nished by a rural community hospital, the amounts 

14 described in section 1834(p).’’. 

15 (3) TECHNICAL AMENDMENTS.— 

16 (A) CONSULTATION WITH STATE AGEN17 CIES.—Section 1863 of such Act (42 U.S.C. 

18 1395z) is amended by striking ‘‘and (dd)(2)’’ 

19 and inserting ‘‘(dd)(2), (mm)(1), and (jjj)(1)’’. 

20 (B) PROVIDER AGREEMENTS.—Section 

21 1866(a)(2)(A) of such Act (42 U.S.C. 

22 1395cc(a)(2)(A)) is amended by inserting ‘‘sec23 tion 1834(p)(2),’’ after ‘‘section 1833(b),’’. 


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1 (e) EFFECTIVE DATE.—The amendments made by 

2 this section shall apply to items and services furnished on 

3 or after October 1, 2014. 

4 SEC. 424. MEDICARE REMOTE MONITORING PILOT 

5 PROJECTS. 

6 (a) PILOT PROJECTS.— 

7 (1) IN GENERAL.—Not later than 9 months 

8 after the date of enactment of this Act, the Sec9 retary of Health and Human Services (in this sec10 tion referred to as the ‘‘Secretary’’) shall conduct 

11 pilot projects under title XVIII of the Social Secu12 rity Act for the purpose of providing incentives to 

13 home health agencies to utilize home monitoring and 

14 communications technologies that— 

15 (A) enhance health outcomes for Medicare 

16 beneficiaries; and 

17 (B) reduce expenditures under such title. 

18 (2) SITE REQUIREMENTS.— 

19 (A) URBAN AND RURAL.—The Secretary 

20 shall conduct the pilot projects under this sec21 tion in both urban and rural areas. 

22 (B) SITE IN A SMALL STATE.—The Sec23 retary shall conduct at least 3 of the pilot 

24 projects in a State with a population of less 

25 than 1,000,000. 


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1 (3) DEFINITION OF HOME HEALTH AGENCY.— 

2 In this section, the term ‘‘home health agency’’ has 

3 the meaning given that term in section 1861(o) of 

4 the Social Security Act (42 U.S.C. 1395x(o)). 

5 (b) MEDICARE BENEFICIARIES WITHIN THE SCOPE

6 OF PROJECTS.—The Secretary shall specify the criteria 

7 for identifying those Medicare beneficiaries who shall be 

8 considered within the scope of the pilot projects under this 

9 section for purposes of the application of subsection (c) 

10 and for the assessment of the effectiveness of the home 

11 health agency in achieving the objectives of this section. 

12 Such criteria may provide for the inclusion in the projects 

13 of Medicare beneficiaries who begin receiving home health 

14 services under title XVIII of the Social Security Act after 

15 the date of the implementation of the projects. 

16 (c) INCENTIVES.— 

17 (1) PERFORMANCE TARGETS.—The Secretary 

18 shall establish for each home health agency partici19 pating in a pilot project under this section a per20 formance target using one of the following meth21 odologies, as determined appropriate by the Sec22 retary: 

23 (A) ADJUSTED HISTORICAL PERFORMANCE

24 TARGET.—The Secretary shall establish for the 

25 agency— 


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1 (i) a base expenditure amount equal 

2 to the average total payments made to the 

3 agency under parts A and B of title XVIII 

4 of the Social Security Act for Medicare 

5 beneficiaries determined to be within the 

6 scope of the pilot project in a base period 

7 determined by the Secretary; and 

8 (ii) an annual per capita expenditure 

9 target for such beneficiaries, reflecting the 

10 base expenditure amount adjusted for risk 

11 and adjusted growth rates. 

12 (B) COMPARATIVE PERFORMANCE TAR13 GET.—The Secretary shall establish for the 

14 agency a comparative performance target equal 

15 to the average total payments under such parts 

16 A and B during the pilot project for comparable 

17 individuals in the same geographic area that 

18 are not determined to be within the scope of the 

19 pilot project. 

20 (2) INCENTIVE.—Subject to paragraph (3), the 

21 Secretary shall pay to each participating home care 

22 agency an incentive payment for each year under the 

23 pilot project equal to a portion of the Medicare sav24 ings realized for such year relative to the perform25 ance target under paragraph (1). 


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1 (3) LIMITATION ON EXPENDITURES.—The Sec2 retary shall limit incentive payments under this sec3 tion in order to ensure that the aggregate expendi4 tures under title XVIII of the Social Security Act 

5 (including incentive payments under this subsection) 

6 do not exceed the amount that the Secretary esti7 mates would have been expended if the pilot projects 

8 under this section had not been implemented. 

9 (d) WAIVER AUTHORITY.—The Secretary may waive 

10 such provisions of titles XI and XVIII of the Social Secu11 rity Act as the Secretary determines to be appropriate for 

12 the conduct of the pilot projects under this section. 

13 (e) REPORT TO CONGRESS.—Not later than 5 years 

14 after the date that the first pilot project under this section 

15 is implemented, the Secretary shall submit to Congress a 

16 report on the pilot projects. Such report shall contain a 

17 detailed description of issues related to the expansion of 

18 the projects under subsection (f) and recommendations for 

19 such legislation and administrative actions as the Sec20 retary considers appropriate. 

21 (f) EXPANSION.—If the Secretary determines that 

22 any of the pilot projects under this section enhance health 

23 outcomes for Medicare beneficiaries and reduce expendi24 tures under title XVIII of the Social Security Act, the SecVerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00230 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294

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1 retary may initiate comparable projects in additional 

2 areas. 

3 (g) INCENTIVE PAYMENTS HAVE NO EFFECT ON

4 OTHER MEDICARE PAYMENTS TO AGENCIES.—An incen5 tive payment under this section— 

6 (1) shall be in addition to the payments that a 

7 home health agency would otherwise receive under 

8 title XVIII of the Social Security Act for the provi9 sion of home health services; and 

10 (2) shall have no effect on the amount of such 

11 payments. 

12 SEC. 425. RURAL HEALTH QUALITY ADVISORY COMMISSION 

13 AND DEMONSTRATION PROJECTS. 

14 (a) RURAL HEALTH QUALITY ADVISORY COMMIS15 SION.— 

16 (1) ESTABLISHMENT.—Not later than 6 

17 months after the date of the enactment of this sec18 tion, the Secretary of Health and Human Services 

19 (in this section referred to as the ‘‘Secretary’’) shall 

20 establish a commission to be known as the Rural 

21 Health Quality Advisory Commission (in this section 

22 referred to as the ‘‘Commission’’). 

23 (2) DUTIES OF COMMISSION.— 

24 (A) NATIONAL PLAN.—The Commission 

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1 mentation of a national plan for rural health 

2 quality improvement. The national plan shall— 

3 (i) identify objectives for rural health 

4 quality improvement; 

5 (ii) identify strategies to eliminate 

6 known gaps in rural health system capacity 

7 and improve rural health quality; and 

8 (iii) provide for Federal programs to 

9 identify opportunities for strengthening 

10 and aligning policies and programs to im11 prove rural health quality. 

12 (B) DEMONSTRATION PROJECTS.—The 

13 Commission shall design demonstration projects 

14 to test alternative models for rural health qual15 ity improvement, including with respect to both 

16 personal and population health. 

17 (C) MONITORING.—The Commission shall 

18 monitor progress toward the objectives identi19 fied pursuant to paragraph (1)(A). 

20 (3) MEMBERSHIP.— 

21 (A) NUMBER.—The Commission shall be 

22 composed of 11 members appointed by the Sec23 retary. 

24 (B) SELECTION.—The Secretary shall se25 lect the members of the Commission from 


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1 among individuals with significant rural health 

2 care and health care quality expertise, including 

3 expertise in clinical health care, health care 

4 quality research, population or public health, or 

5 purchaser organizations. 

6 (4) CONTRACTING AUTHORITY.—Subject to the 

7 availability of funds, the Commission may enter into 

8 contracts and make other arrangements, as may be 

9 necessary to carry out the duties described in para10 graph (2). 

11 (5) STAFF.—Upon the request of the Commis12 sion, the Secretary may detail, on a reimbursable 

13 basis, any of the personnel of the Office of Rural 

14 Health Policy of the Health Resources and Services 

15 Administration, the Agency for Healthcare Quality 

16 and Research, or the Centers for Medicare & Med17 icaid Services to the Commission to assist in car18 rying out this subsection. 

19 (6) REPORTS TO CONGRESS.—Not later than 1 

20 year after the establishment of the Commission, and 

21 annually thereafter, the Commission shall submit a 

22 report to the Congress on rural health quality. Each 

23 such report shall include the following: 


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1 (A) An inventory of relevant programs and 

2 recommendations for improved coordination and 

3 integration of policy and programs. 

4 (B) An assessment of achievement of the 

5 objectives identified in the national plan devel6 oped under paragraph (2) and recommenda7 tions for realizing such objectives. 

8 (C) Recommendations on Federal legisla9 tion, regulations, or administrative policies to 

10 enhance rural health quality and outcomes. 

11 (b) RURAL HEALTH QUALITY DEMONSTRATION

12 PROJECTS.— 

13 (1) IN GENERAL.—Not later than 270 days 

14 after the date of the enactment of this section, the 

15 Secretary, in consultation with the Rural Health 

16 Quality Advisory Commission, the Office of Rural 

17 Health Policy of the Health Resources and Services 

18 Administration, the Agency for Healthcare Research 

19 and Quality, and the Centers for Medicare & Med20 icaid Services, shall make grants to eligible entities 

21 for 5 demonstration projects to implement and 

22 evaluate methods for improving the quality of health 

23 care in rural communities. Each such demonstration 

24 project shall include— 

25 (A) alternative community models that— 


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1 (i) will achieve greater integration of 

2 personal and population health services; 

3 and 

4 (ii) address safety, effectiveness, 

5 patient- or community-centeredness, timeli6 ness, efficiency, and equity (the 6 aims 

7 identified by the Institute of Medicine of 

8 the National Academies in its report enti9 tled ‘‘Crossing the Quality Chasm: A New 

10 Health System for the 21st Century’’ re11 leased on March 1, 2001); 

12 (B) innovative approaches to the financing 

13 and delivery of health services to achieve rural 

14 health quality goals; and 

15 (C) development of quality improvement 

16 support structures to assist rural health sys17 tems and professionals (such as workforce sup18 port structures, quality monitoring and report19 ing, clinical care protocols, and information 

20 technology applications). 

21 (2) ELIGIBLE ENTITIES.—In this subsection, 

22 the term ‘‘eligible entity’’ means a consortium 

23 that— 

24 (A) shall include— 


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1 (i) at least one health care provider or 

2 health care delivery system located in a 

3 rural area; and 

4 (ii) at least one organization rep5 resenting multiple community stakeholders; 

6 and 

7 (B) may include other partners such as 

8 rural research centers. 

9 (3) CONSULTATION.—In developing the pro10 gram for awarding grants under this subsection, the 

11 Secretary shall consult with the Administrator of the 

12 Agency for Healthcare Research and Quality, rural 

13 health care providers, rural health care researchers, 

14 and private and nonprofit groups (including national 

15 associations) which are undertaking similar efforts. 

16 (4) EXPEDITED WAIVERS.—The Secretary shall 

17 expedite the processing of any waiver that— 

18 (A) is authorized under title XVIII or XIX 

19 of the Social Security Act (42 U.S.C. 1395 et 

20 seq.); and 

21 (B) is necessary to carry out a demonstra22 tion project under this subsection. 

23 (5) DEMONSTRATION PROJECT SITES.—The 

24 Secretary shall ensure that the 5 demonstration 

25 projects funded under this subsection are conducted 


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1 at a variety of sites representing the diversity of 

2 rural communities in the Nation. 

3 (6) DURATION.—Each demonstration project 

4 under this subsection shall be for a period of 4 

5 years. 

6 (7) INDEPENDENT EVALUATION.—The Sec7 retary shall enter into an arrangement with an enti8 ty that has experience working directly with rural 

9 health systems for the conduct of an independent 

10 evaluation of the program carried out under this 

11 subsection. 

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

13 conclusion of all of the demonstration projects fund14 ed under this subsection, the Secretary shall submit 

15 a report to the Congress on the results of such 

16 projects. The report shall include— 

17 (A) an evaluation of patient access to care, 

18 patient outcomes, and an analysis of the cost 

19 effectiveness of each such project; and 

20 (B) recommendations on Federal legisla21 tion, regulations, or administrative policies to 

22 enhance rural health quality and outcomes. 

23 (c) APPROPRIATION.— 

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1 priated to the Secretary to carry out this section 

2 $30,000,000 for the period of fiscal years 2015 

3 through 2019. 

4 (2) AVAILABILITY.— 

5 (A) IN GENERAL.—Funds appropriated 

6 under paragraph (1) shall remain available for 

7 expenditure through fiscal year 2019. 

8 (B) REPORT.—For purposes of carrying 

9 out subsection (b)(8), funds appropriated under 

10 paragraph (1) shall remain available for ex11 penditure through fiscal year 2020. 

12 (3) RESERVATION.—Of the amount appro13 priated under paragraph (1), the Secretary shall re14 serve— 

15 (A) $5,000,000 to carry out subsection (a); 

16 and 

17 (B) $25,000,000 to carry out subsection 

18 (b), of which— 

19 (i) 2 percent shall be for the provision 

20 of technical assistance to grant recipients; 

21 and 

22 (ii) 5 percent shall be for independent 

23 evaluation under subsection (b)(7). 


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1 SEC. 426. RURAL HEALTH CARE SERVICES. 

2 Section 330A of the Public Health Service Act (42 

3 U.S.C. 254c) is amended to read as follows: 

4 ‘‘SEC. 330A. RURAL HEALTH CARE SERVICES OUTREACH, 

5 RURAL HEALTH NETWORK DEVELOPMENT, 

6 DELTA RURAL DISPARITIES AND HEALTH 

7 SYSTEMS DEVELOPMENT, AND SMALL RURAL 

8 HEALTH CARE PROVIDER QUALITY IMPROVE9 MENT GRANT PROGRAMS. 

10 ‘‘(a) PURPOSE.—The purpose of this section is to 

11 provide for grants— 

12 ‘‘(1) under subsection (b), to promote rural 

13 health care services outreach; 

14 ‘‘(2) under subsection (c), to provide for the 

15 planning and implementation of integrated health 

16 care networks in rural areas; 

17 ‘‘(3) under subsection (d), to assist rural com18 munities in the Delta Region to reduce health dis19 parities and to promote and enhance health system 

20 development; and 

21 ‘‘(4) under subsection (e), to provide for the 

22 planning and implementation of small rural health 

23 care provider quality improvement activities. 

24 ‘‘(b) RURAL HEALTH CARE SERVICES OUTREACH

25 GRANTS.— 


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1 ‘‘(1) GRANTS.—The Director of the Office of 

2 Rural Health Policy of the Health Resources and 

3 Services Administration may award grants to eligible 

4 entities to promote rural health care services out5 reach by expanding the delivery of health care serv6 ices to include new and enhanced services in rural 

7 areas. The Director may award the grants for peri8 ods of not more than 3 years. 

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

10 grant under this subsection for a project, an enti11 ty— 

12 ‘‘(A) shall be a rural public or rural non13 profit private entity, a facility that qualifies as 

14 a rural health clinic under title XVIII of the 

15 Social Security Act, a public or nonprofit entity 

16 existing exclusively to provide services to mi17 grant and seasonal farm workers in rural areas, 

18 or a tribal government whose grant-funded ac19 tivities will be conducted within federally recog20 nized tribal areas; 

21 ‘‘(B) shall represent a consortium com22 posed of members— 

23 ‘‘(i) that include 3 or more independ24 ently owned health care entities; and 


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1 ‘‘(ii) that may be nonprofit or for2 profit entities; and 

3 ‘‘(C) shall not previously have received a 

4 grant under this subsection for the same or a 

5 similar project, unless the entity is proposing to 

6 expand the scope of the project or the area that 

7 will be served through the project. 

8 ‘‘(3) APPLICATIONS.—To be eligible to receive a 

9 grant under this subsection, an eligible entity shall 

10 prepare and submit to the Director an application at 

11 such time, in such manner, and containing such in12 formation as the Director may require, including— 

13 ‘‘(A) a description of the project that the 

14 eligible entity will carry out using the funds 

15 provided under the grant; 

16 ‘‘(B) a description of the manner in which 

17 the project funded under the grant will meet 

18 the health care needs of rural populations in 

19 the local community or region to be served; 

20 ‘‘(C) a plan for quantifying how health 

21 care needs will be met through identification of 

22 the target population and benchmarks of service 

23 delivery or health status, such as— 


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1 ‘‘(i) quantifiable measurements of 

2 health status improvement for projects fo3 cusing on health promotion; or 

4 ‘‘(ii) benchmarks of increased access 

5 to primary care, including tracking factors 

6 such as the number and type of primary 

7 care visits, identification of a medical 

8 home, or other general measures of such 

9 access; 

10 ‘‘(D) a description of how the local com11 munity or region to be served will be involved 

12 in the development and ongoing operations of 

13 the project; 

14 ‘‘(E) a plan for sustaining the project after 

15 Federal support for the project has ended; 

16 ‘‘(F) a description of how the project will 

17 be evaluated; 

18 ‘‘(G) the administrative capacity to submit 

19 annual performance data electronically as speci20 fied by the Director; and 

21 ‘‘(H) other such information as the Direc22 tor determines to be appropriate. 

23 ‘‘(c) RURAL HEALTH NETWORK DEVELOPMENT

24 GRANTS.— 

25 ‘‘(1) GRANTS.— 


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1 ‘‘(A) IN GENERAL.—The Director may 

2 award rural health network development grants 

3 to eligible entities to promote, through planning 

4 and implementation, the development of inte5 grated health care networks that have combined 

6 the functions of the entities participating in the 

7 networks in order to— 

8 ‘‘(i) achieve efficiencies and economies 

9 of scale; 

10 ‘‘(ii) expand access to, coordinate, and 

11 improve the quality of the health care de12 livery system through development of orga13 nizational efficiencies; 

14 ‘‘(iii) implement health information 

15 technology to achieve efficiencies, reduce 

16 medical errors, and improve quality; 

17 ‘‘(iv) coordinate care and manage 

18 chronic illness; and 

19 ‘‘(v) strengthen the rural health care 

20 system as a whole in such a manner as to 

21 show a quantifiable return on investment 

22 to the participants in the network. 

23 ‘‘(B) GRANT PERIODS.—The Director may 

24 award such a rural health network development 

25 grant— 


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1 ‘‘(i) for a period of 3 years for imple2 mentation activities; or 

3 ‘‘(ii) for a period of 1 year for plan4 ning activities to assist in the initial devel5 opment of an integrated health care net6 work, if the proposed participants in the 

7 network do not have a history of collabo8 rative efforts and a 3-year grant would be 

9 inappropriate. 

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

11 grant under this subsection, an entity— 

12 ‘‘(A) shall be a rural public or rural non13 profit private entity, a facility that qualifies as 

14 a rural health clinic under title XVIII of the 

15 Social Security Act, a public or nonprofit entity 

16 existing exclusively to provide services to mi17 grant and seasonal farm workers in rural areas, 

18 or a tribal government whose grant-funded ac19 tivities will be conducted within federally recog20 nized tribal areas; 

21 ‘‘(B) shall represent a network composed 

22 of participants— 

23 ‘‘(i) that include 3 or more independ24 ently owned health care entities; and 


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1 ‘‘(ii) that may be nonprofit or for2 profit entities; and 

3 ‘‘(C) shall not previously have received a 

4 grant under this subsection (other than a 1- 

5 year grant for planning activities) for the same 

6 or a similar project. 

7 ‘‘(3) APPLICATIONS.—To be eligible to receive a 

8 grant under this subsection, an eligible entity, in 

9 consultation with the appropriate State office of 

10 rural health or another appropriate State entity, 

11 shall prepare and submit to the Director an applica12 tion at such time, in such manner, and containing 

13 such information as the Director may require, in14 cluding— 

15 ‘‘(A) a description of the project that the 

16 eligible entity will carry out using the funds 

17 provided under the grant; 

18 ‘‘(B) an explanation of the reasons why 

19 Federal assistance is required to carry out the 

20 project; 

21 ‘‘(C) a description of— 

22 ‘‘(i) the history of collaborative activi23 ties carried out by the participants in the 

24 network; 


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1 ‘‘(ii) the degree to which the partici2 pants are ready to integrate their func3 tions; and 

4 ‘‘(iii) how the local community or re5 gion to be served will benefit from and be 

6 involved in the activities carried out by the 

7 network; 

8 ‘‘(D) a description of how the local com9 munity or region to be served will experience in10 creased access to quality health care services 

11 across the continuum of care as a result of the 

12 integration activities carried out by the net13 work, including a description of— 

14 ‘‘(i) return on investment for the com15 munity and the network members; and 

16 ‘‘(ii) other quantifiable performance 

17 measures that show the benefit of the net18 work activities; 

19 ‘‘(E) a plan for sustaining the project after 

20 Federal support for the project has ended; 

21 ‘‘(F) a description of how the project will 

22 be evaluated; 

23 ‘‘(G) the administrative capacity to submit 

24 annual performance data electronically as speci25 fied by the Director; and 


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1 ‘‘(H) other such information as the Direc2 tor determines to be appropriate. 

3 ‘‘(d) DELTA RURAL DISPARITIES AND HEALTH SYS4 TEMS DEVELOPMENT GRANTS.— 

5 ‘‘(1) GRANTS.—The Director may award grants 

6 to eligible entities to support reduction of health dis7 parities, improve access to health care, and enhance 

8 rural health system development in the Delta Re9 gion. 

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

11 grant under this subsection, an entity shall be a 

12 rural public or rural nonprofit private entity, a facil13 ity that qualifies as a rural health clinic under title 

14 XVIII of the Social Security Act, a public or non15 profit entity existing exclusively to provide services 

16 to migrant and seasonal farm workers in rural 

17 areas, or a tribal government whose grant-funded 

18 activities will be conducted within federally recog19 nized tribal areas. 

20 ‘‘(3) APPLICATIONS.—To be eligible to receive a 

21 grant under this subsection, an eligible entity shall 

22 prepare and submit to the Director an application at 

23 such time, in such manner, and containing such in24 formation as the Director may require, including— 


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1 ‘‘(A) a description of the project that the 

2 eligible entity will carry out using the funds 

3 provided under the grant; 

4 ‘‘(B) an explanation of the reasons why 

5 Federal assistance is required to carry out the 

6 project; 

7 ‘‘(C) a description of the manner in which 

8 the project funded under the grant will meet 

9 the health care needs of the Delta Region; 

10 ‘‘(D) a description of how the local com11 munity or region to be served will experience in12 creased access to quality health care services as 

13 a result of the activities carried out by the enti14 ty; 

15 ‘‘(E) a description of how health dispari16 ties will be reduced or the health system will be 

17 improved; 

18 ‘‘(F) a plan for sustaining the project after 

19 Federal support for the project has ended; 

20 ‘‘(G) a description of how the project will 

21 be evaluated including process and outcome 

22 measures related to the quality of care provided 

23 or how the health care system improves its per24 formance; 


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1 ‘‘(H) a description of how the grantee will 

2 develop an advisory group made up of rep3 resentatives of the communities to be served to 

4 provide guidance to the grantee to best meet 

5 community need; and 

6 ‘‘(I) other such information as the Director 

7 determines to be appropriate. 

8 ‘‘(e) SMALL RURAL HEALTH CARE PROVIDER QUAL9 ITY IMPROVEMENT GRANTS.— 

10 ‘‘(1) GRANTS.—The Director may award grants 

11 to provide for the planning and implementation of 

12 small rural health care provider quality improvement 

13 activities. The Director may award the grants for 

14 periods of 1 to 3 years. 

15 ‘‘(2) ELIGIBILITY.—To be eligible for a grant 

16 under this subsection, an entity— 

17 ‘‘(A) shall be— 

18 ‘‘(i) a rural public or rural nonprofit 

19 private health care provider or provider of 

20 health care services, such as a rural health 

21 clinic; or 

22 ‘‘(ii) another rural provider or net23 work of small rural providers identified by 

24 the Director as a key source of local care; 

25 and 


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1 ‘‘(B) shall not previously have received a 

2 grant under this subsection for the same or a 

3 similar project. 

4 ‘‘(3) PREFERENCE.—In awarding grants under 

5 this subsection, the Director shall give preference to 

6 facilities that qualify as rural health clinics under 

7 title XVIII of the Social Security Act. 

8 ‘‘(4) APPLICATIONS.—To be eligible to receive a 

9 grant under this subsection, an eligible entity shall 

10 prepare and submit to the Director an application at 

11 such time, in such manner, and containing such in12 formation as the Director may require, including— 

13 ‘‘(A) a description of the project that the 

14 eligible entity will carry out using the funds 

15 provided under the grant; 

16 ‘‘(B) an explanation of the reasons why 

17 Federal assistance is required to carry out the 

18 project; 

19 ‘‘(C) a description of the manner in which 

20 the project funded under the grant will assure 

21 continuous quality improvement in the provision 

22 of services by the entity; 

23 ‘‘(D) a description of how the local com24 munity or region to be served will experience in25 creased access to quality health care services as 


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1 a result of the activities carried out by the enti2 ty; 

3 ‘‘(E) a plan for sustaining the project after 

4 Federal support for the project has ended; 

5 ‘‘(F) a description of how the project will 

6 be evaluated including process and outcome 

7 measures related to the quality of care pro8 vided; and 

9 ‘‘(G) other such information as the Direc10 tor determines to be appropriate. 

11 ‘‘(f) GENERAL REQUIREMENTS.— 

12 ‘‘(1) PROHIBITED USES OF FUNDS.—An entity 

13 that receives a grant under this section may not use 

14 funds provided through the grant— 

15 ‘‘(A) to build or acquire real property; or 

16 ‘‘(B) for construction. 

17 ‘‘(2) COORDINATION WITH OTHER AGENCIES.— 

18 The Director shall coordinate activities carried out 

19 under grant programs described in this section, to 

20 the extent practicable, with Federal and State agen21 cies and nonprofit organizations that are operating 

22 similar grant programs, to maximize the effect of 

23 public dollars in funding meritorious proposals. 

24 ‘‘(g) REPORT.—Not later than September 30, 2016, 

25 the Secretary shall prepare and submit to the appropriate 


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1 committees of Congress a report on the progress and ac2 complishments of the grant programs described in sub3 sections (b), (c), (d), and (e). 

4 ‘‘(h) DEFINITIONS.—In this section: 

5 ‘‘(1) The term ‘Delta Region’ has the meaning 

6 given to the term ‘region’ in section 382A of the 

7 Consolidated Farm and Rural Development Act (7 

8 U.S.C. 2009aa). 

9 ‘‘(2) The term ‘Director’ means the Director of 

10 the Office of Rural Health Policy of the Health Re11 sources and Services Administration. 

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

13 are authorized to be appropriated to carry out this section 

14 $40,000,000 for fiscal year 2015, and such sums as may 

15 be necessary for each of fiscal years 2016 through 2019.’’. 

16 SEC. 427. COMMUNITY HEALTH CENTER COLLABORATIVE 

17 ACCESS EXPANSION. 

18 Section 330 of the Public Health Service Act (42 

19 U.S.C. 254b) is amended by adding at the end the fol20 lowing: 

21 ‘‘(t) MISCELLANEOUS PROVISIONS.— 

22 ‘‘(1) RULE OF CONSTRUCTION WITH RESPECT

23 TO RURAL HEALTH CLINICS.—Nothing in this sec24 tion shall be construed to prevent a community 

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1 tified rural health clinic (as defined by section 

2 1861(aa)(2) of the Social Security Act) for the deliv3 ery of primary health care and other mental, dental, 

4 and physical health services that are available at the 

5 rural health clinic to individuals who would other6 wise be eligible for free or reduced cost care if that 

7 individual were able to obtain that care at the com8 munity health center. Such services may be limited 

9 in scope to those primary health care and other 

10 mental, dental, and physical health services available 

11 in that rural health clinic. 

12 ‘‘(2) ENABLING SERVICES.—To the extent pos13 sible, enabling services such as transportation and 

14 translation assistance shall be provided by rural 

15 health clinics described in paragraph (1). 

16 ‘‘(3) ASSURANCES.—In order for a rural health 

17 clinic to receive funds under this section through a 

18 contract with a community health center for the de19 livery of primary health care and other services de20 scribed in paragraph (1), such rural health clinic 

21 shall establish policies to ensure— 

22 ‘‘(A) nondiscrimination based upon the 

23 ability of a patient to pay; 

24 ‘‘(B) the establishment of a sliding fee 

25 scale for low-income patients; and 


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1 ‘‘(C) any such services should be subject to 

2 full reimbursement according to the Prospective 

3 Payment System scale.’’. 

4 SEC. 428. FACILITATING THE PROVISION OF TELEHEALTH 

5 SERVICES ACROSS STATE LINES. 

6 (a) IN GENERAL.—For purposes of expediting the 

7 provision of telehealth services, for which payment is made 

8 under the Medicare Program, across State lines, the Sec9 retary of Health and Human Services shall, in consulta10 tion with representatives of States, physicians, health care 

11 practitioners, and patient advocates, encourage and facili12 tate the adoption of provisions allowing for multistate 

13 practitioner practice across State lines. 

14 (b) DEFINITIONS.—In subsection (a): 

15 (1) TELEHEALTH SERVICE.—The term ‘‘tele16 health service’’ has the meaning given that term in 

17 subparagraph (F) of section 1834(m)(4) of the So18 cial Security Act (42 U.S.C. 1395m(m)(4)). 

19 (2) PHYSICIAN, PRACTITIONER.—The terms 

20 ‘‘physician’’ and ‘‘practitioner’’ have the meaning 

21 given those terms in subparagraphs (D) and (E), re22 spectively, of such section. 

23 (3) MEDICARE PROGRAM.—The term ‘‘Medicare 

24 Program’’ means the program of health insurance 

25 administered by the Secretary of Health and Human 


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1 Services under title XVIII of the Social Security Act 

2 (42 U.S.C. 1395 et seq.). 

3 SEC. 429. SCORING OF PREVENTIVE HEALTH SAVINGS. 

4 Section 202 of the Congressional Budget and Im5 poundment Control Act of 1974 (2 U.S.C. 602) is amend6 ed by adding at the end the following new subsection: 

7 ‘‘(h) SCORING OF PREVENTIVE HEALTH SAVINGS.— 

8 ‘‘(1) DETERMINATION BY THE DIRECTOR.— 

9 Upon a request by the chairman or ranking minority 

10 member of the Committee on the Budget of the Sen11 ate, or by the chairman or ranking minority member 

12 of the Committee on the Budget of the House of 

13 Representatives, the Director shall determine if a 

14 proposed measure would result in reductions in 

15 budget outlays in budgetary outyears through the 

16 use of preventive health and preventive health serv17 ices. 

18 ‘‘(2) PROJECTIONS.—If the Director determines 

19 that a measure would result in substantial reduc20 tions in budget outlays as described in paragraph 

21 (1), the Director— 

22 ‘‘(A) shall include, in any projection pre23 pared by the Director, a description and esti24 mate of the reductions in budget outlays in the 


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1 budgetary outyears and a description of the 

2 basis for such conclusions; and 

3 ‘‘(B) may prepare a budget projection that 

4 includes some or all of the budgetary outyears, 

5 notwithstanding the time periods for projections 

6 described in subsection (e) and sections 308, 

7 402, and 424. 

8 ‘‘(3) DEFINITIONS.—As used in this sub9 section— 

10 ‘‘(A) the term ‘preventive health’ means an 

11 action that focuses on the health of the public, 

12 individuals, and defined populations in order to 

13 protect, promote, and maintain health, wellness, 

14 and functional ability, and prevent disease, dis15 ability, and premature death that is dem16 onstrated by credible and publicly available epi17 demiological projection models, incorporating 

18 clinical trials or observational studies in hu19 mans, to avoid future health care costs; and 

20 ‘‘(B) the term ‘budgetary outyears’ means 

21 the 2 consecutive 10-year periods beginning 

22 with the first fiscal year that is 10 years after 

23 the budget year provided for in the most re24 cently agreed to concurrent resolution on the 

25 budget.’’. 


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1 SEC. 430. SENSE OF CONGRESS. 

2 It is the sense of the Congress that— 

3 (1) the maintenance of effort provisions added 

4 to sections 1902 and 2105(d) of the Social Security 

5 Act by sections 2001(b) and 2101(b) of the Patient 

6 Protection and Affordable Care Act were written to 

7 maintain the eligibility standards for the Medicaid 

8 program under title XIX of the Social Security Act 

9 and Children’s Health Insurance Program under 

10 title XXI of such Act until the American Health 

11 Benefit Exchanges in the States are fully oper12 ational; 

13 (2) it is imperative that the maintenance of ef14 fort provisions are enforced to the strict standard in15 tended by the Congress; 

16 (3) waiving the maintenance of effort provisions 

17 should not be permitted, except in the case of a re18 quest for a waiver that meets the explicit non19 application requirements; 

20 (4) the maintenance of effort provisions ensure 

21 the continued success of the Medicaid program and 

22 Children’s Health Insurance Program and were writ23 ten deliberately to specifically protect vulnerable and 

24 disabled individuals, children, and senior citizens, 

25 many of whom are also members of communities of 

26 color; and 


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1 (5) the maintenance of effort provisions must 

2 be strictly enforced and proposals to weaken the 

3 maintenance of effort provisions must not be consid4 ered. 

5 SEC. 431. REPEAL OF REQUIREMENT FOR DOCUMENTA6 TION EVIDENCING CITIZENSHIP OR NATION7 ALITY UNDER THE MEDICAID PROGRAM. 

8 (a) REPEAL.—Subsections (i)(22) and (x) of section 

9 1903 of the Social Security Act (42 U.S.C. 1396b) are 

10 each repealed. 

11 (b) CONFORMING AMENDMENTS.— 

12 (1) Section 1902 of the Social Security Act (42 

13 U.S.C. 1396a) is amended— 

14 (A) by amending paragraph (46) of sub15 section (a) to read as follows: 

16 ‘‘(46) provide that information is requested and 

17 exchanged for purposes of income and eligibility 

18 verification in accordance with a State system which 

19 meets the requirements of section 1137 of this 

20 Act;’’; 

21 (B) in subsection (e)(13)(A)(i)— 

22 (i) in the matter preceding subclause 

23 (I), by striking ‘‘sections 1902(a)(46)(B) 

24 and 1137(d)’’ and inserting ‘‘section 

25 1137(d)’’; and 


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1 (ii) in subclause (IV), by striking 

2 ‘‘1902(a)(46)(B) or’’; and 

3 (C) by striking subsection (ee). 

4 (2) Section 1903 of the Social Security Act (42 

5 U.S.C. 1396b) is amended— 

6 (A) in subsection (i), by redesignating 

7 paragraphs (23) through (26) as paragraphs 

8 (22) through (25), respectively; and 

9 (B) by redesignating subsections (y) and 

10 (z) as subsections (x) and (y), respectively. 

11 (3) Subsection (c) of section 6036 of the Deficit 

12 Reduction Act of 2005 (42 U.S.C. 1396b note) is re13 pealed. 

14 (c) EFFECTIVE DATE.—The repeals and amend15 ments made by this section shall take effect as if included 

16 in the enactment of the Deficit Reduction Act of 2005. 

17 SEC. 432. OFFICE OF MINORITY HEALTH IN VETERANS 

18 HEALTH ADMINISTRATION OF DEPARTMENT 

19 OF VETERANS AFFAIRS. 

20 (a) ESTABLISHMENT AND FUNCTIONS.—Subchapter 

21 I of chapter 73 of title 38, United States Code, is amended 

22 by adding at the end the following new section: 

23 ‘‘§ 7310. Office of Minority Health 

24 ‘‘(a) ESTABLISHMENT.—There is established in the 

25 Department within the Office of the Under Secretary for 


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1 Health an office to be known as the ‘Office of Minority 

2 Health’ (in this section referred to as the ‘Office’). 

3 ‘‘(b) HEAD.—The Director of the Office of Minority 

4 Health shall be the head of the Office. The Director of 

5 the Office of Minority Health shall be appointed by the 

6 Under Secretary of Health from among individuals quali7 fied to perform the duties of the position. 

8 ‘‘(c) FUNCTIONS.—The functions of the Office are as 

9 follows: 

10 ‘‘(1) To establish short-range and long-range 

11 goals and objectives and coordinate all other activi12 ties within the Veterans Health Administration that 

13 relate to disease prevention, health promotion, health 

14 care services delivery, and health care research con15 cerning veterans who are members of a racial or eth16 nic minority group. 

17 ‘‘(2) To support research, demonstrations, and 

18 evaluations to test new and innovative models for 

19 the discharge of activities described in paragraph 

20 (1). 

21 ‘‘(3) To increase knowledge and understanding 

22 of health risk factors for veterans who are members 

23 of a racial or ethnic minority group. 

24 ‘‘(4) To develop mechanisms that support bet25 ter health care information dissemination, education, 


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1 prevention, and services delivery to veterans from 

2 disadvantaged backgrounds, including veterans who 

3 are members of a racial or ethnic minority group. 

4 ‘‘(5) To enter into contracts or agreements with 

5 appropriate public and nonprofit private entities to 

6 develop and carry out programs to provide bilingual 

7 or interpretive services to assist veterans who are 

8 members of a racial or ethnic minority group and 

9 who lack proficiency in speaking the English lan10 guage in accessing and receiving health care services 

11 through the Veterans Health Administration. 

12 ‘‘(6) To carry out programs to improve access 

13 to health care services through the Veterans Health 

14 Administration for veterans with limited proficiency 

15 in speaking the English language, including the de16 velopment and evaluation of demonstration and pilot 

17 projects for that purpose. 

18 ‘‘(7) To advise the Under Secretary of Health 

19 on matters relating to the development, implementa20 tion, and evaluation of health professions education 

21 in decreasing disparities in health care outcomes be22 tween veterans who are members of a racial or eth23 nic minority group and other veterans, including cul24 tural competency as a method of eliminating such 

25 health disparities. 


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1 ‘‘(8) To perform such other functions and du2 ties as the Secretary or the Under Secretary for 

3 Health considers appropriate. 

4 ‘‘(d) DEFINITIONS.—In this section: 

5 ‘‘(1) The term ‘racial or ethnic minority group’ 

6 means the following: 

7 ‘‘(A) American Indians (including Alaska 

8 Natives, Eskimos, and Aleuts). 

9 ‘‘(B) Asian-Americans. 

10 ‘‘(C) Native Hawaiians and other Pacific 

11 Islanders. 

12 ‘‘(D) Blacks. 

13 ‘‘(E) Hispanics. 

14 ‘‘(2) The term ‘Hispanic’ means individuals 

15 whose origin is Mexican, Puerto Rican, Cuban, Cen16 tral or South American, or any other Spanish-speak17 ing country.’’. 

18 (b) CLERICAL AMENDMENT.—The table of sections 

19 at the beginning of such chapter is amended by inserting 

20 after the item relating to section 7309 the following new 

21 item: 

‘‘7310. Office of Minority Health.’’. 

22 SEC. 433. INDIAN DEFINED IN PPACA. 

23 (a) DEFINITION OF INDIAN.—Section 1304 of the 

24 Patient Protection and Affordable Care Act (42 U.S.C. 

25 18024) is amended by adding at the end the following: 


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1 ‘‘(f) INDIAN.— 

2 ‘‘(1) IN GENERAL.—In this title, the term ‘In3 dian’ means any individual— 

4 ‘‘(A) described in paragraph (13) or (28) 

5 of section 4 of the Indian Health Care Improve6 ment Act (25 U.S.C. 1603); 

7 ‘‘(B) who is eligible for health services pro8 vided by the Indian Health Service under sec9 tion 809 of the Indian Health Care Improve10 ment Act (25 U.S.C. 1679); 

11 ‘‘(C) who is of Indian descent and belongs 

12 to the Indian community served by the local fa13 cilities and program of the Indian Health Serv14 ice; or 

15 ‘‘(D) who is described in paragraph (2). 

16 ‘‘(2) INCLUDED INDIVIDUALS.—The following 

17 individuals shall be considered to be an ‘Indian’: 

18 ‘‘(A) A member of a federally recognized 

19 Indian tribe. 

20 ‘‘(B) A resident of an urban center who 

21 meets 1 or more of the following 4 criteria: 

22 ‘‘(i) Membership in a tribe, band, or 

23 other organized group of Indians, including 

24 those tribes, bands, or groups terminated 

25 since 1940 and those recognized as of the 


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1 date of enactment of the Health Equity 

2 and Accountability Act of 2014 or later by 

3 the State in which they reside, or being a 

4 descendant, in the first or second degree, 

5 of any such member. 

6 ‘‘(ii) Is an Eskimo or Aleut or other 

7 Alaska Native. 

8 ‘‘(iii) Is considered by the Secretary of 

9 the Interior to be an Indian for any pur10 pose. 

11 ‘‘(iv) Is determined to be an Indian 

12 under regulations promulgated by the Sec13 retary. 

14 ‘‘(C) An individual who is considered by 

15 the Secretary of the Interior to be an Indian for 

16 any purpose. 

17 ‘‘(D) An individual who is considered by 

18 the Secretary to be an Indian for purposes of 

19 eligibility for Indian health care services, includ20 ing as a California Indian, Eskimo, Aleut, or 

21 other Alaska Native.’’. 

22 (b) CONFORMING AMENDMENTS.— 

23 (1) AFFORDABLE CHOICES HEALTH BENEFIT

24 PLANS.—Section 1311(c)(6)(D) of the Patient Pro25 tection and Affordable Care Act (42 U.S.C. 


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1 18031(c)(6)(D)) is amended by striking ‘‘section 4 

2 of the Indian Health Care Improvement Act’’ and 

3 inserting ‘‘section 1304(f)’’. 

4 (2) REDUCED COST-SHARING FOR INDIVIDUALS

5 ENROLLING IN QUALIFIED HEALTH PLANS.—Section 

6 1402(d) of the Patient Protection and Affordable 

7 Care Act (42 U.S.C. 18071(d)) is amended— 

8 (A) in paragraph (1), in the matter pre9 ceding subparagraph (A), by striking ‘‘section 

10 4(d) of the Indian Self-Determination and Edu11 cation Assistance Act (25 U.S.C. 450b(d))’’ and 

12 inserting ‘‘section 1304(f)’’; and 

13 (B) in paragraph (2), in the matter pre14 ceding subparagraph (A), by striking ‘‘(as so 

15 defined)’’ and inserting ‘‘(as defined in section 

16 1304(f))’’. 

17 (3) EXEMPTION FROM PENALTY FOR NOT

18 MAINTAINING MINIMUM ESSENTIAL COVERAGE.— 

19 Section 5000A(e) of the Internal Revenue Code of 

20 1986 is amended by striking paragraph (3) and in21 serting the following: 

22 ‘‘(3) INDIANS.—Any applicable individual who 

23 is an Indian (as defined in section 1304(f) of the 

24 Patient Protection and Affordable Care Act).’’. 


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1 SEC. 434. STUDY OF DSH PAYMENTS TO ENSURE HOSPITAL 

2 ACCESS FOR LOW-INCOME PATIENTS. 

3 (a) IN GENERAL.—Not later than January 1, 2016, 

4 the Comptroller General of the United States shall con5 duct a study on how certain amendments made by the Pa6 tient Protection and Affordable Care Act (Public Law 

7 111–148) to titles XVIII and XIX of the Social Security 

8 Act affect the timely access to health care services for low9 income patients. Such study shall— 

10 (1) evaluate and examine whether States elect11 ing to make medical assistance available under sec12 tion 1902(a)(10)(A)(i)(VIII) of the Social Security 

13 Act (42 U.S.C. 1396a(a)(10)(A)(i)(VIII)) (including 

14 States making such an election through a waiver of 

15 the State plan) to individuals described in such sec16 tion mitigates the need for payments to dispropor17 tionate share hospitals under section 1886(d)(5)(F) 

18 of the Social Security Act (42 U.S.C. 

19 1395ww(d)(5)(F)) and section 1923 of such Act (42 

20 U.S.C. 1396r–4), including the impact of such 

21 States electing to make medical assistance available 

22 to such individuals on— 

23 (A) the number of individuals in the 

24 United States who are without health insurance 

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1 tion to areas primarily served by dispropor2 tionate share hospitals; and 

3 (B) the low-income utilization rate of such 

4 hospitals and the resulting fiscal sustainability 

5 of such hospitals; 

6 (2) evaluate the appropriate level and distribu7 tion of such payments among disproportionate hos8 pitals for purposes of— 

9 (A) sufficiently accounting for the level of 

10 uncompensated care provided by such hospitals 

11 to low-income patients; and 

12 (B) providing timely access to health serv13 ices for individuals in medically underserved 

14 areas; and 

15 (3) assess, with respect to disproportionate hos16 pitals— 

17 (A) the role played by such hospitals in 

18 providing critical access to emergency, inpa19 tient, and outpatient health services, as well as 

20 the location of such hospitals in relation to 

21 medically underserved areas; and 

22 (B) the extent to which such hospitals sat23 isfy the requirements established for charitable 

24 hospital organizations under section 501(r) of 

25 the Internal Revenue Code of 1986 with respect 


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1 to community health needs assessments, finan2 cial assistance policy requirements, limitations 

3 on charges, and billing and collection require4 ments. 

5 (b) REPORTS.— 

6 (1) REPORT TO CONGRESS.—Not later than 

7 180 days after the date on which the study under 

8 subsection (a) is completed, the Comptroller General 

9 of the United States shall submit to the Committee 

10 on Energy and Commerce of the House of Rep11 resentatives and the Committee on Health, Edu12 cation, Labor, and Pensions of the Senate a report 

13 that contains— 

14 (A) the results of the study; 

15 (B) recommendations to Congress for any 

16 legislative changes to the payments to dis17 proportionate share hospitals under section 

18 1886(d)(5)(F) of the Social Security Act (42 

19 U.S.C. 1395ww(d)(5)(F)) and section 1923 of 

20 such Act (42 U.S.C. 1396r–4) that are needed 

21 to ensure access to health services for low-in22 come patients that— 

23 (i) are based on the number of indi24 viduals without health insurance, the 

25 amount of uncompensated care provided by 


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1 such hospitals, and the impact of reduced 

2 payments levels on low-income commu3 nities; and 

4 (ii) takes into account any reports 

5 submitted by the Secretary of the Treas6 ury, in consultation with the Secretary of 

7 Health and Human Services, to Congres8 sional committees regarding the costs in9 curred by charitable hospital organizations 

10 for charity care, bad debt, nonreimbursed 

11 expenses for services provided to individ12 uals under the Medicare Program under 

13 title XVIII of the Social Security Act and 

14 the Medicaid Program under title XIX of 

15 such Act, and any community benefit ac16 tivities provided by such organizations. 

17 (2) REPORT TO THE SECRETARY OF HEALTH

18 AND HUMAN SERVICES.—Not later than 180 days 

19 after the date on which the study under subsection 

20 (a) is completed, the Comptroller General of the 

21 United States shall submit to the Secretary of 

22 Health and Human Services a report that con23 tains— 

24 (A) the results of the study; and 


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1 (B) any recommendations for purposes of 

2 assisting in the development of the methodology 

3 for the adjustment of payments to dispropor4 tionate share hospitals, as required under sec5 tion 1886(r) of the Social Security Act (42 

6 U.S.C. 1395ww(r)) and the reduction of such 

7 payments section 1923(f)(7) of such Act (42 

8 U.S.C. 1396r–4(f)(7)), taking into account the 

9 reports referred to in paragraph (1)(B)(ii). 

10 SEC. 435. ASSISTANT SECRETARY OF THE INDIAN HEALTH 

11 SERVICE. 

12 (a) REFERENCES.—Any reference in a law, regula13 tion, document, paper, or other record of the United 

14 States to the Director of the Indian Health Service shall 

15 be deemed to be a reference to the Assistant Secretary 

16 of the Indian Health Service. 

17 (b) EXECUTIVE SCHEDULE.—Section 5315 of title 5, 

18 United States Code, is amended in the matter relating to 

19 the Assistant Secretaries of Health and Human Services 

20 by striking ‘‘(6)’’ and inserting ‘‘(7), 1 of whom shall be 

21 the Assistant Secretary of the Indian Health Service’’. 

22 (c) CONFORMING AMENDMENT.—Section 5316 of 

23 title 5, United States Code, is amended by striking ‘‘Direc24 tor, Indian Health Service, Department of Health and 

25 Human Services.’’. 


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1 SEC. 436. REAUTHORIZATION OF THE NATIVE HAWAIIAN 

2 HEALTH CARE IMPROVEMENT ACT. 

3 (a) NATIVE HAWAIIAN HEALTH CARE SYSTEMS.— 

4 Section 6(h)(1) of the Native Hawaiian Health Care Im5 provement Act (42 U.S.C. 11705(h)(1)) is amended by 

6 striking ‘‘may be necessary for fiscal years 1993 through 

7 2019’’ and inserting ‘‘are necessary’’. 

8 (b) ADMINISTRATIVE GRANT FOR PAPA OLA

9 LOKAHI.—Section 7(b) of the Native Hawaiian Health 

10 Care Improvement Act (42 U.S.C. 11706(b)) is amended 

11 by striking ‘‘may be necessary for fiscal years 1993 

12 through 2019’’ and inserting ‘‘are necessary’’. 

13 (c) NATIVE HAWAIIAN HEALTH SCHOLARSHIPS.— 

14 Section 10(c) of the Native Hawaiian Health Care Im15 provement Act (42 U.S.C. 11709(c)) is amended by strik16 ing ‘‘may be necessary for fiscal years 1993 through 

17 2019’’ and inserting ‘‘are necessary’’. 

18 TITLE V—IMPROVING HEALTH 

19 OUTCOMES FOR WOMEN, 

20 CHILDREN, AND FAMILIES 

21 SEC. 501. GRANTS TO PROMOTE POSITIVE HEALTH BEHAV22 IORS IN WOMEN AND CHILDREN. 

23 Part Q of title III of the Public Health Service Act 

24 (42 U.S.C. 280g et seq.) is amended by adding at the end 

25 the following: 


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1 ‘‘SEC. 399Z–2. GRANTS TO PROMOTE POSITIVE HEALTH BE2 HAVIORS IN WOMEN AND CHILDREN. 

3 ‘‘(a) GRANTS AUTHORIZED.—The Secretary, in col4 laboration with the Administrator of the Health Resources 

5 and Services Administration and other Federal officials 

6 determined appropriate by the Secretary, is authorized to 

7 award grants to eligible entities to promote positive health 

8 behaviors for women and children in target populations, 

9 especially racial and ethnic minority women and children 

10 in medically underserved communities. 

11 ‘‘(b) USE OF FUNDS.—Grants awarded pursuant to 

12 subsection (a) may be used to support the activities of 

13 community health workers, including such activities— 

14 ‘‘(1) to educate and provide outreach regarding 

15 enrollment in health insurance including the State 

16 Children’s Health Insurance Program under title 

17 XXI of the Social Security Act, Medicare under title 

18 XVIII of such Act, and Medicaid under title XIX of 

19 such Act; 

20 ‘‘(2) to educate, guide, and provide outreach in 

21 a community setting regarding health problems prev22 alent among women and children and especially 

23 among racial and ethnic minority women and chil24 dren; 

25 ‘‘(3) to educate, guide, and provide experiential 

26 learning opportunities that target risk factors that 


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1 impede achieving healthy behaviors and good health 

2 outcomes, including— 

3 ‘‘(A) poor nutrition; 

4 ‘‘(B) physical inactivity; 

5 ‘‘(C) being overweight or obese; 

6 ‘‘(D) tobacco use; 

7 ‘‘(E) alcohol and substance use; 

8 ‘‘(F) injury and violence; 

9 ‘‘(G) risky sexual behavior; 

10 ‘‘(H) mental health problems; 

11 ‘‘(I) musculoskeletal health and arthritis; 

12 ‘‘(J) dental and oral health problems; 

13 ‘‘(K) understanding informed consent; and 

14 ‘‘(L) stigma; 

15 ‘‘(4) to educate and guide regarding effective 

16 strategies to promote positive health behaviors with17 in the family; 

18 ‘‘(5) to promote community wellness and aware19 ness; and 

20 ‘‘(6) to educate and refer target populations to 

21 appropriate health care agencies and community22 based programs and organizations in order to in23 crease access to quality health care services, includ24 ing preventive health services. 

25 ‘‘(c) APPLICATION.— 


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1 ‘‘(1) IN GENERAL.—Each eligible entity that 

2 desires to receive a grant under subsection (a) shall 

3 submit an application to the Secretary, at such time, 

4 in such manner, and accompanied by such additional 

5 information as the Secretary may require. 

6 ‘‘(2) CONTENTS.—Each application submitted 

7 pursuant to paragraph (1) shall— 

8 ‘‘(A) describe the activities for which as9 sistance under this section is sought; 

10 ‘‘(B) contain an assurance that, with re11 spect to each community health worker pro12 gram receiving funds under the grant awarded, 

13 such program provides in-language training and 

14 supervision to community health workers to en15 able such workers to provide authorized pro16 gram activities in (at least) the most commonly 

17 used languages within a particular geographic 

18 region; 

19 ‘‘(C) contain an assurance that the appli20 cant will evaluate the effectiveness of commu21 nity health worker programs receiving funds 

22 under the grant; 

23 ‘‘(D) contain an assurance that each com24 munity health worker program receiving funds 

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1 petent services in the linguistic context most 

2 appropriate for the individuals served by the 

3 program; 

4 ‘‘(E) contain a plan to document and dis5 seminate project descriptions and results to 

6 other States and organizations as identified by 

7 the Secretary; and 

8 ‘‘(F) describe plans to enhance the capac9 ity of individuals to utilize health services and 

10 health-related social services under Federal, 

11 State, and local programs by— 

12 ‘‘(i) assisting individuals in estab13 lishing eligibility under the programs and 

14 in receiving the services or other benefits 

15 of the programs; and 

16 ‘‘(ii) providing other services, as the 

17 Secretary determines to be appropriate, 

18 which may include transportation and 

19 translation services. 

20 ‘‘(d) PRIORITY.—In awarding grants under sub21 section (a), the Secretary shall give priority to those appli22 cants— 

23 ‘‘(1) who propose to target geographic areas 

24 that— 


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1 ‘‘(A)(i) have a high percentage of residents 

2 who are uninsured or underinsured (if the tar3 geted geographic area is located in a State that 

4 has elected to make medical assistance available 

5 under section 1902(a)(10)(A)(i)(VIII) of the 

6 Social Security Act to individuals described in 

7 such section); or 

8 ‘‘(ii) have a high percentage of under9 insured residents in a particular geographic 

10 area (if the targeted geographic area is located 

11 in a State that has not so elected); and 

12 ‘‘(B) have a high percentage of families for 

13 whom English is not their primary language or 

14 including smaller limited-English-proficient 

15 communities within the region that are not oth16 erwise reached by linguistically appropriate 

17 health services; 

18 ‘‘(2) with experience in providing health or 

19 health-related social services to individuals who are 

20 underserved with respect to such services; and 

21 ‘‘(3) with documented community activity and 

22 experience with community health workers. 

23 ‘‘(e) COLLABORATION WITH ACADEMIC INSTITU24 TIONS.—The Secretary shall encourage community health 

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1 laborate with academic institutions, including minority2 serving institutions. Nothing in this section shall be con3 strued to require such collaboration. 

4 ‘‘(f) QUALITY ASSURANCE AND COST EFFECTIVE5 NESS.—The Secretary shall establish guidelines for ensur6 ing the quality of the training and supervision of commu7 nity health workers under the programs funded under this 

8 section and for ensuring the cost effectiveness of such pro9 grams. 

10 ‘‘(g) MONITORING.—The Secretary shall monitor 

11 community health worker programs identified in approved 

12 applications and shall determine whether such programs 

13 are in compliance with the guidelines established under 

14 subsection (f). 

15 ‘‘(h) TECHNICAL ASSISTANCE.—The Secretary may 

16 provide technical assistance to community health worker 

17 programs identified in approved applications with respect 

18 to planning, developing, and operating programs under the 

19 grant. 

20 ‘‘(i) REPORT TO CONGRESS.— 

21 ‘‘(1) IN GENERAL.—Not later than 4 years 

22 after the date on which the Secretary first awards 

23 grants under subsection (a), the Secretary shall sub24 mit to Congress a report regarding the grant 

25 project. 


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1 ‘‘(2) CONTENTS.—The report required under 

2 paragraph (1) shall include the following: 

3 ‘‘(A) A description of the programs for 

4 which grant funds were used. 

5 ‘‘(B) The number of individuals served. 

6 ‘‘(C) An evaluation of— 

7 ‘‘(i) the effectiveness of these pro8 grams; 

9 ‘‘(ii) the cost of these programs; and 

10 ‘‘(iii) the impact of the project on the 

11 health outcomes of the community resi12 dents. 

13 ‘‘(D) Recommendations for sustaining the 

14 community health worker programs developed 

15 or assisted under this section. 

16 ‘‘(E) Recommendations regarding training 

17 to enhance career opportunities for community 

18 health workers. 

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

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

21 ‘community health worker’ means an individual who 

22 promotes health or nutrition within the community 

23 in which the individual resides— 

24 ‘‘(A) by serving as a liaison between com25 munities and health care agencies; 


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1 ‘‘(B) by providing guidance and social as2 sistance to community residents; 

3 ‘‘(C) by enhancing community residents’ 

4 ability to effectively communicate with health 

5 care providers; 

6 ‘‘(D) by providing culturally and linguis7 tically appropriate health or nutrition edu8 cation; 

9 ‘‘(E) by advocating for individual and com10 munity health, including dental, oral, mental, 

11 and environmental health, or nutrition needs; 

12 ‘‘(F) by taking into consideration the 

13 needs of the communities served, including the 

14 prevalence rates of risk factors that impede 

15 achieving healthy behaviors and good health 

16 outcomes among women and children, especially 

17 among racial and ethnic minority women and 

18 children; and 

19 ‘‘(G) by providing referral and followup 

20 services. 

21 ‘‘(2) COMMUNITY SETTING.—The term ‘commu22 nity setting’ means a home or a community organi23 zation that serves a population. 

24 ‘‘(3) ELIGIBLE ENTITY.—The term ‘eligible en25 tity’ means— 


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1 ‘‘(A) a unit of State, territorial, local, or 

2 tribal government (including a federally recog3 nized tribe or Alaska Native village); or 

4 ‘‘(B) a community-based organization. 

5 ‘‘(4) MEDICALLY UNDERSERVED COMMUNITY.— 

6 The term ‘medically underserved community’ means 

7 a community— 

8 ‘‘(A) that has a substantial number of in9 dividuals who are members of a medically un10 derserved population, as defined by section 

11 330(b)(3); 

12 ‘‘(B) a significant portion of which is a 

13 health professional shortage area as designated 

14 under section 332; and 

15 ‘‘(C) that includes populations that are lin16 guistically isolated, such as geographic areas 

17 with a shortage of health professionals able to 

18 provide linguistically appropriate services. 

19 ‘‘(5) SUPPORT.—The term ‘support’ means the 

20 provision of training, supervision, and materials 

21 needed to effectively deliver the services described in 

22 subsection (b), reimbursement for services, and 

23 other benefits. 

24 ‘‘(6) TARGET POPULATION.—The term ‘target 

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1 gardless of their current childbearing status and 

2 children under 21 years of age. 

3 ‘‘(k) AUTHORIZATION OF APPROPRIATIONS.—There 

4 are authorized to be appropriated to carry out this section 

5 $15,000,000 for each of fiscal years 2015 through 2019.’’. 

6 SEC. 502. REMOVING BARRIERS TO HEALTH CARE AND NU7 TRITION ASSISTANCE FOR CHILDREN, PREG8 NANT WOMEN, AND LAWFULLY PRESENT IN9 DIVIDUALS. 

10 (a) MEDICAID.—Section 1903(v) of the Social Secu11 rity Act (42 U.S.C. 1396b(v)) is amended by striking 

12 paragraph (4) and inserting the following new paragraph: 

13 ‘‘(4)(A) Notwithstanding sections 401(a), 

14 402(b), 403, and 421 of the Personal Responsibility 

15 and Work Opportunity Reconciliation Act of 1996 

16 and paragraph (1), payment shall be made to a 

17 State under this section for medical assistance fur18 nished to an alien under this title (including an alien 

19 described in such paragraph) who meets any of the 

20 following conditions: 

21 ‘‘(i) The alien is otherwise eligible for such 

22 assistance under the State plan approved under 

23 this title (other than the requirement of the re24 ceipt of aid or assistance under title IV, supple25 mental security income benefits under title 


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1 XVI, or a State supplementary payment) within 

2 either or both of the following eligibility cat3 egories: 

4 ‘‘(I) Children under 21 years of age, 

5 including any optional targeted low-income 

6 child (as such term is defined in section 

7 1905(u)(2)(B)). 

8 ‘‘(II) Pregnant women during preg9 nancy and during the 60-day period begin10 ning on the last day of the pregnancy. 

11 ‘‘(ii) The alien is lawfully present in the 

12 United States. 

13 ‘‘(B) No debt shall accrue under an affidavit of 

14 support against any sponsor of an alien who meets 

15 the conditions specified in subparagraph (A) on the 

16 basis of the provision of medical assistance to such 

17 alien under this paragraph and the cost of such as18 sistance shall not be considered as an unreimbursed 

19 cost.’’. 

20 (b) SCHIP.—Subparagraph (J) of section 

21 2107(e)(1) of the Social Security Act (42 U.S.C. 

22 1397gg(e)(1)) is amended to read as follows: 

23 ‘‘(J) Paragraph (4) of section 1903(v) (re24 lating to coverage of categories of children, 


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1 pregnant women, and other lawfully present in2 dividuals).’’. 

3 (c) SUPPLEMENTAL NUTRITION ASSISTANCE.—Not4 withstanding sections 401(a), 402(a), and 403(a) of the 

5 Personal Responsibility and Work Opportunity Reconcili6 ation Act of 1996 (8 U.S.C. 1611(a); 1612(a); 1613(a)) 

7 and section 6(f) of the Food and Nutrition Act of 2008 

8 (7 U.S.C. 2015(f)), persons who are lawfully present in 

9 the United States shall be not be ineligible for benefits 

10 under the supplemental nutrition assistance program on 

11 the basis of their immigration status or date of entry into 

12 the United States. 

13 (d) ELIGIBILITY FOR FAMILIES WITH CHILDREN.— 

14 Section of the 421(d)(3) of the Personal Responsibility 

15 and Work Opportunity Reconciliation Act of 1996 (8 

16 U.S.C. 1631(d)(3)) is amended by striking ‘‘to the extent 

17 that a qualified alien is eligible under section 

18 402(a)(2)(J)’’ and inserting, ‘‘to the extent that a child 

19 is a member of a household under the supplemental nutri20 tion assistance program’’. 

21 (e) ENSURING PROPER SCREENING.—Section 

22 11(e)(2)(B) of the Food and Nutrition Act of 2008 (7 

23 U.S.C. 2020(e)(2)(B)) is amended— 

24 (1) by redesignating clauses (vi) and (vii) as 

25 clauses (vii) and (viii); and 


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1 (2) by inserting after clause (v) the following: 

2 ‘‘(vi) shall provide a method for imple3 menting section 421 of the Personal Re4 sponsibility and Work Opportunity Rec5 onciliation Act of 1996 (8 U.S.C. 1631) 

6 that does not require any unnecessary in7 formation from persons who may be ex8 empt from that provision;’’. 

9 SEC. 503. REPEAL OF DENIAL OF BENEFITS. 

10 Section 115 of the Personal Responsibility and Work 

11 Opportunity Reconciliation Act of 1996 (21 U.S.C. 862a) 

12 is amended— 

13 (1) in subsection (a) by striking paragraph (2); 

14 (2) in subsection (b) by striking paragraph (2); 

15 and 

16 (3) in subsection (e) by striking paragraph (2). 

17 SEC. 504. BIRTH DEFECTS PREVENTION, RISK REDUCTION, 

18 AND AWARENESS. 

19 (a) IN GENERAL.—The Secretary shall establish and 

20 implement a birth defects prevention and public awareness 

21 program, consisting of the activities described in sub22 sections (c) and (d). 

23 (b) DEFINITIONS.—In this section: 

24 (1) The term ‘‘pregnancy and breastfeeding in25 formation services’’ includes only— 


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1 (A) information services to provide accu2 rate, evidence-based, clinical information re3 garding maternal exposures during pregnancy 

4 that may be associated with birth defects or 

5 other health risks, such as exposures to medica6 tions, chemicals, infections, foodborne patho7 gens, illnesses, nutrition, or lifestyle factors; 

8 (B) information services to provide accu9 rate, evidence-based, clinical information re10 garding maternal exposures during breast11 feeding that may be associated with health risks 

12 to a breast-fed infant, such as exposures to 

13 medications, chemicals, infections, foodborne 

14 pathogens, illnesses, nutrition, or lifestyle fac15 tors; 

16 (C) the provision of accurate, evidence17 based information weighing risks of exposures 

18 during breastfeeding against the benefits of 

19 breastfeeding; and 

20 (D) the provision of information described 

21 in subparagraph (A), (B), or (C) through coun22 selors, Web sites, fact sheets, telephonic or elec23 tronic communication, community outreach ef24 forts, or other appropriate means. 


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

2 of Health and Human Services, acting through the 

3 Director of the Centers for Disease Control and Pre4 vention. 

5 (c) NATIONWIDE MEDIA CAMPAIGN.—In carrying out 

6 subsection (a), the Secretary shall conduct or support a 

7 nationwide media campaign to increase awareness among 

8 health care providers and at-risk populations about preg9 nancy and breastfeeding information services. 

10 (d) GRANTS FOR PREGNANCY AND BREASTFEEDING

11 INFORMATION SERVICES.— 

12 (1) IN GENERAL.—In carrying out subsection 

13 (a), the Secretary shall award grants to State or re14 gional agencies or organizations for any of the fol15 lowing: 

16 (A) INFORMATION SERVICES.—The provi17 sion of, or campaigns to increase awareness 

18 about, pregnancy and breastfeeding information 

19 services. 

20 (B) SURVEILLANCE AND RESEARCH.—The 

21 conduct or support of— 

22 (i) surveillance of or research on— 

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1 maturity, or other adverse pregnancy 

2 outcomes; and 

3 (II) maternal exposures that may 

4 influence health risks to a breastfed 

5 infant; or 

6 (ii) networking to facilitate surveil7 lance or research described in this sub8 paragraph. 

9 (2) PREFERENCE FOR CERTAIN STATES.—The 

10 Secretary, in making any grant under this sub11 section, shall give preference to States, otherwise 

12 equally qualified, that have or had a pregnancy and 

13 breastfeeding information service in place on or after 

14 January 1, 2006. 

15 (3) MATCHING FUNDS.—The Secretary may 

16 only award a grant under this subsection to a State 

17 or regional agency or organization that agrees, with 

18 respect to the costs to be incurred in carrying out 

19 the grant activities, to make available (directly or 

20 through donations from public or private entities) 

21 non-Federal funds toward such costs in an amount 

22 equal to not less than 25 percent of the amount of 

23 the grant. 

24 (4) COORDINATION.—The Secretary shall en25 sure that activities funded through a grant under 


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1 this subsection are coordinated, to the maximum ex2 tent practicable, with other birth defects prevention 

3 and environmental health activities of the Federal 

4 Government, including with respect to pediatric envi5 ronmental health specialty units and children’s envi6 ronmental health centers. 

7 (e) EVALUATION.—In furtherance of the program 

8 under subsection (a), the Secretary shall provide for an 

9 evaluation of pregnancy and breastfeeding information 

10 services to identify efficient and effective models of— 

11 (1) providing information; 

12 (2) raising awareness and increasing knowledge 

13 about birth defects prevention measures and tar14 geting education to at-risk groups; 

15 (3) modifying risk behaviors; or 

16 (4) other outcome measures as determined ap17 propriate by the Secretary. 

18 (f) AUTHORIZATION OF APPROPRIATIONS.—To carry 

19 out this section, there are authorized to be appropriated 

20 $5,000,000 for fiscal year 2015, $6,000,000 for fiscal year 

21 2016, $7,000,000 for fiscal year 2017, $8,000,000 for fis22 cal year 2018, and $9,000,000 for fiscal year 2019. 


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1 SEC. 505. UNIFORM STATE MATERNAL MORTALITY REVIEW 

2 COMMITTEES ON PREGNANCY-RELATED 

3 DEATHS. 

4 (a) IN GENERAL.—Title V of the Social Security Act 

5 (42 U.S.C. 701 et seq.) is amended by adding at the end 

6 the following new section: 

7 ‘‘SEC. 514. UNIFORM STATE MATERNAL MORTALITY RE8 VIEW COMMITTEES ON PREGNANCY-RE9 LATED DEATHS. 

10 ‘‘(a) GRANTS.— 

11 ‘‘(1) IN GENERAL.—Notwithstanding any other 

12 provision of this title, for each of fiscal years 2015 

13 through 2021, in addition to payments from allot14 ments for States under section 502 for such year, 

15 the Secretary shall, subject to paragraph (3) and in 

16 accordance with the criteria established under para17 graph (2), award grants to States to— 

18 ‘‘(A) carry out the activities described in 

19 subsection (b)(1); 

20 ‘‘(B) establish a State maternal mortality 

21 review committee, in accordance with subsection 

22 (b)(2), to carry out the activities described in 

23 subsection (b)(2)(A), and to establish the proc24 esses described in subsection (b)(1); 

25 ‘‘(C) ensure the State department of 

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1 scribed in subsection (b)(3), with respect to 

2 pregnancy-related deaths occurring within the 

3 State during such fiscal year; 

4 ‘‘(D) implement and use the comprehensive 

5 case abstraction form developed under sub6 section (c), in accordance with such subsection; 

7 and 

8 ‘‘(E) provide for public disclosure of infor9 mation, in accordance with subsection (e). 

10 ‘‘(2) CRITERIA.—The Secretary shall establish 

11 criteria for determining eligibility for and the 

12 amount of a grant awarded to a State under para13 graph (1). Such criteria shall provide that in the 

14 case of a State that receives such a grant for a fiscal 

15 year and is determined by the Secretary to have not 

16 used such grant in accordance with this section, 

17 such State shall not be eligible for such a grant for 

18 any subsequent fiscal year. 

19 ‘‘(3) AUTHORIZATION OF APPROPRIATIONS.— 

20 For purposes of carrying out the grant program 

21 under this section, including for administrative pur22 poses, there is authorized to be appropriated 

23 $10,000,000 for each of fiscal years 2015 through 

24 2021. 

25 ‘‘(b) PREGNANCY-RELATED DEATH REVIEW.— 


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1 ‘‘(1) REVIEW OF PREGNANCY-RELATED DEATH

2 AND PREGNANCY-ASSOCIATED DEATH CASES.—For 

3 purposes of subsection (a), with respect to a State 

4 that receives a grant under subsection (a), the fol5 lowing shall apply: 

6 ‘‘(A) MANDATORY REPORTING OF PREG7 NANCY-RELATED DEATHS.— 

8 ‘‘(i) IN GENERAL.—The State shall, 

9 through the State maternal mortality re10 view committee, develop a process, sepa11 rate from any reporting process established 

12 by the State department of health prior to 

13 the date of the enactment of this section, 

14 that provides for mandatory and confiden15 tial case reporting by individuals and enti16 ties described in clause (ii) of pregnancy17 related deaths to the State department of 

18 health. 

19 ‘‘(ii) INDIVIDUALS AND ENTITIES DE20 SCRIBED.—Individuals and entities de21 scribed in this clause include each of the 

22 following: 

23 ‘‘(I) Health care providers. 

24 ‘‘(II) Medical examiners. 

25 ‘‘(III) Medical coroners. 


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1 ‘‘(IV) Hospitals. 

2 ‘‘(V) Free-standing birth centers. 

3 ‘‘(VI) Federally qualified health 

4 centers. 

5 ‘‘(VII) Other health care facili6 ties. 

7 ‘‘(VIII) Any other individuals re8 sponsible for completing death certifi9 cates. 

10 ‘‘(IX) Any other appropriate in11 dividuals or entities specified by the 

12 Secretary. 

13 ‘‘(B) VOLUNTARY REPORTING OF PREG14 NANCY-RELATED AND PREGNANCY-ASSOCIATED

15 DEATHS.— 

16 ‘‘(i) The State shall, through the 

17 State maternal mortality review committee, 

18 develop a process for and encourage, sepa19 rate from any reporting process established 

20 by the State department of health prior to 

21 the date of the enactment of this section, 

22 voluntary and confidential case reporting 

23 by individuals described in clause (ii) of 

24 pregnancy-associated deaths to the State 

25 department of health. 


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1 ‘‘(ii) The State shall, through the 

2 State maternal mortality review committee, 

3 develop a process for voluntary and con4 fidential reporting by family members of 

5 the deceased and by other individuals on 

6 possible pregnancy-related and pregnancy7 associated deaths to the State department 

8 of health. Such process shall include— 

9 ‘‘(I) making publicly available on 

10 the Internet Web site of the State de11 partment of health a telephone num12 ber, Internet Web link, and email ad13 dress for such reporting; and 

14 ‘‘(II) publicizing to local profes15 sional organizations, community orga16 nizations, and social services agencies 

17 the availability of the telephone num18 ber, Internet Web link, and email ad19 dress made available under subclause 

20 (I). 

21 ‘‘(C) DEVELOPMENT OF CASE-FINDING.— 

22 The State, through the vital statistics unit of 

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1 ring in such State during the year involved 

2 by— 

3 ‘‘(i) matching all death records, with 

4 respect to such year, for women of child5 bearing age to live birth certificates and in6 fant death certificates to identify deaths of 

7 women that occurred during pregnancy 

8 and within one year after the end of a 

9 pregnancy; 

10 ‘‘(ii) identifying deaths reported dur11 ing such year as having an underlying or 

12 contributing cause of death related to 

13 pregnancy, regardless of the time that has 

14 passed between the end of the pregnancy 

15 and the death; 

16 ‘‘(iii) collecting data from medical ex17 aminer and coroner reports; and 

18 ‘‘(iv) any other methods the States 

19 may devise to identify maternal deaths, 

20 such as through review of a random sam21 ple of reported deaths of women of child22 bearing age to ascertain cases of preg23 nancy-related and pregnancy-associated 

24 deaths that are not discernable from a re25 view of death certificates alone. 


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1 When feasible and for purposes of effectively 

2 collecting and obtaining data on pregnancy-re3 lated and pregnancy-associated deaths, the 

4 State shall adopt the most recent standardized 

5 birth and death certificates, as issued by the 

6 National Center for Vital Health Statistics, in7 cluding the recommended checkbox section for 

8 pregnancy on the death certificates. 

9 ‘‘(D) CASE INVESTIGATION AND DEVELOP10 MENT OF CASE SUMMARIES.—Following receipt 

11 of reports by the State department of health 

12 pursuant to subparagraph (A) or (B) and col13 lection by the vital statistics unit of the State 

14 of possible cases of pregnancy-related and preg15 nancy-associated deaths pursuant to subpara16 graph (C), the State, through the State mater17 nal mortality review committee established 

18 under subsection (a), shall investigate each 

19 case, utilizing the case abstraction form de20 scribed in subsection (c), and prepare de-identi21 fied case summaries, which shall be reviewed by 

22 the committee and included in applicable re23 ports. For purposes of subsection (a), under the 

24 processes established under subparagraphs (A), 

25 (B), and (C), a State department of health or 


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1 vital statistics unit of a State shall provide to 

2 the State maternal mortality review committee 

3 access to information collected pursuant to such 

4 subparagraphs as necessary to carry out this 

5 subparagraph. Data and information collected 

6 for the case summary and review are for pur7 poses of public health activities, in accordance 

8 with HIPAA privacy and security law (as de9 fined in section 3009(a)(2) of the Public Health 

10 Service Act). Such case investigations shall in11 clude data and information obtained through— 

12 ‘‘(i) medical examiner and autopsy re13 ports of the woman involved; 

14 ‘‘(ii) medical records of the woman, 

15 including such records related to health 

16 care prior to pregnancy, prenatal and post17 natal care, labor and delivery care, emer18 gency room care, hospital discharge 

19 records including immunization status and 

20 screening status for prevalent diseases, and 

21 any care delivered up until the time of 

22 death of the woman for purposes of public 

23 health activities, in accordance with 

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1 fined in section 3009(a)(2) of the Public 

2 Health Service Act); 

3 ‘‘(iii) oral and written interviews of in4 dividuals directly involved in the maternal 

5 care of the woman during and immediately 

6 following the pregnancy of the woman, in7 cluding health care, mental health, and so8 cial service providers in-language when 

9 possible, as applicable; 

10 ‘‘(iv) optional oral or written inter11 views of the family of the woman; 

12 ‘‘(v) socioeconomic and other relevant 

13 background information about the woman; 

14 ‘‘(vi) information collected in subpara15 graph (C)(i); and 

16 ‘‘(vii) other information on the cause 

17 of death of the woman, such as social serv18 ices and child welfare reports, including ex19 periences with intimate partner violence. 

20 ‘‘(2) STATE MATERNAL MORTALITY REVIEW

21 COMMITTEES.— 

22 ‘‘(A) DUTIES.— 

23 ‘‘(i) REQUIRED COMMITTEE ACTIVI24 TIES.—For purposes of subsection (a), a 

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1 lished by a State pursuant to a grant 

2 under such subsection shall carry out the 

3 following pregnancy-related death and 

4 pregnancy-associated death review activi5 ties and shall include all information rel6 evant to the death involved on the case ab7 straction form developed under subsection 

8 (d): 

9 ‘‘(I) With respect to a case of 

10 pregnancy-related or pregnancy-asso11 ciated death of a woman, review the 

12 case summaries prepared under sub13 paragraphs (A), (B), (C), and (D) of 

14 paragraph (1). 

15 ‘‘(II) Review aggregate statistical 

16 reports developed by the vital statis17 tics unit of the State under paragraph 

18 (1)(C) regarding pregnancy-related 

19 and pregnancy-associated deaths to 

20 identify trends, patterns, and dispari21 ties in adverse outcomes and address 

22 medical, nonmedical, and system-re23 lated factors that may have contrib24 uted to such pregnancy-related and 


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1 pregnancy-associated deaths and dis2 parities. 

3 ‘‘(III) Develop recommendations, 

4 based on the review of the case sum5 maries under paragraph (1)(D) and 

6 aggregate statistical reports under 

7 subclause (II), to improve maternal 

8 care, social and health services, and 

9 public health policy and institutions, 

10 including with respect to improving 

11 access to maternal care, improving the 

12 availability of social services, and 

13 eliminating disparities in maternal 

14 care and outcomes. 

15 ‘‘(ii) OPTIONAL COMMITTEE ACTIVI16 TIES.—For purposes of subsection (a), a 

17 maternal mortality review committee estab18 lished by a State under such subsection 

19 may present findings and recommendations 

20 regarding a specific case or set of cir21 cumstances directly to a health care facil22 ity or its local or State professional organi23 zation for the purpose of instituting policy 

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1 wise improving the quality of care provided 

2 by the facilities. 

3 ‘‘(B) COMPOSITION OF MATERNAL MOR4 TALITY REVIEW COMMITTEES.— 

5 ‘‘(i) IN GENERAL.—Each State mater6 nal mortality review committee established 

7 pursuant to a grant under subsection (a) 

8 shall be multidisciplinary, consisting of 

9 health care, behavioral health, and social 

10 service providers, public health officials, 

11 other persons with professional expertise 

12 on maternal health and mortality, and pa13 tient and community advocates who rep14 resent those communities within such State 

15 that are the most affected by maternal 

16 mortality. Membership on such a com17 mittee of a State shall be reviewed annu18 ally by the State department of health to 

19 ensure that membership representation re20 quirements are being fulfilled in accord21 ance with this paragraph. 

22 ‘‘(ii) REQUIRED MEMBERSHIP.—Each 

23 such review committee shall include— 

24 ‘‘(I) representatives from medical 

25 specialties providing care to pregnant 


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1 and postpartum patients, including 

2 obstetricians (including generalists 

3 and maternal fetal medicine special4 ists), and family practice physicians; 

5 ‘‘(II) representatives from mid6 wifery specialties (including certified 

7 professional midwives and certified 

8 midwives); 

9 ‘‘(III) advanced practice nurses; 

10 ‘‘(IV) hospital-based nurses; 

11 ‘‘(V) representatives of the State 

12 department of health maternal and 

13 child health department; 

14 ‘‘(VI) social service providers or 

15 social workers; 

16 ‘‘(VII) the chief medical exam17 iners or designees; 

18 ‘‘(VIII) facility representatives, 

19 such as from hospitals or free-stand20 ing birth centers; and 

21 ‘‘(IX) community or patient ad22 vocates who represent those commu23 nities within the State that are the 

24 most affected by maternal mortality. 


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1 ‘‘(iii) ADDITIONAL MEMBERS.—Each 

2 such review committee may also include 

3 representatives from other relevant aca4 demic, health, social service, or policy pro5 fessions, or community organizations, on 

6 an ongoing basis, or as needed, as deter7 mined beneficial by the review committee, 

8 including— 

9 ‘‘(I) anesthesiologists; 

10 ‘‘(II) emergency physicians; 

11 ‘‘(III) pathologists; 

12 ‘‘(IV) epidemiologists or biostat13 isticians; 

14 ‘‘(V) intensivists; 

15 ‘‘(VI) orthopedic surgeons and/or 

16 orthopedic physicians; 

17 ‘‘(VII) vital statistics officers; 

18 ‘‘(VIII) nutritionists; 

19 ‘‘(IX) mental health profes20 sionals; 

21 ‘‘(X) substance abuse treatment 

22 specialists; 

23 ‘‘(XI) representatives of relevant 

24 advocacy groups; 

25 ‘‘(XII) academics; 


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1 ‘‘(XIII) representatives of bene2 ficiaries of the State plan under the 

3 Medicaid Program under title XIX; 

4 ‘‘(XIV) paramedics; 

5 ‘‘(XV) lawyers; 

6 ‘‘(XVI) risk management special7 ists; 

8 ‘‘(XVII) representatives of the 

9 departments of health or public health 

10 of major cities in the State involved; 

11 and 

12 ‘‘(XVIII) policymakers. 

13 ‘‘(iv) DIVERSE COMMUNITY MEMBER14 SHIP.—The composition of such a com15 mittee, with respect to a State, shall in16 clude— 

17 ‘‘(I) representatives from diverse 

18 communities, particularly those com19 munities within such State most se20 verely affected by pregnancy-related 

21 deaths or pregnancy-associated deaths 

22 and by a lack of access to relevant 

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1 tions, and from minority advocacy 

2 groups; 

3 ‘‘(II) members, including health 

4 care providers, from different geo5 graphic regions in the State, including 

6 any rural, urban, and tribal areas; 

7 and 

8 ‘‘(III) health care and social serv9 ice providers who work in commu10 nities that are diverse with regard to 

11 race, ethnicity, immigration status, in12 digenous status, and English pro13 ficiency. 

14 ‘‘(v) MATERNAL MORTALITY REVIEW

15 STAFF.—Staff of each such review com16 mittee shall include— 

17 ‘‘(I) vital health statisticians, ma18 ternal child health statisticians, or 

19 epidemiologists; 

20 ‘‘(II) a coordinator of the State 

21 maternal mortality review committee, 

22 to be designated by the State; and 

23 ‘‘(III) administrative staff. 

24 ‘‘(C) OPTION FOR STATES TO FORM RE25 GIONAL MATERNAL MORTALITY REVIEWS.— 


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1 States with a low rate of occurrence of preg2 nancy-associated or pregnancy-related deaths 

3 may choose to partner with one or more neigh4 boring States to fulfill the activities described in 

5 paragraph (1)(C). In such a case, with respect 

6 to States in such a partnership, any require7 ment under this section relating to the report8 ing of information related to such activities 

9 shall be deemed to be fulfilled by each such 

10 State if a single such report is submitted for 

11 the partnership. 

12 ‘‘(3) STATE DEPARTMENT OF HEALTH ACTIVI13 TIES.—For purposes of subsection (a), a State de14 partment of health of a State receiving a grant 

15 under such subsection shall— 

16 ‘‘(A) in consultation with the maternal 

17 mortality review committee of the State and in 

18 conjunction with relevant professional organiza19 tions, develop a plan for ongoing health care 

20 provider education, based on the findings and 

21 recommendations of the committee, in order to 

22 improve the quality of maternal care; and 

23 ‘‘(B) take steps to widely disseminate the 

24 findings and recommendations of the State ma25 ternal mortality review committees of the State 


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1 and to implement the recommendations of such 

2 committee. 

3 ‘‘(c) CASE ABSTRACTION FORM.— 

4 ‘‘(1) DEVELOPMENT.—The Director of the Cen5 ters for Disease Control and Prevention shall de6 velop a uniform, comprehensive case abstraction 

7 form and make such form available to States for 

8 State maternal mortality review committees for use 

9 by such committees in order to— 

10 ‘‘(A) ensure that the cases and information 

11 collected and reviewed by such committees can 

12 be pooled for review by the Department of 

13 Health and Human Services and its agencies; 

14 and 

15 ‘‘(B) preserve the uniformity of the infor16 mation and its use for Federal public health 

17 purposes. 

18 ‘‘(2) PERMISSIBLE STATE MODIFICATION.— 

19 Each State may modify the form developed under 

20 paragraph (1) for implementation and use by such 

21 State or by the State maternal mortality review com22 mittee of such State by including on such form addi23 tional information to be collected, but may not alter 

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1 sure that the information can be collected and re2 viewed centrally at the Federal level. 

3 ‘‘(d) TREATMENT AS PUBLIC HEALTH AUTHORITY

4 FOR PURPOSES OF HIPAA.—For purposes of applying 

5 HIPAA privacy and security law (as defined in section 

6 3009(a)(2) of the Public Health Service Act), a State ma7 ternal mortality review committee of a State established 

8 pursuant to this section to carry out activities described 

9 in subsection (b)(2)(A) shall be deemed to be a public 

10 health authority described in section 164.501 (and ref11 erenced in section 164.512(b)(1)(i)) of title 45, Code of 

12 Federal Regulations (or any successor regulation), car13 rying out public health activities and purposes described 

14 in such section 164.512(b)(1)(i) (or any such successor 

15 regulation). 

16 ‘‘(e) PUBLIC DISCLOSURE OF INFORMATION.— 

17 ‘‘(1) IN GENERAL.—For fiscal year 2015 or a 

18 subsequent fiscal year, each State receiving a grant 

19 under this section for such year shall, subject to 

20 paragraph (3), provide for the public disclosure, and 

21 submission to the information clearinghouse estab22 lished under paragraph (2), of the information in23 cluded in the report of the State under section 

24 506(a)(2)(F) for such year (relating to the findings 

25 for such year of the State maternal mortality review 


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1 committee established by the State under this sec2 tion). 

3 ‘‘(2) INFORMATION CLEARINGHOUSE.—The 

4 Secretary of Health and Human Services shall es5 tablish an information clearinghouse, that shall be 

6 administered by the Director of the Centers for Dis7 ease Control and Prevention, that will maintain find8 ings and recommendations submitted pursuant to 

9 paragraph (1) and provide such findings and rec10 ommendations for public review and research pur11 poses by State health departments, maternal mor12 tality review committees, and health providers and 

13 institutions. 

14 ‘‘(3) CONFIDENTIALITY OF INFORMATION.—In 

15 no case shall any individually identifiable health in16 formation be provided to the public, or submitted to 

17 the information clearinghouse, under paragraph (1). 

18 ‘‘(f) CONFIDENTIALITY OF REVIEW COMMITTEE

19 PROCEEDINGS.— 

20 ‘‘(1) IN GENERAL.—All proceedings and activi21 ties of a State maternal mortality review committee 

22 under this section, opinions of members of such a 

23 committee formed as a result of such proceedings 

24 and activities, and records obtained, created, or 

25 maintained pursuant to this section, including 


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1 records of interviews, written reports, and state2 ments procured by the Department of Health and 

3 Human Services or by any other person, agency, or 

4 organization acting jointly with the Department, in 

5 connection with morbidity and mortality reviews 

6 under this section, shall be confidential, and not sub7 ject to discovery, subpoena, or introduction into evi8 dence in any civil, criminal, legislative, or other pro9 ceeding. Such records shall not be open to public in10 spection. 

11 ‘‘(2) TESTIMONY OF MEMBERS OF COM12 MITTEE.— 

13 ‘‘(A) IN GENERAL.—Members of a State 

14 maternal mortality review committee under this 

15 section may not be questioned in any civil, 

16 criminal, legislative, or other proceeding regard17 ing information presented in, or opinions 

18 formed as a result of, a meeting or communica19 tion of the committee. 

20 ‘‘(B) CLARIFICATION.—Nothing in this 

21 subsection shall be construed to prevent a mem22 ber of such a committee from testifying regard23 ing information that was obtained independent 

24 of such member’s participation on the com25 mittee, or that is public information. 


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1 ‘‘(3) AVAILABILITY OF INFORMATION FOR RE2 SEARCH PURPOSES.—Nothing in this subsection 

3 shall prohibit the publishing by such a committee or 

4 the Department of Health and Human Services of 

5 statistical compilations and research reports that— 

6 ‘‘(A) are based on confidential information, 

7 relating to morbidity and mortality review; and 

8 ‘‘(B) do not contain identifying informa9 tion or any other information that could be 

10 used to ultimately identify the individuals con11 cerned. 

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

13 ‘‘(1) The term ‘pregnancy-associated death’ 

14 means the death of a woman while pregnant or dur15 ing the one-year period following the date of the end 

16 of pregnancy, irrespective of the cause of such death. 

17 ‘‘(2) The term ‘pregnancy-related death’ means 

18 the death of a woman while pregnant or during the 

19 one-year period following the date of the end of 

20 pregnancy, irrespective of the duration or site of the 

21 pregnancy, from any cause related to or aggravated 

22 by the pregnancy or its management, but not from 

23 any accidental or incidental cause. 


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1 ‘‘(3) The term ‘woman of childbearing age’ 

2 means a woman who is at least 10 years of age and 

3 not more than 54 years of age.’’. 

4 (b) INCLUSION OF FINDINGS OF REVIEW COMMIT5 TEES IN REQUIRED REPORTS.— 

6 (1) STATE TRIENNIAL REPORTS.—Paragraph 

7 (2) of section 506(a) of such Act (42 U.S.C. 706(a)) 

8 is amended by inserting after subparagraph (E) the 

9 following new subparagraph: 

10 ‘‘(F) In the case of a State receiving a 

11 grant under section 514, beginning for the first 

12 fiscal year beginning after 3 years after the 

13 date of establishment of the State maternal 

14 mortality review committee established by the 

15 State pursuant to such grant and once every 3 

16 years thereafter, information containing the 

17 findings and recommendations of such com18 mittee and information on the implementation 

19 of such recommendations during the period in20 volved.’’. 

21 (2) ANNUAL REPORTS TO CONGRESS.—Para22 graph (3) of such section is amended— 

23 (A) in subparagraph (D), at the end, by 

24 striking ‘‘and’’; 


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1 (B) in subparagraph (E), at the end, by 

2 striking the period and inserting ‘‘; and’’; and 

3 (C) by adding at the end the following new 

4 subparagraph: 

5 ‘‘(F) For fiscal year 2015 and each subse6 quent fiscal year, taking into account the find7 ings, recommendations, and implementation in8 formation submitted by States pursuant to 

9 paragraph (2)(F), on the status of pregnancy10 related deaths and pregnancy-associated deaths 

11 in the United States and including rec12 ommendations on methods to prevent such 

13 deaths in the United States.’’. 

14 SEC. 506. ELIMINATING DISPARITIES IN MATERNITY 

15 HEALTH OUTCOMES. 

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

17 is amended by inserting after section 317V, as added, the 

18 following new section: 

19 ‘‘SEC. 317W. ELIMINATING DISPARITIES IN MATERNITY 

20 HEALTH OUTCOMES. 

21 ‘‘(a) IN GENERAL.—The Secretary (in consultation 

22 with the Deputy Assistant Secretary for Minority Health, 

23 the Director of the National Institutes of Health, the Di24 rector of the Centers for Disease Control and Prevention, 

25 the Administrator of the Centers for Medicare & Medicaid 


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1 Services, and the Administrator of the Agency for 

2 Healthcare Research & Quality, and in consultation with 

3 relevant national stakeholder organizations such as na4 tional medical specialty organizations, national maternal 

5 child health organizations, national groups that represent 

6 minority populations, and national health disparity organi7 zations) shall carry out the following activities to eliminate 

8 disparities in maternal health outcomes: 

9 ‘‘(1) Conduct research into the determinants 

10 and the distribution of disparities in maternal care, 

11 health risks, and health outcomes, and improve the 

12 capacity of the performance measurement infrastruc13 ture to measure such disparities. 

14 ‘‘(2) Expand access to services that have been 

15 demonstrated to improve the quality and outcomes 

16 of maternity care for vulnerable populations. 

17 ‘‘(3) Establish a demonstration project to com18 pare the effectiveness of interventions to reduce dis19 parities in maternity services and outcomes, and im20 plement and assess effective interventions. 

21 ‘‘(b) SCOPE AND SELECTION OF STATES FOR DEM22 ONSTRATION PROJECT.—The demonstration project 

23 under subsection (a)(3) shall be conducted in no more 

24 than 8 States, which shall be selected by the Secretary 

25 based on— 


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1 ‘‘(1) applications submitted by States, which 

2 specify which regions and populations the State in3 volved will serve under the demonstration project; 

4 ‘‘(2) criteria designed by the Secretary to en5 sure that, as a whole, the demonstration project is, 

6 to the greatest extent possible, representative of the 

7 demographic and geographic composition of commu8 nities most affected by disparities; 

9 ‘‘(3) criteria designed by the Secretary to en10 sure that a variety of types of models are tested 

11 through the demonstration project and that such 

12 models include interventions that have an existing 

13 evidence base for effectiveness; and 

14 ‘‘(4) criteria designed by the Secretary to as15 sure that the demonstration projects and models will 

16 be carried out in consultation with local and regional 

17 provider organizations, such as community health 

18 centers, hospital systems, and medical societies rep19 resenting providers of maternity services. 

20 ‘‘(c) DURATION OF DEMONSTRATION PROJECT.— 

21 The demonstration project under subsection (a)(3) shall 

22 begin on January 1, 2015, and end on December 31, 

23 2019. 

24 ‘‘(d) GRANTS FOR EVALUATION AND MONITORING.— 

25 The Secretary may make grants to States and health care 


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1 providers participating in the demonstration project under 

2 subsection (a)(3) for the purpose of collecting data nec3 essary for the evaluation and monitoring of such project. 

4 ‘‘(e) REPORTS.— 

5 ‘‘(1) STATE REPORTS.—Each State that par6 ticipates in the demonstration project under sub7 section (a)(3) shall report to the Secretary, in a 

8 time, form, and manner specified by the Secretary, 

9 the data necessary to— 

10 ‘‘(A) monitor the— 

11 ‘‘(i) outcomes of the project; 

12 ‘‘(ii) costs of the project; and 

13 ‘‘(iii) quality of maternity care pro14 vided under the project; and 

15 ‘‘(B) evaluate the rationale for the selec16 tion of the items and services included in any 

17 bundled payment made by the State under the 

18 project. 

19 ‘‘(2) FINAL REPORT.—Not later than December 

20 31, 2020, the Secretary shall submit to Congress a 

21 report on the results of the demonstration project 

22 under subsection (a)(3).’’. 


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1 SEC. 507. DECREASING THE RISK FACTORS FOR SUDDEN 

2 UNEXPECTED INFANT DEATH AND SUDDEN 

3 UNEXPLAINED DEATH IN CHILDHOOD. 

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

5 Human Services, acting through the Administrator of the 

6 Health Resources and Services Administration and in con7 sultation with the Director of the Centers for Disease Con8 trol and Prevention and the Director of the National Insti9 tutes of Health (in this section referred to as the ‘‘Sec10 retary’’), shall establish and implement a culturally com11 petent public health awareness and education campaign 

12 to provide information that is focused on decreasing the 

13 risk factors for sudden unexpected infant death and sud14 den unexplained death in childhood, including educating 

15 individuals about safe sleep environments, sleep positions, 

16 and reducing exposure to smoking during pregnancy and 

17 after birth. 

18 (b) TARGETED POPULATIONS.—The campaign under 

19 subsection (a) shall be designed to reduce health dispari20 ties through the targeting of populations with high rates 

21 of sudden unexpected infant death and sudden unex22 plained death in childhood. 

23 (c) CONSULTATION.—In establishing and imple24 menting the campaign under subsection (a), the Secretary 

25 shall consult with national organizations representing 

26 health care providers, including nurses and physicians, 


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1 parents, child care providers, children’s advocacy and safe2 ty organizations, maternal and child health programs, nu3 trition professionals focusing on women, infants, and chil4 dren, and other individuals and groups determined nec5 essary by the Secretary for such establishment and imple6 mentation. 

7 (d) GRANTS.— 

8 (1) IN GENERAL.—In carrying out the cam9 paign under subsection (a), the Secretary shall 

10 award grants to national organizations, State and 

11 local health departments, and community-based or12 ganizations for the conduct of education and out13 reach programs for nurses, parents, child care pro14 viders, public health agencies, and community orga15 nizations. 

16 (2) APPLICATION.—To be eligible to receive a 

17 grant under paragraph (1), an entity shall submit to 

18 the Secretary an application at such time, in such 

19 manner, and containing such information as the Sec20 retary may require. 

21 (e) AUTHORIZATION OF APPROPRIATIONS.—There is 

22 authorized to be appropriated to carry out this section 

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

24 2015 through 2019. 


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1 SEC. 508. REDUCING UNINTENDED TEENAGE PREG2 NANCIES. 

3 Title III of the Public Health Service Act (42 U.S.C. 

4 241 et seq.) is amended by adding at the end the following 

5 new part: 

6 ‘‘PART W—YOUTH PREGNANCY PREVENTION 

7 PROGRAMS 

8 ‘‘SEC. 399OO. PURPOSE. 

9 ‘‘It is the purpose of this part to develop and carry 

10 out research and demonstration projects on new and exist11 ing program interventions to provide youth in communities 

12 at disproportionate risk for unintended teen pregnancy 

13 (particularly youth in racial or ethnic minority or immi14 grant communities, youth in the foster care system, youth 

15 in the juvenile justice system, rural youth, and LGBT 

16 youth) the information and skills needed to prevent unin17 tended teenage pregnancies, build healthy relationships, 

18 and improve overall health and well-being. 

19 ‘‘SEC. 399OO–1. LIMITATION. 

20 ‘‘No Federal funds provided under this Act may be 

21 used for health education programs or media awareness 

22 campaigns that— 

23 ‘‘(1) deliberately withhold life-saving informa24 tion about the human immunodeficiency virus 

25 (HIV); 


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1 ‘‘(2) undermine young people’s confidence in 

2 the effectiveness of contraception; 

3 ‘‘(3) are medically inaccurate or have been sci4 entifically shown to be ineffective; 

5 ‘‘(4) promote gender, racial, or ethnic stereo6 types; 

7 ‘‘(5) are insensitive and unresponsive to the 

8 needs of sexually active youth or LGBT youth; 

9 ‘‘(6) are inconsistent with the ethical impera10 tives of medicine and public health; or 

11 ‘‘(7) stigmatize and shame youth who are par12 enting or choose to parent. 

13 ‘‘SEC. 399OO–2. DEMONSTRATION GRANTS TO REDUCE UN14 INTENDED TEENAGE PREGNANCIES. 

15 ‘‘(a) IN GENERAL.—The Secretary shall award com16 petitive grants to eligible entities for establishing or ex17 panding programs to provide youth in communities at dis18 proportionate risk for unintended teen pregnancy (particu19 larly youth in racial or ethnic minority or immigrant com20 munities, youth in the foster care system, youth in the 

21 juvenile justice system, rural youth, and LGBT youth) the 

22 information and skills needed to prevent unintended teen23 age pregnancy and develop healthy relationships. 

24 ‘‘(b) PRIORITY.—In awarding grants under this sec25 tion, the Secretary shall give priority to applicants— 


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1 ‘‘(1) proposing to carry out projects in commu2 nities at disproportionate risk for unintended teen 

3 pregnancy (particularly youth in racial or ethnic mi4 nority or immigrant communities, youth in the foster 

5 care system, youth in the juvenile justice system, 

6 rural youth, and LGBT youth); 

7 ‘‘(2) that have a demonstrated history of effec8 tively working with such targeted communities; 

9 ‘‘(3) that have a demonstrated history of engag10 ing in a meaningful and significant partnership with 

11 such targeted communities; or 

12 ‘‘(4) that have an integrated approach that also 

13 promotes the skills necessary to build healthy rela14 tionships and recognize abusive or unhealthy behav15 iors. 

16 ‘‘(c) PROGRAM SETTINGS.—Programs funded 

17 through a grant under subsection (a) shall be provided— 

18 ‘‘(1) through classroom-based settings, such as 

19 school health education, humanities, language arts, 

20 or family and consumer science education; after21 school programs; community-based programs; work22 force development programs; and health care set23 tings, including community health centers; or 


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1 ‘‘(2) in collaboration with systems that serve 

2 large numbers of at-risk youth such as juvenile jus3 tice or foster care systems. 

4 ‘‘(d) PROJECT REQUIREMENTS.—As a condition of 

5 receipt of a grant under this section, an entity shall agree 

6 that, with respect to information and skills provided 

7 through the grant— 

8 ‘‘(1) such information and skills will be— 

9 ‘‘(A) age-appropriate; 

10 ‘‘(B) evidence-based or evidence-informed; 

11 ‘‘(C) provided in accordance with section 

12 399OO–6(b); and 

13 ‘‘(D) culturally sensitive and relevant to 

14 the target populations; and 

15 ‘‘(2) any information provided about contracep16 tives shall include the health benefits and side ef17 fects of all contraceptives and barrier methods. 

18 ‘‘(e) EVALUATION.—Of the total amount made avail19 able to carry out this section for a fiscal year, the Sec20 retary, acting through the Director of the Centers for Dis21 ease Control and Prevention and other agencies as appro22 priate, shall allot up to 10 percent of such amount to carry 

23 out a rigorous, independent evaluation to determine the 

24 extent and the effectiveness of activities funded through 

25 this section during such fiscal year in changing attitudes 


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1 and behavior of teenagers with respect to healthy relation2 ships and childbearing. 

3 ‘‘(f) GRANTS FOR INDIAN TRIBES OR TRIBAL ORGA4 NIZATIONS.—Of the total amount made available to carry 

5 out this section for a fiscal year, the Secretary shall re6 serve 5 percent of such amount to award grants under 

7 this section to Indian tribes and tribal organizations in 

8 such manner, and subject to such requirements, as the 

9 Secretary, in consultation with Indian tribes and tribal or10 ganizations, determines appropriate. 

11 ‘‘(g) ELIGIBLE ENTITY DEFINED.— 

12 ‘‘(1) IN GENERAL.—In this section, the term 

13 ‘eligible entity’ means a State, local, or tribal agen14 cy; a school or postsecondary institution; an after15 school program; a nonprofit organization; or a com16 munity or faith-based organization. 

17 ‘‘(2) PREVENTING EXCLUSION OF SMALLER

18 COMMUNITY-BASED ORGANIZATIONS.—In carrying 

19 out this section, the Secretary shall ensure that the 

20 amounts and requirements of grants provided under 

21 this section do not preclude receipt of such grants 

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1 munities or engaged in meaningful and significant 

2 partnership with such communities. 

3 ‘‘SEC. 399OO–3. MULTIMEDIA CAMPAIGNS TO REDUCE UNIN4 TENDED TEENAGE PREGNANCIES. 

5 ‘‘(a) IN GENERAL.—The Secretary shall award com6 petitive grants to public and private entities to carry out 

7 multimedia campaigns to provide public education and in8 crease public awareness regarding unintended teenage 

9 pregnancy and related social and emotional issues, such 

10 as violence prevention. 

11 ‘‘(b) PRIORITY.—In awarding grants under this sec12 tion, the Secretary shall give priority to applicants pro13 posing to carry out campaigns developed for communities 

14 at disproportionate risk for unintended teen pregnancy 

15 (particularly youth in racial or ethnic minority or immi16 grant communities, youth in the foster care system, youth 

17 in the juvenile justice system, rural youth, and LGBT 

18 youth). 

19 ‘‘(c) INFORMATION TO BE PROVIDED.—As a condi20 tion of receipt of a grant under this section, an entity shall 

21 agree to use the grant to carry out multimedia campaigns 

22 described in subsection (a) that— 

23 ‘‘(1) at a minimum, shall provide information 

24 on— 


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1 ‘‘(A) the prevention of unintended teenage 

2 pregnancy; and 

3 ‘‘(B) healthy relationship development; and 

4 ‘‘(2) may provide information on the prevention 

5 of dating violence and sexual assault. 

6 ‘‘SEC. 399OO–4. RESEARCH ON REDUCING UNINTENDED 

7 TEENAGE PREGNANCIES AND TEENAGE DAT8 ING VIOLENCE AND IMPROVING HEALTHY 

9 RELATIONSHIPS. 

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

11 the Director of the Centers for Disease Control and Pre12 vention, shall make grants to public and private entities 

13 to conduct, support, or coordinate research on unintended 

14 teenage pregnancy, dating violence, and healthy relation15 ships among racial or ethnic minority or immigrant com16 munities that— 

17 ‘‘(1) improves data collection on— 

18 ‘‘(A) sexual and reproductive health, in19 cluding unintended teenage pregnancies and 

20 births, among all minority communities and 

21 subpopulations in which such data are not col22 lected, including American Indian and Alaska 

23 Native youth; 


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1 ‘‘(B) sexual behavior, reproductive and sex2 ual coercion, and teenage contraceptive use pat3 terns at the State level, as appropriate; 

4 ‘‘(C) unintended teenage pregnancies 

5 among youth in and aging out of foster care or 

6 juvenile justice systems and the underlying fac7 tors that lead to unintended teenage pregnancy 

8 among youth in foster care or juvenile justice 

9 systems; and 

10 ‘‘(D) sexual and reproductive health, in11 cluding teenage pregnancies and births, sexual 

12 behavior, reproductive and sexual coercion, and 

13 teenage contraceptive use among— 

14 ‘‘(i) LGBT youth; and 

15 ‘‘(ii) rural youth; 

16 ‘‘(2) investigates— 

17 ‘‘(A) the variance in the rates of unin18 tended teenage pregnancy by— 

19 ‘‘(i) racial and ethnic group (such as 

20 Hispanic, Asian-American, African-Amer21 ican, Pacific Islander, American Indian, 

22 and Alaska Native); and 

23 ‘‘(ii) socioeconomic status, based on 

24 the income of the family and education at25 tainment; 


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1 ‘‘(B) factors affecting the risk for youth of 

2 unintended teenage pregnancy or dating vio3 lence, including the physical and social environ4 ment, level of acculturation, access to health 

5 care, aspirations for the future, and history of 

6 physical or sexual violence or abuse; 

7 ‘‘(C) the role that violence and abuse play 

8 in teenage sex, pregnancy, and childbearing; 

9 ‘‘(D) strategies to address the dispropor10 tionate rates of unintended teenage pregnancies 

11 and dating violence in racial or ethnic minority 

12 or immigrant communities; 

13 ‘‘(E) how effective interventions can be 

14 replicated or adapted in other settings to serve 

15 racial or ethnic minority or immigrant commu16 nities in a culturally appropriate manner; and 

17 ‘‘(F) the effectiveness of media campaigns 

18 in addressing healthy relationship development, 

19 dating violence prevention, and unintended 

20 teenage pregnancy; and 

21 ‘‘(3) tests research-based strategies for address22 ing high rates of unintended teenage pregnancy 

23 through programs that emphasize healthy relation24 ships and violence prevention. 


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1 ‘‘(b) PRIORITY.—In carrying out this section, the 

2 Secretary shall give priority to research that incor3 porates— 

4 ‘‘(1) interdisciplinary approaches; 

5 ‘‘(2) a strong emphasis on community-based 

6 participatory research; or 

7 ‘‘(3) translational research. 

8 ‘‘SEC. 399OO–5. HHS ADOLESCENT HEALTH WORK GROUP. 

9 ‘‘(a) PURPOSE.—Not later than 30 days after the 

10 date of the enactment of this part, the Secretary shall di11 rect the interagency adolescent health workgroup within 

12 the Office of Adolescent Health of the Department of 

13 Health and Human Services to— 

14 ‘‘(1) include in the work of the group strategies 

15 for teenage dating violence prevention and healthy 

16 teenage relationships with a particular focus among 

17 racial or ethnic minority or immigrant communities; 

18 and 

19 ‘‘(2) with respect to including such strategies, 

20 consult, to the greatest extent possible, with the 

21 Federal Interagency Workgroup on Teen Dating Vi22 olence formed under the leadership of the National 

23 Institute of Justice of the Department of Justice. 


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1 ‘‘(b) REPORT REQUIREMENT.—The Secretary, 

2 through the Office of Adolescent Health, shall periodically 

3 submit to Congress a report that— 

4 ‘‘(1) includes a review of the evidence-based 

5 programs on preventing unintended teenage preg6 nancy, which are carried out and identified by the 

7 Office; and 

8 ‘‘(2) identifies the programs of the Department 

9 of Health and Human Services that include teenage 

10 dating violence prevention and the promotion of 

11 healthy teenage relationships as part of a strategy to 

12 prevent unintended teenage pregnancy. 

13 ‘‘SEC. 399OO–6. GENERAL GRANT PROVISIONS. 

14 ‘‘(a) APPLICATIONS.—To seek a grant under this 

15 part, an entity shall submit an application to the Secretary 

16 in such form, in such manner, and containing such agree17 ments, assurances, and information as the Secretary may 

18 require. 

19 ‘‘(b) ADDITIONAL REQUIREMENTS.—A grant may be 

20 made under this part only if the applicant involved agrees 

21 that information, activities, and services provided under 

22 the grant— 

23 ‘‘(1) will be evidence-based or evidence-in24 formed; 


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1 ‘‘(2) will be factually and medically accurate 

2 and complete; and 

3 ‘‘(3) if directed to a particular population 

4 group, will be provided in an appropriate language 

5 and cultural context. 

6 ‘‘(c) TRAINING AND TECHNICAL ASSISTANCE.— 

7 ‘‘(1) IN GENERAL.—Of the total amount made 

8 available to carry out this part for a fiscal year, the 

9 Secretary shall use 10 percent to provide, directly or 

10 through a competitive grant process, training and 

11 technical assistance to the grant recipients under 

12 this part, including by disseminating research and 

13 information regarding effective and promising prac14 tices, providing consultation and resources on a 

15 broad array of teenage and unintended pregnancy 

16 and violence prevention strategies, and developing 

17 resources and materials. 

18 ‘‘(2) COLLABORATION.—In carrying out this 

19 subsection, the Secretary shall collaborate with enti20 ties that have expertise in the prevention of teenage 

21 pregnancy, healthy relationship development, minor22 ity health and health disparities, and violence pre23 vention. 

24 ‘‘SEC. 399OO–7. DEFINITIONS. 

25 ‘‘In this part: 


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1 ‘‘(1) MEDICALLY ACCURATE AND COMPLETE.— 

2 The term ‘medically accurate and complete’ means, 

3 with respect to information, activities, or services, 

4 verified or supported by the weight of research con5 ducted in compliance with accepted scientific meth6 ods and— 

7 ‘‘(A) published in peer-reviewed journals, 

8 where applicable; or 

9 ‘‘(B) comprising information that leading 

10 professional organizations and agencies with 

11 relevant expertise in the field recognize as accu12 rate, objective, and complete. 

13 ‘‘(2) LGBT YOUTH.—The term ‘LGBT youth’ 

14 means lesbian, gay, bisexual, and transgender youth. 

15 ‘‘(3) RACIAL OR ETHNIC MINORITY OR IMMI16 GRANT COMMUNITIES.—The term ‘racial or ethnic 

17 minority or immigrant communities’ means commu18 nities with a substantial number of residents who 

19 are members of racial or ethnic minority groups or 

20 who are immigrants. 

21 ‘‘(4) REPRODUCTIVE AND SEXUAL COERCION.— 

22 The term ‘reproductive and sexual coercion’— 

23 ‘‘(A) means, with respect to a person, coer24 cive behavior that interferes with the ability of 

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1 sionmaking of such person, such as inten2 tionally exposing such person to sexually trans3 mitted infections; in the case such person is a 

4 female, attempting to impregnate such person 

5 against her will; intentionally interfering with 

6 the person’s birth control; or threatening or act7 ing violent if the person does not comply with 

8 the perpetrator’s wishes regarding contracep9 tion or the decision whether to terminate or 

10 continue a pregnancy; and 

11 ‘‘(B) includes a range of behaviors that a 

12 partner may use related to sexual decision-mak13 ing to pressure or coerce a person to have sex 

14 without using physical force, such as repeatedly 

15 pressuring a partner to have sex when he or she 

16 does not want to; threatening to end a relation17 ship if a person does not have sex; and threat18 ening retaliation if notified of a positive sexu19 ally transmitted disease test result. 

20 ‘‘(5) YOUTH.—The term ‘youth’ means individ21 uals who are 11 to 19 years of age. 

22 ‘‘SEC. 399OO–8. REPORTS. 

23 ‘‘(a) REPORT ON USE OF FUNDS.—Not later than 

24 1 year after the date of the enactment of this part, the 


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1 Secretary shall submit to Congress a report on the use 

2 of funds provided pursuant to this part. 

3 ‘‘(b) REPORT ON IMPACT OF PROGRAMS.—Not later 

4 than March 1, 2019, the Secretary shall submit to Con5 gress a report on the impact of the programs under this 

6 part on reducing unintended teenage pregnancies. 

7 ‘‘SEC. 399OO–9. AUTHORIZATION OF APPROPRIATIONS. 

8 ‘‘(a) IN GENERAL.—There are authorized to be ap9 propriated to carry out this part such sums as may be 

10 necessary for each of the fiscal years 2015 through 2019. 

11 ‘‘(b) AVAILABILITY.—Amounts appropriated pursu12 ant to subsection (a)— 

13 ‘‘(1) are authorized to remain available until ex14 pended; and 

15 ‘‘(2) are in addition to amounts otherwise made 

16 available for such purposes.’’. 

17 SEC. 509. GESTATIONAL DIABETES. 

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

19 (42 U.S.C. 243 et seq.) is amended by adding after section 

20 317H the following: 

21 ‘‘SEC. 317H–1. GESTATIONAL DIABETES. 

22 ‘‘(a) UNDERSTANDING AND MONITORING GESTA23 TIONAL DIABETES.— 

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

25 through the Director of the Centers for Disease 


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1 Control and Prevention, in consultation with the Di2 abetes Mellitus Interagency Coordinating Committee 

3 established under section 429 and representatives of 

4 appropriate national health organizations, shall de5 velop a multisite gestational diabetes research 

6 project within the diabetes program of the Centers 

7 for Disease Control and Prevention to expand and 

8 enhance surveillance data and public health research 

9 on gestational diabetes. 

10 ‘‘(2) AREAS TO BE ADDRESSED.—The research 

11 project developed under paragraph (1) shall ad12 dress— 

13 ‘‘(A) procedures to establish accurate and 

14 efficient systems for the collection of gestational 

15 diabetes data within each State and common16 wealth, territory, or possession of the United 

17 States; 

18 ‘‘(B) the progress of collaborative activities 

19 with the National Vital Statistics System, the 

20 National Center for Health Statistics, and 

21 State health departments with respect to the 

22 standard birth certificate, in order to improve 

23 surveillance of gestational diabetes; 

24 ‘‘(C) postpartum methods of tracking 

25 women with gestational diabetes after delivery 


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1 as well as targeted interventions proven to 

2 lower the incidence of type 2 diabetes in that 

3 population; 

4 ‘‘(D) variations in the distribution of diag5 nosed and undiagnosed gestational diabetes, 

6 and of impaired fasting glucose tolerance and 

7 impaired fasting glucose, within and among 

8 groups of women; and 

9 ‘‘(E) factors and culturally sensitive inter10 ventions that influence risks and reduce the in11 cidence of gestational diabetes and related com12 plications during childbirth, including cultural, 

13 behavioral, racial, ethnic, geographic, demo14 graphic, socioeconomic, and genetic factors. 

15 ‘‘(3) REPORT.—Not later than 2 years after the 

16 date of the enactment of this section, and annually 

17 thereafter, the Secretary shall generate a report on 

18 the findings and recommendations of the research 

19 project including prevalence of gestational diabetes 

20 in the multisite area and disseminate the report to 

21 the appropriate Federal and non-Federal agencies. 

22 ‘‘(b) EXPANSION OF GESTATIONAL DIABETES RE23 SEARCH.— 


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

2 and intensify public health research regarding gesta3 tional diabetes. Such research may include— 

4 ‘‘(A) developing and testing novel ap5 proaches for improving postpartum diabetes 

6 testing or screening and for preventing type 2 

7 diabetes in women with a history of gestational 

8 diabetes; and 

9 ‘‘(B) conducting public health research to 

10 further understanding of the epidemiologic, 

11 socioenvironmental, behavioral, translation, and 

12 biomedical factors and health systems that in13 fluence the risk of gestational diabetes and the 

14 development of type 2 diabetes in women with 

15 a history of gestational diabetes. 

16 ‘‘(2) AUTHORIZATION OF APPROPRIATIONS.— 

17 There is authorized to be appropriated to carry out 

18 this subsection $5,000,000 for each of fiscal years 

19 2015 through 2019. 

20 ‘‘(c) DEMONSTRATION GRANTS TO LOWER THE

21 RATE OF GESTATIONAL DIABETES.— 

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

23 through the Director of the Centers for Disease 

24 Control and Prevention, shall award grants, on a 

25 competitive basis, to eligible entities for demonstraVerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00335 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294

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1 tion projects that implement evidence-based inter2 ventions to reduce the incidence of gestational diabe3 tes, the recurrence of gestational diabetes in subse4 quent pregnancies, and the development of type 2 di5 abetes in women with a history of gestational diabe6 tes. 

7 ‘‘(2) PRIORITY.—In making grants under this 

8 subsection, the Secretary shall give priority to 

9 projects focusing on— 

10 ‘‘(A) helping women who have 1 or more 

11 risk factors for developing gestational diabetes; 

12 ‘‘(B) working with women with a history of 

13 gestational diabetes during a previous preg14 nancy; 

15 ‘‘(C) providing postpartum care for women 

16 with gestational diabetes; 

17 ‘‘(D) tracking cases where women with a 

18 history of gestational diabetes developed type 2 

19 diabetes; 

20 ‘‘(E) educating mothers with a history of 

21 gestational diabetes about the increased risk of 

22 their child developing diabetes; 

23 ‘‘(F) working to prevent gestational diabe24 tes and prevent or delay the development of 


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1 type 2 diabetes in women with a history of ges2 tational diabetes; and 

3 ‘‘(G) achieving outcomes designed to assess 

4 the efficacy and cost-effectiveness of interven5 tions that can inform decisions on long-term 

6 sustainability, including third-party reimburse7 ment. 

8 ‘‘(3) APPLICATION.—An eligible entity desiring 

9 to receive a grant under this subsection shall submit 

10 to the Secretary— 

11 ‘‘(A) an application at such time, in such 

12 manner, and containing such information as the 

13 Secretary may require; and 

14 ‘‘(B) a plan to— 

15 ‘‘(i) lower the rate of gestational dia16 betes during pregnancy; or 

17 ‘‘(ii) develop methods of tracking 

18 women with a history of gestational diabe19 tes and develop effective interventions to 

20 lower the incidence of the recurrence of 

21 gestational diabetes in subsequent preg22 nancies and the development of type 2 dia23 betes. 

24 ‘‘(4) USES OF FUNDS.—An eligible entity re25 ceiving a grant under this subsection shall use the 


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1 grant funds to carry out demonstration projects de2 scribed in paragraph (1), including— 

3 ‘‘(A) expanding community-based health 

4 promotion education, activities, and incentives 

5 focused on the prevention of gestational diabe6 tes and development of type 2 diabetes in 

7 women with a history of gestational diabetes; 

8 ‘‘(B) aiding State- and tribal-based diabe9 tes prevention and control programs to collect, 

10 analyze, disseminate, and report surveillance 

11 data on women with, and at risk for, gesta12 tional diabetes, the recurrence of gestational di13 abetes in subsequent pregnancies, and, for 

14 women with a history of gestational diabetes, 

15 the development of type 2 diabetes; and 

16 ‘‘(C) training and encouraging health care 

17 providers— 

18 ‘‘(i) to promote risk assessment, high19 quality care, and self-management for ges20 tational diabetes and the recurrence of ges21 tational diabetes in subsequent preg22 nancies; and 

23 ‘‘(ii) to prevent the development of 

24 type 2 diabetes in women with a history of 

25 gestational diabetes, and its complications 


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1 in the practice settings of the health care 

2 providers. 

3 ‘‘(5) REPORT.—Not later than 4 years after the 

4 date of the enactment of this section, the Secretary 

5 shall prepare and submit to the Congress a report 

6 concerning the results of the demonstration projects 

7 conducted through the grants awarded under this 

8 subsection. 

9 ‘‘(6) DEFINITION OF ELIGIBLE ENTITY.—In 

10 this subsection, the term ‘eligible entity’ means a 

11 nonprofit organization (such as a nonprofit academic 

12 center or community health center) or a State, trib13 al, or local health agency. 

14 ‘‘(7) AUTHORIZATION OF APPROPRIATIONS.— 

15 There is authorized to be appropriated to carry out 

16 this subsection $5,000,000 for each of fiscal years 

17 2015 through 2019. 

18 ‘‘(d) POSTPARTUM FOLLOWUP REGARDING GESTA19 TIONAL DIABETES.—The Secretary, acting through the 

20 Director of the Centers for Disease Control and Preven21 tion, shall work with the State- and tribal-based diabetes 

22 prevention and control programs assisted by the Centers 

23 to encourage postpartum followup after gestational diabe24 tes, as medically appropriate, for the purpose of reducing 

25 the incidence of gestational diabetes, the recurrence of 


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1 gestational diabetes in subsequent pregnancies, the devel2 opment of type 2 diabetes in women with a history of ges3 tational diabetes, and related complications.’’. 

4 SEC. 510. EMERGENCY CONTRACEPTION EDUCATION AND 

5 INFORMATION PROGRAMS. 

6 (a) EMERGENCY CONTRACEPTION PUBLIC EDU7 CATION PROGRAM.— 

8 (1) IN GENERAL.—The Secretary, acting 

9 through the Director of the Centers for Disease 

10 Control and Prevention, shall develop and dissemi11 nate to the public information on emergency contra12 ception. 

13 (2) DISSEMINATION.—The Secretary may dis14 seminate information under paragraph (1) directly 

15 or through arrangements with nonprofit organiza16 tions, consumer groups, institutions of higher edu17 cation, clinics, the media, and Federal, State, and 

18 local agencies. 

19 (3) INFORMATION.—The information dissemi20 nated under paragraph (1) shall include, at a min21 imum, a description of emergency contraception and 

22 an explanation of the use, safety, efficacy, and avail23 ability of such contraception. 

24 (b) EMERGENCY CONTRACEPTION INFORMATION

25 PROGRAM FOR HEALTH CARE PROVIDERS.— 


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

2 through the Administrator of the Health Resources 

3 and Services Administration and in consultation 

4 with major medical and public health organizations, 

5 shall develop and disseminate to health care pro6 viders information on emergency contraception. 

7 (2) INFORMATION.—The information dissemi8 nated under paragraph (1) shall include, at a min9 imum— 

10 (A) information describing the use, safety, 

11 efficacy, and availability of emergency contra12 ception; 

13 (B) a recommendation regarding the use of 

14 such contraception in appropriate cases; and 

15 (C) information explaining how to obtain 

16 copies of the information developed under sub17 section (a) for distribution to the patients of 

18 the providers. 

19 (c) DEFINITIONS.—In this section: 

20 (1) EMERGENCY CONTRACEPTION.—The term 

21 ‘‘emergency contraception’’ means a drug or device 

22 (as the terms are defined in section 201 of the Fed23 eral Food, Drug, and Cosmetic Act (21 U.S.C. 321)) 

24 or a drug regimen that— 

25 (A) is used postcoitally; 


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1 (B) prevents pregnancy primarily by pre2 venting or delaying ovulation, and does not ter3 minate an established pregnancy; and 

4 (C) is approved by the Food and Drug Ad5 ministration. 

6 (2) HEALTH CARE PROVIDER.—The term 

7 ‘‘health care provider’’ means an individual who is li8 censed or certified under State law to provide health 

9 care services and who is operating within the scope 

10 of such license. Such term shall include a phar11 macist. 

12 (3) INSTITUTION OF HIGHER EDUCATION.—The 

13 term ‘‘institution of higher education’’ has the same 

14 meaning given such term in section 101(a) of the 

15 Higher Education Act of 1965 (20 U.S.C. 1001(a)). 

16 (4) SECRETARY.—The term ‘‘Secretary’’ means 

17 the Secretary of Health and Human Services. 

18 (d) AUTHORIZATION OF APPROPRIATIONS.—There 

19 are authorized to be appropriated to carry out this section 

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

21 2015 through 2019. 

22 SEC. 511. SUPPORTING HEALTHY ADOLESCENT DEVELOP23 MENT. 

24 (a) IN GENERAL.—The Secretary may award a grant 

25 to each eligible State to conduct programs of sex education 


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1 described in subsection (b), including education on both 

2 abstinence and contraception for the prevention of teenage 

3 pregnancy and sexually transmitted diseases, including 

4 HIV/AIDS and viral hepatitis. 

5 (b) REQUIREMENTS FOR SEX EDUCATION PRO6 GRAMS.—A program of sex education described in this 

7 subsection is a program that— 

8 (1) is age appropriate and medically accurate; 

9 (2) stresses the value of abstinence while not ig10 noring those young people who have been or are sex11 ually active; 

12 (3) includes information providing a factual un13 derstanding of male and female reproductive anat14 omy; 

15 (4) provides information about the health bene16 fits and side effects of contraceptive and barrier 

17 methods used— 

18 (A) as a means to prevent pregnancy; and 

19 (B) to reduce the risk of contracting sexu20 ally transmitted disease, including HIV/AIDS 

21 and viral hepatitis; 

22 (5) encourages family communication between 

23 parent and child about sexuality; 

24 (6) cultivates a respectful dialogue about sexu25 ality, including sexual orientation and gender idenVerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00343 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294

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1 tity, and embraces the principles of nondiscrimina2 tion based on sexual orientation and gender identity; 

3 (7) counters the perpetuation of narrow gender 

4 roles, including the sexualization of female children, 

5 adolescents, and adults; 

6 (8) teaches young people the skills to make re7 sponsible decisions about sexuality, including how to 

8 avoid unwanted verbal, physical, and sexual ad9 vances and how to avoid making verbal, physical, 

10 and sexual advances that are not wanted by the 

11 other party; 

12 (9) develops healthy relationships, including the 

13 prevention of dating and sexual violence; 

14 (10) teaches young people how alcohol and drug 

15 use can affect responsible decisionmaking; and 

16 (11) does not teach or promote religion. 

17 (c) ADDITIONAL ACTIVITIES.—In carrying out a pro18 gram of sex education, a State may expend grant funds 

19 awarded under subsection (a) to carry out educational and 

20 motivational activities that help young people— 

21 (1) gain knowledge about the physical, emo22 tional, biological, and hormonal changes of adoles23 cence and subsequent stages of human maturation; 

24 (2) develop the knowledge and skills nec25 essary— 


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1 (A) to ensure and protect their sexual and 

2 reproductive health from unintended pregnancy 

3 and sexually transmitted disease, including 

4 HIV/AIDS, throughout their lifespan; 

5 (B) to be aware that certain racial and 

6 ethnic groups are more affected by certain sex7 ually transmitted diseases; and 

8 (C) to receive the education to prevent fur9 ther transmission; 

10 (3) gain knowledge about the specific involve11 ment and responsibility of each individual in sexual 

12 decisionmaking; 

13 (4) develop healthy attitudes and values about 

14 adolescent growth and development, body image, 

15 gender roles, racial and ethnic diversity, sexual ori16 entation and gender identity, and other subjects; 

17 (5) develop and practice healthy life skills in18 cluding goal-setting, decisionmaking, negotiation, 

19 communication, and stress management; and 

20 (6) promote self-esteem and positive inter21 personal skills focusing on relationship dynamics, in22 cluding friendships, dating, romantic involvement, 

23 marriage, and family interactions. 

24 (d) MATCHING FUNDS.—The Secretary may not 

25 make payments to a State under this section in an amount 


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1 exceeding Federal medical assistance percentage for such 

2 State (as such term is defined in section 1905(b) of the 

3 Social Security Act (42 U.S.C. 1396d(b))) of the costs of 

4 the programs conducted by the State under this section. 

5 (e) EVALUATION OF PROGRAMS.— 

6 (1) IN GENERAL.—For the purpose of evalu7 ating the effectiveness of programs of sex education 

8 carried out with a grant under this section, evalua9 tions shall be carried out in accordance with para10 graphs (2) and (3). 

11 (2) NATIONAL EVALUATION.— 

12 (A) METHOD.—The Secretary shall pro13 vide for a national evaluation of a representa14 tive sample of programs of sex education car15 ried out with grants under this section to deter16 mine— 

17 (i) the effectiveness of such programs 

18 in helping to delay the initiation of sexual 

19 intercourse and other high-risk behaviors; 

20 (ii) the effectiveness of such programs 

21 in preventing adolescent pregnancy; 

22 (iii) the effectiveness of such pro23 grams in preventing sexually transmitted 

24 disease, including HIV/AIDS and viral 

25 hepatitis; 


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1 (iv) the effectiveness of such programs 

2 in increasing contraceptive knowledge and 

3 contraceptive behaviors when sexual inter4 course occurs; and 

5 (v) a list of best practices that— 

6 (I) is based upon essential pro7 grammatic components of evaluated 

8 programs that have led to success de9 scribed in clauses (i) through (iv); and 

10 (II) documents the racial and 

11 ethnic minority populations that are 

12 recipients of grant funds under this 

13 section or are served by programs of 

14 sex education funded under this sec15 tion. 

16 (B) GRANT CONDITION.—A condition for 

17 the receipt of a grant to a State under this sec18 tion is that the State cooperate with the evalua19 tion under subparagraph (A). 

20 (C) REPORT.—The Secretary shall submit 

21 to the Congress— 

22 (i) not later than the end of each fis23 cal year during the 5-year period beginning 

24 with fiscal year 2015, an interim report on 


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1 the national evaluation under subpara2 graph (A); and 

3 (ii) not later than March 31, 2020, a 

4 final report providing the results of such 

5 national evaluation. 

6 (3) INDIVIDUAL STATE EVALUATIONS.—A con7 dition for the receipt of a grant under this section 

8 is that the State evaluate the programs of sex edu9 cation funded through such grant in accordance with 

10 the following requirements: 

11 (A) The evaluation will be conducted by an 

12 external, independent entity. 

13 (B) The purposes of the evaluation will be 

14 the determination of— 

15 (i) the effectiveness of such programs 

16 in helping to delay the initiation of sexual 

17 intercourse and other high-risk behaviors; 

18 (ii) the effectiveness of such programs 

19 in preventing adolescent pregnancy; 

20 (iii) the effectiveness of such pro21 grams in preventing sexually transmitted 

22 disease, including HIV/AIDS; and 

23 (iv) the effectiveness of such programs 

24 in increasing contraceptive and barrier 


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1 method knowledge and contraceptive be2 haviors when sexual intercourse occurs. 

3 (f) LIMITATIONS ON USE OF FUNDS.— 

4 (1) LIMITATIONS ON SECRETARY.—Of the 

5 amounts appropriated for a fiscal year for purposes 

6 of this section, the Secretary may not use more 

7 than— 

8 (A) 7 percent of such amounts for admin9 istrative expenses related to carrying out this 

10 section for that fiscal year; and 

11 (B) 10 percent of such amounts for the 

12 national evaluation under subsection (e)(2). 

13 (2) LIMITATIONS TO STATES.—Of amounts pro14 vided to an eligible State under this subsection, the 

15 State may not use more than 10 percent of the 

16 grant to conduct any evaluation under subsection 

17 (e)(3). 

18 (g) NONDISCRIMINATION REQUIRED.—Programs 

19 funded under this section shall not discriminate on the 

20 basis of sex, race, ethnicity, national origin, disability, reli21 gion, marital status, familial status, sexual orientation, or 

22 gender identity. Nothing in this section shall be construed 

23 to invalidate or limit rights, remedies, procedures, or legal 

24 standards available to victims of discrimination under any 

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1 division of a State, including title VI of the Civil Rights 

2 Act of 1964 (42 U.S.C. 2000d et seq.), title IX of the 

3 Education Amendments of 1972 (20 U.S.C. 1681 et seq.), 

4 section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 

5 794), and the Americans with Disabilities Act of 1990 (42 

6 U.S.C. 12101 et seq.). 

7 (h) DEFINITIONS.—For purposes of this section: 

8 (1) The term ‘‘age appropriate’’ means, with re9 spect to topics, messages, and teaching methods, 

10 those suitable to particular ages or age groups of 

11 children, adolescents, and adults, based on devel12 oping cognitive, emotional, and behavioral capacity 

13 typical for the age or age group. 

14 (2) The term ‘‘eligible State’’ means a State 

15 that submits to the Secretary an application for a 

16 grant under this section that is in such form, is 

17 made in such manner, and contains such agree18 ments, assurances, and information as the Secretary 

19 determines to be necessary to carry out this section. 

20 (3) The term ‘‘HIV/AIDS’’ means the human 

21 immunodeficiency virus, and includes acquired im22 mune deficiency syndrome. 

23 (4) The term ‘‘medically accurate’’, with respect 

24 to information, means information that is supported 

25 by research, recognized as accurate and objective by 


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1 leading medical, psychological, psychiatric, and pub2 lic health organizations and agencies, and, published 

3 in journals that are peer reviewed. 

4 (5) The term ‘‘State’’ means the 50 States, the 

5 District of Columbia, the Commonwealth of Puerto 

6 Rico, the Commonwealth of the Northern Mariana 

7 Islands, American Samoa, Guam, the United States 

8 Virgin Islands, and any other territory or possession 

9 of the United States. 

10 (i) AUTHORIZATION OF APPROPRIATIONS.—For the 

11 purpose of carrying out this section, there is authorized 

12 to be appropriated $50,000,000 for each of the fiscal years 

13 2015 through 2019. 

14 SEC. 512. COMPASSIONATE ASSISTANCE FOR RAPE EMER15 GENCIES. 

16 (a) MEDICARE.— 

17 (1) LIMITATION ON PAYMENT.—Section 

18 1866(a)(1) of the Social Security Act (42 U.S.C. 

19 1395cc(a)(1)) is amended— 

20 (A) by striking ‘‘and’’ at the end of sub21 paragraph (V); 

22 (B) in the subparagraph (W) added by sec23 tion 3005(1)(C) of Public Law 111–148— 

24 (i) by striking the period at the end 

25 and inserting a comma; 


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1 (ii) by moving the indentation 2 ems 

2 to the left; and 

3 (iii) by moving such subparagraph to 

4 immediately follow subparagraph (V); 

5 (C) in the subparagraph (W) added by sec6 tion 6406(b)(3) of Public Law 111–148— 

7 (i) by striking the period at the end 

8 and inserting ‘‘, and’’; 

9 (ii) by moving the indentation 2 ems 

10 to the left; 

11 (iii) by redesignating such subpara12 graph as subparagraph (X); and 

13 (iv) by moving such subparagraph to 

14 immediately follow subparagraph (W), as 

15 moved under paragraph (2)(C); and 

16 (D) by inserting after the subparagraph 

17 (X), as redesignated and moved under para18 graph (3), the following: 

19 ‘‘(Y) in the case of a hospital or critical ac20 cess hospital, to adopt and enforce a policy to 

21 ensure compliance with the requirements of 

22 subsection (l) and to meet the requirements of 

23 such subsection.’’. 

24 (2) ASSISTANCE TO VICTIMS.—Section 1866 of 

25 the Social Security Act (42 U.S.C. 1395cc) is 


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1 amended by adding at the end the following new 

2 subsection: 

3 ‘‘(l) COMPASSIONATE ASSISTANCE FOR RAPE EMER4 GENCIES.— 

5 ‘‘(1) IN GENERAL.—For purposes of section 

6 1866(a)(1)(Y), a hospital meets the requirements of 

7 this subsection if the hospital provides each of the 

8 services described in paragraph (2) to each female 

9 individual, whether or not eligible for benefits under 

10 this title or under any other form of health insur11 ance. who comes to the hospital on or after January 

12 1, 2015, and— 

13 ‘‘(A) who states to hospital personnel that 

14 she is a victim of sexual assault; 

15 ‘‘(B) who is accompanied by an individual 

16 who states to hospital personnel that the female 

17 individual is a victim of sexual assault; or 

18 ‘‘(C) whom hospital personnel, during the 

19 course of treatment and care for the female in20 dividual, have reason to believe is a victim of 

21 sexual assault. 

22 ‘‘(2) REQUIRED SERVICES DESCRIBED.—For 

23 purposes of paragraph (1), the services described in 

24 this subparagraph are the following: 


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1 ‘‘(A) Provision of medically and factually 

2 accurate and unbiased written and oral infor3 mation about emergency contraception that— 

4 ‘‘(i) is written in clear and concise 

5 language; 

6 ‘‘(ii) is readily comprehensible; 

7 ‘‘(iii) includes an explanation that— 

8 ‘‘(I) emergency contraception has 

9 been approved by the Food and Drug 

10 Administration as an over-the-counter 

11 medication for female individuals, and 

12 is a safe and effective way to prevent 

13 pregnancy after unprotected inter14 course or contraceptive failure if 

15 taken in a timely manner; 

16 ‘‘(II) emergency contraception is 

17 more effective the sooner it is taken; 

18 and 

19 ‘‘(III) emergency contraception 

20 does not cause an abortion and cannot 

21 interrupt an established pregnancy; 

22 ‘‘(iv) meets such conditions regarding 

23 the provision of such information in lan24 guages other than English as the Secretary 

25 may establish; and 


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1 ‘‘(v) is provided without regard to the 

2 ability of the individual or her family to 

3 pay costs associated with the provision of 

4 such information to the individual. 

5 ‘‘(B) Prompt offer to provide emergency 

6 contraception to the individual, and in the case 

7 that the individual accepts such offer, prompt 

8 provision of such contraception to such indi9 vidual without regard to the inability of the in10 dividual or her family to pay costs associated 

11 with the offer and provision of such contracep12 tion. 

13 ‘‘(3) DEFINITIONS.—For purposes of this para14 graph: 

15 ‘‘(A) The term ‘emergency contraception’ 

16 means a drug or device (as such terms are de17 fined in section 201 of the Federal Food, Drug, 

18 and Cosmetic Act (21 U.S.C. 321)) or a drug 

19 regimen that— 

20 ‘‘(i) is used postcoitally; 

21 ‘‘(ii) prevents pregnancy primarily by 

22 preventing or delaying ovulation, and does 

23 not terminate an established pregnancy; 

24 and 


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1 ‘‘(iii) is approved by the Food and 

2 Drug Administration. 

3 ‘‘(B) The term ‘hospital’ includes a critical 

4 access hospital, as defined in section 

5 1861(mm)(1). 

6 ‘‘(C) The term ‘sexual assault’ means co7 itus in which the individual involved does not 

8 consent or lacks the legal capacity to consent.’’. 

9 (b) LIMITATION ON PAYMENT UNDER MEDICAID.— 

10 Section 1903(i) of the Social Security Act (42 U.S.C. 

11 1396b(i)) is amended by inserting after paragraph (11) 

12 the following new paragraph: 

13 ‘‘(12) with respect to any amount expended for 

14 care or services furnished under the plan by a hos15 pital on or after January 1, 2015, unless such hos16 pital meets the requirements specified in section 

17 1866(l) for purposes of title XVIII.’’. 

18 SEC. 513. ACCESS TO BIRTH CONTROL DUTIES OF PHAR19 MACIES TO ENSURE PROVISION OF FDA-AP20 PROVED CONTRACEPTION. 

21 Part B of title II of the Public Health Service Act 

22 (42 U.S.C. 238 et seq.) is amended by adding at the end 

23 the following: 


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1 ‘‘SEC. 249. DUTIES OF PHARMACIES TO ENSURE PROVISION 

2 OF FDA-APPROVED CONTRACEPTION. 

3 ‘‘(a) IN GENERAL.—Subject to subsection (c), a 

4 pharmacy that receives Food and Drug Administration5 approved drugs or devices in interstate commerce shall 

6 maintain compliance with the following: 

7 ‘‘(1) If a customer requests a contraceptive that 

8 is in stock, the pharmacy shall ensure that the con9 traceptive is provided to the customer without delay. 

10 ‘‘(2) If a customer requests a contraceptive that 

11 is not in stock and the pharmacy in the normal 

12 course of business stocks contraception, the phar13 macy shall immediately inform the customer that the 

14 contraceptive is not in stock and without delay offer 

15 the customer the following options: 

16 ‘‘(A) If the customer prefers to obtain the 

17 contraceptive through a referral or transfer, the 

18 pharmacy shall— 

19 ‘‘(i) locate a pharmacy of the cus20 tomer’s choice or the closest pharmacy 

21 confirmed to have the contraceptive in 

22 stock; and 

23 ‘‘(ii) refer the customer or transfer 

24 the prescription to that pharmacy. 

25 ‘‘(B) If the customer prefers for the phar26 macy to order the contraceptive, the pharmacy 


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1 shall obtain the contraceptive under the phar2 macy’s standard procedure for expedited order3 ing of medication and notify the customer when 

4 the contraceptive arrives. 

5 ‘‘(3) The pharmacy shall ensure that its em6 ployees do not— 

7 ‘‘(A) intimidate, threaten, or harass cus8 tomers in the delivery of services relating to a 

9 request for contraception; 

10 ‘‘(B) interfere with or obstruct the delivery 

11 of services relating to a request for contracep12 tion; 

13 ‘‘(C) intentionally misrepresent or deceive 

14 customers about the availability of contracep15 tion or its mechanism of action; 

16 ‘‘(D) breach medical confidentiality with 

17 respect to a request for contraception or threat18 en to breach such confidentiality; or 

19 ‘‘(E) refuse to return a valid, lawful pre20 scription for contraception upon customer re21 quest. 

22 ‘‘(b) CONTRACEPTIVES NOT ORDINARILY

23 STOCKED.—Nothing in subsection (a)(2) shall be con24 strued to require any pharmacy to comply with such subVerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00358 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294

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1 section if the pharmacy does not ordinarily stock contra2 ceptives in the normal course of business. 

3 ‘‘(c) REFUSALS PURSUANT TO STANDARD PHAR4 MACY PRACTICE.—This section does not prohibit a phar5 macy from refusing to provide a contraceptive to a cus6 tomer in accordance with any of the following: 

7 ‘‘(1) If it is unlawful to dispense the contracep8 tive to the customer without a valid, lawful prescrip9 tion and no such prescription is presented. 

10 ‘‘(2) If the customer is unable to pay for the 

11 contraceptive. 

12 ‘‘(3) If the employee of the pharmacy refuses to 

13 provide the contraceptive on the basis of a profes14 sional clinical judgment. 

15 ‘‘(d) RULE OF CONSTRUCTION.—Nothing in this sec16 tion shall be construed to invalidate or limit rights, rem17 edies, procedures, or legal standards under title VII of the 

18 Civil Rights Act of 1964. 

19 ‘‘(e) PREEMPTION.—This section does not preempt 

20 any provision of State law or any professional obligation 

21 made applicable by a State board or other entity respon22 sible for licensing or discipline of pharmacies or phar23 macists, to the extent that such State law or professional 

24 obligation provides protections for customers that are 

25 greater than the protections provided by this section. 


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1 ‘‘(f) ENFORCEMENT.— 

2 ‘‘(1) CIVIL PENALTY.—A pharmacy that vio3 lates a requirement of subsection (a) is liable to the 

4 United States for a civil penalty in an amount not 

5 exceeding $1,000 per day of violation, not to exceed 

6 $100,000 for all violations adjudicated in a single 

7 proceeding. 

8 ‘‘(2) PRIVATE CAUSE OF ACTION.—Any person 

9 aggrieved as a result of a violation of a requirement 

10 of subsection (a) may, in any court of competent ju11 risdiction, commence a civil action against the phar12 macy involved to obtain appropriate relief, including 

13 actual and punitive damages, injunctive relief, and a 

14 reasonable attorney’s fee and cost. 

15 ‘‘(3) LIMITATIONS.—A civil action under para16 graph (1) or (2) may not be commenced against a 

17 pharmacy after the expiration of the 5-year period 

18 beginning on the date on which the pharmacy alleg19 edly engaged in the violation involved. 

20 ‘‘(g) DEFINITIONS.—In this section: 

21 ‘‘(1) The term ‘contraception’ or ‘contraceptive’ 

22 means any drug or device approved by the Food and 

23 Drug Administration to prevent pregnancy. 


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1 ‘‘(2) The term ‘employee’ means a person hired, 

2 by contract or any other form of an agreement, by 

3 a pharmacy. 

4 ‘‘(3) The term ‘pharmacy’ means an entity 

5 that— 

6 ‘‘(A) is authorized by a State to engage in 

7 the business of selling prescription drugs at re8 tail; and 

9 ‘‘(B) employs one or more employees. 

10 ‘‘(4) The term ‘product’ means a Food and 

11 Drug Administration-approved drug or device. 

12 ‘‘(5) The term ‘professional clinical judgment’ 

13 means the use of professional knowledge and skills 

14 to form a clinical judgment, in accordance with pre15 vailing medical standards. 

16 ‘‘(6) The term ‘without delay’, with respect to 

17 a pharmacy providing, providing a referral for, or 

18 ordering contraception, or transferring the prescrip19 tion for contraception, means within the usual and 

20 customary timeframe at the pharmacy for providing, 

21 providing a referral for, or ordering other products, 

22 or transferring the prescription for other products, 

23 respectively. 

24 ‘‘(h) EFFECTIVE DATE.—This section shall take ef25 fect on the 31st day after the date of the enactment of 


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1 this section, without regard to whether the Secretary has 

2 issued any guidance or final rule regarding this section.’’. 

3 SEC. 514. ADDITIONAL FOCUS AREA FOR THE OFFICE ON 

4 WOMEN’S HEALTH. 

5 Section 229(b) of the Public Health Service Act (42 

6 U.S.C. 237a(b)) is amended— 

7 (1) in paragraph (6), at the end, by striking 

8 ‘‘and’’; 

9 (2) in paragraph (7), at the end, by striking the 

10 period and inserting ‘‘; and’’; and 

11 (3) by adding at the end the following new 

12 paragraph: 

13 ‘‘(8) facilitate policymakers, health system lead14 ers and providers, consumers, and other stake15 holders in understanding optimal maternity care and 

16 support for the provision of such care, including the 

17 priorities of— 

18 ‘‘(A) protecting, promoting, and supporting 

19 the innate capacities of childbearing women and 

20 their newborns for childbirth, breastfeeding, 

21 and attachment; 

22 ‘‘(B) using obstetric interventions only 

23 when such interventions are supported by 

24 strong, high-quality evidence, and minimizing 

25 overuse of maternity practices that have been 


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1 shown to have benefit in limited situations and 

2 that can expose women, infants, or both to risk 

3 of harm if used routinely and indiscriminately, 

4 including continuous electronic fetal monitoring, 

5 labor induction, epidural analgesia, primary ce6 sarean section, and routine repeat cesarean 

7 birth; 

8 ‘‘(C) reliably incorporating noninvasive, 

9 evidence-based practices that have documented 

10 correlation with considerable improvement in 

11 outcomes with no detrimental side effects, such 

12 as smoking cessation programs in pregnancy 

13 and proven models of group prenatal care that 

14 integrate health assessment, education, and 

15 support into a unified program; 

16 ‘‘(D) a shared understanding of the quali17 fications of licensed providers of maternity care 

18 and the best evidence about the safety, satisfac19 tion, outcomes, and costs of their care, and ap20 propriate deployment of such caregivers within 

21 the maternity care workforce to address the 

22 needs of childbearing women and newborns and 

23 the growing shortage of maternity caregivers; 

24 ‘‘(E) a shared understanding of the results 

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1 pital, birth center, and planned home births, in2 cluding information about each setting’s safety, 

3 satisfaction, outcomes, and costs; and 

4 ‘‘(F) high-quality, evidence-based child5 birth education that promotes a natural, 

6 healthy, and safe approach to pregnancy, child7 birth, and early parenting; is taught by certified 

8 educators, peer counselors, and health profes9 sionals; and promotes informed decisionmaking 

10 by childbearing women.’’. 

11 SEC. 515. INTERAGENCY COORDINATING COMMITTEE ON 

12 THE PROMOTION OF OPTIMAL MATERNITY 

13 OUTCOMES. 

14 (a) IN GENERAL.—Part A of title II of the Public 

15 Health Service Act (42 U.S.C. 202 et seq.) is amended 

16 by adding at the end the following new section: 

17 ‘‘SEC. 229A. INTERAGENCY COORDINATING COMMITTEE ON 

18 THE PROMOTION OF OPTIMAL MATERNITY 

19 OUTCOMES. 

20 ‘‘(a) IN GENERAL.—The Secretary of Health and 

21 Human Services, acting through the Deputy Assistant 

22 Secretary for Women’s Health under section 229 and in 

23 collaboration with the Federal officials specified in sub24 section (b), shall establish the Interagency Coordinating 


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1 Committee on the Promotion of Optimal Maternity Out2 comes (referred to in this subsection as the ‘ICCPOM’). 

3 ‘‘(b) OTHER AGENCIES.—The officials specified in 

4 this subsection are the Secretary of Labor, the Secretary 

5 of Defense, the Secretary of Veterans Affairs, the Surgeon 

6 General, the Director of the Centers for Disease Control 

7 and Prevention, the Administrator of the Health Re8 sources and Services Agency, the Administrator of the 

9 Centers for Medicare & Medicaid Services, the Director 

10 of the Indian Health Service, the Administrator of the 

11 Substance Abuse and Mental Health Services Administra12 tion, the Director of the National Institute on Child 

13 Health and Development, the Director of the Agency for 

14 Healthcare Research and Quality, the Assistant Secretary 

15 for Children and Families, the Deputy Assistant Secretary 

16 for Minority Health, the Director of the Office of Per17 sonnel Management, and such other Federal officials as 

18 the Secretary of Health and Human Services determines 

19 to be appropriate. 

20 ‘‘(c) CHAIR.—The Deputy Assistant Secretary for 

21 Women’s Health shall serve as the chair of the ICCPOM. 

22 ‘‘(d) DUTIES.—The ICCPOM shall guide policy and 

23 program development across the Federal Government with 

24 respect to promotion of optimal maternity care, provided, 

25 however, that nothing in this section shall be construed 


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1 as transferring regulatory or program authority from an 

2 agency to the ICCPOM. 

3 ‘‘(e) CONSULTATIONS.—The ICCPOM shall actively 

4 seek the input of, and shall consult with, all appropriate 

5 and interested stakeholders, including State health depart6 ments, public health research and interest groups, founda7 tions, childbearing women and their advocates, and mater8 nity care professional associations and organizations, re9 flecting racially, ethnically, demographically, and geo10 graphically diverse communities. 

11 ‘‘(f) ANNUAL REPORT.— 

12 ‘‘(1) IN GENERAL.—The Secretary, on behalf of 

13 the ICCPOM, shall annually submit to Congress a 

14 report that summarizes— 

15 ‘‘(A) all programs and policies of Federal 

16 agencies (including the Medicare Program 

17 under title XVIII of the Social Security Act and 

18 the Medicaid program under title XIX of such 

19 Act) designed to promote optimal maternity 

20 care, focusing particularly on programs and 

21 policies that support the adoption of evidence 

22 based maternity care, as defined by timely, sci23 entifically sound systematic reviews; 

24 ‘‘(B) all programs and policies of Federal 

25 agencies (including the Medicare Program 


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1 under title XVIII of the Social Security Act and 

2 the Medicaid program under title XIX of such 

3 Act) designed to address the problems of mater4 nal mortality and morbidity, infant mortality, 

5 prematurity, and low birth weight, including 

6 such programs and policies designed to address 

7 racial and ethnic disparities with respect to 

8 each of such problems; 

9 ‘‘(C) the extent of progress in reducing 

10 maternal mortality and infant mortality, low 

11 birth weight, and prematurity at State and na12 tional levels; and 

13 ‘‘(D) such other information regarding op14 timal maternity care as the Secretary deter15 mines to be appropriate. 

16 The information specified in subparagraph (C) shall 

17 be included in each such report in a manner that 

18 disaggregates such information by race, ethnicity, 

19 and indigenous status in order to determine the ex20 tent of progress in reducing racial and ethnic dis21 parities and disparities related to indigenous status. 

22 ‘‘(2) CERTAIN INFORMATION.—Each report 

23 under paragraph (1) shall include information 

24 (disaggregated by race, ethnicity, and indigenous 


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1 status, as applicable) on the following rates and 

2 costs by State: 

3 ‘‘(A) The rate of primary cesarean deliv4 eries and repeat cesarean deliveries. 

5 ‘‘(B) The rate of vaginal births after cesar6 ean. 

7 ‘‘(C) The rate of vaginal breech births. 

8 ‘‘(D) The rate of induction of labor. 

9 ‘‘(E) The rate of freestanding birth center 

10 births. 

11 ‘‘(F) The rate of planned and unplanned 

12 home birth. 

13 ‘‘(G) The rate of attended births by pro14 vider, including by an obstetrician-gynecologist, 

15 family practice physician, obstetrician-gyne16 cologist physician assistant, certified nurse-mid17 wife, certified midwife, and certified profes18 sional midwife. 

19 ‘‘(H) The cost of maternity care 

20 disaggregated by place of birth and provider of 

21 care, including— 

22 ‘‘(i) uncomplicated vaginal birth; 

23 ‘‘(ii) complicated vaginal birth; 

24 ‘‘(iii) uncomplicated cesarean birth; 

25 and 


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1 ‘‘(iv) complicated cesarean birth. 

2 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There 

3 is authorized to be appropriated, in addition to such 

4 amounts authorized to be appropriated under section 

5 229(e), to carry out this section $1,000,000 for each of 

6 the fiscal years 2015 through 2019.’’. 

7 (b) CONFORMING AMENDMENTS.— 

8 (1) INCLUSION AS DUTY OF HHS OFFICE ON

9 WOMEN’S HEALTH.—Section 229(b) of such Act (42 

10 U.S.C. 237a(b)), as amended, is amended— 

11 (A) in paragraph (7), at the end, by strik12 ing ‘‘and’’; 

13 (B) in paragraph (8), at the end, by strik14 ing the period and inserting ‘‘; and’’; and 

15 (C) by adding at the end the following new 

16 paragraph: 

17 ‘‘(9) establish the Interagency Coordinating 

18 Committee on the Promotion of Optimal Maternity 

19 Outcomes in accordance with section 229A.’’. 

20 (2) TREATMENT OF BIENNIAL REPORTS.—Sec21 tion 229(d) of such Act (42 U.S.C. 237a(d)) is 

22 amended by inserting ‘‘(other than under subsection 

23 (b)(9))’’ after ‘‘under this section’’. 


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1 SEC. 516. CONSUMER EDUCATION CAMPAIGN. 

2 Section 229 of the Public Health Service Act (42 

3 U.S.C. 237a), as amended, is further amended in sub4 section (b)— 

5 (1) in paragraph (8), at the end, by striking 

6 ‘‘and’’; 

7 (2) in paragraph (9), at the end, by striking the 

8 period and inserting ‘‘; and’’; and 

9 (3) by adding at the end the following new 

10 paragraph: 

11 ‘‘(10) not later than one year after the date of 

12 the enactment of the Health Equity and Account13 ability Act of 2014, develop and implement a 4-year 

14 culturally and linguistically appropriate multimedia 

15 consumer education campaign that is designed to 

16 promote understanding and acceptance of evidence17 based maternity practices and models of care for op18 timal maternity outcomes among women of child19 bearing ages and families of such women and that— 

20 ‘‘(A) highlights the importance of pro21 tecting, promoting, and supporting the innate 

22 capacities of childbearing women and their 

23 newborns for childbirth, breastfeeding, and at24 tachment; 

25 ‘‘(B) promotes understanding of the impor26 tance of using obstetric interventions when 


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1 medically necessary and when supported by 

2 strong, high-quality evidence; 

3 ‘‘(C) highlights the widespread overuse of 

4 maternity practices that have been shown to 

5 have benefit when used appropriately in situa6 tions of medical necessity, but which can expose 

7 women, infants, or both to risk of harm if used 

8 routinely and indiscriminately, including contin9 uous fetal monitoring, labor induction, epidural 

10 anesthesia, elective primary cesarean section, 

11 and repeat cesarean delivery; 

12 ‘‘(D) emphasizes the noninvasive maternity 

13 practices that have strong proven correlation or 

14 may be associated with considerable improve15 ment in outcomes with no detrimental side ef16 fects, and are significantly underused in the 

17 United States, including smoking cessation pro18 grams in pregnancy, group model prenatal care, 

19 continuous labor support, nonsupine positions 

20 for birth, and external version to turn breech 

21 babies at term; 

22 ‘‘(E) educates consumers about the quali23 fications of licensed providers of maternity care 

24 and the best evidence about their safety, satis25 faction, outcomes, and costs; 


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1 ‘‘(F) informs consumers about the best 

2 available research comparing birth center 

3 births, planned home births, and hospital 

4 births, including information about each set5 ting’s safety, satisfaction, outcomes, and costs; 

6 ‘‘(G) fosters participation in high-quality, 

7 evidence-based childbirth education that pro8 motes a natural, healthy, and safe approach to 

9 pregnancy, childbirth, and early parenting; is 

10 taught by certified educators, peer counselors, 

11 and health professionals; and promotes in12 formed decisionmaking by childbearing women; 

13 and 

14 ‘‘(H) is pilot tested for consumer com15 prehension, cultural sensitivity, and acceptance 

16 of the messages across geographically, racially, 

17 ethnically, and linguistically diverse popu18 lations.’’. 

19 SEC. 517. BIBLIOGRAPHIC DATABASE OF SYSTEMATIC RE20 VIEWS FOR CARE OF CHILDBEARING WOMEN 

21 AND NEWBORNS. 

22 (a) IN GENERAL.—Not later than one year after the 

23 date of the enactment of this Act, the Secretary of Health 

24 and Human Services, through the Agency for Healthcare 

25 Research and Quality, shall— 


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1 (1) make publicly available an online biblio2 graphic database identifying systematic reviews, in3 cluding an explanation of the level and quality of 

4 evidence, for care of childbearing women and 

5 newborns; and 

6 (2) initiate regular updates that incorporate 

7 newly issued and updated systematic reviews. 

8 (b) SOURCES.—To aim for a comprehensive inventory 

9 of systematic reviews relevant to maternal and newborn 

10 care, the database shall identify reviews from diverse 

11 sources, including— 

12 (1) scientific peer-reviewed journals; 

13 (2) databases, including Cochrane Database of 

14 Systematic Reviews, Clinical Evidence, and Data15 base of Abstracts of Reviews of Effects; and 

16 (3) Internet Web sites of agencies and organi17 zations throughout the world that produce such sys18 tematic reviews. 

19 (c) FEATURES.—The database shall— 

20 (1) provide bibliographic citations for each 

21 record within the database, and for each such cita22 tion include an explanation of the level and quality 

23 of evidence; 

24 (2) include abstracts, as available; 


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1 (3) provide reference to companion documents 

2 as may exist for each review, such as evidence tables 

3 and guidelines or consumer educational materials de4 veloped from the review; 

5 (4) provide links to the source of the full review 

6 and to any companion documents; 

7 (5) provide links to the source of a previous 

8 version or update of the review; 

9 (6) be searchable by intervention or other topic 

10 of the review, reported outcomes, author, title, and 

11 source; and 

12 (7) offer to users periodic electronic notification 

13 of database updates relating to users’ topics of inter14 est. 

15 (d) OUTREACH.—Not later than the first date the 

16 database is made publicly available and periodically there17 after, the Secretary of Health and Human Services shall 

18 publicize the availability, features, and uses of the data19 base under this section to the stakeholders described in 

20 subsection (e). 

21 (e) CONSULTATION.—For purposes of developing the 

22 database under this section and maintaining and updating 

23 such database, the Secretary of Health and Human Serv24 ices shall convene and consult with an advisory committee 

25 composed of relevant stakeholders, including— 


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1 (1) Federal Medicaid administrators and State 

2 agencies administrating State plans under title XIX 

3 of the Social Security Act pursuant to section 

4 1902(a)(5) of such Act (42 U.S.C. 1396a(a)(5)); 

5 (2) providers of maternity and newborn care 

6 from both academic and community-based settings, 

7 including obstetrician-gynecologists, family physi8 cians, certified nurse midwives, certified midwives, 

9 certified professional midwives, physician assistants, 

10 perinatal nurses, pediatricians, and nurse practi11 tioners; 

12 (3) maternal-fetal medicine specialists; 

13 (4) neonatologists; 

14 (5) childbearing women and advocates for such 

15 women, including childbirth educators certified by a 

16 nationally accredited program, representing commu17 nities that are diverse in terms of race, ethnicity, in18 digenous status, and geographic area; 

19 (6) employers and purchasers; 

20 (7) health facility and system leaders, including 

21 both hospital and birth center facilities; 

22 (8) journalists; and 

23 (9) bibliographic informatics specialists. 

24 (f) AUTHORIZATION OF APPROPRIATIONS.—There is 

25 authorized to be appropriated $2,500,000 for each of the 


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1 fiscal years 2015 through 2017 for the purpose of devel2 oping the database and such sums as may be necessary 

3 for each subsequent fiscal year for updating the database 

4 and providing outreach and notification to users, as de5 scribed in this section. 

6 SEC. 518. MATERNITY CARE HEALTH PROFESSIONAL 

7 SHORTAGE AREAS. 

8 Section 332 of the Public Health Service Act (42 

9 U.S.C. 254e) is amended by adding at the end the fol10 lowing new subsection: 

11 ‘‘(k)(1) The Secretary, acting through the Adminis12 trator of the Health Resources and Services Administra13 tion, shall designate maternity care health professional 

14 shortage areas in the States, publish a descriptive list of 

15 the area’s population groups, medical facilities, and other 

16 public facilities so designated, and at least annually review 

17 and, as necessary, revise such designations. 

18 ‘‘(2) For purposes of paragraph (1), a complete de19 scriptive list shall be published in the Federal Register not 

20 later than one year after the date of the enactment of the 

21 Health Equity and Accountability Act of 2014 and annu22 ally thereafter. 

23 ‘‘(3) The provisions of subsections (b), (c), (e), (f), 

24 (g), (h), (i), and (j) (other than (j)(1)(B)) of this section 

25 shall apply to the designation of a maternity care health 


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1 professional shortage area in a similar manner and extent 

2 as such provisions apply to the designation of health pro3 fessional shortage areas, except in applying subsection 

4 (b)(3), the reference in such subsection to ‘physicians’ 

5 shall be deemed to be a reference to nationally certified 

6 and State licensed obstetricians, family practice physicians 

7 who practice full-scope maternity care, certified nurse 

8 midwives, certified midwives, certified professional mid9 wives, and physician’s assistants who practice full scope 

10 maternity care. 

11 ‘‘(4) For purposes of this subsection, the term ‘ma12 ternity care health professional shortage area’ means— 

13 ‘‘(A) an area in an urban or rural area (which 

14 need not conform to the geographic boundaries of a 

15 political subdivision and which is a rational area for 

16 the delivery of health services) which the Secretary 

17 determines has a shortage of providers of maternity 

18 care health services including those referenced in 

19 paragraph (3) or an urban or rural area that the 

20 Secretary determines has lost a significant number 

21 of such providers during the 10-year period begin22 ning with 2004 or has no obstetrical providers li23 censed to provide operative obstetrical services; 

24 ‘‘(B) an area in an urban or rural area (which 

25 need not conform to the geographic boundaries of a 


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1 political subdivision and which is a rational area for 

2 the delivery of health services) which the Secretary 

3 determines has a shortage of hospital or labor and 

4 delivery units, hospital birth center units, or free5 standing birth centers or an area that lost a signifi6 cant number of these units during the 10-year pe7 riod beginning with 2004; or 

8 ‘‘(C) a population group which the Secretary 

9 determines has such a shortage of providers or fa10 cilities.’’. 

11 SEC. 519. EXPANSION OF CDC PREVENTION RESEARCH 

12 CENTERS PROGRAM TO INCLUDE CENTERS 

13 ON OPTIMAL MATERNITY OUTCOMES. 

14 (a) IN GENERAL.—Not later than one year after the 

15 date of the enactment of this Act, the Secretary of Health 

16 and Human Services, shall support the establishment of 

17 additional Prevention Research Centers under the Preven18 tion Research Center Program administered by the Cen19 ters for Disease Control and Prevention. Such additional 

20 centers shall each be known as a Center for Excellence 

21 on Optimal Maternity Outcomes. 

22 (b) RESEARCH.—Each Center for Excellence on Opti23 mal Maternity Outcomes shall— 

24 (1) conduct at least one focused program of re25 search to improve maternity outcomes, including the 


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1 reduction of cesarean birth rates, elective inductions, 

2 prematurity rates, and low birth weight rates within 

3 an underserved population that has a disproportion4 ately large burden of suboptimal maternity out5 comes, including maternal mortality and morbidity, 

6 infant mortality, prematurity, or low birth weight; 

7 (2) work with partners on special interest 

8 projects, as specified by the Centers for Disease 

9 Control and Prevention and other relevant agencies 

10 within the Department of Health and Human Serv11 ices, and on projects funded by other sources; and 

12 (3) involve a minimum of two distinct birth set13 ting models, such as a hospital labor and delivery 

14 model and freestanding birth center model; or a hos15 pital labor and delivery model and planned home 

16 birth model. 

17 (c) INTERDISCIPLINARY PROVIDERS.—Each Center 

18 for Excellence on Optimal Maternity Outcomes shall in19 clude the following interdisciplinary providers of maternity 

20 care: 

21 (1) Obstetrician-gynecologists. 

22 (2) At least two of the following providers: 

23 (A) Family practice physicians. 

24 (B) Nurse practitioners. 

25 (C) Physician assistants. 


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1 (D) Certified professional midwives. 

2 (d) SERVICES.—Research conducted by each Center 

3 for Excellence on Optimal Maternity Outcomes shall in4 clude at least 2 (and preferably more) of the following sup5 portive provider services: 

6 (1) Mental health. 

7 (2) Doula labor support. 

8 (3) Nutrition education. 

9 (4) Childbirth education. 

10 (5) Social work. 

11 (6) Physical therapy or occupation therapy. 

12 (7) Substance abuse services. 

13 (8) Home visiting. 

14 (e) COORDINATION.—The programs of research at 

15 each of the two Centers of Excellence on Optimal Mater16 nity Outcomes shall compliment and not replicate the 

17 work of the other. 

18 (f) AUTHORIZATION OF APPROPRIATIONS.—There is 

19 authorized to be appropriated to carry out this section 

20 $2,000,000 for each of the fiscal years 2015 through 

21 2019. 


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1 SEC. 520. EXPANDING MODELS ALLOWED TO BE TESTED BY 

2 CENTER FOR MEDICARE AND MEDICAID IN3 NOVATION TO INCLUDE MATERNITY CARE 

4 MODELS. 

5 Section 1115A(b)(2)(B) of the Social Security Act 

6 (42 U.S.C. 1315a(b)(2)(B)) is amended by adding at the 

7 end the following new clause: 

8 ‘‘(xxi) Promoting evidence-based mod9 els of care that have been associated with 

10 reductions in maternal and infant health 

11 disparities, including incorporating the use 

12 of doula and promotoras support for preg13 nant and childbearing women into evi14 dence-based models of prenatal care, labor 

15 and delivery, and postpartum care, and 

16 supporting the appropriate use of out-of17 hospital birth models, including births at 

18 home and in freestanding birth centers.’’. 

19 SEC. 521. DEVELOPMENT OF INTERPROFESSIONAL MATER20 NITY CARE EDUCATIONAL MODELS AND 

21 TOOLS. 

22 (a) IN GENERAL.—Not later than 6 months after the 

23 date of the enactment of this Act, the Secretary of Health 

24 and Human Services, acting in conjunction with the Ad25 ministrator of Health Resources and Services Administra26 tion, shall convene, for a 1-year period, an InterprofesVerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00381 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294

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1 sional Maternity Provider Education Commission to dis2 cuss and make recommendations for— 

3 (1) a consensus standard physiologic maternity 

4 care curriculum that takes into account the core 

5 competencies for basic midwifery practice such as 

6 those developed by the American College of Nurse 

7 Midwives and the North American Registry of Mid8 wives, and the educational objectives for physicians 

9 practicing in obstetrics and gynecology as deter10 mined by the Council on Resident Education in Ob11 stetrics and Gynecology; 

12 (2) suggestions for multidisciplinary use of the 

13 consensus physiologic curriculum; 

14 (3) strategies to integrate and coordinate edu15 cation across maternity care disciplines, including 

16 recommendations to increase medical and midwifery 

17 student exposure to out-of-hospital birth; and 

18 (4) pilot demonstrations of interprofessional 

19 educational models. 

20 (b) PARTICIPANTS.—The Commission shall include 

21 maternity care educators, curriculum developers, service 

22 leaders, certification leaders, and accreditation leaders 

23 from the various professions that provide maternity care 

24 in this country. Such professions shall include obstetrician 

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1 wives, family practice physicians, nurse practitioners, phy2 sician assistants, certified professional midwives, and 

3 perinatal nurses. Additionally, the Commission shall in4 clude representation from maternity care consumer advo5 cates. 

6 (c) CURRICULUM.—The consensus standard physio7 logic maternity care curriculum described in subsection 

8 (a)(1) shall— 

9 (1) have a public health focus with a foundation 

10 in health promotion and disease prevention; 

11 (2) foster physiologic childbearing and woman 

12 and family centered care; 

13 (3) integrate strategies to reduce maternal and 

14 infant morbidity and mortality; 

15 (4) incorporate recommendations to ensure re16 spectful, safe, and seamless consultation, referral, 

17 transport, and transfer of care when necessary; and 

18 (5) include cultural sensitivity and strategies to 

19 decrease disparities in maternity outcomes. 

20 (d) REPORT.—Not later than 6 months after the final 

21 meeting of the Commission, the Secretary of Health and 

22 Human Services shall— 

23 (1) submit to Congress a report containing the 

24 recommendations made by the Commission under 

25 this section; and 


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1 (2) make such report publicly available. 

2 (e) AUTHORIZATION OF APPROPRIATIONS.—There is 

3 authorized to be appropriated to carry out this section 

4 $1,000,000 for each of the fiscal years 2015 and 2016, 

5 and such sums as are necessary for each of the fiscal years 

6 2017 through 2019. 

7 SEC. 522. INCLUDING WITHIN INPATIENT HOSPITAL SERV8 ICES UNDER MEDICARE SERVICES FUR9 NISHED BY CERTAIN STUDENTS, INTERNS, 

10 AND RESIDENTS SUPERVISED BY CERTIFIED 

11 NURSE MIDWIVES. 

12 (a) IN GENERAL.—Section 1861(b) of the Social Se13 curity Act (42 U.S.C. 1395x(b)) is amended— 

14 (1) in paragraph (6), by striking ‘‘; or’’ and in15 serting ‘‘, or in the case of services in a hospital or 

16 osteopathic hospital by a student midwife or an in17 tern or resident-in-training under a teaching pro18 gram previously described in this paragraph who is 

19 in the field of obstetrics and gynecology, if such stu20 dent midwife, intern, or resident-in-training is super21 vised by a certified nurse-midwife to the extent per22 mitted under applicable State law and as may be au23 thorized by the hospital;’’; 

24 (2) in paragraph (7), by striking the period at 

25 the end and inserting ‘‘; or’’; and 


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1 (3) by adding at the end the following new 

2 paragraph: 

3 ‘‘(8) a certified nurse-midwife where the hos4 pital has a teaching program approved as specified 

5 in paragraph (6), if (A) the hospital elects to receive 

6 any payment due under this title for reasonable 

7 costs of such services, and (B) all certified nurse8 midwives in such hospital agree not to bill charges 

9 for professional services rendered in such hospital to 

10 individuals covered under the insurance program es11 tablished by this title.’’. 

12 (b) EFFECTIVE DATE.—The amendments made by 

13 subsection (a) shall apply to services furnished on or after 

14 the date of the enactment of this Act. 

15 SEC. 523. GRANTS TO PROFESSIONAL ORGANIZATIONS TO 

16 INCREASE DIVERSITY IN MATERNITY CARE 

17 PROFESSIONALS. 

18 (a) IN GENERAL.—The Secretary of Health and 

19 Human Services, through the Administrator of the Health 

20 Resources and Services Administration, shall carry out a 

21 grant program under which the Secretary may make to 

22 eligible health professional organizations— 

23 (1) for fiscal year 2015, planning grants de24 scribed in subsection (b); and 


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1 (2) for the subsequent 4-year period, implemen2 tation grants described in subsection (c). 

3 (b) PLANNING GRANTS.— 

4 (1) IN GENERAL.—Planning grants described in 

5 this subsection are grants for the following purposes: 

6 (A) To collect data and identify any work7 force disparities, with respect to a health pro8 fession, at each of the following areas along the 

9 health professional continuum: 

10 (i) Pipeline availability with respect to 

11 students at the high school and college or 

12 university levels considering and working 

13 toward entrance in the profession. 

14 (ii) Entrance into the training pro15 gram for the profession. 

16 (iii) Graduation from such training 

17 program. 

18 (iv) Entrance into practice. 

19 (v) Retention in practice for more 

20 than a 5-year period. 

21 (B) To develop one or more strategies to 

22 address the workforce disparities within the 

23 health profession, as identified under (and in 

24 response to the findings pursuant to) subpara25 graph (A). 


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1 (2) APPLICATION.—To be eligible to receive a 

2 grant under this subsection, an eligible health pro3 fessional organization shall submit to the Secretary 

4 of Health and Human Services an application in 

5 such form and manner and containing such informa6 tion as specified by the Secretary. 

7 (3) AMOUNT.—Each grant awarded under this 

8 subsection shall be for an amount not to exceed 

9 $300,000. 

10 (4) REPORT.—Each recipient of a grant under 

11 this subsection shall submit to the Secretary of 

12 Health and Human Services a report containing— 

13 (A) information on the extent and distribu14 tion of workforce disparities identified through 

15 the grant; and 

16 (B) reasonable objectives and strategies 

17 developed to address such disparities within a 

18 5-, 10-, and 25-year period. 

19 (c) IMPLEMENTATION GRANTS.— 

20 (1) IN GENERAL.—Implementation grants de21 scribed in this subsection are grants to implement 

22 one or more of the strategies developed pursuant to 

23 a planning grant awarded under subsection (b). 

24 (2) APPLICATION.—To be eligible to receive a 

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1 fessional organization shall submit to the Secretary 

2 of Health and Human Services an application in 

3 such form and manner as specified by the Secretary. 

4 Each such application shall contain information on 

5 the capability of the organization to carry out a 

6 strategy described in paragraph (1), involvement of 

7 partners or coalitions, plans for developing sustain8 ability of the efforts after the culmination of the 

9 grant cycle, and any other information specified by 

10 the Secretary. 

11 (3) AMOUNT.—Each grant awarded under this 

12 subsection shall be for an amount not to exceed 

13 $500,000 each year during the 4-year period of the 

14 grant. 

15 (4) REPORTS.—For each of the first 3 years for 

16 which an eligible health professional organization is 

17 awarded a grant under this subsection, the organiza18 tion shall submit to the Secretary of Health and 

19 Human Services a report on the activities carried 

20 out by such organization through the grant during 

21 such year and objectives for the subsequent year. 

22 For the fourth year for which an eligible health pro23 fessional organization is awarded a grant under this 

24 subsection, the organization shall submit to the Sec25 retary a report that includes an analysis of all the 


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1 activities carried out by the organization through the 

2 grant and a detailed plan for continuation of out3 reach efforts. 

4 (d) ELIGIBLE HEALTH PROFESSIONAL ORGANIZA5 TION DEFINED.—For purposes of this section, the term 

6 ‘‘eligible health professional organization’’ means a profes7 sional organization representing obstetrician-gyne8 cologists, certified nurse midwives, certified midwives, 

9 family practice physicians, nurse practitioners whose scope 

10 of practice includes maternity care, physician assistants 

11 whose scope of practice includes obstetrical care, or cer12 tified professional midwives. 

13 (e) AUTHORIZATION OF APPROPRIATIONS.—There is 

14 authorized to be appropriated to carry out this section 

15 $2,000,000 for fiscal year 2015 and $3,000,000 for each 

16 of the fiscal years 2016 through 2019. 

17 TITLE VI—MENTAL HEALTH 

18 SEC. 601. COVERAGE OF MARRIAGE AND FAMILY THERA19 PIST SERVICES, MENTAL HEALTH COUN20 SELOR SERVICES, AND SUBSTANCE ABUSE 

21 COUNSELOR SERVICES UNDER PART B OF 

22 THE MEDICARE PROGRAM. 

23 (a) COVERAGE OF SERVICES.— 


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1 (1) IN GENERAL.—Section 1861(s)(2) of the 

2 Social Security Act (42 U.S.C. 1395x(s)(2)) is 

3 amended— 

4 (A) in subparagraph (EE), by striking 

5 ‘‘and’’ at the end; 

6 (B) in subparagraph (FF), by inserting 

7 ‘‘and’’ at the end; and 

8 (C) by adding at the end the following new 

9 subparagraph: 

10 ‘‘(GG) marriage and family therapist services 

11 (as defined in subsection (kkk)(1)) and mental 

12 health counselor services (as defined in subsection 

13 (kkk)(3)) and substance abuse counselor services (as 

14 defined in subsection (kkk)(5));’’. 

15 (2) DEFINITIONS.—Section 1861 of such Act 

16 (42 U.S.C. 1395x), as amended by sections 

17 202(b)(1)(A) and 423(a), is amended by adding at 

18 the end the following new subsection: 

19 ‘‘Marriage and Family Therapist Services; Marriage and 

20 Family Therapist; Mental Health Counselor Serv21 ices; Mental Health Counselor 

22 ‘‘(kkk)(1) The term ‘marriage and family therapist 

23 services’ means services performed by a marriage and 

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1 riage and family therapist is legally authorized to perform 

2 under State law (or the State regulatory mechanism pro3 vided by State law) of the State in which such services 

4 are performed, as would otherwise be covered if furnished 

5 by a physician or as an incident to a physician’s profes6 sional service, but only if no facility or other provider 

7 charges or is paid any amounts with respect to the fur8 nishing of such services. 

9 ‘‘(2) The term ‘marriage and family therapist’ means 

10 an individual who— 

11 ‘‘(A) possesses a master’s or doctoral degree 

12 which qualifies for licensure or certification as a 

13 marriage and family therapist pursuant to State 

14 law; 

15 ‘‘(B) after obtaining such degree has performed 

16 at least 2 years of clinical supervised experience in 

17 marriage and family therapy; and 

18 ‘‘(C) in the case of an individual performing 

19 services in a State that provides for licensure or cer20 tification of marriage and family therapists, is li21 censed or certified as a marriage and family thera22 pist in such State. 

23 ‘‘(3) The term ‘mental health counselor services’ 

24 means services performed by a mental health counselor (as 

25 defined in paragraph (4)) for the diagnosis and treatment 


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1 of mental illnesses which the mental health counselor is 

2 legally authorized to perform under State law (or the 

3 State regulatory mechanism provided by the State law) of 

4 the State in which such services are performed, as would 

5 otherwise be covered if furnished by a physician or as inci6 dent to a physician’s professional service, but only if no 

7 facility or other provider charges or is paid any amounts 

8 with respect to the furnishing of such services. 

9 ‘‘(4) The term ‘mental health counselor’ means an 

10 individual who— 

11 ‘‘(A) possesses a master’s or doctor’s degree in 

12 mental health counseling or a related field; 

13 ‘‘(B) after obtaining such a degree has per14 formed at least 2 years of supervised mental health 

15 counselor practice; and 

16 ‘‘(C) in the case of an individual performing 

17 services in a State that provides for licensure or cer18 tification of mental health counselors or professional 

19 counselors, is licensed or certified as a mental health 

20 counselor or professional counselor in such State. 

21 ‘‘(5) The term ‘substance abuse counselor services’ 

22 means services performed by a substance abuse counselor 

23 (as defined in paragraph (6)) for the diagnosis and treat24 ment of substance abuse and addiction which the sub25 stance abuse counselor is legally authorized to perform 


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1 under State law (or the State regulatory mechanism pro2 vided by the State law) of the State in which such services 

3 are performed, as would otherwise be covered if furnished 

4 by a physician or as incident to a physician’s professional 

5 service, but only if no facility or other provider charges 

6 or is paid any amounts with respect to the furnishing of 

7 such services. 

8 ‘‘(6) The term ‘substance abuse counselor’ means an 

9 individual who— 

10 ‘‘(A) has performed at least 2 years of super11 vised substance abuse counselor practice; 

12 ‘‘(B) in the case of an individual performing 

13 services in a State that provides for licensure or cer14 tification of substance abuse counselors or profes15 sional counselors, is licensed or certified as a sub16 stance abuse counselor or professional counselor in 

17 such State; or 

18 ‘‘(C) the individual is a drug and alcohol coun19 selor as defined in section 40.281 of title 49, Code 

20 of Federal Regulations.’’. 

21 (3) PROVISION FOR PAYMENT UNDER PART

22 B.—Section 1832(a)(2)(B) of such Act (42 U.S.C. 

23 1395k(a)(2)(B)) is amended by adding at the end 

24 the following new clause: 


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1 ‘‘(v) marriage and family therapist 

2 services, mental health counselor services, 

3 and substance abuse counselor services;’’. 

4 (4) AMOUNT OF PAYMENT.—Section 1833(a)(1) 

5 of such Act (42 U.S.C. 1395l(a)(1)) is amended— 

6 (A) by striking ‘‘and (Z)’’ and inserting 

7 ‘‘(Z)’’; and 

8 (B) by inserting before the semicolon at 

9 the end the following: ‘‘, and (AA) with respect 

10 to marriage and family therapist services, men11 tal health counselor services, and substance 

12 abuse counselor services under section 

13 1861(s)(2)(GG), the amounts paid shall be 80 

14 percent of the lesser of the actual charge for 

15 the services or 75 percent of the amount deter16 mined for payment of a psychologist under sub17 paragraph (L)’’. 

18 (5) EXCLUSION OF MARRIAGE AND FAMILY

19 THERAPIST SERVICES AND MENTAL HEALTH COUN20 SELOR SERVICES FROM SKILLED NURSING FACILITY

21 PROSPECTIVE PAYMENT SYSTEM.—Section 

22 1888(e)(2)(A)(ii) of such Act (42 U.S.C. 

23 1395yy(e)(2)(A)(ii)) is amended by inserting ‘‘mar24 riage and family therapist services (as defined in 

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1 ices (as defined in section 1861(kkk)(3)),’’ after 

2 ‘‘qualified psychologist services,’’. 

3 (6) INCLUSION OF MARRIAGE AND FAMILY

4 THERAPISTS, MENTAL HEALTH COUNSELORS, AND

5 SUBSTANCE ABUSE COUNSELORS AS PRACTITIONERS

6 FOR ASSIGNMENT OF CLAIMS.—Section 

7 1842(b)(18)(C) of such Act (42 U.S.C. 

8 1395u(b)(18)(C)) is amended by adding at the end 

9 the following new clauses: 

10 ‘‘(vii) A marriage and family therapist (as de11 fined in section 1861(kkk)(2)). 

12 ‘‘(viii) A mental health counselor (as defined in 

13 section 1861(kkk)(4)). 

14 ‘‘(ix) A substance abuse counselor (as defined 

15 in section 1861 (kkk)(6)).’’. 

16 (b) COVERAGE OF CERTAIN MENTAL HEALTH SERV17 ICES PROVIDED IN CERTAIN SETTINGS.— 

18 (1) RURAL HEALTH CLINICS AND FEDERALLY

19 QUALIFIED HEALTH CENTERS.—Section 

20 1861(aa)(1)(B) of the Social Security Act (42 

21 U.S.C. 1395x(aa)(1)(B)) is amended by striking ‘‘or 

22 by a clinical social worker (as defined in subsection 

23 (hh)(1)),’’ and inserting ‘‘, by a clinical social worker 

24 (as defined in subsection (hh)(1)), by a marriage 

25 and family therapist (as defined in subsection 


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1 (kkk)(2)), or by a mental health counselor (as de2 fined in subsection (kkk)(4)), or by a substance 

3 abuse counselor (as defined in section 1861 

4 (kkk)(6)).’’. 

5 (2) HOSPICE PROGRAMS.—Section 

6 1861(dd)(2)(B)(i)(III) of such Act (42 U.S.C. 

7 1395x(dd)(2)(B)(i)(III)) is amended by inserting ‘‘or 

8 one marriage and family therapist (as defined in 

9 subsection (kkk)(2))’’ after ‘‘social worker’’. 

10 (c) AUTHORIZATION OF MARRIAGE AND FAMILY

11 THERAPISTS TO DEVELOP DISCHARGE PLANS FOR POST12 HOSPITAL SERVICES.—Section 1861(ee)(2)(G) of the So13 cial Security Act (42 U.S.C. 1395x(ee)(2)(G)) is amended 

14 by inserting ‘‘marriage and family therapist (as defined 

15 in subsection (kkk)(2)),’’ after ‘‘social worker,’’. 

16 (d) EFFECTIVE DATE.—The amendments made by 

17 this section shall apply with respect to services furnished 

18 on or after January 1, 2015. 

19 SEC. 602. MINORITY FELLOWSHIP PROGRAM. 

20 Title V of the Public Health Service Act is amended 

21 by inserting after section 506B of such Act (42 U.S.C. 

22 290aa–5b) the following: 

23 ‘‘SEC. 506C. MINORITY FELLOWSHIP PROGRAM. 

24 ‘‘(a) FELLOWSHIPS.—The Administrator shall main25 tain a program, to be known as the Minority Fellowship 


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1 Program, under which the Administrator awards grants 

2 or contracts to national associations or other appropriate 

3 entities for the financial support of graduate students, 

4 postdoctoral fellows, and residents in the professions of 

5 psychology, psychiatry, social work, psychiatric advance6 practice nursing, marriage and family therapy, and profes7 sional counseling to students who demonstrate a commit8 ment to clinical or research careers focused on racial and 

9 ethnic minority populations. 

10 ‘‘(b) TERM OF FINANCIAL SUPPORT.—Financial sup11 port provided to an individual pursuant to subsection (a) 

12 shall be for a term of not more than 12 months and may 

13 be renewed thereafter. 

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

15 carry out this section, there is authorized to be appro16 priated $10,000,000 for each of fiscal years 2015 through 

17 2019.’’. 

18 SEC. 603. INTEGRATED HEALTH CARE DEMONSTRATION 

19 PROGRAM. 

20 Part D of title V of the Public Health Service Act 

21 (42 U.S.C. 290dd et seq.) is amended by adding at the 

22 end the following: 


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1 ‘‘SEC. 544. INTERPROFESSIONAL HEALTH CARE TEAMS FOR 

2 PROVISION OF BEHAVIORAL HEALTH CARE 

3 IN PRIMARY CARE SETTINGS. 

4 ‘‘(a) GRANTS.—The Secretary, acting through the 

5 Deputy Assistant Secretary for Minority Health, shall 

6 award grants to eligible entities for the purpose of pro7 viding technical assistance and training regarding the ef8 fective development and implementation of integrated 

9 interprofessional health care teams that provide behavioral 

10 health care. 

11 ‘‘(b) ELIGIBLE ENTITIES.—To be eligible to receive 

12 a grant under this section, an entity shall be a federally 

13 qualified health center (as defined in section 1861(aa) of 

14 the Social Security Act) serving a high proportion of indi15 viduals from racial and ethnic minority groups (as defined 

16 in section 1707(g)). 

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

18 carry out this section, there is authorized to be appro19 priated $20,000,000 for each of fiscal years 2014 through 

20 2016.’’. 

21 SEC. 604. ADDRESSING RACIAL AND ETHNIC MINORITY 

22 MENTAL HEALTH DISPARITIES RESEARCH 

23 GAPS. 

24 Not later than 6 months after the date of the enact25 ment of this Act, the Director of the National Institute 

26 on Minority Health and Health Disparities shall enter into 


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1 an arrangement with the Institute of Medicine (or, if the 

2 Institute declines to enter into such an arrangement, an3 other appropriate entity)— 

4 (1) to conduct a study with respect to mental 

5 and behavioral health disparities in racial and ethnic 

6 minority groups (as defined in section 1707(g) of 

7 the Public Health Service Act (42 U.S.C. 300u– 

8 6(g)); and 

9 (2) to submit to the Congress a report on the 

10 results of such study, including— 

11 (A) a compilation of information on the dy12 namics of mental disorders in such racial and 

13 ethnic minority groups; 

14 (B) an identification of gaps in knowledge 

15 and research needs; and 

16 (C) recommendations for an interprofes17 sional research agenda at the National Insti18 tutes of Health aimed at reducing and ulti19 mately eliminating mental and behavioral health 

20 disparities in such racial and ethnic minority 

21 groups. 


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1 SEC. 605. HEALTH PROFESSIONS COMPETENCIES TO AD2 DRESS RACIAL AND ETHNIC MINORITY MEN3 TAL HEALTH DISPARITIES. 

4 (a) IN GENERAL.—The Secretary of Health and 

5 Human Services, acting through the Administrator of the 

6 Substance Abuse and Mental Health Services Administra7 tion, shall award grants to qualified national organizations 

8 for the purpose of developing, and disseminating to health 

9 professional educational programs, curricula or core com10 petencies addressing mental health disparities among ra11 cial and ethnic minority groups. 

12 (b) USE OF FUNDS.—Organizations receiving funds 

13 under subsection (a) shall use the funds to develop and 

14 disseminate curricula or core competencies, as described 

15 in such subsection, for use in the training of students in 

16 the professions of social work, psychology, psychiatry, 

17 marriage and family therapy, mental health counseling, 

18 and substance abuse counseling. 

19 (c) ALLOWABLE ACTIVITIES.—Organizations receiv20 ing funds under subsection (a) may use the funds to en21 gage in the following activities related to the development 

22 and dissemination of curricula or core competencies: 

23 (1) Formation of committees or working groups 

24 comprised of experts from accredited health profes25 sions schools to identify core competencies relating 


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1 to mental health disparities among racial and ethnic 

2 minority groups. 

3 (2) Planning of workshops in national fora to 

4 allow for public input into the educational needs as5 sociated with mental health disparities among racial 

6 and ethnic minority groups. 

7 (3) Dissemination and promotion of the use of 

8 curricula or core competencies in undergraduate and 

9 graduate health professions training programs na10 tionwide. 

11 (d) DEFINITIONS.—In this section: 

12 (1) The term ‘‘qualified national organization’’ 

13 means a national organization that focuses on the 

14 education of students in programs of social work, 

15 psychology, psychiatry, and marriage and family 

16 therapy. 

17 (2) The term ‘‘racial and ethnic minority 

18 group’’ has the meaning given to such term in sec19 tion 1707(g) of the Public Health Service Act (42 

20 U.S.C. 300u–6(g)). 

21 (e) AUTHORIZATION OF APPROPRIATIONS.—There 

22 are authorized to be appropriated to carry out this section 

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

24 2014 through 2018. 


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1 TITLE VII—ADDRESSING HIGH 

2 IMPACT MINORITY DISEASES 

3 Subtitle A—Cancer 

4 SEC. 701. LUNG CANCER MORTALITY REDUCTION. 

5 (a) SHORT TITLE.—This section may be cited as the 

6 ‘‘Lung Cancer Mortality Reduction Act of 2014’’. 

7 (b) FINDINGS.—Congress makes the following find8 ings: 

9 (1) Lung cancer is the leading cause of cancer 

10 death for both men and women, accounting for 28 

11 percent of all cancer deaths. 

12 (2) Lung cancer kills more people annually 

13 than breast cancer, prostate cancer, colon cancer, 

14 liver cancer, melanoma, and kidney cancer combined. 

15 (3) Since the National Cancer Act of 1971 

16 (Public Law 92–218; 85 Stat. 778), coordinated and 

17 comprehensive research has raised the 5-year sur18 vival rates for breast cancer to 88 percent, for pros19 tate cancer to 99 percent, and for colon cancer to 

20 64 percent. 

21 (4) However, the 5-year survival rate for lung 

22 cancer is still only 15 percent and a similar coordi23 nated and comprehensive research effort is required 

24 to achieve increases in lung cancer survivability 

25 rates. 


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1 (5) Sixty percent of lung cancer cases are now 

2 diagnosed nonsmokers or former smokers. 

3 (6) Two-thirds of nonsmokers diagnosed with 

4 lung cancer are women. 

5 (7) Certain minority populations, such as Afri6 can-American males, have disproportionately high 

7 rates of lung cancer incidence and mortality, not8 withstanding their similar smoking rate. 

9 (8) Members of the baby boomer generation are 

10 entering their sixties, the most common age at which 

11 people develop lung cancer. 

12 (9) Tobacco addiction and exposure to other 

13 lung cancer carcinogens such as Agent Orange and 

14 other herbicides and battlefield emissions are serious 

15 problems among military personnel and war vet16 erans. 

17 (10) Significant and rapid improvements in 

18 lung cancer mortality can be expected through great19 er use and access to lung cancer screening tests for 

20 at-risk individuals. 

21 (11) Additional strategies are necessary to fur22 ther enhance the existing tests and therapies avail23 able to diagnose and treat lung cancer in the future. 

24 (12) The August 2001 Report of the Lung 

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1 cer Institute stated that funding for lung cancer re2 search was ‘‘far below the levels characterized for 

3 other common malignancies and far out of propor4 tion to its massive health impact’’. 

5 (13) The Report of the Lung Cancer Progress 

6 Review Group identified as its ‘‘highest priority’’ the 

7 creation of integrated, multidisciplinary, multi-insti8 tutional research consortia organized around the 

9 problem of lung cancer rather than around specific 

10 research disciplines. 

11 (14) The United States must enhance its re12 sponse to the issues raised in the Report of the 

13 Lung Cancer Progress Review Group, and this can 

14 be accomplished through the establishment of a co15 ordinated effort designed to reduce the lung cancer 

16 mortality rate by 50 percent by 2015 and targeted 

17 funding to support this coordinated effort. 

18 (c) SENSE OF CONGRESS CONCERNING INVESTMENT

19 IN LUNG CANCER RESEARCH.—It is the sense of the Con20 gress that— 

21 (1) lung cancer mortality reduction should be 

22 made a national public health priority; and 

23 (2) a comprehensive mortality reduction pro24 gram coordinated by the Secretary of Health and 


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1 Human Services is justified and necessary to ade2 quately address and reduce lung cancer mortality. 

3 (d) LUNG CANCER MORTALITY REDUCTION PRO4 GRAM.— 

5 (1) IN GENERAL.—Subpart 1 of part C of title 

6 IV of the Public Health Service Act (42 U.S.C. 285 

7 et seq.) is amended by adding at the end the fol8 lowing: 

9 ‘‘SEC. 417H. LUNG CANCER MORTALITY REDUCTION PRO10 GRAM. 

11 ‘‘(a) IN GENERAL.—Not later than 6 months after 

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

13 in consultation with the Secretary of Defense, the Sec14 retary of Veterans Affairs, the Director of the National 

15 Institutes of Health, the Director of the Centers for Dis16 ease Control and Prevention, the Commissioner of Food 

17 and Drugs, the Administrator of the Centers for Medicare 

18 & Medicaid Services, the Director of the National Institute 

19 on Minority Health and Health Disparities, and other 

20 members of the Lung Cancer Advisory Board established 

21 under section 701 of the Health Equity and Accountability 

22 Act of 2014, shall implement a comprehensive program, 

23 to be known as the Lung Cancer Mortality Reduction Pro24 gram, to achieve a reduction of at least 25 percent in the 

25 mortality rate of lung cancer by 2020. 


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1 ‘‘(b) REQUIREMENTS.—The Program shall include at 

2 least the following: 

3 ‘‘(1) With respect to the National Institutes of 

4 Health— 

5 ‘‘(A) a strategic review and prioritization 

6 by the National Cancer Institute of research 

7 grants to achieve the goal of the Lung Cancer 

8 Mortality Reduction Program in reducing lung 

9 cancer mortality; 

10 ‘‘(B) the provision of funds to enable the 

11 Airway Biology and Disease Branch of the Na12 tional Heart, Lung, and Blood Institute to ex13 pand its research programs to include pre14 dispositions to lung cancer, the interrelationship 

15 between lung cancer and other pulmonary and 

16 cardiac disease, and the diagnosis and treat17 ment of these interrelationships; 

18 ‘‘(C) the provision of funds to enable the 

19 National Institute of Biomedical Imaging and 

20 Bioengineering to expedite the development of 

21 computer-assisted diagnostic, surgical, treat22 ment, and drug-testing innovations to reduce 

23 lung cancer mortality, such as through expan24 sion of the Institute’s Quantum Grant Program 

25 and Image-Guided Interventions programs; and 


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1 ‘‘(D) the provision of funds to enable the 

2 National Institute of Environmental Health 

3 Sciences to implement research programs rel4 ative to the lung cancer incidence. 

5 ‘‘(2) With respect to the Food and Drug Ad6 ministration— 

7 ‘‘(A) activities under section 530 of the 

8 Federal Food, Drug, and Cosmetic Act; and 

9 ‘‘(B) activities under section 561 of the 

10 Federal Food, Drug, and Cosmetic Act to ex11 pand access to investigational drugs and devices 

12 for the diagnosis, monitoring, or treatment of 

13 lung cancer. 

14 ‘‘(3) With respect to the Centers for Disease 

15 Control and Prevention, the establishment of an 

16 early disease research and management program 

17 under section 1511. 

18 ‘‘(4) With respect to the Agency for Healthcare 

19 Research and Quality, the conduct of a biannual re20 view of lung cancer screening, diagnostic, and treat21 ment protocols, and the issuance of updated guide22 lines. 

23 ‘‘(5) The cooperation and coordination of all 

24 minority and health disparity programs within the 

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1 sure that all aspects of the Lung Cancer Mortality 

2 Reduction Program under this section adequately 

3 address the burden of lung cancer on minority and 

4 rural populations. 

5 ‘‘(6) The cooperation and coordination of all to6 bacco control and cessation programs within agen7 cies of the Department of Health and Human Serv8 ices to achieve the goals of the Lung Cancer Mor9 tality Reduction Program under this section with 

10 particular emphasis on the coordination of drug and 

11 other cessation treatments with early detection pro12 tocols.’’. 

13 (2) FEDERAL FOOD, DRUG, AND COSMETIC

14 ACT.—Subchapter B of chapter V of the Federal 

15 Food, Drug, and Cosmetic Act (21 U.S.C. 360aaa et 

16 seq.) is amended by adding at the end the following: 

17 ‘‘DRUGS RELATING TO LUNG CANCER

18 ‘‘SEC. 530. (a) IN GENERAL.—The provisions of this 

19 subchapter shall apply to a drug described in subsection 

20 (b) to the same extent and in the same manner as such 

21 provisions apply to a drug for a rare disease or condition. 

22 ‘‘(b) QUALIFIED DRUGS.—A drug described in this 

23 subsection is— 

24 ‘‘(1) a chemoprevention drug for precancerous 

25 conditions of the lung; 


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1 ‘‘(2) a drug for targeted therapeutic treat2 ments, including any vaccine, for lung cancer; and 

3 ‘‘(3) a drug to curtail or prevent nicotine addic4 tion. 

5 ‘‘(c) BOARD.—The Board established under the 

6 Health Equity and Accountability Act of 2014 shall mon7 itor the program implemented under this section.’’. 

8 (3) ACCESS TO UNAPPROVED THERAPIES.—Sec9 tion 561(e) of the Federal Food, Drug, and Cos10 metic Act (21 U.S.C. 360bbb(e)) is amended by in11 serting before the period the following: ‘‘and shall 

12 include expanding access to drugs under section 

13 530, with substantial consideration being given to 

14 whether the totality of information available to the 

15 Secretary regarding the safety and effectiveness of 

16 an investigational drug, as compared to the risk of 

17 morbidity and death from the disease, indicates that 

18 a patient may obtain more benefit than risk if treat19 ed with the drug’’. 

20 (4) CDC.—Title XV of the Public Health Serv21 ice Act (42 U.S.C. 300k et seq.) is amended by add22 ing at the end the following: 


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1 ‘‘SEC. 1511. EARLY DISEASE RESEARCH AND MANAGEMENT 

2 PROGRAM. 

3 ‘‘The Secretary shall establish and implement an 

4 early disease research and management program targeted 

5 at the high incidence and mortality rates of lung cancer 

6 among minority and low-income populations.’’. 

7 (e) DEPARTMENT OF DEFENSE AND THE DEPART8 MENT OF VETERANS AFFAIRS.—The Secretary of Defense 

9 and the Secretary of Veterans Affairs shall coordinate 

10 with the Secretary of Health and Human Services— 

11 (1) in the development of the Lung Cancer 

12 Mortality Reduction Program under section 417H; 

13 (2) in the implementation within the Depart14 ment of Defense and the Department of Veterans 

15 Affairs of an early detection and disease manage16 ment research program for military personnel and 

17 veterans whose smoking history and exposure to car18 cinogens during active duty service has increased 

19 their risk for lung cancer; and 

20 (3) in the implementation of coordinated care 

21 programs for military personnel and veterans diag22 nosed with lung cancer. 

23 (f) LUNG CANCER ADVISORY BOARD.— 

24 (1) IN GENERAL.—The Secretary of Health and 

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1 sory Board (referred to in this section as the 

2 ‘‘Board’’)— 

3 (A) to monitor the programs established 

4 under this section (and the amendments made 

5 by this section); and 

6 (B) to provide annual reports to the Con7 gress concerning benchmarks, expenditures, 

8 lung cancer statistics, and the public health im9 pact of such programs. 

10 (2) COMPOSITION.—The Board shall be com11 posed of— 

12 (A) the Secretary of Health and Human 

13 Services; 

14 (B) the Secretary of Defense; 

15 (C) the Secretary of Veterans Affairs; and 

16 (D) two representatives each from the 

17 fields of clinical medicine focused on lung can18 cer, lung cancer research, imaging, drug devel19 opment, and lung cancer advocacy, to be ap20 pointed by the Secretary of Health and Human 

21 Services. 

22 (g) AUTHORIZATION OF APPROPRIATIONS.— 

23 (1) IN GENERAL.—To carry out this section 

24 (and the amendments made by this section), there 

25 are authorized to be appropriated such sums as may 


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1 be necessary for each of fiscal years 2015 through 

2 2019. 

3 (2) LUNG CANCER MORTALITY REDUCTION PRO4 GRAM.—Of the amounts authorized to be appro5 priated by subsection (a), there are authorized to be 

6 appropriated— 

7 (A) $25,000,000 for fiscal year 2015, and 

8 such sums as may be necessary for each of fis9 cal years 2016 through 2019, for the activities 

10 described in section 417H(b)(1)(B) of the Pub11 lic Health Service Act, as added by subsection 

12 (d)(1); 

13 (B) $25,000,000 for fiscal year 2015, and 

14 such sums as may be necessary for each of fis15 cal years 2016 through 2019, for the activities 

16 described in section 417H(b)(1)(C) of such Act; 

17 (C) $10,000,000 for fiscal year 2015, and 

18 such sums as may be necessary for each of fis19 cal years 2016 through 2019, for the activities 

20 described in section 417H(b)(1)(D) of such Act; 

21 and 

22 (D) $15,000,000 for fiscal year 2015, and 

23 such sums as may be necessary for each of fis24 cal years 2016 through 2019, for the activities 

25 described in section 417H(b)(3) of such Act. 


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1 SEC. 702. EXPANDING PROSTATE CANCER RESEARCH, OUT2 REACH, SCREENING, TESTING, ACCESS, AND 

3 TREATMENT EFFECTIVENESS. 

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

5 ‘‘Prostate Research, Outreach, Screening, Testing, Access, 

6 and Treatment Effectiveness Act of 2014’’ or the ‘‘PROS7 TATE Act’’. 

8 (b) FINDINGS.—Congress makes the following find9 ings: 

10 (1) Prostate cancer is the second leading cause 

11 of cancer death among men. 

12 (2) In 2010, more than 217,730 new patients 

13 were diagnosed with prostate cancer and more than 

14 32,000 men died from this disease. 

15 (3) Roughly 2,000,000 Americans are living 

16 with a diagnosis of prostate cancer and its con17 sequences. 

18 (4) While prostate cancer generally affects older 

19 individuals, younger men are also at risk for the dis20 ease, and when prostate cancer appears in early 

21 middle age it frequently takes on a more aggressive 

22 form. 

23 (5) There are significant racial and ethnic dis24 parities that demand attention, namely African25 Americans have prostate cancer mortality rates that 

26 are more than double those in the White population. 


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1 (6) Underserved rural populations have higher 

2 rates of mortality compared to their urban counter3 parts, and innovative and cost-efficient methods to 

4 improve rural access to high quality care should take 

5 advantage of advances in telehealth to diagnose and 

6 treat prostate cancer when appropriate. 

7 (7) Certain veterans populations may have 

8 nearly twice the incidence of prostate cancer as the 

9 general population of the United States. 

10 (8) Urologists may constitute the specialists 

11 who diagnose and treat the vast majority of prostate 

12 cancer patients. 

13 (9) Although much basic and translational re14 search has been completed and much is currently 

15 known, there are still many unanswered questions. 

16 For example, it is not fully understood how much of 

17 known disparities are attributable to disease eti18 ology, access to care, or education and awareness in 

19 the community. 

20 (10) Causes of prostate cancer are not known. 

21 There is not good information regarding how to dif22 ferentiate accurately, early on, between aggressive 

23 and indolent forms of the disease. As a result, there 

24 is significant overtreatment in prostate cancer. 

25 There are no treatments that can durably arrest 


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1 growth or cure prostate cancer once it has metasta2 sized. 

3 (11) A significant proportion (roughly 23 to 54 

4 percent) of cases may be clinically indolent and 

5 ‘‘overdiagnosed’’, resulting in significant overtreat6 ment. More accurate tests will allow men and their 

7 families to face less physical, psychological, financial, 

8 and emotional trauma and billions of dollars could 

9 be saved in private and public health care systems 

10 in an area that has been identified by the Medicare 

11 Program as one of eight high-volume, high-cost 

12 areas in the Resource Utilization Report Program 

13 authorized by Congress under the Medicare Im14 provements for Patients and Providers Act of 2008. 

15 (12) Prostate cancer research and health care 

16 programs across Federal agencies should be coordi17 nated to improve accountability and actively encour18 age the translation of research into practice, to iden19 tify and implement best practices, in order to foster 

20 an integrated and consistent focus on effective pre21 vention, diagnosis, and treatment of this disease. 

22 (c) PROSTATE CANCER COORDINATION AND EDU23 CATION.— 

24 (1) INTERAGENCY PROSTATE CANCER COORDI25 NATION AND EDUCATION TASK FORCE.—Not later 


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1 than 180 days after the date of the enactment of 

2 this section, the Secretary of Veterans Affairs, in co3 operation with the Secretary of Defense and the Sec4 retary of Health and Human Services, shall estab5 lish an Interagency Prostate Cancer Coordination 

6 and Education Task Force (in this section referred 

7 to as the ‘‘Prostate Cancer Task Force’’). 

8 (2) DUTIES.—The Prostate Cancer Task Force 

9 shall— 

10 (A) develop a summary of advances in 

11 prostate cancer research supported or con12 ducted by Federal agencies relevant to the diag13 nosis, prevention, and treatment of prostate 

14 cancer, including psychosocial impairments re15 lated to prostate cancer treatment, and compile 

16 a list of best practices that warrant broader 

17 adoption in health care programs; 

18 (B) consider establishing, and advocating 

19 for, a guidance to enable physicians to allow 

20 screening of men who are over age 74, on a 

21 case-by-case basis, taking into account quality 

22 of life and family history of prostate cancer; 

23 (C) share and coordinate information on 

24 Federal research and health care program ac25 tivities, including activities related to— 


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1 (i) determining how to improve re2 search and health care programs, including 

3 psychosocial impairments related to pros4 tate cancer treatment; 

5 (ii) identifying any gaps in the overall 

6 research inventory and in health care pro7 grams; 

8 (iii) identifying opportunities to pro9 mote translation of research into practice; 

10 and 

11 (iv) maximizing the effects of Federal 

12 efforts by identifying opportunities for col13 laboration and leveraging of resources in 

14 research and health care programs that 

15 serve those susceptible to or diagnosed 

16 with prostate cancer; 

17 (D) develop a comprehensive interagency 

18 strategy and advise relevant Federal agencies in 

19 the solicitation of proposals for collaborative, 

20 multidisciplinary research and health care pro21 grams, including proposals to evaluate factors 

22 that may be related to the etiology of prostate 

23 cancer, that would— 

24 (i) result in innovative approaches to 

25 study emerging scientific opportunities or 


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1 eliminate knowledge gaps in research to 

2 improve the prostate cancer research port3 folio of the Federal Government; 

4 (ii) outline key research questions, 

5 methodologies, and knowledge gaps; and 

6 (iii) ensure consistent action, as out7 lined by section 402(b) of the Public 

8 Health Service Act; 

9 (E) develop a coordinated message related 

10 to screening and treatment for prostate cancer 

11 to be reflected in educational and beneficiary 

12 materials for Federal health programs as such 

13 documents are updated; and 

14 (F) not later than 2 years after the date 

15 of the establishment of the Prostate Cancer 

16 Task Force, submit to the Expert Advisory 

17 Panel to be reviewed and returned within 30 

18 days, and then within 90 days submitted to 

19 Congress recommendations— 

20 (i) regarding any appropriate changes 

21 to research and health care programs, in22 cluding recommendations to improve the 

23 research portfolio of the Department of 

24 Veterans Affairs, Department of Defense, 

25 National Institutes of Health, and other 


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1 Federal agencies to ensure that scientif2 ically based strategic planning is imple3 mented in support of research and health 

4 care program priorities; 

5 (ii) designed to ensure that the re6 search and health care programs and ac7 tivities of the Department of Veterans Af8 fairs, the Department of Defense, the De9 partment of Health and Human Services, 

10 and other Federal agencies are free of un11 necessary duplication; 

12 (iii) regarding public participation in 

13 decisions relating to prostate cancer re14 search and health care programs to in15 crease the involvement of patient advo16 cates, community organizations, and med17 ical associations representing a broad geo18 graphical area; 

19 (iv) on how to best disseminate infor20 mation on prostate cancer research and 

21 progress achieved by health care programs; 

22 (v) about how to expand partnerships 

23 between public entities, including Federal 

24 agencies, and private entities to encourage 


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1 collaborative, cross-cutting research and 

2 health care delivery; 

3 (vi) assessing any cost savings and ef4 ficiencies realized through the efforts iden5 tified and supported in this section and 

6 recommending expansion of those efforts 

7 that have proved most promising while also 

8 ensuring against any conflicts in directives 

9 from other congressional or statutory man10 dates or enabling statutes; 

11 (vii) identifying key priority action 

12 items from among the recommendations; 

13 and 

14 (viii) with respect to the level of fund15 ing needed by each agency to implement 

16 the recommendations contained in the re17 port. 

18 (3) MEMBERS OF THE PROSTATE CANCER TASK

19 FORCE.—The Prostate Cancer Task Force described 

20 in subsection (a) shall be composed of representa21 tives from such Federal agencies, as each Secretary 

22 determines necessary, to coordinate a uniform mes23 sage relating to prostate cancer screening and treat24 ment where appropriate, including representatives of 

25 the following: 


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1 (A) The Department of Veterans Affairs, 

2 including representatives of each relevant pro3 gram areas of the Department of Veterans Af4 fairs. 

5 (B) The Prostate Cancer Research Pro6 gram of the Congressionally Directed Medical 

7 Research Program of the Department of De8 fense. 

9 (C) The Department of Health and 

10 Human Services, including at a minimum rep11 resentatives of the following: 

12 (i) The National Institutes of Health. 

13 (ii) National research institutes and 

14 centers, including the National Cancer In15 stitute, the National Institute of Allergy 

16 and Infectious Diseases, and the Office of 

17 Minority Health. 

18 (iii) The Centers for Medicare & Med19 icaid Services. 

20 (iv) The Food and Drug Administra21 tion. 

22 (v) The Centers for Disease Control 

23 and Prevention. 

24 (vi) The Agency for Healthcare Re25 search and Quality. 


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1 (vii) The Health Resources and Serv2 ices Administration. 

3 (4) APPOINTING EXPERT ADVISORY PANELS.— 

4 The Prostate Cancer Task Force shall appoint ex5 pert advisory panels, as determined appropriate, to 

6 provide input and concurrence from individuals and 

7 organizations from the medical, prostate cancer pa8 tient and advocate, research, and delivery commu9 nities with expertise in prostate cancer diagnosis, 

10 treatment, and research, including practicing urolo11 gists, primary care providers, and others and indi12 viduals with expertise in education and outreach to 

13 underserved populations affected by prostate cancer. 

14 (5) MEETINGS.—The Prostate Cancer Task 

15 Force shall convene not less than twice a year, or 

16 more frequently as the Secretary determines to be 

17 appropriate. 

18 (6) SUBMISSION OF RECOMMENDATIONS TO

19 CONGRESS.—The Secretary of Veterans Affairs shall 

20 submit to Congress any recommendations submitted 

21 to the Secretary under paragraph (2)(E). 

22 (7) FEDERAL ADVISORY COMMITTEE ACT.— 

23 (A) IN GENERAL.—Except as provided in 

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1 mittee Act (5 U.S.C. App.) shall apply to the 

2 Prostate Cancer Task Force. 

3 (B) EXCEPTION.—Section 14(a)(2)(B) of 

4 such Act (relating to the termination of advi5 sory committees) shall not apply to the Prostate 

6 Cancer Task Force. 

7 (8) SUNSET DATE.—The Prostate Cancer Task 

8 Force shall terminate at the end of fiscal year 2019. 

9 (d) PROSTATE CANCER RESEARCH.— 

10 (1) RESEARCH COORDINATION.—The Secretary 

11 of Veterans Affairs, in coordination with the Secre12 taries of Defense and of Health and Human Serv13 ices, shall establish and carry out a program to co14 ordinate and intensify prostate cancer research as 

15 needed. Specifically, such research program shall— 

16 (A) develop advances in diagnostic and 

17 prognostic methods and tests, including bio18 markers and an improved prostate cancer 

19 screening blood test, including improvements or 

20 alternatives to the prostate specific antigen test 

21 and additional tests to distinguish indolent from 

22 aggressive disease; 

23 (B) better understand the etiology of the 

24 disease (including an analysis of lifestyle factors 

25 proven to be involved in higher rates of prostate 


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1 cancer, such as obesity and diet, and in dif2 ferent ethnic, racial, and socioeconomic groups, 

3 such as the African-American, Latino or His4 panic, and American Indian populations and 

5 men with a family history of prostate cancer) to 

6 improve prevention efforts; 

7 (C) expand basic research into prostate 

8 cancer, including studies of fundamental molec9 ular and cellular mechanisms; 

10 (D) identify and provide clinical testing of 

11 novel agents for the prevention and treatment 

12 of prostate cancer; 

13 (E) establish clinical registries for prostate 

14 cancer; 

15 (F) use the National Institute of Bio16 medical Imaging and Bioengineering and the 

17 National Cancer Institute for assessment of ap18 propriate imaging modalities; and 

19 (G) address such other matters relating to 

20 prostate cancer research as may be identified by 

21 the Federal agencies participating in the pro22 gram under this section. 

23 (2) PROSTATE CANCER ADVISORY BOARD.— 

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1 tate Cancer Scientific Advisory Board. Such board 

2 shall be responsible for accelerating real-time shar3 ing of the latest research data and accelerating 

4 movement of new medicines to patients. 

5 (3) UNDERSERVED MINORITY GRANT PRO6 GRAM.—In carrying out such program, the Secretary 

7 shall— 

8 (A) award grants to eligible entities to 

9 carry out components of the research outlined 

10 in paragraph (1); 

11 (B) integrate and build upon existing 

12 knowledge gained from comparative effective13 ness research; and 

14 (C) recognize and address— 

15 (i) the racial and ethnic disparities in 

16 the incidence and mortality rates of pros17 tate cancer and men with a family history 

18 of prostate cancer; 

19 (ii) any barriers in access to care and 

20 participation in clinical trials that are spe21 cific to racial, ethnic, and other under22 served minorities and men with a family 

23 history of prostate cancer; 


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1 (iii) needed outreach and educational 

2 efforts to raise awareness in these commu3 nities; and 

4 (iv) appropriate access and utilization 

5 of imaging modalities. 

6 (e) TELEHEALTH AND RURAL ACCESS PILOT

7 PROJECT.— 

8 (1) IN GENERAL.—The Secretary of Veterans 

9 Affairs, the Secretary of Defense, and the Secretary 

10 of Health and Human Services (in this section re11 ferred to as the ‘‘Secretaries’’) shall establish 4-year 

12 telehealth pilot projects for the purpose of analyzing 

13 the clinical outcomes and cost effectiveness associ14 ated with telehealth services in a variety of geo15 graphic areas that contain high proportions of medi16 cally underserved populations, including African17 Americans, Latino or Hispanic, American Indians/ 

18 Alaska Natives, and those in rural areas. Such 

19 projects shall promote efficient use of specialist care 

20 through better coordination of primary care and 

21 physician extender teams in underserved areas and 

22 more effectively employ tumor boards to better coun23 sel patients. 

24 (2) ELIGIBLE ENTITIES.— 


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1 (A) IN GENERAL.—The Secretaries shall 

2 select eligible entities to participate in the pilot 

3 projects under this section. 

4 (B) PRIORITY.—In selecting eligible enti5 ties to participate in the pilot projects under 

6 this section, the Secretaries shall give priority 

7 to such entities located in medically under8 served areas, particularly those that include Af9 rican-Americans, Latinos and Hispanics, and 

10 facilities of the Indian Health Service, including 

11 Indian Health Service operated facilities, trib12 ally operated facilities, and Urban Indian Clin13 ics, and those in rural areas. 

14 (3) EVALUATION.—The Secretaries shall, 

15 through the pilot projects, evaluate— 

16 (A) the effective and economic delivery of 

17 care in diagnosing and treating prostate cancer 

18 with the use of telehealth services in medically 

19 underserved and tribal areas including collabo20 rative uses of health professionals and integra21 tion of the range of telehealth and other tech22 nologies; 

23 (B) the effectiveness of improving the ca24 pacity of nonmedical providers and nonspecial25 ized medical providers to provide health services 


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1 for prostate cancer in medically underserved 

2 and tribal areas, including the exploration of in3 novative medical home models with collabora4 tion between urologists, other relevant medical 

5 specialists, including oncologists, radiologists, 

6 and primary care teams and coordination of 

7 care through the efficient use of primary care 

8 teams and physician extenders; and 

9 (C) the effectiveness of using telehealth 

10 services to provide prostate cancer treatment in 

11 medically underserved areas, including the use 

12 of tumor boards to facilitate better patient 

13 counseling. 

14 (4) REPORT.—Not later than 12 months after 

15 the completion of the pilot projects under this sub16 section, the Secretaries shall submit to Congress a 

17 report describing the outcomes of such pilot projects, 

18 including any cost savings and efficiencies realized, 

19 and providing recommendations, if any, for expand20 ing the use of telehealth services. 

21 (f) EDUCATION AND AWARENESS.— 

22 (1) IN GENERAL.—The Secretary of Veterans 

23 Affairs shall develop a national education campaign 

24 for prostate cancer. Such campaign shall involve the 

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1 ice announcements consistent with the findings of 

2 the Prostate Cancer Task Force under subsection 

3 (c), that are intended to encourage men to seek 

4 prostate cancer screening when appropriate. 

5 (2) RACIAL DISPARITIES AND THE POPULATION

6 OF MEN WITH A FAMILY HISTORY OF PROSTATE

7 CANCER.—In developing the national campaign 

8 under paragraph (1), the Secretary shall ensure that 

9 such educational materials and public service an10 nouncements are more readily available in commu11 nities experiencing racial disparities in the incidence 

12 and mortality rates of prostate cancer and by men 

13 of any race classification with a family history of 

14 prostate cancer. 

15 (3) GRANTS.—In carrying out the national 

16 campaign under this section, the Secretary shall 

17 award grants to nonprofit private entities to enable 

18 such entities to test alternative outreach and edu19 cation strategies. 

20 (g) AUTHORIZATION OF APPROPRIATIONS.— 

21 (1) IN GENERAL.—There is authorized to be 

22 appropriated to carry out this section for the period 

23 of fiscal years 2015 through 2019 an amount equal 

24 to the savings described in paragraph (2). 


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1 (2) CORRESPONDING REDUCTION.—The 

2 amount authorized to be appropriated by provisions 

3 of law other than this section for the period of fiscal 

4 years 2015 through 2019 for Federal research and 

5 health care program activities related to prostate 

6 cancer is reduced by the amount of Federal savings 

7 projected to be achieved over such period by imple8 mentation of subsection (c)(2)(C) of this section. 

9 SEC. 703. IMPROVED MEDICAID COVERAGE FOR CERTAIN 

10 BREAST AND CERVICAL CANCER PATIENTS 

11 IN THE TERRITORIES. 

12 (a) ELIMINATION OF FUNDING LIMITATIONS.— 

13 (1) IN GENERAL.—Section 1108(g)(4) of the 

14 Social Security Act (42 U.S.C. 1308(g)(4)) is 

15 amended by adding at the end the following: ‘‘With 

16 respect to fiscal years beginning with fiscal year 

17 2015, payment for medical assistance for individuals 

18 who are eligible for such assistance only on the basis 

19 of section 1902(a)(10)(A)(ii)(XVIII) shall not be 

20 taken into account in applying subsection (f) (as in21 creased in accordance with paragraphs (1), (2), (3), 

22 and (5) of this subsection) to such commonwealth or 

23 territory for such fiscal year.’’. 


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1 (2) TECHNICAL AMENDMENT.—Such section is 

2 further amended by striking ‘‘(3), and (4)’’ and in3 serting ‘‘(3), and (5)’’. 

4 (b) APPLICATION OF ENHANCED FMAP FOR HIGH5 EST STATE.—Section 1905(b) of such Act (42 U.S.C. 

6 1396d(b)) is amended by adding at the end the following: 

7 ‘‘Notwithstanding the first sentence of this subsection, 

8 with respect to medical assistance described in clause (4) 

9 of such sentence that is furnished in Puerto Rico, the 

10 United States Virgin Islands, Guam, the Commonwealth 

11 of the Northern Mariana Islands, or American Samoa in 

12 a fiscal year, the Federal medical assistance percentage 

13 is equal to the highest such percentage applied under such 

14 clause for such fiscal year for any of the 50 States or the 

15 District of Columbia that provides such medical assistance 

16 for any portion of such fiscal year.’’ 

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

18 this section shall apply to payment for medical assistance 

19 for items and services furnished on or after October 1, 

20 2014. 

21 SEC. 704. CANCER PREVENTION AND TREATMENT DEM22 ONSTRATION FOR ETHNIC AND RACIAL MI23 NORITIES. 

24 (a) DEMONSTRATION.— 


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1 (1) IN GENERAL.—The Secretary of Health and 

2 Human Services (in this section referred to as the 

3 ‘‘Secretary’’) shall conduct demonstration projects 

4 (in this section referred to as ‘‘demonstration 

5 projects’’) for the purpose of developing models and 

6 evaluating methods that— 

7 (A) improve the quality of items and serv8 ices provided to target individuals in order to 

9 facilitate reduced disparities in early detection 

10 and treatment of cancer; 

11 (B) improve clinical outcomes, satisfaction, 

12 quality of life, appropriate use of items and 

13 services covered under the Medicare Program 

14 under title XVIII of the Social Security Act (42 

15 U.S.C. 1395 et seq.), and referral patterns with 

16 respect to target individuals with cancer; 

17 (C) eliminate disparities in the rate of pre18 ventive cancer screening measures, such as Pap 

19 smears, prostate cancer screenings, colon cancer 

20 screenings, breast cancer screenings, and com21 puted tomography (CT) scans, for lung cancer 

22 among target individuals; 

23 (D) promote collaboration with community24 based organizations to ensure cultural com25 petency of health care professionals and linVerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00432 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294

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1 guistic access for target individuals who are 

2 persons with limited-English proficiency; and 

3 (E) encourage the incorporation of commu4 nity health workers to increase the efficiency 

5 and appropriateness of cancer screening pro6 grams. 

7 (2) COMMUNITY HEALTH WORKER DEFINED.— 

8 In this section, the term ‘‘community health worker’’ 

9 includes a community health advocate, a lay health 

10 worker, a community health representative, a peer 

11 health promotor, a community health outreach work12 er, and a promotore de salud, who promotes health 

13 or nutrition within the community in which the indi14 vidual resides. 

15 (3) TARGET INDIVIDUAL DEFINED.—In this 

16 section, the term ‘‘target individual’’ means an indi17 vidual of a racial and ethnic minority group, as de18 fined in section 1707(g)(1) of the Public Health 

19 Service Act (42 U.S.C. 300u–6(g)(1)), who is enti20 tled to benefits under part A, and enrolled under 

21 part B, of title XVIII of the Social Security Act. 

22 (b) PROGRAM DESIGN.— 

23 (1) INITIAL DESIGN.—Not later than 1 year 

24 after the date of the enactment of this Act, the Sec25 retary shall evaluate best practices in the private 


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1 sector, community programs, and academic research 

2 of methods that reduce disparities among individuals 

3 of racial and ethnic minority groups in the preven4 tion and treatment of cancer and shall design the 

5 demonstration projects based on such evaluation. 

6 (2) NUMBER AND PROJECT AREAS.—Not later 

7 than 2 years after the date of the enactment of this 

8 Act, the Secretary shall implement at least nine 

9 demonstration projects, including the following: 

10 (A) Two projects, each of which shall tar11 get different ethnic subpopulations, for each of 

12 the four following major racial and ethnic mi13 nority groups: 

14 (i) American Indians and Alaska Na15 tives, Eskimos and Aleuts. 

16 (ii) Asian-Americans. 

17 (iii) Blacks/African-Americans. 

18 (iv) Latinos or Hispanics. 

19 (v) Native Hawaiians and other Pa20 cific Islanders. 

21 (B) One project within the Pacific Islands 

22 or United States insular areas. 

23 (C) At least one project each in a rural 

24 area and inner-city area. 


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1 (3) EXPANSION OF PROJECTS; IMPLEMENTA2 TION OF DEMONSTRATION PROJECT RESULTS.—If 

3 the initial report under subsection (c) contains an 

4 evaluation that demonstration projects— 

5 (A) reduce expenditures under the Medi6 care Program under title XVIII of the Social 

7 Security Act (42 U.S.C. 1395 et seq.); or 

8 (B) do not increase expenditures under the 

9 Medicare Program and reduce racial and ethnic 

10 health disparities in the quality of health care 

11 services provided to target individuals and in12 crease satisfaction of Medicare beneficiaries and 

13 health care providers; 

14 the Secretary shall continue the existing demonstra15 tion projects and may expand the number of dem16 onstration projects. 

17 (c) REPORT TO CONGRESS.— 

18 (1) IN GENERAL.—Not later than 2 years after 

19 the date the Secretary implements the initial dem20 onstration projects, and biannually thereafter, the 

21 Secretary shall submit to Congress a report regard22 ing the demonstration projects. 

23 (2) CONTENTS OF REPORT.—Each report under 

24 paragraph (1) shall include the following: 


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1 (A) A description of the demonstration 

2 projects. 

3 (B) An evaluation of— 

4 (i) the cost effectiveness of the dem5 onstration projects; 

6 (ii) the quality of the health care serv7 ices provided to target individuals under 

8 the demonstration projects; and 

9 (iii) beneficiary and health care pro10 vider satisfaction under the demonstration 

11 projects. 

12 (C) Any other information regarding the 

13 demonstration projects that the Secretary de14 termines to be appropriate. 

15 (d) WAIVER AUTHORITY.—The Secretary shall waive 

16 compliance with the requirements of title XVIII of the So17 cial Security Act (42 U.S.C. 1395 et seq.) to such extent 

18 and for such period as the Secretary determines is nec19 essary to conduct demonstration projects. 

20 SEC. 705. REDUCING CANCER DISPARITIES WITHIN MEDI21 CARE. 

22 (a) DEVELOPMENT OF MEASURES OF DISPARITIES

23 IN QUALITY OF CANCER CARE.— 

24 (1) DEVELOPMENT OF MEASURES.—The Sec25 retary of Health and Human Services (in this secVerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00436 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294

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1 tion referred to as the ‘‘Secretary’’) shall enter into 

2 an agreement with an entity that specializes in de3 veloping quality measures for cancer care under 

4 which the entity shall develop a uniform set of meas5 ures to evaluate disparities in the quality of cancer 

6 care and annually update such set of measures. 

7 (2) MEASURES TO BE INCLUDED.—Such set of 

8 measures shall include, with respect to the treatment 

9 of cancer, measures of patient outcomes, the process 

10 for delivering medical care related to such treat11 ment, patient counseling and engagement in deci12 sionmaking, patient experience of care, resource use, 

13 and practice capabilities, such as care coordination. 

14 (b) ESTABLISHMENT OF REPORTING PROCESS.— 

15 (1) IN GENERAL.—The Secretary shall establish 

16 a reporting process that requires and provides for a 

17 method for health care providers specified under 

18 paragraph (2) to submit to the Secretary and make 

19 public data on the performance of such providers 

20 during each reporting period through use of the 

21 measures developed pursuant to subsection (a). Such 

22 data shall be submitted in a form and manner and 

23 at a time specified by the Secretary. 

24 (2) SPECIFICATION OF PROVIDERS TO REPORT

25 ON MEASURES.—The Secretary shall specify the 


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1 classes of Medicare providers of services and sup2 pliers, including hospitals, cancer centers, physi3 cians, primary care providers, and specialty pro4 viders, that will be required under such process to 

5 publicly report on the measures specified under sub6 section (a). 

7 (3) ASSESSMENT OF CHANGES.—Under such 

8 reporting process, the Secretary shall establish a for9 mat that assesses changes in both the absolute and 

10 relative disparities in cancer care over time. These 

11 measures shall be presented in an easily comprehen12 sible format, such as those presented in the final 

13 publications relating to Healthy People 2010 or the 

14 National Healthcare Disparities Report. 

15 (4) INITIAL IMPLEMENTATION.—The Secretary 

16 shall implement the reporting process under this 

17 subsection for reporting periods beginning not later 

18 than 6 months after the date that measures are first 

19 established under subsection (a). 


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1 Subtitle B—Viral Hepatitis and 

2 Liver Cancer Control and Pre3 vention 

4 SEC. 711. VIRAL HEPATITIS AND LIVER CANCER CONTROL 

5 AND PREVENTION. 

6 (a) SHORT TITLE.—This subtitle may be cited as the 

7 ‘‘Viral Hepatitis and Liver Cancer Control and Prevention 

8 Act of 2014’’. 

9 (b) FINDINGS.—Congress finds the following: 

10 (1) Approximately 5,300,000 Americans are 

11 chronically infected with the hepatitis B virus (re12 ferred to in this section as ‘‘HBV’’), the hepatitis C 

13 virus (referred to in this section as ‘‘HCV’’), or 

14 both. 

15 (2) In the United States, chronic HBV and 

16 HCV are the most common cause of liver cancer, 

17 one of the most lethal and fastest growing cancers 

18 in this country. It is the most common cause of 

19 chronic liver disease, liver cirrhosis, and the most 

20 common indication for liver transplantation. At least 

21 15,000 deaths per year in the United States can be 

22 attributed to chronic HBV and HCV. Chronic HCV 

23 is also a leading cause of death in Americans living 

24 with HIV/AIDS, many of those living with HIV/ 


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1 AIDS are coinfected with chronic HBV, chronic 

2 HCV, or both. 

3 (3) According to the Centers for Disease Con4 trol and Prevention (referred to in this section as 

5 the ‘‘CDC’’), approximately 2 percent of the popu6 lation of the United States is living with chronic 

7 HBV, chronic HCV, or both. The CDC has recog8 nized HCV as the Nation’s most common chronic 

9 bloodborne virus infection and HBV as the deadliest 

10 vaccine-preventable disease. 

11 (4) HBV is easily transmitted and is 100 times 

12 more infectious than HIV. According to the CDC, 

13 HBV is transmitted through contact with infectious 

14 blood, semen, or other body fluids. HCV is trans15 mitted by contact with infectious blood, particularly 

16 through percutaneous exposures (i.e. puncture 

17 through the skin). 

18 (5) The CDC conservatively estimates that in 

19 2010 approximately 17,000 Americans were newly 

20 infected with HCV and more than 35,000 Americans 

21 were newly infected with HBV. These estimates 

22 could be much higher due to many reasons, includ23 ing lack of screening education and awareness, and 

24 perceived marginalization of the populations at risk. 


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1 (6) In 2012, CDC released new guidelines rec2 ommending every person born between 1945 and 

3 1965 receive a one-time test. Among the estimated 

4 102 million (1.6 million chronically HCV-infected) 

5 eligible for screening, birth-cohort screening leads to 

6 84,000 fewer cases of decompensated cirrhosis, 

7 46,000 fewer cases of hepatocellular carcinoma, 

8 10,000 fewer liver transplants, and 78,000 fewer 

9 HCV-related deaths gained versus risk-based screen10 ing. 

11 (7) In 2013, the United States Preventive Task 

12 Force (USPSTF) issued a Grade B rating for 

13 screening for the hepatitis C virus (HCV) infection 

14 in persons at high risk for infection and adults born 

15 between 1945 and 1965. In 2014, the USPSTF 

16 issued a Grade B for screening for the hepatitis B 

17 virus (HBV) in persons at high-risk of hepatitis B 

18 infection. In 2009, the USPSTF issued a Grade A 

19 for screening pregnant women for the hepatitis B 

20 virus (HBV) during their first prenatal visit. 

21 (8) There were 35 outbreaks (19 of HBV, 16 

22 of HCV) reported to CDC for investigation from 

23 2008 through 2012 related to health care acquired 

24 infection of HBV and HCV, 33 of which occurred in 


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1 nonhospital settings. There were more than 99,975 

2 patients potentially exposed to one of the viruses. 

3 (9) Chronic HBV and chronic HCV usually do 

4 not cause symptoms early in the course of the dis5 ease, but after many years of a clinically ‘‘silent’’ 

6 phase, CDC estimates show more than 33 percent of 

7 infected individuals will develop cirrhosis, end-stage 

8 liver disease, or liver cancer. Since most individuals 

9 with chronic HBV, HCV, or both are unaware of 

10 their infection, they do not know to take precautions 

11 to prevent the spread of their infection and can un12 knowingly exacerbate their own disease progression. 

13 (10) HBV and HCV disproportionately affect 

14 certain populations in the United States. Although 

15 representing only 6 percent of the population, Asian16 Americans and Pacific Islanders account for over 

17 half of the 1,400,000 domestic chronic HBV cases. 

18 Baby boomers (those born between 1945 and 1965) 

19 account for more than half of domestic chronic hepa20 titis C cases. In addition, African-Americans, 

21 Latinos (Latinas), and American Indian/Native 

22 Alaskans are among the groups which have dis23 proportionately high rates of HBV and/or HCV in24 fections in the United States. 


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1 (11) For both chronic HBV and chronic HCV, 

2 behavioral changes can slow disease progression if 

3 diagnosis is made early. Early diagnosis, which is 

4 determined through simple blood tests, can reduce 

5 the risk of transmission and disease progression 

6 through education and vaccination of household 

7 members and other susceptible persons at risk. 

8 (12) Advancements have led to the development 

9 of improved diagnostic tests for viral hepatitis. 

10 These tests, including rapid, point of care testing 

11 and others in development, can facilitate testing, no12 tification of results and post-test counseling, and re13 ferral to care at the time of the testing visit. In par14 ticular, these tests are also advantageous because 

15 they can be used simultaneously with HIV rapid 

16 testing for persons at risk for both HCV and HIV 

17 infections. 

18 (13) For those chronically infected with HBV 

19 or HCV, regular monitoring can lead to the early de20 tection of liver cancer at a stage where a cure is still 

21 possible. Liver cancer is the second deadliest cancer 

22 in the United States; however, liver cancer has re23 ceived little funding for research, prevention, or 

24 treatment. 


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1 (14) Treatment for chronic HCV can eradicate 

2 the disease in approximately 75 percent of those cur3 rently treated. The treatment of chronic HBV can 

4 effectively suppress viral replication in the over5 whelming majority (over 80 percent) of those treat6 ed, thereby reducing the risk of transmission and 

7 progression to liver scarring or liver cancer, even 

8 though a complete cure is much less common than 

9 for HCV. 

10 (15) To combat the viral hepatitis epidemic in 

11 the United States, in May 2011, the Department of 

12 Health and Human Services released ‘‘Combating 

13 the Silent Epidemic of Viral Hepatitis: Action Plan 

14 for the Prevention, Care & Treatment of Viral Hepa15 titis’’ (hereafter referred to as the HHS Action 

16 Plan). The Institute of Medicine (IOM) of the Na17 tional Academies produced a 2010 report on the 

18 Federal response to HBV and HCV titled: ‘‘Hepa19 titis and Liver Cancer: A National Strategy for Pre20 vention and Control of Hepatitis B and C’’. These 

21 recommendations and guidelines provide a frame22 work for HBV and HCV prevention, education, con23 trol, research, and medical management programs. 

24 (16) The annual health care costs attributable 

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1 cant. For HBV, it is estimated to be approximately 

2 $2,500,000,000 ($2,000 per infected person). In 

3 2000, the lifetime cost of HBV—-before the avail4 ability of most current therapies—-was approxi5 mately $80,000 per chronically infected person, to6 taling more than $100,000,000,000. For HCV, med7 ical costs for patients are expected to increase from 

8 $30,000,000,000 in 2009 to over $85,000,000,000 

9 in 2024. Avoiding these costs by screening and diag10 nosing individuals earlier—and connecting them to 

11 appropriate treatment and care, will save lives and 

12 critical health care dollars. Currently, without a 

13 comprehensive screening, testing, and diagnosis pro14 gram, most patients are diagnosed too late when 

15 they need a liver transplant costing at least 

16 $314,000 for uncomplicated cases or when they have 

17 liver cancer or end stage liver disease which costs 

18 $30,980 to $110,576 per hospital admission. As 

19 health care costs continue to grow, it is critical that 

20 the Federal Government invests in effective mecha21 nisms to avoid documented cost drivers. 

22 (17) According to the IOM report in 2010 (de23 scribed in paragraph (15)), chronic HBV and HCV 

24 infections cause substantial morbidity and mortality 

25 despite being preventable and treatable. Deficiencies 


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1 in the implementation of established guidelines for 

2 the prevention, diagnosis, and medical management 

3 of chronic HBV and HCV infections perpetuate per4 sonal and economic burdens. Existing grants are not 

5 sufficient for the scale of the health burden pre6 sented by HBV and HCV. 

7 (18) Screening and testing for HBV and HCV 

8 is aligned with the Healthy People 2020 goal to in9 crease immunization rates and reduce preventable 

10 infectious diseases. Awareness of disease and access 

11 to prevention and treatment remain essential compo12 nents for reducing infectious disease transmission. 

13 (19) Federal support is necessary to increase 

14 knowledge and awareness of HBV and HCV and to 

15 assist State and local prevention and control efforts 

16 in reducing the morbidity and mortality of these 

17 epidemics. 

18 (20) The Secretary of Health and Human Serv19 ices has the discretion to carry out this Act directly 

20 and through whichever of the agencies of the Public 

21 Health Service the Secretary determines to be ap22 propriate, which may (in the Secretary’s discretion) 

23 include the Centers for Disease Control and Preven24 tion, the Health Resources and Services Administra25 tion, the Substance Abuse and Mental Health ServVerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00446 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294

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1 ices Administration, the National Institutes of 

2 Health (including the National Institute on Minority 

3 Health and Health Disparities), and other agencies 

4 of such Service. 

5 (c) BIENNIAL ASSESSMENT OF HHS HEPATITIS B 

6 AND HEPATITIS C PREVENTION, EDUCATION, RESEARCH, 

7 AND MEDICAL MANAGEMENT PLAN.—Title III of the 

8 Public Health Service Act (42 U.S.C. 241 et seq.) is 

9 amended— 

10 (1) by striking section 317N (42 U.S.C. 247b– 

11 15); and 

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

13 ‘‘PART W—BIENNIAL ASSESSMENT OF HHS HEPA14 TITIS B AND HEPATITIS C PREVENTION, EDU15 CATION, RESEARCH, AND MEDICAL MANAGE16 MENT PLAN 

17 ‘‘SEC. 399NN. BIENNIAL UPDATE OF THE PLAN. 

18 ‘‘(a) IN GENERAL.—The Secretary shall conduct a bi19 ennial assessment of the Secretary’s plan for the preven20 tion, control, and medical management of, and education 

21 and research relating to, hepatitis B and hepatitis C, for 

22 the purposes of— 

23 ‘‘(1) incorporating into such plan new knowl24 edge or observations relating to hepatitis B and hep25 atitis C (such as knowledge and observations that 


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1 may be derived from clinical, laboratory, and epide2 miological research and disease detection, preven3 tion, and surveillance outcomes); 

4 ‘‘(2) addressing gaps in the coverage or effec5 tiveness of the plan; and 

6 ‘‘(3) evaluating and, if appropriate, updating 

7 recommendations, guidelines, or educational mate8 rials of the Centers for Disease Control and Preven9 tion or the National Institutes of Health for health 

10 care providers or the public on viral hepatitis in 

11 order to be consistent with the plan. 

12 ‘‘(b) PUBLICATION OF NOTICE OF ASSESSMENTS.— 

13 Not later than October 1 of the first even-numbered year 

14 beginning after the date of the enactment of this part, 

15 and October 1 of each even-numbered year thereafter, the 

16 Secretary shall publish in the Federal Register a notice 

17 of the results of the assessments conducted under para18 graph (1). Such notice shall include— 

19 ‘‘(1) a description of any revisions to the plan 

20 referred to in subsection (a) as a result of the as21 sessment; 

22 ‘‘(2) an explanation of the basis for any such 

23 revisions, including the ways in which such revisions 

24 can reasonably be expected to further promote the 

25 original goals and objectives of the plan; and 


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1 ‘‘(3) in the case of a determination by the Sec2 retary that the plan does not need revision, an expla3 nation of the basis for such determination. 

4 ‘‘SEC. 399NN–1. ELEMENTS OF PROGRAM. 

5 ‘‘(a) EDUCATION AND AWARENESS PROGRAMS.—The 

6 Secretary, acting through the Director of the Centers for 

7 Disease Control and Prevention, the Administrator of the 

8 Health Resources and Services Administration, and the 

9 Administrator of the Substance Abuse and Mental Health 

10 Services Administration, and in accordance with the plan 

11 referred to in section 399NN(a), shall implement pro12 grams to increase awareness and enhance knowledge and 

13 understanding of hepatitis B and hepatitis C. Such pro14 grams shall include— 

15 ‘‘(1) the conduct of culturally and language ap16 propriate health education in primary and secondary 

17 schools, college campuses, public awareness cam18 paigns, and community outreach activities (especially 

19 to the ethnic communities with high rates of chronic 

20 hepatitis B and chronic hepatitis C and other high21 risk groups) to promote public awareness and knowl22 edge about the value of hepatitis A and hepatitis B 

23 immunization, risk factors, the transmission and 

24 prevention of hepatitis B and hepatitis C, the value 

25 of screening for the early detection of hepatitis B 


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1 and hepatitis C, and options available for the treat2 ment of chronic hepatitis B and chronic hepatitis C; 

3 ‘‘(2) the promotion of immunization programs 

4 that increase awareness and access to hepatitis A 

5 and hepatitis B vaccines for susceptible adults and 

6 children; 

7 ‘‘(3) the training of health care professionals 

8 regarding the importance of vaccinating individuals 

9 infected with hepatitis C and individuals who are at 

10 risk for hepatitis C infection against hepatitis A and 

11 hepatitis B; 

12 ‘‘(4) the training of health care professionals 

13 regarding the importance of vaccinating individuals 

14 chronically infected with hepatitis B and individuals 

15 who are at risk for chronic hepatitis B infection 

16 against the hepatitis A virus; 

17 ‘‘(5) the training of health care professionals 

18 and health educators to make them aware of the 

19 high rates of chronic hepatitis B and chronic hepa20 titis C in certain adult ethnic populations, and the 

21 importance of prevention, detection, and medical 

22 management of hepatitis B and hepatitis C and of 

23 liver cancer screening; 

24 ‘‘(6) the development and distribution of health 

25 education curricula (including information relating 


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1 to the special needs of individuals infected with hep2 atitis B and hepatitis C, such as the importance of 

3 prevention and early intervention, regular moni4 toring, the recognition of psychosocial needs, appro5 priate treatment, and liver cancer screening) for in6 dividuals providing hepatitis B and hepatitis C coun7 seling; and 

8 ‘‘(7) support for the implementation curricula 

9 described in paragraph (6) by State and local public 

10 health agencies. 

11 ‘‘(b) IMMUNIZATION, PREVENTION, AND CONTROL

12 PROGRAMS.— 

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

14 through the Director of the Centers for Disease 

15 Control and Prevention, shall support the integra16 tion of activities described in paragraph (3) into ex17 isting clinical and public health programs at State, 

18 local, territorial, and tribal levels (including commu19 nity health clinics, programs for the prevention and 

20 treatment of HIV/AIDS, sexually transmitted dis21 eases, and substance abuse, and programs for indi22 viduals in correctional settings). 

23 ‘‘(2) COORDINATION OF DEVELOPMENT OF

24 FEDERAL SCREENING GUIDELINES.— 


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1 ‘‘(A) REFERENCES.—For purposes of this 

2 subsection, the term ‘CDC Director’ means the 

3 Director of the Centers for Disease Control and 

4 Prevention, and the term ‘AHRQ Director’ 

5 means the Director of the Agency for 

6 Healthcare Research and Quality. 

7 ‘‘(B) AGENCY FOR HEALTHCARE RE8 SEARCH AND QUALITY.—Due to the rapidly 

9 evolving standard of care associated with diag10 nosing and treating viral hepatitis infection, the 

11 AHRQ Director shall convene the Preventive 

12 Services Task Force under section 915(a) of 

13 the Public Health Service Act to review its rec14 ommendation for screening for HBV and HCV 

15 infection every 3 years. 

16 ‘‘(3) ACTIVITIES.— 

17 ‘‘(A) VOLUNTARY TESTING PROGRAMS.— 

18 ‘‘(i) IN GENERAL.—The Secretary 

19 shall establish a mechanism by which to 

20 support and promote the development of 

21 State, local, territorial, and tribal vol22 untary hepatitis B and hepatitis C testing 

23 programs to screen the high-prevalence 

24 populations to aid in the early identifica25 tion of chronically infected individuals. 


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1 ‘‘(ii) CONFIDENTIALITY OF THE TEST

2 RESULTS.—The Secretary shall prohibit 

3 the use of the results of a hepatitis B or 

4 hepatitis C test conducted by a testing pro5 gram developed or supported under this 

6 subparagraph for any of the following: 

7 ‘‘(I) Issues relating to health in8 surance. 

9 ‘‘(II) To screen or determine 

10 suitability for employment. 

11 ‘‘(III) To discharge a person 

12 from employment. 

13 ‘‘(B) COUNSELING REGARDING VIRAL HEP14 ATITIS.—The Secretary shall support State, 

15 local, territorial, and tribal programs in a wide 

16 variety of settings, including those providing 

17 primary and specialty health care services in 

18 nonprofit private and public sectors, to— 

19 ‘‘(i) provide individuals with ongoing 

20 risk factors for hepatitis B and hepatitis C 

21 infection with client-centered education 

22 and counseling which concentrates on— 

23 ‘‘(I) promoting testing of individ24 uals that have been exposed to their 


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1 blood, family members, and their sex2 ual partners; and 

3 ‘‘(II) changing behaviors that 

4 place individuals at risk for infection; 

5 ‘‘(ii) provide individuals chronically in6 fected with hepatitis B or hepatitis C with 

7 education, health information, and coun8 seling to reduce their risk of— 

9 ‘‘(I) dying from end-stage liver 

10 disease and liver cancer; and 

11 ‘‘(II) transmitting viral hepatitis 

12 to others; and 

13 ‘‘(iii) provide women chronically in14 fected with hepatitis B or hepatitis C who 

15 are pregnant or of childbearing age with 

16 culturally and language appropriate health 

17 information, such as how to prevent hepa18 titis B perinatal infection, and to alleviate 

19 fears associated with pregnancy or raising 

20 a family. 

21 ‘‘(C) IMMUNIZATION.—The Secretary shall 

22 support State, local, territorial, and tribal ef23 forts to expand the current vaccination pro24 grams to protect every child in the country and 

25 all susceptible adults, particularly those infected 


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1 with hepatitis C and high-prevalence ethnic 

2 populations and other high-risk groups, from 

3 the risks of acute and chronic hepatitis B infec4 tion by— 

5 ‘‘(i) ensuring continued funding for 

6 hepatitis B vaccination for all children 19 

7 years of age or younger through the Vac8 cines for Children Program; 

9 ‘‘(ii) ensuring that the recommenda10 tions of the Advisory Committee on Immu11 nization Practices are followed regarding 

12 the birth dose of hepatitis B vaccinations 

13 for newborns; 

14 ‘‘(iii) requiring proof of hepatitis B 

15 vaccination for entry into public or private 

16 daycare, preschool, elementary school, sec17 ondary school, and institutions of higher 

18 education; 

19 ‘‘(iv) expanding the availability of 

20 hepatitis B vaccination for all susceptible 

21 adults to protect them from becoming 

22 acutely or chronically infected, including 

23 ethnic and other populations with high 

24 prevalence rates of chronic hepatitis B in25 fection; 


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1 ‘‘(v) expanding the availability of hep2 atitis B vaccination for all susceptible 

3 adults, particularly those in their reproduc4 tive age (women and men less than 45 

5 years of age), to protect them from the 

6 risk of hepatitis B infection; 

7 ‘‘(vi) ensuring the vaccination of indi8 viduals infected, or at risk for infection, 

9 with hepatitis C against hepatitis A, hepa10 titis B, and other infectious diseases, as 

11 appropriate, for which such individuals 

12 may be at increased risk; and 

13 ‘‘(vii) ensuring the vaccination of indi14 viduals infected, or at risk for infection, 

15 with hepatitis B against hepatitis A virus 

16 and other infectious diseases, as appro17 priate, for which such individuals may be 

18 at increased risk. 

19 ‘‘(D) MEDICAL REFERRAL.—The Secretary 

20 shall support State, local, territorial, and tribal 

21 programs that support— 

22 ‘‘(i) referral of persons chronically in23 fected with hepatitis B or hepatitis C— 

24 ‘‘(I) for medical evaluation to de25 termine the appropriateness for 


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1 antiviral treatment to reduce the risk 

2 of progression to cirrhosis and liver 

3 cancer; and 

4 ‘‘(II) for ongoing medical man5 agement including regular monitoring 

6 of liver function and screening for 

7 liver cancer; and 

8 ‘‘(ii) referral of persons infected with 

9 acute or chronic hepatitis B infection or 

10 acute or chronic hepatitis C infection for 

11 drug and alcohol abuse treatment where 

12 appropriate. 

13 ‘‘(4) INCREASED SUPPORT FOR ADULT VIRAL

14 HEPATITIS COORDINATORS.—The Secretary, acting 

15 through the Director of the Centers for Disease 

16 Control and Prevention, shall provide increased sup17 port to Adult Viral Hepatitis Coordinators in State, 

18 local, territorial, and tribal health departments in 

19 order to enhance the additional management, net20 working, and technical expertise needed to ensure 

21 successful integration of hepatitis B and hepatitis C 

22 prevention and control activities into existing public 

23 health programs. 

24 ‘‘(c) EPIDEMIOLOGICAL SURVEILLANCE.— 


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

2 through the Director of the Centers for Disease 

3 Control and Prevention, shall support the establish4 ment and maintenance of a national chronic and 

5 acute hepatitis B and hepatitis C surveillance pro6 gram, in order to identify— 

7 ‘‘(A) trends in the incidence of acute and 

8 chronic hepatitis B and acute and chronic hepa9 titis C; 

10 ‘‘(B) trends in the prevalence of acute and 

11 chronic hepatitis B and acute and chronic hepa12 titis C infection among groups that may be dis13 proportionately affected; and 

14 ‘‘(C) trends in liver cancer and end-stage 

15 liver disease incidence and deaths, caused by 

16 chronic hepatitis B and chronic hepatitis C in 

17 the high-risk ethnic populations. 

18 ‘‘(2) SEROPREVALENCE AND LIVER CANCER

19 STUDIES.—The Secretary, acting through the Direc20 tor of the Centers for Disease Control and Preven21 tion, shall prepare a report outlining the population22 based seroprevalence studies currently underway, fu23 ture planned studies, the criteria involved in deter24 mining which seroprevalence studies to conduct, 

25 defer, or suspend, and the scope of those studies, the 


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1 economic and clinical impact of hepatitis B and hep2 atitis C, and the impact of chronic hepatitis B and 

3 chronic hepatitis C infections on the quality of life. 

4 Not later than one year after the date of the enact5 ment of this part, the Secretary shall submit the re6 port to the Committee on Energy and Commerce of 

7 the House of Representatives and the Committee on 

8 Health, Education, Labor, and Pensions of the Sen9 ate. 

10 ‘‘(3) CONFIDENTIALITY.—The Secretary shall 

11 not disclose any individually identifiable information 

12 identified under paragraph (1) or derived through 

13 studies under paragraph (2). 

14 ‘‘(d) RESEARCH.—The Secretary, acting through the 

15 Director of the Centers for Disease Control and Preven16 tion, the Director of the National Cancer Institute, and 

17 the Director of the National Institutes of Health, shall— 

18 ‘‘(1) conduct epidemiologic and community19 based research to develop, implement, and evaluate 

20 best practices for hepatitis B and hepatitis C pre21 vention especially in the ethnic populations with high 

22 rates of chronic hepatitis B and chronic hepatitis C 

23 and other high-risk groups; 

24 ‘‘(2) conduct research on hepatitis B and hepa25 titis C natural history, pathophysiology, improved 


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1 treatments and prevention (such as the hepatitis C 

2 vaccine), and noninvasive tests that help to predict 

3 the risk of progression to liver cirrhosis and liver 

4 cancer; 

5 ‘‘(3) conduct research that will lead to better 

6 noninvasive or blood tests to screen for liver cancer, 

7 and more effective treatments of liver cancer caused 

8 by chronic hepatitis B and chronic hepatitis C; and 

9 ‘‘(4) conduct research comparing the effective10 ness of screening, diagnostic, management, and 

11 treatment approaches for chronic hepatitis B, chron12 ic hepatitis C, and liver cancer in the affected com13 munities. 

14 ‘‘(e) UNDERSERVED AND DISPROPORTIONATELY AF15 FECTED POPULATIONS.—In carrying out this section, the 

16 Secretary shall provide expanded support for individuals 

17 with limited access to health education, testing, and health 

18 care services and groups that may be disproportionately 

19 affected by hepatitis B and hepatitis C. 

20 ‘‘(f) EVALUATION OF PROGRAM.—The Secretary 

21 shall develop benchmarks for evaluating the effectiveness 

22 of the programs and activities conducted under this sec23 tion and make determinations as to whether such bench24 marks have been achieved. 


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1 ‘‘SEC. 399NN–2. GRANTS. 

2 ‘‘(a) IN GENERAL.—The Secretary may award grants 

3 to, or enter into contracts or cooperative agreements with, 

4 States, political subdivisions of States, territories, Indian 

5 tribes, or nonprofit entities that have special expertise re6 lating to hepatitis B, hepatitis C, or both, to carry out 

7 activities under this part. 

8 ‘‘(b) APPLICATION.—To be eligible for a grant, con9 tract, or cooperative agreement under subsection (a), an 

10 entity shall prepare and submit to the Secretary an appli11 cation at such time, in such manner, and containing such 

12 information as the Secretary may require. 

13 ‘‘SEC. 399NN–3. AUTHORIZATION OF APPROPRIATIONS. 

14 ‘‘There are authorized to be appropriated to carry out 

15 this part $90,000,000 for fiscal year 2015, $90,000,000 

16 for fiscal year 2016, $110,000,000 for fiscal year 2017, 

17 $130,000,000 for fiscal year 2018, and $150,000,000 for 

18 fiscal year 2019.’’. 

19 (d) ENHANCING SAMHSA’S ROLE IN HEPATITIS AC20 TIVITIES.—Paragraph (6) of section 501(d) of the Public 

21 Health Service Act (42 U.S.C. 290aa(d)) is amended by 

22 striking ‘‘HIV or tuberculosis’’ and inserting ‘‘HIV, tuber23 culosis, or hepatitis’’. 


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1 Subtitle C—Acquired Bone Marrow 

2 Failure Diseases 

3 SEC. 721. ACQUIRED BONE MARROW FAILURE DISEASES. 

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

5 ‘‘Bone Marrow Failure Disease Research and Treatment 

6 Act of 2014’’. 

7 (b) FINDINGS.—The Congress finds the following: 

8 (1) Between 20,000 and 30,000 Americans are 

9 diagnosed each year with myelodysplastic syndromes, 

10 aplastic anemia, paroxysmal nocturnal hemo11 globinuria, and other acquired bone marrow failure 

12 diseases. 

13 (2) Acquired bone marrow failure diseases have 

14 a debilitating and often fatal impact on those diag15 nosed with these diseases. 

16 (3) While some treatments for acquired bone 

17 marrow failure diseases can prolong and improve the 

18 quality of patients’ lives, there is no single cure for 

19 these diseases. 

20 (4) The prevalence of acquired bone marrow 

21 failure diseases in the United States will continue to 

22 grow as the general public ages. 

23 (5) Evidence exists suggesting that acquired 

24 bone marrow failure diseases occur more often in 


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1 minority populations, particularly in Asian-American 

2 and Latino or Hispanic populations. 

3 (6) The National Heart, Lung, and Blood Insti4 tute and the National Cancer Institute have con5 ducted important research into the causes of and 

6 treatments for acquired bone marrow failure dis7 eases. 

8 (7) The National Marrow Donor Program Reg9 istry has made significant contributions to the fight 

10 against bone marrow failure diseases by connecting 

11 millions of potential marrow donors with individuals 

12 and families suffering from these conditions. 

13 (8) Despite these advances, a more comprehen14 sive Federal strategic effort among numerous Fed15 eral agencies is needed to discover a cure for ac16 quired bone marrow failure disorders. 

17 (9) Greater Federal surveillance of acquired 

18 bone marrow failure diseases is needed to gain a bet19 ter understanding of the causes of acquired bone 

20 marrow failure diseases. 

21 (10) The Federal Government should increase 

22 its research support for and engage with public and 

23 private organizations in developing a comprehensive 

24 approach to combat and cure acquired bone marrow 

25 failure diseases. 


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1 (c) NATIONAL ACQUIRED BONE MARROW FAILURE

2 DISEASE REGISTRY.—Part B of the Public Health Service 

3 Act (42 U.S.C. 311 et seq.) is amended by inserting after 

4 section 317W, as added, the following: 

5 ‘‘SEC. 317X. NATIONAL ACQUIRED BONE MARROW FAILURE 

6 DISEASE REGISTRY. 

7 ‘‘(a) ESTABLISHMENT OF REGISTRY.— 

8 ‘‘(1) IN GENERAL.—Not later than 6 months 

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

10 Secretary, acting through the Director of the Cen11 ters for Disease Control and Prevention, shall— 

12 ‘‘(A) develop a system to collect data on 

13 acquired bone marrow failure diseases; and 

14 ‘‘(B) establish and maintain a national and 

15 publicly available registry, to be known as the 

16 National Acquired Bone Marrow Failure Dis17 ease Registry, in accordance with paragraph 

18 (3). 

19 ‘‘(2) RECOMMENDATIONS OF ADVISORY COM20 MITTEE.—In carrying out this subsection, the Sec21 retary shall take into consideration the recommenda22 tions of the Advisory Committee on Acquired Bone 

23 Marrow Failure Diseases established under sub24 section (b). 


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1 ‘‘(3) PURPOSES OF REGISTRY.—The National 

2 Acquired Bone Marrow Failure Disease Registry— 

3 ‘‘(A) shall identify the incidence and preva4 lence of acquired bone marrow failure diseases 

5 in the United States; 

6 ‘‘(B) shall be used to collect and store data 

7 on acquired bone marrow failure diseases, in8 cluding data concerning— 

9 ‘‘(i) the age, race or ethnicity, general 

10 geographic location, sex, and family history 

11 of individuals who are diagnosed with ac12 quired bone marrow failure diseases, and 

13 any other characteristics of such individ14 uals determined appropriate by the Sec15 retary; 

16 ‘‘(ii) the genetic and environmental 

17 factors that may be associated with devel18 oping acquired bone marrow failure dis19 eases; 

20 ‘‘(iii) treatment approaches for deal21 ing with acquired bone marrow failure dis22 eases; 

23 ‘‘(iv) outcomes for individuals treated 

24 for acquired bone marrow failure diseases, 

25 including outcomes for recipients of stem 


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1 cell therapeutic products as contained in 

2 the database established pursuant to sec3 tion 379A; and 

4 ‘‘(v) any other factors pertaining to 

5 acquired bone marrow failure diseases de6 termined appropriate by the Secretary; and 

7 ‘‘(C) shall be made available— 

8 ‘‘(i) to the general public; and 

9 ‘‘(ii) to researchers to facilitate fur10 ther research into the causes of, and treat11 ments for, acquired bone marrow failure 

12 diseases in accordance with standard prac13 tices of the Centers for Disease Control 

14 and Preventions. 

15 ‘‘(b) ADVISORY COMMITTEE.— 

16 ‘‘(1) ESTABLISHMENT.—Not later than 6 

17 months after the date of the enactment of this sec18 tion, the Secretary, acting through the Director of 

19 the Centers for Disease Control and Prevention, 

20 shall establish an advisory committee, to be known 

21 as the Advisory Committee on Acquired Bone Mar22 row Failure Diseases. 

23 ‘‘(2) MEMBERS.—The members of the Advisory 

24 Committee on Acquired Bone Marrow Failure Dis25 eases shall be appointed by the Secretary, acting 


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1 through the Director of the Centers for Disease 

2 Control and Prevention, and shall include at least 

3 one representative from each of the following: 

4 ‘‘(A) A national patient advocacy organiza5 tion with experience advocating on behalf of pa6 tients suffering from acquired bone marrow 

7 failure diseases. 

8 ‘‘(B) The National Institutes of Health, in9 cluding at least one representative from each 

10 of— 

11 ‘‘(i) the National Cancer Institute; 

12 ‘‘(ii) the National Heart, Lung, and 

13 Blood Institute; and 

14 ‘‘(iii) the Office of Rare Diseases. 

15 ‘‘(C) The Centers for Disease Control and 

16 Prevention. 

17 ‘‘(D) Clinicians with experience in— 

18 ‘‘(i) diagnosing or treating acquired 

19 bone marrow failure diseases; and 

20 ‘‘(ii) medical data registries. 

21 ‘‘(E) Epidemiologists who have experience 

22 with data registries. 

23 ‘‘(F) Publicly or privately funded research24 ers who have experience researching acquired 

25 bone marrow failure diseases. 


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1 ‘‘(G) The entity operating the C.W. Bill 

2 Young Cell Transplantation Program estab3 lished pursuant to section 379 and the entity 

4 operating the C.W. Bill Young Cell Transplan5 tation Program Outcomes Database. 

6 ‘‘(3) RESPONSIBILITIES.—The Advisory Com7 mittee on Acquired Bone Marrow Failure Diseases 

8 shall provide recommendations to the Secretary on 

9 the establishment and maintenance of the National 

10 Acquired Bone Marrow Failure Disease Registry, in11 cluding recommendations on the collection, mainte12 nance, and dissemination of data. 

13 ‘‘(4) PUBLIC AVAILABILITY.—The Secretary 

14 shall make the recommendations of the Advisory 

15 Committee on Acquired Bone Marrow Failure Dis16 ease publicly available. 

17 ‘‘(c) GRANTS.—The Secretary, acting through the 

18 Director of the Centers for Disease Control and Preven19 tion, may award grants to, and enter into contracts and 

20 cooperative agreements with, public or private nonprofit 

21 entities for the management of, as well as the collection, 

22 analysis, and reporting of data to be included in, the Na23 tional Acquired Bone Marrow Failure Disease Registry. 

24 ‘‘(d) DEFINITION.—In this section, the term ‘ac25 quired bone marrow failure disease’ means— 


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1 ‘‘(1) myelodysplastic syndromes (MDS); 

2 ‘‘(2) aplastic anemia; 

3 ‘‘(3) paroxysmal nocturnal hemoglobinuria 

4 (PNH); 

5 ‘‘(4) pure red cell aplasia; 

6 ‘‘(5) acute myeloid leukemia that has pro7 gressed from myelodysplastic syndromes; or 

8 ‘‘(6) large granular lymphocytic leukemia. 

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

10 is authorized to be appropriated to carry out this section 

11 $3,000,000 for each of fiscal years 2015 through 2019.’’. 

12 (d) PILOT STUDIES THROUGH THE AGENCY FOR

13 TOXIC SUBSTANCES AND DISEASE REGISTRY.— 

14 (1) PILOT STUDIES.—The Secretary of Health 

15 and Human Services, acting through the Adminis16 trator of the Agency for Toxic Substances and Dis17 ease Registry, shall conduct pilot studies to deter18 mine which environmental factors, including expo19 sure to toxins, may cause acquired bone marrow fail20 ure diseases. 

21 (2) COLLABORATION WITH THE RADIATION IN22 JURY TREATMENT NETWORK.—In carrying out the 

23 directives of this section, the Secretary may collabo24 rate with the Radiation Injury Treatment Network 

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1 gram established pursuant to section 379 of the 

2 Public Health Service Act (42 U.S.C. 274j) to— 

3 (A) augment data for the pilot studies au4 thorized by this section; 

5 (B) access technical assistance that may be 

6 provided by the Radiation Injury Treatment 

7 Network; or 

8 (C) perform joint research projects. 

9 (3) AUTHORIZATION OF APPROPRIATIONS.— 

10 There is authorized to be appropriated to carry out 

11 this section $1,000,000 for each of fiscal years 2015 

12 through 2019. 

13 (e) MINORITY-FOCUSED PROGRAMS ON ACQUIRED

14 BONE MARROW FAILURE DISEASES.—Title XVII of the 

15 Public Health Service Act (42 U.S.C. 300u et seq.) is 

16 amended by inserting after section 1707A the following: 

17 ‘‘MINORITY-FOCUSED PROGRAMS ON ACQUIRED BONE

18 MARROW FAILURE DISEASES

19 ‘‘SEC. 1707B. (a) INFORMATION AND REFERRAL

20 SERVICES.— 

21 ‘‘(1) IN GENERAL.—Not later than 6 months 

22 after the date of the enactment of this section, the 

23 Secretary, acting through the Deputy Assistant Sec24 retary for Minority Health, shall establish and co25 ordinate outreach and informational programs tarVerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00470 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294

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1 geted to minority populations affected by acquired 

2 bone marrow failure diseases. 

3 ‘‘(2) PROGRAM REQUIREMENTS.—Minority-fo4 cused outreach and informational programs author5 ized by this section— 

6 ‘‘(A) shall make information about treat7 ment options and clinical trials for acquired 

8 bone marrow failure diseases publicly available, 

9 and 

10 ‘‘(B) shall provide referral services for 

11 treatment options and clinical trials, 

12 at the National Minority Health Resource Center 

13 supported under section 1707(b)(8) (including by 

14 means of the Center’s Web site, through appropriate 

15 locations such as the Center’s knowledge center, and 

16 through appropriate programs such as the Center’s 

17 resource persons network) and through minority 

18 health consultants located at each Department of 

19 Health and Human Services regional office. 

20 ‘‘(b) HISPANIC AND ASIAN-AMERICAN AND PACIFIC

21 ISLANDER OUTREACH.— 

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

23 through the Deputy Assistant Secretary for Minority 

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1 cific Islander communities with comprehensive serv2 ices focused on treatment of, and information about, 

3 acquired bone marrow failure diseases. 

4 ‘‘(2) COLLABORATION.—In carrying out this 

5 subsection, the Secretary may collaborate with public 

6 health agencies, nonprofit organizations, community 

7 groups, and online entities to disseminate informa8 tion about treatment options and clinical trials for 

9 acquired bone marrow failure diseases. 

10 ‘‘(c) GRANTS AND COOPERATIVE AGREEMENTS.— 

11 ‘‘(1) IN GENERAL.—Not later than 6 months 

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

13 Secretary, acting through the Deputy Assistant Sec14 retary for Minority Health, shall award grants to, or 

15 enter into cooperative agreements with, entities to 

16 perform research on acquired bone marrow failure 

17 diseases. 

18 ‘‘(2) REQUIREMENT.—Grants and cooperative 

19 agreements authorized by this subsection shall be 

20 awarded or entered into on a competitive, peer-re21 viewed basis. 

22 ‘‘(3) SCOPE OF RESEARCH.—Research funded 

23 under this section shall examine factors affecting the 

24 incidence of acquired bone marrow failure diseases 

25 in minority populations. 


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1 ‘‘(d) DEFINITION.—In this section, the term ‘ac2 quired bone marrow failure disease’ has the meaning given 

3 to such term in section 317X(d). 

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

5 is authorized to be appropriated to carry out this section 

6 $2,000,000 for each of fiscal years 2015 through 2019.’’. 

7 (f) DIAGNOSIS AND QUALITY OF CARE FOR AC8 QUIRED BONE MARROW FAILURE DISEASES.— 

9 (1) GRANTS.—The Secretary of Health and 

10 Human Services, acting through the Director of the 

11 Agency for Healthcare Research and Quality, shall 

12 award grants to entities to improve diagnostic prac13 tices and quality of care with respect to patients 

14 with acquired bone marrow failure diseases. 

15 (2) AUTHORIZATION OF APPROPRIATIONS.— 

16 There is authorized to be appropriated to carry out 

17 this section $2,000,000 for each of fiscal years 2015 

18 through 2019. 

19 (g) DEFINITION.—In this section, the term ‘‘acquired 

20 bone marrow failure disease’’ means— 

21 (1) myelodysplastic syndromes (MDS); 

22 (2) aplastic anemia; 

23 (3) paroxysmal nocturnal hemoglobinuria 

24 (PNH); 

25 (4) pure red cell aplasia; 


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1 (5) acute myeloid leukemia that progressed 

2 from myelodysplastic syndromes; or 

3 (6) large granular lymphocytic leukemia. 

4 Subtitle D—Cardiovascular Dis5 ease, Chronic Disease, and 

6 Other Disease Issues 

7 SEC. 731. GUIDELINES FOR DISEASE SCREENING FOR MI8 NORITY PATIENTS. 

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

10 Director of the Agency for Healthcare Research and Qual11 ity, shall convene a series of meetings to develop guidelines 

12 for disease screening for minority patient populations 

13 which have a higher than average risk for many chronic 

14 diseases and cancers. 

15 (b) PARTICIPANTS.—In convening meetings under 

16 subsection (a), the Secretary shall ensure that meeting 

17 participants include representatives of— 

18 (1) professional societies and associations; 

19 (2) minority health organizations; 

20 (3) health care researchers and providers, in21 cluding those with expertise in minority health; 

22 (4) Federal health agencies, including the Of23 fice of Minority Health, the National Institute on 

24 Minority Health and Health Disparities, and the 

25 National Institutes of Health; and 


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1 (5) other experts determined appropriate by the 

2 Secretary. 

3 (c) DISEASES.—Screening guidelines for minority 

4 populations shall be developed as appropriate under sub5 section (a) for— 

6 (1) hypertension; 

7 (2) hypercholesterolemia; 

8 (3) diabetes; 

9 (4) cardiovascular disease; 

10 (5) cancers, including breast, prostate, colon, 

11 cervical, and lung cancer; 

12 (6) asthma; 

13 (7) diabetes; 

14 (8) kidney diseases; 

15 (9) eye diseases and disorders, including glau16 coma; 

17 (10) HIV/AIDS and sexually transmitted dis18 eases; 

19 (11) uterine fibroids; 

20 (12) autoimmune disease; 

21 (13) mental health conditions; 

22 (14) dental health conditions and oral diseases, 

23 including oral cancer; 

24 (15) environmental and related health illnesses 

25 and conditions; 


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1 (16) Sickle cell disease; 

2 (17) violence and injury prevention and control; 

3 (18) genetic and related conditions; 

4 (19) heart disease and stroke; 

5 (20) tuberculosis; 

6 (21) chronic obstructive pulmonary disease; 

7 (22) musculoskeletal diseases, arthritis, and 

8 obesity; and 

9 (23) other diseases determined appropriate by 

10 the Secretary. 

11 (d) DISSEMINATION.—Not later than 24 months 

12 after the date of enactment of this title, the Secretary 

13 shall publish and disseminate to health care provider orga14 nizations the guidelines developed under subsection (a). 

15 (e) AUTHORIZATION OF APPROPRIATIONS.—There 

16 are authorized to be appropriated to carry out this section, 

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

18 2015 through 2019. 

19 SEC. 732. CDC WISEWOMAN SCREENING PROGRAM. 

20 Section 1509 of the Public Health Service Act (42 

21 U.S.C. 300n–4a) is amended— 

22 (1) in subsection (a)— 

23 (A) by striking the heading and inserting 

24 ‘‘IN GENERAL.—’’; and 


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1 (B) in the matter preceding paragraph (1), 

2 by striking ‘‘may make grants’’ and all that fol3 lows through ‘‘purpose’’ and inserting the fol4 lowing: ‘‘may make grants to such States for 

5 the purpose’’; and 

6 (2) in subsection (d)(1), by striking ‘‘there are 

7 authorized’’ and all that follows through the period 

8 and inserting ‘‘there are authorized to be appro9 priated $23,000,000 for fiscal year 2015, 

10 $25,300,000 for fiscal year 2016, $27,800,000 for 

11 fiscal year 2017, $30,800,000 for fiscal year 2018, 

12 and $34,000,000 for fiscal year 2019.’’. 

13 SEC. 733. REPORT ON CARDIOVASCULAR CARE FOR WOMEN 

14 AND MINORITIES. 

15 Part P of title III of the Public Health Service Act 

16 (42 U.S.C. 280g et seq.) is amended by adding at the end 

17 the following: 

18 ‘‘SEC. 399V–6. REPORT ON CARDIOVASCULAR CARE FOR 

19 WOMEN AND MINORITIES. 

20 ‘‘Not later than September 30, 2015, and annually 

21 thereafter, the Secretary shall prepare and submit to the 

22 Congress a report on the quality of and access to care 

23 for women and minorities with heart disease, stroke, and 

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1 ing the treatment of, heart disease, stroke, and other car2 diovascular diseases in women, racial and ethnic minori3 ties, those for whom English is not their primary lan4 guage, and individuals with disabilities.’’. 

5 SEC. 734. COVERAGE OF COMPREHENSIVE TOBACCO CES6 SATION SERVICES IN MEDICAID. 

7 (a) REQUIRING COVERAGE OF COUNSELING AND

8 PHARMACOTHERAPY FOR CESSATION OF TOBACCO

9 USE.—Section 1905 of the Social Security Act (42 U.S.C. 

10 1396d) is amended— 

11 (1) in subsection (a)(4)(D) is amended by strik12 ing ‘‘by pregnant women’’; and 

13 (2) in subsection (bb)— 

14 (A) by striking ‘‘by pregnant women’’ each 

15 place it appears; 

16 (B) in paragraph (1), in the matter before 

17 subparagraph (A), by inserting ‘‘by individuals’’ 

18 before ‘‘who use tobacco’’; and 

19 (C) in paragraph (2)(A), by striking ‘‘with 

20 respect to pregnant women’’. 

21 (b) EXCEPTION FROM OPTIONAL RESTRICTION

22 UNDER MEDICAID PRESCRIPTION DRUG COVERAGE.— 

23 Section 1927(d)(2)(F) of the Social Security Act (42 

24 U.S.C. 1396r–8(d)(2)(F)) is amended by striking ‘‘in the 

25 case of pregnant women’’. 


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1 (c) REMOVAL OF COST SHARING FOR COUNSELING

2 AND PHARMACOTHERAPY FOR CESSATION OF TOBACCO

3 USE.— 

4 (1) GENERAL COST SHARING LIMITATIONS.— 

5 Section 1916 of the Social Security Act (42 U.S.C. 

6 1396o) is amended— 

7 (A) in subsections (a)(2)(B) and (b)(2)(B), 

8 by striking ‘‘and counseling and 

9 pharmacotherapy for cessation of tobacco use 

10 by pregnant women (as defined in section 

11 1905(bb)) and covered outpatient drugs (as de12 fined in subsection (k)(2) of section 1927 and 

13 including nonprescription drugs described in 

14 subsection (d)(2) of such section) that are pre15 scribed for purposes of promoting, and when 

16 used to promote, tobacco cessation by pregnant 

17 women in accordance with the Guideline re18 ferred to in section 1905(bb)(2)(A)’’ each place 

19 it appears; and 

20 (B) in each of subsections (a)(2)(D) and 

21 (b)(2)(D) by inserting ‘‘and counseling and 

22 pharmacotherapy for cessation of tobacco use 

23 (as defined in section 1905(bb)) and covered 

24 outpatient drugs (as defined in subsection 

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1 prescription drugs described in subsection 

2 (d)(2) of such section) that are prescribed for 

3 purposes of promoting, and when used to pro4 mote, tobacco cessation in accordance with the 

5 Guideline referred to in section 

6 1905(bb)(2)(A),’’ after ‘‘section 

7 1905(a)(4)(C),’’. 

8 (2) APPLICATION TO ALTERNATIVE COST SHAR9 ING.—Section 1916A(b)(3)(B) of such Act (42 

10 U.S.C. 1396o–1(b)(3)(B)42 U.S.C. 1396o– 

11 1(b)(3)(B)) is amended— 

12 (A) in clause (iii), by striking ‘‘, and coun13 seling and pharmacotherapy for cessation of to14 bacco use by pregnant women (as defined in 

15 section 1905(bb))’’; and 

16 (B) by adding at the end the following: 

17 ‘‘(xi) Counseling and pharmacothera18 py for cessation of tobacco use (as defined 

19 in section 1905(bb)) and covered out20 patient drugs (as defined in subsection 

21 (k)(2) of section 1927 and including non22 prescription drugs described in subsection 

23 (d)(2) of such section) that are prescribed 

24 for purposes of promoting, and when used 

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1 ance with the Guideline referred to in sec2 tion 1905(bb)(2)(A).’’. 

3 (d) EFFECTIVE DATE.—The amendments made by 

4 this section shall take effect on October 1, 2014. 

5 SEC. 735. CLINICAL RESEARCH FUNDING FOR ORAL 

6 HEALTH. 

7 (a) IN GENERAL.—The Secretary of Health and 

8 Human Services shall expand and intensify the conduct 

9 and support of the research activities of the National In10 stitutes of Health and the National Institute of Dental 

11 and Craniofacial Research to improve the oral health of 

12 the population through the prevention and management 

13 of oral diseases and conditions. 

14 (b) INCLUDED RESEARCH ACTIVITIES.—Research 

15 activities under subsection (a) shall include— 

16 (1) comparative effectiveness research and clin17 ical disease management research addressing early 

18 childhood caries and oral cancer; and 

19 (2) awarding of grants and contracts to support 

20 the training and development of health services re21 searchers, comparative effectiveness researchers, and 

22 clinical researchers whose research improves the oral 

23 health of the population. 


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1 SEC. 736. PARTICIPATION BY MEDICAID BENEFICIARIES IN 

2 APPROVED CLINICAL TRIALS. 

3 (a) IN GENERAL.—Title XIX of the Social Security 

4 Act (42 U.S.C. 1396 et seq.) is amended by inserting after 

5 section 1943 the following new section: 

6 ‘‘SEC. 1944. PARTICIPATION IN AN APPROVED CLINICAL 

7 TRIAL. 

8 ‘‘(a) COVERAGE OF ROUTINE PATIENT COSTS ASSO9 CIATED WITH APPROVED CLINICAL TRIALS.— 

10 ‘‘(1) INCLUSION.—Subject to paragraph (2), 

11 routine patient costs shall include all items and serv12 ices consistent with the medical assistance provided 

13 under the State plan that would otherwise be pro14 vided to the individual under such State plan if such 

15 individual was not enrolled in an approved clinical 

16 trial, including any items or services related to the 

17 prevention, detection, and treatment of any medical 

18 complications that arise as a result of participation 

19 in the approved clinical trial. 

20 ‘‘(2) EXCLUSION.—For purposes of paragraph 

21 (1), routine patient costs does not include— 

22 ‘‘(A) the investigational item, device, or 

23 service itself; 

24 ‘‘(B) items and services that are provided 

25 solely to satisfy data collection and analysis 


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1 needs and that are not used in the direct clin2 ical management of the patient; or 

3 ‘‘(C) a service that is clearly inconsistent 

4 with widely accepted and established standards 

5 of care for a particular diagnosis. 

6 ‘‘(3) INFORMATION CONCERNING CLINICAL

7 TRIALS.— 

8 ‘‘(A) IN GENERAL.—Subject to subpara9 graph (B), the Secretary, in consultation with 

10 relevant stakeholders, shall develop a single 

11 standardized electronic form for use by the indi12 vidual or the referring health care provider to 

13 submit to the State agency administering the 

14 State plan in order to verify that the clinical 

15 trial meets the conditions established for an ap16 proved clinical trial (as defined in subsection 

17 (c)). 

18 ‘‘(B) EXCLUDED INFORMATION.—For pur19 poses of subparagraph (A) or any such request 

20 by the State agency for information regarding 

21 a clinical trial, an individual or referring health 

22 care provider shall not be required to submit— 

23 ‘‘(i) the clinical protocol document for 

24 the clinical trial; or 


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1 ‘‘(ii) subject to subparagraph (C), any 

2 additional information other than such in3 formation as is required pursuant to the 

4 form described in subparagraph (A). 

5 ‘‘(C) OPTIONAL INFORMATION.—For pur6 poses of subparagraphs (A) and (B)(ii), the 

7 form may include a requirement that the refer8 ring health care provider attest that the indi9 vidual is eligible to participate in the clinical 

10 trial pursuant to the trial protocol and that 

11 their participation in such trial would be appro12 priate. 

13 ‘‘(D) REVIEW OF INFORMATION.— 

14 ‘‘(i) IN GENERAL.—A State plan 

15 under this title shall establish a process for 

16 timely review by the State agency of the 

17 form and information submitted pursuant 

18 to subparagraph (A) and, not later than 

19 48 hours after receipt of such form, con20 firmation that the information provided in 

21 such form satisfies the requirements estab22 lished under such subparagraph, with such 

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1 ber and e-mail address to provide for expe2 dited communication. 

3 ‘‘(ii) FAILURE TO RESPOND.—If an 

4 individual or the referring health care pro5 vider does not receive a response or re6 quest for additional information from the 

7 State agency following the 48-hour period 

8 described in clause (i), the information 

9 provided in the form may be presumed to 

10 satisfy the requirements established under 

11 this paragraph. 

12 ‘‘(b) ENCOURAGEMENT OF PARTICIPATION IN AP13 PROVED CLINICAL TRIALS.— 

14 ‘‘(1) REASONABLY ACCESSIBLE PROVIDER.— 

15 For purposes of participation in an approved clinical 

16 trial by an individual eligible for medical assistance 

17 under this title, the State agency administering the 

18 State plan shall make reasonable efforts to ensure 

19 that the individual is provided with access to a pro20 vider who is— 

21 ‘‘(A) participating in the approved clinical 

22 trial; 

23 ‘‘(B) located not more than 25 miles from 

24 the residence of the individual (or, if no such 


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1 provider is available, as close as possible to the 

2 residence of the individual); and 

3 ‘‘(C) a participating provider under the 

4 State plan or has been deemed to be a partici5 pating provider under the State plan for pur6 poses of providing medical assistance to the in7 dividual during their participation in the ap8 proved clinical trial. 

9 ‘‘(2) INFORMATIONAL MATERIALS.—The State 

10 agency administering the plan approved under this 

11 title shall develop informational materials and pro12 grams to encourage participating providers to make 

13 appropriate referrals to physicians and other appro14 priate health care professionals who can provide in15 dividuals with access to approved clinical trials. 

16 ‘‘(c) DEFINITION OF APPROVED CLINICAL TRIAL.— 

17 The term ‘approved clinical trial’ has the same meaning 

18 as provided under section 2709(d) of the Public Health 

19 Service Act.’’. 

20 (b) CONFORMING AMENDMENT.—Section 1902(a) of 

21 such Act (42 U.S.C. 1396a(a)) is amended by inserting 

22 after paragraph (77) the following new paragraph: 

23 ‘‘(78) provide that participation in an approved 

24 clinical trial and coverage of routine patient costs 

25 associated with such trial for an individual eligible 


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1 for medical assistance under this title is conducted 

2 in accordance with the requirements under section 

3 1944;’’. 

4 (c) EFFECTIVE DATE.— 

5 (1) IN GENERAL.—Except as provided in para6 graph (2), the amendments made by this section 

7 shall apply to calendar quarters beginning on or 

8 after October 1, 2014. 

9 (2) DELAY PERMITTED FOR STATE PLAN

10 AMENDMENT.—In the case of a State plan for med11 ical assistance under title XIX of the Social Security 

12 Act which the Secretary of Health and Human Serv13 ices determines requires State legislation (other than 

14 legislation appropriating funds) in order for the plan 

15 to meet the additional requirements imposed by the 

16 amendments made by this section, the State plan 

17 shall not be regarded as failing to comply with the 

18 requirements of such title solely on the basis of its 

19 failure to meet these additional requirements before 

20 the first day of the first calendar quarter beginning 

21 after the close of the first regular session of the 

22 State legislature that begins after the date of enact23 ment of this Act. For purposes of the previous sen24 tence, in the case of a State that has a 2-year legis25 lative session, each year of such session shall be 


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1 deemed to be a separate regular session of the State 

2 legislature. 

3 Subtitle E—HIV/AIDS 

4 SEC. 741. STATEMENT OF POLICY. 

5 It is the policy of the United States to achieve an 

6 AIDS-free generation, and to— 

7 (1) expand access to lifesaving antiretroviral 

8 therapy for people living with HIV/AIDS and imme9 diately link people to continuous and coordinated 

10 high-quality care when they learn they are infected 

11 with HIV; 

12 (2) expand targeted efforts to prevent HIV in13 fection using a combination of effective, evidence14 based approaches, including routine HIV screening, 

15 and universal access to HIV prevention tools in the 

16 communities where HIV/AIDS is most heavily con17 centrated, particularly communities of color; 

18 (3) ensure laws, policies, and regulations do not 

19 impede access to prevention, treatment, and care for 

20 people living with HIV/AIDS or at risk for acquiring 

21 HIV; 

22 (4) accelerate research for more efficacious HIV 

23 prevention and treatments tools, a cure, and a vac24 cine; and 


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1 (5) respect the human rights and dignity of 

2 persons living with HIV/AIDS. 

3 SEC. 742. FINDINGS. 

4 The Congress finds the following: 

5 (1) Over one million people are estimated to be 

6 living with HIV in the United States according to 

7 the Centers for Disease Control and Prevention, 18 

8 percent of whom are unaware of their HIV-positive 

9 status. 

10 (2) Annually there are over 50,000 new HIV in11 fections and 20,000 deaths in people with an HIV 

12 diagnoses in 50 States and 6 dependent areas of the 

13 United States. 

14 (3) The Centers for Disease Control and Pre15 vention estimates that in 2011 there were approxi16 mately 50,199 people newly diagnosed with HIV. 

17 Though this number seems to be staying relatively 

18 stable, the number of new infections is rapidly in19 creasing among certain populations especially among 

20 young African-American men who have sex with men 

21 (MSM) who, in 2010, accounted for 45 percent of 

22 new HIV infections among black MSM and 55 per23 cent of HIV infections among young MSM overall. 

24 (4) HIV disproportionately affects certain popu25 lations in the United States. Though African-AmeriVerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00489 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294

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1 cans represent less than 13 percent of the popu2 lation, African-Americans account for almost half 

3 (44 percent) of all people living with HIV in the 

4 United States. Men who have sex with men (MSM) 

5 make up approximately 4 percent of the population, 

6 but account for 63 percent of all new HIV infections 

7 and are the only risk group in which HIV infections 

8 continue to increase. 

9 (5) Disparities exist among Latinos/Hispanics; 

10 they make up 16 percent of US population and 22 

11 percent of new infections (2011). 

12 (6) Though American Indians/Alaska Natives 

13 represent less than 2 percent of the total number of 

14 HIV/AIDS cases, American Indians and Alaska Na15 tives rank fifth in rates of HIV/AIDS diagnosis, still 

16 higher than their White counterparts. 

17 (7) While Asian-Americans, Native Hawaiians, 

18 and Pacific Islanders HIV/AIDS cases account for 

19 approximately 1 percent of cases nationally, between 

20 2010 and 2011, the rate of new HIV diagnoses in21 creased for Asian-Americans by 22 percent. 

22 (8) The latest data from the CDC (2013) indi23 cate that women account for 1 in 5 (20 percent) new 

24 HIV infections in the United States women of color, 

25 particularly Black women, have been especially hard 


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1 hit and represent the majority of women living with 

2 the disease and women newly infected. In addition, 

3 Black women accounted for nearly two-thirds (64 

4 percent) of all estimated new HIV infections among 

5 women, while only accounting for 13 percent of the 

6 female population; White women accounted for 18 

7 percent and Latinas 15 percent of new infections. 

8 (9) The history of HIV shows that culturally 

9 relevant and gender-responsive supportive services, 

10 including psychosocial support, treatment literacy, 

11 case management, and transportation are necessary 

12 strategies to reach and engage women and girls in 

13 medical care. 

14 (10) The limited data available on transgender 

15 individuals point to a disproportionate burden of 

16 HIV infection. 

17 (11) Stigma and discrimination contribute to 

18 these disparities. 

19 (12) The Centers for Disease Control and Pre20 vention has determined that increasing the propor21 tion of people who know their HIV status is an es22 sential component of comprehensive HIV/AIDS 

23 treatment and prevention efforts and that early di24 agnosis is critical in order for people with HIV/ 

25 AIDS to receive life-extending therapy. Additionally, 


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1 the Centers for Disease Control and Prevention rec2 ommend routine HIV screening in health care set3 tings for all patients aged 13 to 64, regardless of 

4 risk. 

5 (13) In 1998, Congress created the National 

6 Minority AIDS Initiative to provide technical assist7 ance, build capacity, and strengthen outreach efforts 

8 among local institutions and community-based orga9 nizations that serve racial and ethnic minorities liv10 ing with or vulnerable to HIV/AIDS. 

11 (14) To combat the HIV epidemic in the United 

12 States, the National HIV/AIDS Strategy (NHAS) 

13 from the White House Office of National AIDS Pol14 icy provides a framework of increasing access to 

15 care, reducing new infections, and eliminating HIV16 related health disparities. The vision of NHAS is 

17 ‘‘The United States will become a place where new 

18 HIV infections are rare and when they do occur, 

19 every person, regardless of age, gender, race/eth20 nicity, gender identity, or socioeconomic cir21 cumstance, will have unfettered access to high qual22 ity, life-extending care, free from stigma and dis23 crimination.’’. 

24 (15) In recent years, several thousand people 

25 across the country were waiting to receive AIDS 


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1 treatment through the AIDS Drug Assistance Pro2 gram authorized by the provisions popularly known 

3 as the Ryan White CARE Act. 

4 (16) At present, 34 States and 2 United States 

5 territories have criminal statutes based on ‘‘expo6 sure’’ to HIV. Most of these laws were adopted be7 fore the availability of effective antiretroviral treat8 ment for HIV/AIDS. 

9 (17) Although the cost of education, treatment 

10 and care, and research are not inconsequential, they 

11 are substantially less than the annual health care 

12 cost attributable to HIV in the United States. The 

13 lifetime cost of HIV care and treatment in 2004 was 

14 estimated to be $405,000 to $648,000 annually. 

15 Preventing 40,000 new infections in the United 

16 States each year would save $12.8 billion annually. 

17 (18) According to the Centers for Disease Con18 trol and Prevention (CDC), latex condoms, when 

19 used consistently and correctly, are highly effective 

20 in preventing the transmission of HIV. Latex 

21 condoms also reduce the risk of other STIs. Despite 

22 the effectiveness of condoms in reducing the spread 

23 of STIs, the Bureau of Prisons does not recommend 

24 their use in correctional facilities. 


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1 (19) The distribution of condoms in correctional 

2 facilities is currently legal in certain parts of the 

3 United States and the world. The States of Vermont 

4 and Mississippi, the District of Columbia, and the 

5 cities of New York, San Francisco, Los Angeles, 

6 Washington, DC, and Philadelphia allow condom 

7 distribution in their correctional facilities. However, 

8 these States and cities operate fewer than 1 percent 

9 of all correctional facilities. 

10 (20) Many correctional facilities in the United 

11 States do not provide comprehensive testing and 

12 treatment programs to reduce the spread of STIs. 

13 Fewer than half of correctional facilities provide 

14 counseling to HIV-positive incarcerated persons. 

15 (21) Incarcerated individuals living with HIV/ 

16 AIDS who are eligible for Medicaid would benefit 

17 from prompt and automatic enrollment upon their 

18 release in order to ensure their continued ability to 

19 access health services, including antiretroviral treat20 ment. 

21 (22) Research shows that stable housing leads 

22 to better health outcomes for those living with HIV. 

23 Inadequate or unstable housing is not only a barrier 

24 to effective treatment, but also increases the likeli25 hood of engaging in risky behaviors leading to HIV 


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1 infection. Insecure housing puts people with HIV/ 

2 AIDS at risk of premature death from exposure to 

3 other diseases, poor nutrition, and lack of medical 

4 care. 

5 (23) Due to advances in treatment, many peo6 ple living with HIV/AIDS (PLWHA) today are liv7 ing healthy lives and have the ability and desire to 

8 fully participate in all aspects of community life, in9 cluding employment. Research associates being em10 ployed with tremendous economic, social, and health 

11 benefits for many people living with HIV/AIDS. 

12 (24) The common benefits associated with em13 ployment include income, autonomy, productivity, 

14 and status within society, daily structure, making a 

15 contribution to one’s community, and increased skills 

16 and self-esteem. Research also indicates that many 

17 people with disabilities, including PLWHA, report 

18 perceiving themselves as being less disabled or not 

19 disabled at all, when working. Furthermore, some 

20 studies link working with better physical and mental 

21 health outcomes for PLWHA when compared to 

22 those who are not working. Preliminary data also 

23 suggest that transitioning to employment is associ24 ated with reduced HIV-related health risk behavior 

25 for many people. 


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1 (25) On July 16, 2012, the Food and Drug Ad2 ministration approved the first drug to reduce the 

3 risk of HIV infection in uninfected individuals who 

4 are at high risk of HIV infection and who may en5 gage in sexual activity with HIV-infected partners. 

6 SEC. 743. ADDITIONAL FUNDING FOR AIDS DRUG ASSIST7 ANCE PROGRAM TREATMENTS. 

8 Section 2623 of the Public Health Service Act (42 

9 U.S.C. 300ff–31b) is amended by adding at the end the 

10 following: 

11 ‘‘(c) ADDITIONAL FUNDING FOR AIDS DRUG AS12 SISTANCE PROGRAM TREATMENTS.—In addition to 

13 amounts otherwise authorized to be appropriated for car14 rying out this subpart, there are authorized to be appro15 priated such sums as may be necessary to carry out sec16 tions 2612(b)(3)(B) and 2616 for each of fiscal years 

17 2015 through 2017.’’. 

18 SEC. 744. ENHANCING THE NATIONAL HIV SURVEILLANCE 

19 SYSTEM. 

20 (a) GRANTS.—The Secretary of Health and Human 

21 Services, acting through the Director of the Centers for 

22 Disease Control and Prevention, shall make grants to 

23 States to support integration of public health surveillance 

24 systems into all electronic health records in order to allow 


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1 rapid communications between the clinical setting and 

2 health departments, by means that include— 

3 (1) providing technical assistance and policy 

4 guidance to State and local health departments, clin5 ical providers, and other agencies serving individuals 

6 with HIV to improve the interoperability of data sys7 tems relevant to monitoring HIV care and sup8 portive services; 

9 (2) capturing longitudinal data pertaining to 

10 the initiation and ongoing prescription or dispensing 

11 of antiretroviral therapy for individuals diagnosed 

12 with HIV (such as through pharmacy-based report13 ing); 

14 (3) obtaining information— 

15 (A) on a voluntary basis, on sexual orienta16 tion and gender identity; and 

17 (B) on sources of coverage (or the lack 

18 thereof) for medical treatment (including cov19 erage through Medicaid, Medicare, the program 

20 under title XXVI of the Public Health Service 

21 Act (42 U.S.C. 300ff–11 et seq.; commonly re22 ferred to as the ‘‘Ryan White HIV/AIDS Pro23 gram’’), other public funding, private insurance, 

24 and health maintenance organizations); and 


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1 (4) obtaining and using current geographic 

2 markers of residence (such as current address, zip 

3 code, partial zip code, and census block). 

4 (b) PRIVACY AND SECURITY SAFEGUARDS.—In car5 rying out this section, the Secretary of Health and Human 

6 Services shall ensure that appropriate privacy and security 

7 safeguards are met to prevent unauthorized disclosure of 

8 protected health information and compliance with the 

9 HIPAA privacy and security law (as defined in section 

10 3009 of the Public Health Service Act (42 U.S.C. 300jj– 

11 19)) and other relevant laws and regulations. 

12 (c) PROHIBITION AGAINST IMPROPER USE OF

13 DATA.—No grant under this section may be used to allow 

14 or facilitate the collection or use of surveillance or clinical 

15 data or records— 

16 (1) for punitive measures of any kind, civil or 

17 criminal, against the subject of such data or records; 

18 or 

19 (2) for imposing any requirement or restriction 

20 with respect to an individual without the individual’s 

21 written consent. 

22 (d) AUTHORIZATION OF APPROPRIATIONS.—To carry 

23 out this section, there are authorized to be appropriated 

24 such sums as may be necessary for each of fiscal years 

25 2015 through 2019. 


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1 SEC. 745. EVIDENCE-BASED STRATEGIES FOR IMPROVING 

2 LINKAGE TO AND RETENTION IN APPRO3 PRIATE CARE. 

4 (a) STRATEGIES.—The Secretary of Health and 

5 Human Services, in collaboration with the Director of the 

6 Centers for Disease Control and Prevention, the Adminis7 trator of the Substance Abuse and Mental Health Services 

8 Administration, the Director of the Office of AIDS Re9 search, the Administrator of the Health Resources and 

10 Services Administration, and the Administrator of the 

11 Centers for Medicare & Medicaid Services, shall— 

12 (1) identify evidence-based strategies most ef13 fective at addressing the multifaceted issues that im14 pede disease status awareness and linkage to and re15 tention in appropriate care, taking into consideration 

16 health care systems issues, clinic and provider 

17 issues, and individual psychosocial, environmental, 

18 and other contextual factors; 

19 (2) support the wide-scale implementation of 

20 the evidence-based strategies identified pursuant to 

21 paragraph (1), including through incorporating such 

22 strategies into health care coverage supported by the 

23 Medicaid program under title XIX of the Social Se24 curity Act (42 U.S.C. 1396 et seq.), the program 

25 under title XXVI of the Public Health Service Act 

26 (42 U.S.C. 300ff–11 et seq.; commonly referred to 


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1 as the ‘‘Ryan White HIV/AIDS Program’’), and 

2 health plans purchased through an American Health 

3 Benefit Exchange established pursuant to section 

4 1311 of the Patient Protection and Affordable Care 

5 Act (42 U.S.C. 18031); and 

6 (3) not later than 12 months after the date of 

7 the enactment of this Act, submit a report to the 

8 Congress on the status of activities under para9 graphs (1) and (2). 

10 (b) AUTHORIZATION OF APPROPRIATIONS.—To carry 

11 out this section, there are authorized to be appropriated 

12 such sums as may be necessary for fiscal years 2015 

13 through 2019. 

14 SEC. 746. IMPROVING ENTRY INTO AND RETENTION IN 

15 CARE AND ANTIRETROVIRAL ADHERENCE 

16 FOR PERSONS WITH HIV. 

17 (a) SENSE OF CONGRESS.—It is the sense of the Con18 gress that AIDS research has led to scientific advance19 ments that have— 

20 (1) saved the lives of millions of people with 

21 HIV/AIDS; 

22 (2) prevented millions of people from being in23 fected; and 

24 (3) had broad benefits that extend far beyond 

25 helping people at risk for or living with HIV. 


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1 (b) IN GENERAL.—The Secretary of Health and 

2 Human Services, acting through the Director of the Na3 tional Institutes of Health, shall expand, intensify, and co4 ordinate operational and translational research and other 

5 activities of the National Institutes of Health regarding 

6 methods— 

7 (1) to increase adoption of evidence-based ad8 herence strategies within HIV care and treatment 

9 programs; 

10 (2) to increase HIV testing and case detection 

11 rates; 

12 (3) to reduce HIV-related health disparities; 

13 (4) to ensure that research to improve adher14 ence to HIV care and treatment programs address 

15 the unique concerns of women; 

16 (5) to integrate HIV/AIDS prevention and care 

17 services with mental health and substance use pre18 vention and treatment delivery systems; and 

19 (6) to increase knowledge on the implementa20 tion of preexposure prophylaxis (PrEP), including 

21 with respect to— 

22 (A) who can benefit most from PrEP; 

23 (B) how to provide PrEP safely and effi24 ciently; 


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1 (C) how to integrate PrEP with other es2 sential prevention methods such as condoms; 

3 and 

4 (D) how to ensure high levels of adherence. 

5 (c) AUTHORIZATION OF APPROPRIATIONS.—To carry 

6 out this section, there are authorized to be appropriated 

7 such sums as may be necessary for fiscal years 2015 

8 through 2019. 

9 SEC. 747. SERVICES TO REDUCE HIV/AIDS IN RACIAL AND 

10 ETHNIC MINORITY COMMUNITIES. 

11 (a) IN GENERAL.—For the purpose of reducing HIV/ 

12 AIDS in racial and ethnic minority communities, the Sec13 retary, acting through the Deputy Assistant Secretary for 

14 Minority Health, may make grants to public health agen15 cies and faith-based organizations to conduct— 

16 (1) outreach activities related to HIV/AIDS 

17 prevention and testing activities; 

18 (2) HIV/AIDS prevention activities; and 

19 (3) HIV/AIDS testing activities. 

20 (b) AUTHORIZATION OF APPROPRIATIONS.—To carry 

21 out this section, there are authorized to be appropriated 

22 $50,000,000 for fiscal year 2015, and such sums as may 

23 be necessary for fiscal years 2016 through 2019. 


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1 SEC. 748. MINORITY AIDS INITIATIVE. 

2 (a) EXPANDED FUNDING.—The Secretary, in col3 laboration with the Deputy Assistant Secretary for Minor4 ity Health, the Director of the Centers for Disease Control 

5 and Prevention, the Administrator of the Health Re6 sources and Services Administration, and the Adminis7 trator of the Substance Abuse and Mental Health Services 

8 Administration, shall provide funds and carry out activi9 ties to expand the Minority HIV/AIDS Initiative. 

10 (b) USE OF FUNDS.—The additional funds made 

11 available under this section may be used, through the Mi12 nority AIDS Initiative, to support the following activities: 

13 (1) Providing technical assistance and infra14 structure support to reduce HIV/AIDS in minority 

15 populations. 

16 (2) Increasing minority populations’ access to 

17 HIV/AIDS prevention and care services. 

18 (3) Building strong community programs and 

19 partnerships to address HIV prevention and the 

20 health care needs of specific racial and ethnic minor21 ity populations. 

22 (c) PRIORITY INTERVENTIONS.—Within the racial 

23 and ethnic minority populations referred to in subsection 

24 (b), priority in conducting intervention services shall be 

25 given to— 

26 (1) men who have sex with men; 


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1 (2) youth; 

2 (3) persons who engage in intravenous drug 

3 abuse; 

4 (4) women; 

5 (5) homeless individuals; and 

6 (6) individuals incarcerated or in the penal sys7 tem. 

8 (d) AUTHORIZATION OF APPROPRIATIONS.—For car9 rying out this section, there are authorized to be appro10 priated $610,000,0000 for fiscal year 2015 and such sums 

11 as may be necessary for each of fiscal years 2016 through 

12 2019. 

13 SEC. 749. HEALTH CARE PROFESSIONALS TREATING INDI14 VIDUALS WITH HIV/AIDS. 

15 (a) IN GENERAL.—The Secretary of Health and 

16 Human Services, acting through the Administrator of the 

17 Health Resources and Services Administration, shall ex18 pand, intensify, and coordinate workforce initiatives of the 

19 Health Resources and Services Administration to increase 

20 the capacity of the health workforce focusing primarily on 

21 HIV/AIDS to meet the demand for culturally competent 

22 care, and may award grants for any of the following: 

23 (1) Development of curricula for training pri24 mary care providers in HIV/AIDS prevention and 

25 care, including routine HIV testing. 


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1 (2) Support to expand access to culturally and 

2 linguistically accessible benefits counselors, trained 

3 peer navigators, and mental and behavioral health 

4 professionals with expertise in HIV/AIDS. 

5 (3) Training health care professionals to pro6 vide care to individuals with HIV/AIDS. 

7 (4) Development by grant recipients under title 

8 XXVI of the Public Health Service Act (42 U.S.C. 

9 300ff–11 et seq.; commonly referred to as the Ryan 

10 White HIV/AIDS Program) and other persons, of 

11 policies for providing culturally relevant and sen12 sitive treatment to individuals with HIV/AIDS, with 

13 particular emphasis on treatment to racial and eth14 nic minorities, men who have sex with men, and 

15 women, young people, and children with HIV/AIDS. 

16 (5) Development and implementation of pro17 grams to increase the use of telehealth to respond to 

18 HIV/AIDS-specific health care needs in rural and 

19 minority communities, with particular emphasis 

20 given to medically underserved communities and in21 sular areas. 

22 (6) Evaluating interdisciplinary medical pro23 vider care team models that promote high quality 

24 care, with particular emphasis on care to racial and 

25 ethnic minorities. 


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1 (7) Training health care professionals to make 

2 them aware of the high rates of chronic hepatitis B 

3 and chronic hepatitis C in adult racial and ethnic 

4 populations, and the importance of prevention, de5 tection, and medical management of hepatitis B and 

6 hepatitis C and of liver cancer screening. 

7 (b) AUTHORIZATION OF APPROPRIATIONS.—To carry 

8 out this section, there are authorized to be appropriated 

9 such sums as may be necessary for fiscal years 2015 

10 through 2019. 

11 SEC. 750. HIV/AIDS PROVIDER LOAN REPAYMENT PRO12 GRAM. 

13 (a) IN GENERAL.—The Secretary may enter into an 

14 agreement with any physician, nurse practitioner, or phy15 sician assistant under which— 

16 (1) the physician, nurse practitioner, or physi17 cian assistant agrees to serve as a medical provider 

18 for a period of not less than 2 years— 

19 (A) at a Ryan White-funded or title X20 funded facility with a critical shortage of doc21 tors (as determined by the Secretary); or 

22 (B) in an area with a high incidence of 

23 HIV/AIDS; and 

24 (2) the Secretary agrees to make payments in 

25 accordance with subsection (b) on the professional 


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1 education loans of the physician, nurse practitioner, 

2 or physician assistant. 

3 (b) MANNER OF PAYMENTS.—The payments de4 scribed in subsection (a) shall be made by the Secretary 

5 as follows: 

6 (1) Upon completion by the physician, nurse 

7 practitioner, or physician assistant for whom the 

8 payments are to be made of the first year of the 

9 service specified in the agreement entered into with 

10 the Secretary under subsection (a), the Secretary 

11 shall pay 30 percent of the principal of and the in12 terest on the individual’s professional education 

13 loans. 

14 (2) Upon completion by the physician, nurse 

15 practitioner, or physician assistant of the second 

16 year of such service, the Secretary shall pay another 

17 30 percent of the principal of and the interest on 

18 such loans. 

19 (3) Upon completion by that individual of a 

20 third year of such service, the Secretary shall pay 

21 another 25 percent of the principal of and the inter22 est on such loans. 

23 (c) APPLICABILITY OF CERTAIN PROVISIONS.—The 

24 provisions of subpart III of part D of title III of the Public 

25 Health Service Act (42 U.S.C. 254l et seq.) shall, except 


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1 as inconsistent with this section, apply to the program car2 ried out under this section in the same manner and to 

3 the same extent as such provisions apply to the National 

4 Health Service Corps Loan Repayment Program. 

5 (d) REPORTS.—Not later than 18 months after the 

6 date of the enactment of this Act, and annually thereafter, 

7 the Secretary shall prepare and submit to the Congress 

8 a report describing the program carried out under this sec9 tion, including statements regarding the following: 

10 (1) The number of physicians, nurse practi11 tioners, and physician assistants enrolled in the pro12 gram. 

13 (2) The number and amount of loan repay14 ments. 

15 (3) The placement location of loan repayment 

16 recipients at facilities described in subsection (a)(1). 

17 (4) The default rate and actions required. 

18 (5) The amount of outstanding default funds. 

19 (6) To the extent that it can be determined, the 

20 reason for the default. 

21 (7) The demographics of individuals partici22 pating in the program. 

23 (8) An evaluation of the overall costs and bene24 fits of the program. 

25 (e) DEFINITIONS.—In this section: 


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1 (1) The term ‘‘HIV/AIDS’’ means human im2 munodeficiency virus and acquired immune defi3 ciency syndrome. 

4 (2) The term ‘‘nurse practitioner’’ means a reg5 istered nurse who has completed an accredited grad6 uate degree program in advanced nurse practice and 

7 has successfully passed a national certification exam. 

8 (3) The term ‘‘physician’’ means a graduate of 

9 a school of medicine who has completed post10 graduate training in general or pediatric medicine. 

11 (4) The term ‘‘physician assistant’’ means a 

12 medical provider who completed an accredited physi13 cian assistant training program and successfully 

14 passed the Physician Assistant National Certifying 

15 Examination. 

16 (5) The term ‘‘professional education loan’’— 

17 (A) means a loan that is incurred for the 

18 cost of attendance (including tuition, other rea19 sonable educational expenses, and reasonable 

20 living costs) at a school of medicine, nursing, or 

21 physician assistant training program; and 

22 (B) includes only the portion of the loan 

23 that is outstanding on the date the physician, 

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1 volved begins the service specified in the agree2 ment under subsection (a). 

3 (6) The term ‘‘Ryan White-funded’’ means, 

4 with respect to a facility, receiving funds under title 

5 XXVI of the Public Health Service Act (42 U.S.C. 

6 300ff–11 et seq.). 

7 (7) The term ‘‘Secretary’’ means the Secretary 

8 of Health and Human Services. 

9 (8) The term ‘‘school of medicine’’ has the 

10 meaning given to that term in section 799B of the 

11 Public Health Service Act (42 U.S.C. 295p). 

12 (9) The term ‘‘title X-funded’’ means, with re13 spect to a facility, receiving funds under title X of 

14 the Public Health Service Act (42 U.S.C. 300 et 

15 seq.). 

16 (f) AUTHORIZATION OF APPROPRIATIONS.—To carry 

17 out this section, there are authorized to be appropriated 

18 such sums as may be necessary for fiscal years 2015 

19 through 2019. 

20 SEC. 751. DENTAL EDUCATION LOAN REPAYMENT PRO21 GRAM. 

22 (a) IN GENERAL.—The Secretary of Health and 

23 Human Services may enter into an agreement with any 

24 dentist under which— 


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1 (1) the dentist agrees to serve as a dentist for 

2 a period of not less than 2 years at a facility with 

3 a critical shortage of dentists (as determined by the 

4 Secretary) in an area with a high incidence of HIV/ 

5 AIDS; and 

6 (2) the Secretary agrees to make payments in 

7 accordance with subsection (b) on the dental edu8 cation loans of the dentist. 

9 (b) MANNER OF PAYMENTS.—The payments de10 scribed in subsection (a) shall be made by the Secretary 

11 as follows: 

12 (1) Upon completion by the dentist for whom 

13 the payments are to be made of the first year of the 

14 service specified in the agreement entered into with 

15 the Secretary under subsection (a), the Secretary 

16 shall pay 30 percent of the principal of and the in17 terest on the dental education loans of the dentist. 

18 (2) Upon completion by the dentist of the sec19 ond year of such service, the Secretary shall pay an20 other 30 percent of the principal of and the interest 

21 on such loans. 

22 (3) Upon completion by that individual of a 

23 third year of such service, the Secretary shall pay 

24 another 25 percent of the principal of and the inter25 est on such loans. 


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1 (c) APPLICABILITY OF CERTAIN PROVISIONS.—The 

2 provisions of subpart III of part D of title III of the Public 

3 Health Service Act (42 U.S.C. 254l et seq.) shall, except 

4 as inconsistent with this section, apply to the program car5 ried out under this section in the same manner and to 

6 the same extent as such provisions apply to the National 

7 Health Service Corps Loan Repayment Program. 

8 (d) REPORTS.—Not later than 18 months after the 

9 date of the enactment of this Act, and annually thereafter, 

10 the Secretary shall prepare and submit to the Congress 

11 a report describing the program carried out under this sec12 tion, including statements regarding the following: 

13 (1) The number of dentists enrolled in the pro14 gram. 

15 (2) The number and amount of loan repay16 ments. 

17 (3) The placement location of loan repayment 

18 recipients at facilities described in subsection (a)(1). 

19 (4) The default rate and actions required. 

20 (5) The amount of outstanding default funds. 

21 (6) To the extent that it can be determined, the 

22 reason for the default. 

23 (7) The demographics of individuals partici24 pating in the program. 


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1 (8) An evaluation of the overall costs and bene2 fits of the program. 

3 (e) DEFINITIONS.—In this section: 

4 (1) The term ‘‘dental education loan’’— 

5 (A) means a loan that is incurred for the 

6 cost of attendance (including tuition, other rea7 sonable educational expenses, and reasonable 

8 living costs) at a school of dentistry; and 

9 (B) includes only the portion of the loan 

10 that is outstanding on the date the dentist in11 volved begins the service specified in the agree12 ment under subsection (a). 

13 (2) The term ‘‘dentist’’ means a graduate of a 

14 school of dentistry who has completed postgraduate 

15 training in general or pediatric dentistry. 

16 (3) The term ‘‘HIV/AIDS’’ means human im17 munodeficiency virus and acquired immune defi18 ciency syndrome. 

19 (4) The term ‘‘school of dentistry’’ has the 

20 meaning given to that term in section 799B of the 

21 Public Health Service Act (42 U.S.C. 295p). 

22 (5) The term ‘‘Secretary’’ means the Secretary 

23 of Health and Human Services. 

24 (f) AUTHORIZATION OF APPROPRIATIONS.—To carry 

25 out this section, there are authorized to be appropriated 


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1 such sums as may be necessary for each of fiscal years 

2 2015 through 2019. 

3 SEC. 752. REDUCING NEW HIV INFECTIONS AMONG INJECT4 ING DRUG USERS. 

5 (a) SENSE OF CONGRESS.—It is the sense of the Con6 gress that providing sterile syringes and sterilized equip7 ment to injecting drug users substantially reduces risk of 

8 HIV infection, increases the probability that they will ini9 tiate drug treatment, and does not increase drug use. 

10 (b) IN GENERAL.—The Secretary of Health and 

11 Human Services may provide grants and technical assist12 ance for the purpose of reducing the rate of HIV infections 

13 among injecting drug users through a comprehensive 

14 package of services for such users, including the provision 

15 of sterile syringes, education and outreach, access to infec16 tious disease testing, overdose prevention, and treatment 

17 for drug dependence. 

18 (c) AUTHORIZATION OF APPROPRIATIONS.—To carry 

19 out this section, there are authorized to be appropriated 

20 such sums as may be necessary for fiscal years 2015 

21 through 2019. 


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1 SEC. 753. SUPPORT FOR EXPANSION OF COMPREHENSIVE 

2 SEXUAL HEALTH AND EDUCATION PRO3 GRAMS. 

4 (a) SENSE OF CONGRESS.—It is the sense of Con5 gress that— 

6 (1) federally funded sex education programs 

7 should aim to— 

8 (A) reduce unintended pregnancy and sex9 ually transmitted infections, including HIV; 

10 (B) promote safe and healthy relation11 ships; 

12 (C) use, and be informed by, the best sci13 entific information available; 

14 (D) be built on characteristics of effective 

15 programs; 

16 (E) expand the existing body of evidence 

17 on comprehensive sex education programs 

18 through program evaluation; 

19 (F) expand training programs for teachers 

20 of comprehensive sex education; 

21 (G) build on the personal responsibility 

22 education programs funded under section 513 

23 of the Social Security Act (42 U.S.C. 713) and 

24 the President’s Teen Pregnancy Prevention pro25 gram, funded under title II of the Consolidated 


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1 Appropriations Act, 2010 (Public Law 111– 

2 117; 123 Stat. 3253); and 

3 (H) promote and uphold the rights of 

4 young people to information in order to make 

5 healthy and responsible decisions about their 

6 sexual health; and 

7 (2) no Federal funds should be used for health 

8 education programs that— 

9 (A) deliberately withhold life-saving infor10 mation about HIV; 

11 (B) are medically inaccurate or have been 

12 scientifically shown to be ineffective; 

13 (C) promote gender stereotypes; 

14 (D) are insensitive and unresponsive to the 

15 needs of sexually active adolescents; 

16 (E) are insensitive and unresponsive to the 

17 needs of lesbian, gay, bisexual, or transgender 

18 youth; or 

19 (F) are inconsistent with the ethical im20 peratives of medicine and public health. 

21 (b) GRANTS FOR COMPREHENSIVE SEX EDUCATION

22 FOR ADOLESCENTS.— 

23 (1) PROGRAM AUTHORIZED.—The Secretary, in 

24 coordination with the Director of the Office of Ado25 lescent Health, shall award grants, on a competitive 


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1 basis, to eligible entities to enable such eligible enti2 ties to carry out programs that provide adolescents 

3 with comprehensive sex education, as described in 

4 paragraph (6). 

5 (2) DURATION.—Grants awarded under this 

6 subsection shall be for a period of 5 years. 

7 (3) ELIGIBLE ENTITY.—In this subsection, the 

8 term ‘‘eligible entity’’ means a public or private enti9 ty that focuses on adolescent health or education or 

10 has experience working with adolescents, which may 

11 include— 

12 (A) a State educational agency; 

13 (B) a local educational agency; 

14 (C) a tribe or tribal organization, as de15 fined in section 4 of the Indian Self-Determina16 tion and Education Assistance Act (25 U.S.C. 

17 450b); 

18 (D) a State or local department of health; 

19 (E) a State or local department of edu20 cation; 

21 (F) a nonprofit organization; 

22 (G) a nonprofit or public institution of 

23 higher education; or 

24 (H) a hospital. 


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1 (4) APPLICATIONS.—An eligible entity desiring 

2 a grant under this subsection shall submit an appli3 cation to the Secretary at such time, in such man4 ner, and containing such information as the Sec5 retary may require, including the evaluation plan de6 scribed in paragraph (7)(A). 

7 (5) PRIORITY.—In awarding grants under this 

8 subsection, the Secretary shall give priority to eligi9 ble entities that— 

10 (A) are State or local public entities, with 

11 an additional priority for State or local edu12 cational agencies; and 

13 (B) address health disparities among 

14 young people that are at highest risk for not 

15 less than 1 of the following: 

16 (i) Unintended pregnancies. 

17 (ii) Sexually transmitted infections, 

18 including HIV. 

19 (iii) Dating violence and sexual as20 sault. 

21 (6) USE OF FUNDS.— 

22 (A) IN GENERAL.—Each eligible entity 

23 that receives a grant under this subsection shall 

24 use grant funds to carry out a program that 


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1 provides adolescents with comprehensive sex 

2 education that— 

3 (i) replicates evidence-based sex edu4 cation programs; 

5 (ii) substantially incorporates ele6 ments of evidence-based sex education pro7 grams; or 

8 (iii) creates a demonstration project 

9 based on generally accepted characteristics 

10 of effective sex education programs. 

11 (B) CONTENTS OF SEX EDUCATION PRO12 GRAMS.—The sex education programs funded 

13 under this subsection shall include curricula 

14 and program materials that address— 

15 (i) abstinence and delaying sexual ini16 tiation; 

17 (ii) the health benefits and side effects 

18 of all contraceptive and barrier methods as 

19 a means to prevent pregnancy and sexually 

20 transmitted infections, including HIV; 

21 (iii) healthy relationships, including 

22 the development of healthy attitudes and 

23 skills necessary for understanding— 


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1 (I) healthy relationships between 

2 oneself and family, others, and soci3 ety; and 

4 (II) the prevention of sexual 

5 abuse, teen dating violence, bullying, 

6 harassment, and suicide; 

7 (iv) healthy life skills including goal8 setting, decisionmaking, interpersonal skills 

9 (such as communication, assertiveness, and 

10 peer refusal skills), critical thinking, self11 esteem and self-efficacy, and stress man12 agement; 

13 (v) how to make responsible decisions 

14 about sex and sexuality, including— 

15 (I) how to avoid, and how to 

16 avoid making, unwanted verbal, phys17 ical, and sexual advances; and 

18 (II) how alcohol and drug use 

19 can affect responsible decisionmaking; 

20 (vi) the development of healthy atti21 tudes and values about such topics as ado22 lescent growth and development, body 

23 image, gender roles and gender identity, 

24 racial and ethnic diversity, and sexual ori25 entation; and 


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1 (vii) referral services for local health 

2 clinics and services where adolescents can 

3 obtain additional information and services 

4 related to sexual and reproductive health, 

5 dating violence and sexual assault, and sui6 cide prevention. 

7 (7) EVALUATION; REPORT.— 

8 (A) INDEPENDENT EVALUATION.—Each 

9 eligible entity applying for a grant under this 

10 subsection shall develop and submit to the Sec11 retary a plan for a rigorous independent evalua12 tion of such grant program. The plan shall de13 scribe an independent evaluation that— 

14 (i) uses sound statistical methods and 

15 techniques relating to the behavioral 

16 sciences, including random assignment 

17 methodologies, whenever possible; 

18 (ii) uses quantitative data for assess19 ments and impact evaluations, whenever 

20 possible; and 

21 (iii) is carried out by an entity inde22 pendent from such eligible entity. 

23 (B) SELECTION OF EVALUATED PRO24 GRAMS; BUDGET.— 


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1 (i) SELECTION OF EVALUATED PRO2 GRAMS.—The Secretary shall select, at 

3 random, a subset of the eligible entities 

4 that the Secretary has selected to receive a 

5 grant under this subsection to receive addi6 tional funding to carry out the evaluation 

7 plan described in subparagraph (A). 

8 (ii) BUDGET FOR EVALUATION ACTIVI9 TIES.—The Secretary, in coordination with 

10 the Director of the Office of Adolescent 

11 Health, shall establish a budget for each 

12 eligible entity selected under clause (i) for 

13 the costs of carrying out the evaluation 

14 plan described in subparagraph (A). 

15 (C) FUNDS FOR EVALUATION.—The Sec16 retary shall provide eligible entities who are se17 lected under subparagraph (B)(i) with addi18 tional funds, in accordance with the budget de19 scribed in subparagraph (B)(ii), to carry out 

20 and report to the Secretary on the evaluation 

21 plan described in subparagraph (A). 

22 (D) PERFORMANCE MEASURES.—The Sec23 retary, in coordination with the Director of the 

24 Centers for Disease Control and Prevention, 

25 shall establish a common set of performance 


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1 measures to assess the implementation and im2 pact of grant programs funded under this sub3 section. Such performance measures shall in4 clude— 

5 (i) output measures, such as the num6 ber of individuals served and the number 

7 of hours of service delivery; 

8 (ii) outcome measures, including 

9 measures relating to— 

10 (I) the knowledge that youth par11 ticipating in the grant program have 

12 gained about— 

13 (aa) adolescent growth and 

14 development; 

15 (bb) relationship dynamics; 

16 (cc) ways to prevent unin17 tended pregnancy and sexually 

18 transmitted infections, including 

19 HIV; and 

20 (dd) sexual health; 

21 (II) the skills that adolescents 

22 participating in the grant program 

23 have gained regarding— 

24 (aa) negotiation and commu25 nication; 


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1 (bb) decisionmaking and 

2 goal-setting; 

3 (cc) interpersonal skills and 

4 healthy relationships; and 

5 (dd) condom use; and 

6 (III) the behaviors of adolescents 

7 participating in the grant program, 

8 including data about— 

9 (aa) age of first intercourse; 

10 (bb) number of sexual part11 ners; 

12 (cc) condom and contracep13 tive use at first intercourse; 

14 (dd) recent condom and con15 traceptive use; and 

16 (ee) dating abuse and life17 time history of domestic violence, 

18 sexual assault, dating violence, 

19 bullying, harassment, and stalk20 ing. 

21 (E) REPORT TO THE SECRETARY.—Eligi22 ble entities receiving a grant under this sub23 section who have been selected to receive funds 

24 to carry out the evaluation plan described in 

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1 graph (B)(i), shall collect and report to the Sec2 retary— 

3 (i) the results of the independent eval4 uation described in subparagraph (A); and 

5 (ii) information about the perform6 ance measures described in subparagraph 

7 (B). 

8 (F) EFFECTIVE PROGRAMS.—The Sec9 retary, in coordination with the Director of the 

10 Centers for Disease Control and Prevention, 

11 shall publish on the Web site of the Centers for 

12 Disease Control and Prevention, a list of pro13 grams funded under this subsection that the 

14 Secretary has determined to be effective pro15 grams. 

16 (c) GRANTS FOR COMPREHENSIVE SEX EDUCATION

17 AT INSTITUTIONS OF HIGHER EDUCATION.— 

18 (1) PROGRAM AUTHORIZED.—The Secretary, in 

19 coordination with the Office of Adolescent Health 

20 and the Secretary of Education, shall award grants, 

21 on a competitive basis, to institutions of higher edu22 cation to enable such institutions to provide young 

23 people with comprehensive sex education, described 

24 in paragraph (5)(B), with an emphasis on reducing 


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1 HIV, other sexually transmitted infections, and un2 intended pregnancy through instruction about— 

3 (A) abstinence and contraception; 

4 (B) reducing dating violence, sexual as5 sault, bullying, and harassment; 

6 (C) increasing healthy relationships; and 

7 (D) academic achievement. 

8 (2) DURATION.—Grants awarded under this 

9 subsection shall be for a period of 5 years. 

10 (3) APPLICATIONS.—An institution of higher 

11 education desiring a grant under this subsection 

12 shall submit an application to the Secretary at such 

13 time, in such manner, and containing such informa14 tion as the Secretary may require. 

15 (4) PRIORITY.—In awarding grants under this 

16 subsection, the Secretary shall give priority to an in17 stitution of higher education that— 

18 (A) has an enrollment of needy students as 

19 defined in section 318(b) of the Higher Edu20 cation Act of 1965 (20 U.S.C. 1059e(b)); 

21 (B) is a Hispanic-serving institution, as 

22 defined in section 502(a) of such Act (20 

23 U.S.C. 1101a(a)); 


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1 (C) is a Tribal College or University, as 

2 defined in section 316(b) of such Act (20 

3 U.S.C. 1059c(b)); 

4 (D) is an Alaska Native-serving institution, 

5 as defined in section 317(b) of such Act (20 

6 U.S.C. 1059d(b)); 

7 (E) is a Native Hawaiian-serving institu8 tion, as defined in section 317(b) of such Act 

9 (20 U.S.C. 1059d(b)); 

10 (F) is a Predominately Black Institution, 

11 as defined in section 318(b) of such Act (20 

12 U.S.C. 1059e(b)); 

13 (G) is a Native American-serving, non14 tribal institution, as defined in section 319(b) 

15 of such Act (20 U.S.C. 1059f(b)); 

16 (H) is an Asian American and Native 

17 American Pacific Islander-serving institution, as 

18 defined in section 320(b) of such Act (20 

19 U.S.C. 1059g(b)); or 

20 (I) is a minority institution, as defined in 

21 section 365 of such Act (20 U.S.C. 1067k), 

22 with an enrollment of needy students, as de23 fined in section 312 of such Act (20 U.S.C. 

24 1058). 

25 (5) USES OF FUNDS.— 


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1 (A) IN GENERAL.—An institution of higher 

2 education receiving a grant under this sub3 section may use grant funds to integrate issues 

4 relating to comprehensive sex education into the 

5 academic or support sectors of the institution of 

6 higher education in order to reach a large num7 ber of students, by carrying out 1 or more of 

8 the following activities: 

9 (i) Developing educational content for 

10 issues relating to comprehensive sex edu11 cation that will be incorporated into first12 year orientation or core courses. 

13 (ii) Developing and employing 

14 schoolwide educational programming out15 side of class that delivers elements of com16 prehensive sex education programs to stu17 dents, faculty, and staff. 

18 (iii) Creating innovative technology19 based approaches to deliver sex education 

20 to students, faculty, and staff. 

21 (iv) Developing and employing peer22 outreach and education programs to gen23 erate discussion, educate, and raise aware24 ness among students about issues relating 

25 to comprehensive sex education. 


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1 (B) CONTENTS OF SEX EDUCATION PRO2 GRAMS.—Each institution of higher education’s 

3 program of comprehensive sex education funded 

4 under this subsection shall include curricula 

5 and program materials that address informa6 tion about— 

7 (i) safe and responsible sexual behav8 ior with respect to the prevention of preg9 nancy and sexually transmitted infections, 

10 including HIV, including through— 

11 (I) abstinence; 

12 (II) a reduced number of sexual 

13 partners; and 

14 (III) the use of condoms and con15 traception; 

16 (ii) healthy relationships, including 

17 the development of healthy attitudes and 

18 insights necessary for understanding— 

19 (I) relationships between oneself, 

20 family, partners, others, and society; 

21 and 

22 (II) the prevention of sexual 

23 abuse, dating violence, bullying, har24 assment, and suicide; and 


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1 (iii) referral services to local health 

2 clinics where young people can obtain addi3 tional information and services related to 

4 sexual and reproductive health, dating vio5 lence and sexual assault, and suicide pre6 vention. 

7 (C) OPTIONAL COMPONENTS OF SEX EDU8 CATION.—Each institution of higher education’s 

9 program of comprehensive sex education may 

10 also include information and skills development 

11 relating to— 

12 (i) how to make responsible decisions 

13 about sex and sexuality, including— 

14 (I) how to avoid, and avoid mak15 ing, unwanted verbal, physical, and 

16 sexual advances; and 

17 (II) how alcohol and drug use 

18 can affect responsible decisionmaking; 

19 (ii) healthy life skills, including— 

20 (I) goal-setting and decision21 making; 

22 (II) interpersonal skills, such as 

23 communication, assertiveness, and 

24 peer refusal skills; 

25 (III) critical thinking; 


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1 (IV) self-esteem and self-efficacy; 

2 and 

3 (V) stress management; 

4 (iii) the development of healthy atti5 tudes and values about such topics as body 

6 image, gender roles and gender identity, 

7 racial and ethnic diversity, and sexual ori8 entation; and 

9 (iv) the responsibilities of parenting 

10 and the skills necessary to parent well. 

11 (6) EVALUATION; REPORT.—The requirements 

12 described in section 125B(g) shall also apply to eligi13 ble entities receiving a grant under this subsection 

14 in the same manner as such requirements apply to 

15 eligible entities receiving grants under section 125B. 

16 (d) GRANTS FOR PRE-SERVICE AND IN-SERVICE

17 TEACHER TRAINING.— 

18 (1) PROGRAM AUTHORIZED.—The Secretary, in 

19 coordination with the Director of the Centers for 

20 Disease Control and Prevention and the Secretary of 

21 Education, shall award grants, on a competitive 

22 basis, to eligible entities to enable such eligible enti23 ties to carry out the activities described in para24 graph (5). 


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1 (2) DURATION.—Grants awarded under this 

2 subsection shall be for a period of 5 years. 

3 (3) ELIGIBLE ENTITY.—In this subsection, the 

4 term ‘‘eligible entity’’ means— 

5 (A) a State educational agency; 

6 (B) a local educational agency; 

7 (C) a tribe or tribal organization, as de8 fined in section 4 of the Indian Self-Determina9 tion and Education Assistance Act (25 U.S.C. 

10 450b); 

11 (D) a State or local department of health; 

12 (E) a State or local department of edu13 cation; 

14 (F) a nonprofit institution of higher edu15 cation; 

16 (G) a national or statewide nonprofit orga17 nization that has as its primary purpose the im18 provement of provision of comprehensive sex 

19 education through effective teaching of com20 prehensive sex education; or 

21 (H) a consortium of nonprofit organiza22 tions that has as its primary purpose the im23 provement of provision of comprehensive sex 

24 education through effective teaching of com25 prehensive sex education. 


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1 (4) APPLICATION.—An eligible entity desiring a 

2 grant under this subsection shall submit an applica3 tion to the Secretary at such time, in such manner, 

4 and containing such information as the Secretary 

5 may require. 

6 (5) AUTHORIZED ACTIVITIES.— 

7 (A) REQUIRED ACTIVITY.—Each eligible 

8 entity receiving a grant under this subsection 

9 shall use grant funds to train targeted faculty 

10 and staff, in order to increase effective teaching 

11 of comprehensive sex education for elementary 

12 school and secondary school students. 

13 (B) PERMISSIBLE ACTIVITIES.—Each eligi14 ble entity receiving a grant under this sub15 section may use grant funds to— 

16 (i) strengthen and expand the eligible 

17 entity’s relationships with— 

18 (I) institutions of higher edu19 cation; 

20 (II) State educational agencies; 

21 (III) local educational agencies; 

22 or 

23 (IV) other public and private or24 ganizations with a commitment to 

25 comprehensive sex education and the 


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1 benefits of comprehensive sex edu2 cation; 

3 (ii) support and promote research4 based training of teachers of comprehen5 sive sex education and related disciplines 

6 in elementary schools and secondary 

7 schools as a means of broadening student 

8 knowledge about issues related to human 

9 development, relationships, personal skills, 

10 sexual behavior, sexual health, and society 

11 and culture; 

12 (iii) support the dissemination of in13 formation on effective practices and re14 search findings concerning the teaching of 

15 comprehensive sex education; 

16 (iv) support research on— 

17 (I) effective comprehensive sex 

18 education teaching practices; and 

19 (II) the development of assess20 ment instruments and strategies to 

21 document— 

22 (aa) student understanding 

23 of comprehensive sex education; 

24 and 


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1 (bb) the effects of com2 prehensive sex education; 

3 (v) convene national conferences on 

4 comprehensive sex education, in order to 

5 effectively train teachers in the provision of 

6 comprehensive sex education; and 

7 (vi) develop and disseminate appro8 priate research-based materials to foster 

9 comprehensive sex education. 

10 (C) SUBGRANTS.—Each eligible entity re11 ceiving a grant under this subsection may 

12 award subgrants to nonprofit organizations, 

13 State educational agencies, or local educational 

14 agencies to enable such organizations or agen15 cies to— 

16 (i) train teachers in comprehensive 

17 sex education; 

18 (ii) support Internet or distance learn19 ing related to comprehensive sex education; 

20 (iii) promote rigorous academic stand21 ards and assessment techniques to guide 

22 and measure student performance in com23 prehensive sex education; 


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1 (iv) encourage replication of best 

2 practices and model programs to promote 

3 comprehensive sex education; 

4 (v) develop and disseminate effective, 

5 research-based comprehensive sex edu6 cation learning materials; 

7 (vi) develop academic courses on the 

8 pedagogy of sex education at institutions 

9 of higher education; or 

10 (vii) convene State-based conferences 

11 to train teachers in comprehensive sex edu12 cation and to identify strategies for im13 provement. 

14 (e) REPORT TO CONGRESS.— 

15 (1) IN GENERAL.—Not later than 1 year after 

16 the date of the enactment of this Act, and annually 

17 thereafter for a period of 5 years, the Secretary shall 

18 prepare and submit to the appropriate committees of 

19 Congress a report on the activities to provide adoles20 cents and young people with comprehensive sex edu21 cation funded under this section. 

22 (2) REPORT ELEMENTS.—The report described 

23 in paragraph (1) shall include information about— 


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1 (A) the number of eligible entities and in2 stitutions of higher education that are receiving 

3 grant funds under subsections (b) and (c); 

4 (B) the specific activities supported by 

5 grant funds awarded under subsections (b) and 

6 (c); 

7 (C) the number of adolescents served by 

8 grant programs funded under subsection (b); 

9 (D) the number of young people served by 

10 grant programs funded under subsection (c); 

11 and 

12 (E) the status of program evaluations de13 scribed under subsections (b) and (c). 

14 (f) LIMITATION.—No Federal funds provided under 

15 this section may be used for health education programs 

16 that— 

17 (1) deliberately withhold life-saving information 

18 about HIV; 

19 (2) are medically inaccurate or have been sci20 entifically shown to be ineffective; 

21 (3) promote gender stereotypes; 

22 (4) are insensitive and unresponsive to the 

23 needs of sexually active youth or lesbian, gay, bisex24 ual, or transgender youth; or 


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1 (5) are inconsistent with the ethical imperatives 

2 of medicine and public health. 

3 (g) DEFINITIONS.—In this section: 

4 (1) ESEA DEFINITIONS.—The terms ‘‘elemen5 tary school’’, ‘‘local educational agency’’, ‘‘secondary 

6 school’’, and ‘‘State educational agency’’ have the 

7 meanings given the terms in section 9101 of the Ele8 mentary and Secondary Education Act of 1965 (20 

9 U.S.C. 7801). 

10 (2) AGE AND DEVELOPMENTALLY APPRO11 PRIATE.—The term ‘‘age and developmentally appro12 priate’’ means suitable for a particular age or age 

13 group of children and adolescents, based on devel14 oping cognitive, emotional, and behavioral capacity 

15 typical for that age or age group. 

16 (3) ADOLESCENTS.—The term ‘‘adolescents’’ 

17 means individuals who are ages 10 through 19 at 

18 the time of commencement of participation in a pro19 gram supported under this section. 

20 (4) CHARACTERISTICS OF EFFECTIVE PRO21 GRAMS.—The term ‘‘characteristics of effective pro22 grams’’ means the aspects of evidence-based pro23 grams, including development, content, and imple24 mentation of such programs, that— 


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1 (A) have been shown to be effective in 

2 terms of increasing knowledge, clarifying values 

3 and attitudes, increasing skills, and impacting 

4 upon behavior; and 

5 (B) are widely recognized by leading med6 ical and public health agencies to be effective in 

7 changing sexual behaviors that lead to sexually 

8 transmitted infections, including HIV, unin9 tended pregnancy, and dating violence and sex10 ual assault among young people. 

11 (5) COMPREHENSIVE SEX EDUCATION.—The 

12 term ‘‘comprehensive sex education’’ means a pro13 gram that— 

14 (A) includes age- and developmentally ap15 propriate, culturally and linguistically relevant 

16 information on a broad set of topics related to 

17 sexuality including human development, rela18 tionships, decisionmaking, communication, ab19 stinence, contraception, and disease and preg20 nancy prevention; 

21 (B) provides students with opportunities 

22 for developing skills as well as learning informa23 tion; 


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1 (C) is inclusive of lesbian, gay, bisexual, 

2 transgender, and heterosexual young people; 

3 and 

4 (D) aims to— 

5 (i) provide scientifically accurate and 

6 realistic information about human sexu7 ality; 

8 (ii) provide opportunities for individ9 uals to understand their own, their fami10 lies’, and their communities’ values, atti11 tudes, and insights about sexuality; 

12 (iii) help individuals develop healthy 

13 relationships and interpersonal skills; and 

14 (iv) help individuals exercise responsi15 bility regarding sexual relationships, which 

16 includes addressing abstinence, pressures 

17 to become prematurely involved in sexual 

18 intercourse, and the use of contraception 

19 and other sexual health measures. 

20 (6) EVIDENCE-BASED PROGRAM.—The term 

21 ‘‘evidence-based program’’ means a sex education 

22 program that has been proven through rigorous eval23 uation to be effective in changing sexual behavior or 

24 incorporates elements of other sex education proVerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00540 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294

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1 grams that have been proven to be effective in 

2 changing sexual behavior. 

3 (7) INSTITUTION OF HIGHER EDUCATION.—The 

4 term ‘‘institution of higher education’’ has the 

5 meaning given the term in section 101 of the Higher 

6 Education Act of 1965 (20 U.S.C. 1001). 

7 (8) MEDICALLY ACCURATE AND COMPLETE.— 

8 The term ‘‘medically accurate and complete’’, when 

9 used with respect to a sex education program, means 

10 that— 

11 (A) the information provided through the 

12 program is verified or supported by the weight 

13 of research conducted in compliance with ac14 cepted scientific methods and is published in 

15 peer-reviewed journals, where applicable; or 

16 (B)(i) the program contains information 

17 that leading professional organizations and 

18 agencies with relevant expertise in the field rec19 ognize as accurate, objective, and complete; and 

20 (ii) the program does not withhold infor21 mation about the effectiveness and benefits of 

22 correct and consistent use of condoms and 

23 other contraceptives. 

24 (9) SECRETARY.—The term ‘‘Secretary’’ means 

25 the Secretary of Health and Human Services. 


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1 (10) YOUNG PEOPLE.—The term ‘‘young peo2 ple’’ means individuals who are ages 10 through 24 

3 at the time of commencement of participation in a 

4 program supported under this section. 

5 (h) AUTHORIZATION OF APPROPRIATIONS.—To carry 

6 out this section, there are authorized to be appropriated 

7 such sums as may be necessary for fiscal years 2015 

8 through 2019. 

9 SEC. 754. ELIMINATION OF ABSTINENCE-ONLY EDUCATION 

10 PROGRAM. 

11 (a) IN GENERAL.—Title V of the Social Security Act 

12 (42 U.S.C. 701 et seq.) is amended by striking section 

13 510. 

14 (b) RESCISSION.—Amounts appropriated for fiscal 

15 years 2013 and 2014 under section 510(d) of the Social 

16 Security Act (42 U.S.C. 710(d)) (as in effect on the day 

17 before the date of enactment of this Act) that are unobli18 gated as of the date of enactment of this Act are re19 scinded. 

20 (c) REPROGRAM OF ELIMINATED ABSTINENCE-ONLY

21 FUNDS FOR THE PERSONAL RESPONSIBILITY EDUCATION

22 PROGRAM (PREP).—Section 513(f) of the Social Security 

23 Act (42 U.S.C. 713(f)) is amended by striking 

24 ‘‘$75,000,000 for each of fiscal years 2011 through 2015’’ 

25 and inserting ‘‘$75,000,000 for each of fiscal years 2011 


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1 through 2014, an amount for fiscal year 2015 equal to 

2 $75,000,000 increased by an amount equal to the unobli3 gated portion of funds appropriated for fiscal year 2014 

4 and 2015 under section 510(d) that are rescinded by sec5 tion 754(b) of the Health Equity and Accountability Act 

6 of 2014, and $125,000,000 for each of fiscal years 2016 

7 and 2017’’. 

8 SEC. 755. REPORT ON IMPACT OF HIV/AIDS IN VULNERABLE 

9 POPULATIONS. 

10 (a) IN GENERAL.—The Secretary shall submit to the 

11 Congress and the President an annual report on the im12 pact of HIV/AIDS for racial and ethnic minority commu13 nities, women, and youth aged 24 and younger. 

14 (b) CONTENTS.—The report under subsection (a) 

15 shall include information on the— 

16 (1) progress that has been made in reducing 

17 the impact of HIV/AIDS in such communities; 

18 (2) opportunities that exist to make additional 

19 progress in reducing the impact of HIV/AIDS in 

20 such communities; 

21 (3) challenges that may impede such additional 

22 progress; and 

23 (4) Federal funding necessary to achieve sub24 stantial reductions in HIV/AIDS in racial and ethnic 

25 minority communities. 


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1 SEC. 756. NATIONAL HIV/AIDS OBSERVANCE DAYS. 

2 (a) NATIONAL OBSERVANCE DAYS.—It is the sense 

3 of the Congress that national observance days highlighting 

4 the impact of HIV/AIDS on communities of color include 

5 the following: 

6 (1) National Black HIV/AIDS Awareness Day. 

7 (2) National Latino AIDS Awareness Day. 

8 (3) National Asian and Pacific Islander HIV/ 

9 AIDS Awareness Day. 

10 (4) National Native American HIV/AIDS 

11 Awareness Day. 

12 (5) Caribbean-American HIV/AIDS Awareness 

13 Day. 

14 (6) National Youth HIV/AIDS Awareness Day. 

15 (7) National Black Clergy HIV/AIDS Aware16 ness Sunday. 

17 (b) CALL TO ACTION.—It is the sense of the Con18 gress that the President should call on members of com19 munities of color— 

20 (1) to become involved at the local community 

21 level in HIV/AIDS testing, policy, and advocacy; 

22 (2) to become aware, engaged, and empowered 

23 on the HIV/AIDS epidemic within their commu24 nities; and 

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1 tive measures, be tested for HIV/AIDS, and seek 

2 care when appropriate. 

3 SEC. 757. REVIEW OF ALL FEDERAL AND STATE LAWS, 

4 POLICIES, AND REGULATIONS REGARDING 

5 THE CRIMINAL PROSECUTION OF INDIVID6 UALS FOR HIV-RELATED OFFENSES. 

7 (a) DEFINITIONS.— 

8 (1) HIV AND HIV/AIDS.—The terms ‘‘HIV’’ and 

9 ‘‘HIV/AIDS’’ have the meanings given to such terms 

10 in section 2689 of the Public Health Service Act (42 

11 U.S.C. 300ff–88). 

12 (2) STATE.—The term ‘‘State’’ includes the 

13 District of Columbia, American Samoa, the Com14 monwealth of the Northern Mariana Islands, Guam, 

15 Puerto Rico, and the United States Virgin Islands. 

16 (b) SENSE OF CONGRESS REGARDING LAWS OR REG17 ULATIONS DIRECTED AT PEOPLE LIVING WITH HIV/ 

18 AIDS.—It is the sense of the Congress that Federal and 

19 State laws, policies, and regulations regarding people liv20 ing with HIV/AIDS— 

21 (1) should not place unique or additional bur22 dens on such individuals solely as a result of their 

23 HIV status; and 


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1 (2) should instead demonstrate a public health2 oriented, evidence-based, medically accurate, and 

3 contemporary understanding of— 

4 (A) the multiple factors that lead to HIV 

5 transmission; 

6 (B) the relative risk of HIV transmission 

7 routes; 

8 (C) the current health implications of liv9 ing with HIV; 

10 (D) the associated benefits of treatment 

11 and support services for people living with HIV; 

12 and 

13 (E) the impact of punitive HIV-specific 

14 laws and policies on public health, on people liv15 ing with or affected by HIV, and on their fami16 lies and communities. 

17 (c) REVIEW OF ALL FEDERAL AND STATE LAWS, 

18 POLICIES, AND REGULATIONS REGARDING THE CRIMINAL

19 PROSECUTION OF INDIVIDUALS FOR HIV-RELATED OF20 FENSES.— 

21 (1) REVIEW OF FEDERAL AND STATE LAWS.— 

22 (A) IN GENERAL.—No later than 90 days 

23 after the date of the enactment of this Act, the 

24 Attorney General, the Secretary of Health and 

25 Human Services, and the Secretary of Defense 


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1 acting jointly (in this paragraph and paragraph 

2 (2) referred to as the ‘‘designated officials’’) 

3 shall initiate a national review of Federal and 

4 State laws, policies, regulations, and judicial 

5 precedents and decisions regarding criminal and 

6 related civil commitment cases involving people 

7 living with HIV/AIDS, including in regards to 

8 the Uniform Code of Military Justice. 

9 (B) CONSULTATION.—In carrying out the 

10 review under subparagraph (A), the designated 

11 officials shall ensure diverse participation and 

12 consultation from each State, including with— 

13 (i) State attorneys general (or their 

14 representatives); 

15 (ii) State public health officials (or 

16 their representatives); 

17 (iii) State judicial and court system 

18 officers, including judges, district attor19 neys, prosecutors, defense attorneys, law 

20 enforcement, and correctional officers; 

21 (iv) members of the United States 

22 Armed Forces, including members of other 

23 Federal services subject to the Uniform 

24 Code of Military Justice; 


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1 (v) people living with HIV/AIDS, par2 ticularly those who have been subject to 

3 HIV-related prosecution or who are from 

4 communities whose members have been 

5 disproportionately subject to HIV-specific 

6 arrests and prosecutions; 

7 (vi) legal advocacy and HIV/AIDS 

8 service organizations that work with people 

9 living with HIV/AIDS; 

10 (vii) nongovernmental health organi11 zations that work on behalf of people living 

12 with HIV/AIDS; and 

13 (viii) trade organizations or associa14 tions representing persons or entities de15 scribed in clauses (i) through (vii). 

16 (C) RELATION TO OTHER REVIEWS.—In 

17 carrying out the review under subparagraph 

18 (A), the designated officials may utilize other 

19 existing reviews of criminal and related civil 

20 commitment cases involving people living with 

21 HIV/AIDS, including any such review con22 ducted by any Federal or State agency or any 

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1 cordance with the principles set forth in sub2 section (b). 

3 (2) REPORT.—No later than 180 days after ini4 tiating the review required by paragraph (1), the At5 torney General shall transmit to the Congress and 

6 make publicly available a report containing the re7 sults of the review, which includes the following: 

8 (A) For each State and for the Uniform 

9 Code of Military Justice, a summary of the rel10 evant laws, policies, regulations, and judicial 

11 precedents and decisions regarding criminal 

12 cases involving people living with HIV/AIDS, 

13 including, if applicable, the following: 

14 (i) A determination of whether such 

15 laws, policies, regulations, and judicial 

16 precedents and decisions place any unique 

17 or additional burdens upon people living 

18 with HIV/AIDS. 

19 (ii) A determination of whether such 

20 laws, policies, regulations, and judicial 

21 precedents and decisions demonstrate a 

22 public health-oriented, evidence-based, 

23 medically accurate, and contemporary un24 derstanding of— 


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1 (I) the multiple factors that lead 

2 to HIV transmission; 

3 (II) the relative risk of HIV 

4 transmission routes; 

5 (III) the current health implica6 tions of living with HIV; 

7 (IV) the associated benefits of 

8 treatment and support services for 

9 people living with HIV; and 

10 (V) the impact of punitive HIV11 specific laws and policies on public 

12 health, on people living with or af13 fected by HIV, and on their families 

14 and communities. 

15 (iii) An analysis of the public health 

16 and legal implications of such laws, poli17 cies, regulations, and judicial precedents, 

18 including an analysis of the consequences 

19 of having a similar penal scheme applied to 

20 comparable situations involving other com21 municable diseases. 

22 (iv) An analysis of the proportionality 

23 of punishments imposed under HIV-spe24 cific laws, policies, regulations, and judicial 

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1 alties attached to violation of State laws 

2 against similar degrees of endangerment or 

3 harm, such as driving while intoxicated 

4 (DWI) or transmission of other commu5 nicable diseases, or more serious harms, 

6 such as vehicular manslaughter offenses. 

7 (B) An analysis of common elements 

8 shared among State laws, policies, regulations, 

9 and judicial precedents. 

10 (C) A set of best practice recommendations 

11 directed to State governments, including State 

12 attorneys general, public health officials, and 

13 judicial officers, in order to ensure that laws, 

14 policies, regulations, and judicial precedents re15 garding people living with HIV/AIDS are in ac16 cordance with the principles set forth in sub17 section (b). 

18 (D) Recommendations for adjustments to 

19 the Uniform Code of Military Justice, as may 

20 be necessary, in order to ensure that laws, poli21 cies, regulations, and judicial precedents re22 garding people living with HIV/AIDS are in ac23 cordance with the principles set forth in sub24 section (b). 


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1 (3) GUIDANCE.—Within 90 days of the release 

2 of the report required by paragraph (2), the Attor3 ney General and the Secretary of Health and 

4 Human Services, acting jointly, shall develop and 

5 publicly release updated guidance for States based 

6 on the set of best practice recommendations required 

7 by paragraph (2)(C) in order to assist States dealing 

8 with criminal and related civil commitment cases re9 garding people living with HIV/AIDS. 

10 (4) MONITORING AND EVALUATION SYSTEM.— 

11 Within 60 days of the release of the guidance re12 quired by paragraph (3), the Attorney General and 

13 the Secretary of Health and Human Services, acting 

14 jointly, shall establish an integrated monitoring and 

15 evaluation system which includes, where appropriate, 

16 objective and quantifiable performance goals and in17 dicators to measure progress toward statewide im18 plementation in each State of the best practice rec19 ommendations required in paragraph (2)(C), includ20 ing to monitor, track, and evaluate the effectiveness 

21 of assistance provided pursuant to subsection (d). 

22 (5) ADJUSTMENTS TO FEDERAL LAWS, POLI23 CIES, OR REGULATIONS.—Within 90 days of the re24 lease of the report required by paragraph (2), the 

25 Attorney General, the Secretary of Health and 


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1 Human Services, and the Secretary of Defense, act2 ing jointly, shall develop and transmit to the Presi3 dent and the Congress, and make publicly available, 

4 such proposals as may be necessary to implement 

5 adjustments to Federal laws, policies, or regulations, 

6 including to the Uniform Code of Military Justice, 

7 based on the recommendations required by para8 graph (2)(D), either through Executive order or 

9 through changes to statutory law. 

10 (6) AUTHORIZATION OF APPROPRIATIONS.— 

11 (A) IN GENERAL.—There are authorized to 

12 be appropriated such sums as may be necessary 

13 for the purpose of carrying out this subsection. 

14 Amounts authorized to be appropriated by the 

15 preceding sentence are in addition to amounts 

16 otherwise authorized to be appropriated for 

17 such purpose. 

18 (B) AVAILABILITY OF FUNDS.—Amounts 

19 appropriated pursuant to the authorization of 

20 appropriations in subparagraph (A) are author21 ized to remain available until expended. 

22 (d) AUTHORIZATION TO PROVIDE GRANTS.— 

23 (1) GRANTS BY ATTORNEY GENERAL.— 

24 (A) IN GENERAL.—The Attorney General 

25 may provide assistance to eligible State and 


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1 local entities and eligible nongovernmental orga2 nizations for the purpose of incorporating the 

3 best practice recommendations developed under 

4 subsection (c)(2)(C) within relevant State laws, 

5 policies, regulations, and judicial decisions re6 garding people living with HIV/AIDS. 

7 (B) AUTHORIZED ACTIVITIES.—The assist8 ance authorized by subparagraph (A) may in9 clude— 

10 (i) direct technical assistance to eligi11 ble State and local entities in order to de12 velop, disseminate, or implement State 

13 laws, policies, regulations, or judicial deci14 sions that conform with the best practice 

15 recommendations developed under sub16 section (c)(2)(C); 

17 (ii) direct technical assistance to eligi18 ble nongovernmental organizations in order 

19 to provide education and training, includ20 ing through classes, conferences, meetings, 

21 and other educational activities, to eligible 

22 State and local entities; and 

23 (iii) subcontracting authority to allow 

24 eligible State and local entities and eligible 

25 nongovernmental organizations to seek 


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1 technical assistance from legal and public 

2 health experts with a demonstrated under3 standing of the principles underlying the 

4 best practice recommendations developed 

5 under subsection (c)(2)(C). 

6 (2) GRANTS BY SECRETARY OF HEALTH AND

7 HUMAN SERVICES.— 

8 (A) IN GENERAL.—The Secretary of 

9 Health and Human Services, acting through the 

10 Director of the Centers for Disease Control and 

11 Prevention, may provide assistance to State and 

12 local public health departments and eligible 

13 nongovernmental organizations for the purpose 

14 of supporting eligible State and local entities to 

15 incorporate the best practice recommendations 

16 developed under subsection (c)(2)(C) within rel17 evant State laws, policies, regulations, and judi18 cial decisions regarding people living with HIV/ 

19 AIDS. 

20 (B) AUTHORIZED ACTIVITIES.—The assist21 ance authorized by subparagraph (A) may in22 clude— 

23 (i) direct technical assistance to State 

24 and local public health departments in 

25 order to support the development, dissemiVerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00555 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294

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1 nation, or implementation of State laws, 

2 policies, regulations, or judicial decisions 

3 that conform with the set of best practice 

4 recommendations developed under sub5 section (c)(2)(C); 

6 (ii) direct technical assistance to eligi7 ble nongovernmental organizations in order 

8 to provide education and training, includ9 ing through classes, conferences, meetings, 

10 and other educational activities, to State 

11 and local public health departments; and 

12 (iii) subcontracting authority to allow 

13 State and local public health departments 

14 and eligible nongovernmental organizations 

15 to seek technical assistance from legal and 

16 public health experts with a demonstrated 

17 understanding of the principles underlying 

18 the best practice recommendations devel19 oped under subsection (c)(2)(C). 

20 (3) LIMITATION.—As a condition of receiving 

21 assistance through this subsection, eligible State and 

22 local entities, State and local public health depart23 ments, and eligible nongovernmental organizations 

24 shall agree— 


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1 (A) not to place any unique or additional 

2 burdens on people living with HIV/AIDS solely 

3 as a result of their HIV status; and 

4 (B) that if the entity, department, or orga5 nization promulgates any laws, policies, regula6 tions, or judicial decisions regarding people liv7 ing with HIV/AIDS, such actions shall dem8 onstrate a public health-oriented, evidence9 based, medically accurate, and contemporary 

10 understanding of— 

11 (i) the multiple factors that lead to 

12 HIV transmission; 

13 (ii) the relative risk of HIV trans14 mission routes; 

15 (iii) the current health implications of 

16 living with HIV; 

17 (iv) the associated benefits of treat18 ment and support services for people living 

19 with HIV; and 

20 (v) the impact of punitive HIV-spe21 cific laws and policies on public health, on 

22 people living with or affected by HIV, and 

23 on their families and communities. 

24 (4) REPORT.—No later than 1 year after the 

25 date of the enactment of this Act, and annually 


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1 thereafter, the Attorney General and the Secretary 

2 of Health and Human Services, acting jointly, shall 

3 transmit to Congress and make publicly available a 

4 report describing, for each State, the impact and ef5 fectiveness of the assistance provided through this 

6 Act. Each such report shall include— 

7 (A) a detailed description of the progress 

8 each State has made, if any, in implementing 

9 the best practice recommendations developed 

10 under subsection (c)(2)(C) as a result of the as11 sistance provided under this subsection, and 

12 based on the performance goals and indicators 

13 established as part of the monitoring and eval14 uation system in subsection (c)(4); 

15 (B) a brief summary of any outreach ef16 forts undertaken during the prior year by the 

17 Attorney General and the Secretary of Health 

18 and Human Services to encourage States to 

19 seek assistance under this subsection in order 

20 to implement the best practice recommenda21 tions developed under subsection (c)(2)(C); 

22 (C) a summary of how assistance provided 

23 through this subsection is being utilized by eli24 gible State and local entities, State and local 

25 public health departments, and eligible nonVerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00558 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294

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1 governmental organizations and, if applicable, 

2 any contractors, including with respect to non3 governmental organizations, the type of tech4 nical assistance provided, and an evaluation of 

5 the impact of such assistance on eligible State 

6 and local entities; and 

7 (D) a summary and description of eligible 

8 State and local entities, State and local public 

9 health departments, and eligible nongovern10 mental organizations receiving assistance 

11 through this subsection, including if applicable, 

12 a summary and description of any contractors 

13 selected to assist in implementing such assist14 ance. 

15 (5) DEFINITIONS.—For the purposes of this 

16 subsection: 

17 (A) ELIGIBLE STATE AND LOCAL ENTI18 TIES.—The term ‘‘eligible State and local enti19 ties’’ means the relevant individuals, offices, or 

20 organizations that directly participate in the de21 velopment, dissemination, or implementation of 

22 State laws, policies, regulations, or judicial deci23 sions, including— 

24 (i) State governments, including State 

25 attorneys general, State departments of 


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1 justice, and State National Guards, or 

2 their equivalents; 

3 (ii) State judicial and court systems, 

4 including trial courts, appellate courts, 

5 State supreme courts and courts of appeal, 

6 and State correctional facilities, or their 

7 equivalents; and 

8 (iii) local governments, including city 

9 and county governments, district attorneys, 

10 and local law enforcement departments, or 

11 their equivalents. 

12 (B) STATE AND LOCAL PUBLIC HEALTH

13 DEPARTMENTS.—The term ‘‘State and local 

14 public health departments’’ means the fol15 lowing: 

16 (i) State public health departments, or 

17 their equivalents, including the chief officer 

18 of such departments and infectious disease 

19 and communicable disease specialists with20 in such departments. 

21 (ii) Local public health departments, 

22 or their equivalents, including city and 

23 county public health departments, the chief 

24 officer of such departments, and infectious 


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1 disease and communicable disease special2 ists within such departments. 

3 (iii) Public health departments or offi4 cials, or their equivalents, within State or 

5 local correctional facilities. 

6 (iv) Public health departments or offi7 cials, or their equivalents, within State Na8 tional Guards. 

9 (v) Any other recognized State or 

10 local public health organization or entity 

11 charged with carrying out official State or 

12 local public health duties. 

13 (C) ELIGIBLE NONGOVERNMENTAL ORGA14 NIZATIONS.—The term ‘‘eligible nongovern15 mental organizations’’ means the following: 

16 (i) Nongovernmental organizations, 

17 including trade organizations or associa18 tions that represent— 

19 (I) State attorneys general, or 

20 their equivalents; 

21 (II) State public health officials, 

22 or their equivalents; 

23 (III) State judicial and court offi24 cers, including judges, district attor25 neys, prosecutors, defense attorneys, 


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1 law enforcement, and correctional offi2 cers; 

3 (IV) State National Guards; 

4 (V) people living with HIV/AIDS; 

5 (VI) legal advocacy and HIV/ 

6 AIDS service organizations that work 

7 with people living with HIV/AIDS; 

8 and 

9 (VII) nongovernmental health or10 ganizations that work on behalf of 

11 people living with HIV/AIDS. 

12 (ii) Nongovernmental organizations, 

13 including trade organizations or associa14 tions that demonstrate a public-health ori15 ented, evidence-based, medically accurate, 

16 and contemporary understanding of— 

17 (I) the multiple factors that lead 

18 to HIV transmission; 

19 (II) the relative risk of HIV 

20 transmission routes; 

21 (III) the current health implica22 tions of living with HIV; 

23 (IV) the associated benefits of 

24 treatment and support services for 

25 people living with HIV; and 


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1 (V) the impact of punitive HIV2 specific laws and policies on public 

3 health, on people living with or af4 fected by HIV, and on their families 

5 and communities. 

6 (6) AUTHORIZATION OF APPROPRIATIONS.— 

7 (A) IN GENERAL.—In addition to amounts 

8 otherwise made available, there are authorized 

9 to be appropriated to the Attorney General and 

10 the Secretary of Health and Human Services 

11 such sums as may be necessary to carry out 

12 this subsection for each of the fiscal years 2015 

13 through 2019. 

14 (B) AVAILABILITY OF FUNDS.—Amounts 

15 appropriated pursuant to the authorizations of 

16 appropriations in subparagraph (A) are author17 ized to remain available until expended. 

18 SEC. 758. REPEAL OF LIMITATION AGAINST USE OF FUNDS 

19 FOR EDUCATION OR INFORMATION DE20 SIGNED TO PROMOTE OR ENCOURAGE, DI21 RECTLY, HOMOSEXUAL OR HETEROSEXUAL 

22 ACTIVITY OR INTRAVENOUS SUBSTANCE 

23 ABUSE. 

24 Section 2500 of the Public Health Service Act (42 

25 U.S.C. 300ee) is amended— 


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1 (1) by striking subsection (c); and 

2 (2) by redesignating subsection (d) as sub3 section (c). 

4 SEC. 759. EXPANDING SUPPORT FOR CONDOMS IN PRIS5 ONS. 

6 (a) AUTHORITY TO ALLOW COMMUNITY ORGANIZA7 TIONS TO PROVIDE STI COUNSELING, STI PREVENTION

8 EDUCATION, AND SEXUAL BARRIER PROTECTION DE9 VICES IN FEDERAL CORRECTIONAL FACILITIES.— 

10 (1) DIRECTIVE TO ATTORNEY GENERAL.—Not 

11 later than 30 days after the date of enactment of 

12 this Act, the Attorney General shall direct the Bu13 reau of Prisons to allow community organizations to 

14 distribute sexual barrier protection devices and to 

15 engage in STI counseling and STI prevention edu16 cation in Federal correctional facilities. These activi17 ties shall be subject to all relevant Federal laws and 

18 regulations which govern visitation in correctional 

19 facilities. 

20 (2) INFORMATION REQUIREMENT.—Any com21 munity organization permitted to distribute sexual 

22 barrier protection devices under paragraph (1) shall 

23 ensure that the persons to whom the devices are dis24 tributed are informed about the proper use and dis25 posal of sexual barrier protection devices in accordVerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00564 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294

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1 ance with established public health practices. Any 

2 community organization conducting STI counseling 

3 or STI prevention education under paragraph (1) 

4 shall offer comprehensive sexuality education. 

5 (3) POSSESSION OF DEVICE PROTECTED.—No 

6 Federal correctional facility may, because of the pos7 session or use of a sexual barrier protection device— 

8 (A) take adverse action against an incar9 cerated person; or 

10 (B) consider possession or use as evidence 

11 of prohibited activity for the purpose of any 

12 Federal correctional facility administrative pro13 ceeding. 

14 (4) IMPLEMENTATION.—The Attorney General 

15 and Bureau of Prisons shall implement this section 

16 according to established public health practices in a 

17 manner that protects the health, safety, and privacy 

18 of incarcerated persons and of correctional facility 

19 staff. 

20 (b) SENSE OF CONGRESS REGARDING DISTRIBUTION

21 OF SEXUAL BARRIER PROTECTION DEVICES IN STATE

22 PRISON SYSTEMS.—It is the sense of the Congress that 

23 States should allow for the legal distribution of sexual bar24 rier protection devices in State correctional facilities to re25 duce the prevalence and spread of STIs in those facilities. 


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1 (c) SURVEY OF AND REPORT ON CORRECTIONAL FA2 CILITY PROGRAMS AIMED AT REDUCING THE SPREAD OF

3 STIS.— 

4 (1) SURVEY.—The Attorney General, after con5 sulting with the Secretary of Health and Human 

6 Services, State officials, and community organiza7 tions, shall, to the maximum extent practicable, con8 duct a survey of all Federal and State correctional 

9 facilities, not later than 180 days after the date of 

10 enactment of this Act and annually thereafter for 5 

11 years, to determine the following: 

12 (A) COUNSELING, TREATMENT, AND SUP13 PORTIVE SERVICES.—Whether the correctional 

14 facility requires incarcerated persons to partici15 pate in counseling, treatment, and supportive 

16 services related to STIs, or whether it offers 

17 such programs to incarcerated persons. 

18 (B) ACCESS TO SEXUAL BARRIER PROTEC19 TION DEVICES.—Whether incarcerated persons 

20 can— 

21 (i) possess sexual barrier protection 

22 devices; 

23 (ii) purchase sexual barrier protection 

24 devices; 


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1 (iii) purchase sexual barrier protection 

2 devices at a reduced cost; and 

3 (iv) obtain sexual barrier protection 

4 devices without cost. 

5 (C) INCIDENCE OF SEXUAL VIOLENCE.— 

6 The incidence of sexual violence and assault 

7 committed by incarcerated persons and by cor8 rectional facility staff. 

9 (D) PREVENTION EDUCATION OFFERED.— 

10 The type of prevention education, information, 

11 or training offered to incarcerated persons and 

12 correctional facility staff regarding sexual vio13 lence and the spread of STIs, including whether 

14 such education, information, or training— 

15 (i) constitutes comprehensive sexuality 

16 education; 

17 (ii) is compulsory for new incarcerated 

18 persons and for new staff; and 

19 (iii) is offered on an ongoing basis. 

20 (E) STI TESTING.—Whether the correc21 tional facility tests incarcerated persons for 

22 STIs or gives them the option to undergo such 

23 testing— 

24 (i) at intake; 

25 (ii) on a regular basis; and 


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1 (iii) prior to release. 

2 (F) STI TEST RESULTS.—The number of 

3 incarcerated persons who are tested for STIs 

4 and the outcome of such tests at each correc5 tional facility, disaggregated to include results 

6 for— 

7 (i) the type of sexually transmitted in8 fection tested for; 

9 (ii) the race and/or ethnicity of indi10 viduals tested; 

11 (iii) the age of individuals tested; and 

12 (iv) the gender of individuals tested. 

13 (G) PRERELEASE REFERRAL POLICY.— 

14 Whether incarcerated persons are informed 

15 prior to release about STI-related services or 

16 other health services in their communities, in17 cluding free and low-cost counseling and treat18 ment options. 

19 (H) PRERELEASE REFERRALS MADE.— 

20 The number of referrals to community-based 

21 organizations or public health facilities offering 

22 STI-related or other health services provided to 

23 incarcerated persons prior to release, and the 

24 type of counseling or treatment for which the 

25 referral was made. 


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1 (I) REINSTATEMENT OF MEDICAID BENE2 FITS.—Whether the correctional facility assists 

3 incarcerated persons that were enrolled in the 

4 State Medicaid program prior to their incarcer5 ation, in reinstating their enrollment upon re6 lease and whether such individuals receive refer7 rals as provided by subparagraph (G) to entities 

8 that accept the State Medicaid program, includ9 ing if applicable— 

10 (i) the number of such individuals, in11 cluding those diagnosed with the human 

12 immunodeficiency virus, that have been re13 instated; 

14 (ii) a list of obstacles to reinstating 

15 enrollment or to making determinations of 

16 eligibility for reinstatement, if any; and 

17 (iii) the number of individuals denied 

18 enrollment. 

19 (J) OTHER ACTIONS TAKEN.—Whether the 

20 correctional facility has taken any other action, 

21 in conjunction with community organizations or 

22 otherwise, to reduce the prevalence and spread 

23 of STIs in that facility. 

24 (2) PRIVACY.—In conducting the survey, the 

25 Attorney General shall not request or retain the 


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1 identity of any person who has sought or been of2 fered counseling, treatment, testing, or prevention 

3 education information regarding an STI (including 

4 information about sexual barrier protection devices), 

5 or who has tested positive for an STI. 

6 (3) REPORT.—The Attorney General shall 

7 transmit to Congress and make publicly available 

8 the results of the survey required under paragraph 

9 (1), both for the Nation as a whole and 

10 disaggregated as to each State and each correctional 

11 facility. To the maximum extent possible, the Attor12 ney General shall issue the first report no later than 

13 1 year after the date of enactment of this Act and 

14 shall issue reports annually thereafter for 5 years. 

15 (d) STRATEGY.— 

16 (1) DIRECTIVE TO ATTORNEY GENERAL.—The 

17 Attorney General, in consultation with the Secretary 

18 of Health and Human Services, State officials, and 

19 community organizations, shall develop and imple20 ment a 5-year strategy to reduce the prevalence and 

21 spread of STIs in Federal and State correctional fa22 cilities. To the maximum extent possible, the strat23 egy shall be developed, transmitted to Congress, and 

24 made publicly available no later than 180 days after 


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1 the transmission of the first report required under 

2 subsection (c)(3). 

3 (2) CONTENTS OF STRATEGY.—The strategy 

4 shall include the following: 

5 (A) PREVENTION EDUCATION.—A plan for 

6 improving prevention education, information, 

7 and training offered to incarcerated persons 

8 and correctional facility staff, including infor9 mation and training on sexual violence and the 

10 spread of STIs, and comprehensive sexuality 

11 education. 

12 (B) SEXUAL BARRIER PROTECTION DEVICE

13 ACCESS.—A plan for expanding access to sexual 

14 barrier protection devices in correctional facili15 ties. 

16 (C) SEXUAL VIOLENCE REDUCTION.—A 

17 plan for reducing the incidence of sexual vio18 lence among incarcerated persons and correc19 tional facility staff, developed in consultation 

20 with the National Prison Rape Elimination 

21 Commission. 

22 (D) COUNSELING AND SUPPORTIVE SERV23 ICES.—A plan for expanding access to coun24 seling and supportive services related to STIs in 

25 correctional facilities. 


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1 (E) TESTING.—A plan for testing incarcer2 ated persons for STIs during intake, during 

3 regular health exams, and prior to release, and 

4 that— 

5 (i) is conducted in accordance with 

6 guidelines established by the Centers for 

7 Disease Control and Prevention; 

8 (ii) includes pretest counseling; 

9 (iii) requires that incarcerated persons 

10 are notified of their option to decline test11 ing at any time; 

12 (iv) requires that incarcerated persons 

13 are confidentially notified of their test re14 sults in a timely manner; and 

15 (v) ensures that incarcerated persons 

16 testing positive for STIs receive post-test 

17 counseling, care, treatment, and supportive 

18 services. 

19 (F) TREATMENT.—A plan for ensuring 

20 that correctional facilities have the necessary 

21 medicine and equipment to treat and monitor 

22 STIs and for ensuring that incarcerated per23 sons living with or testing positive for STIs re24 ceive and have access to care and treatment 

25 services. 


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1 (G) STRATEGIES FOR DEMOGRAPHIC

2 GROUPS.—A plan for developing and imple3 menting culturally appropriate, sensitive, and 

4 specific strategies to reduce the spread of STIs 

5 among demographic groups heavily impacted by 

6 STIs. 

7 (H) LINKAGES WITH COMMUNITIES AND

8 FACILITIES.—A plan for establishing and 

9 strengthening linkages to local communities and 

10 health facilities that— 

11 (i) provide counseling, testing, care, 

12 and treatment services; 

13 (ii) may receive persons recently re14 leased from incarceration who are living 

15 with STIs; and 

16 (iii) accept payment through the State 

17 Medicaid program. 

18 (I) ENROLLMENT IN STATE MEDICAID

19 PROGRAMS.—Plans to ensure that incarcerated 

20 persons who were— 

21 (i) enrolled in their State Medicaid 

22 program prior to incarceration in a correc23 tional facility are automatically re-enrolled 

24 in such program upon their release; and 


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1 (ii) not enrolled in their State Med2 icaid program prior to incarceration, but 

3 who are diagnosed with the human im4 munodeficiency virus while incarcerated in 

5 a correctional facility, are automatically 

6 enrolled in such program upon their re7 lease. 

8 (J) OTHER PLANS.—Any other plans de9 veloped by the Attorney General for reducing 

10 the spread of STIs or improving the quality of 

11 health care in correctional facilities. 

12 (K) MONITORING SYSTEM.—A monitoring 

13 system that establishes performance goals re14 lated to reducing the prevalence and spread of 

15 STIs in correctional facilities and which, where 

16 feasible, expresses such goals in quantifiable 

17 form. 

18 (L) MONITORING SYSTEM PERFORMANCE

19 INDICATORS.—Performance indicators that 

20 measure or assess the achievement of the per21 formance goals described in subparagraph (K). 

22 (M) COST ESTIMATE.—A detailed estimate 

23 of the funding necessary to implement the 

24 strategy at the Federal and State levels for all 

25 5 years, including the amount of funds required 


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1 by community organizations to implement the 

2 parts of the strategy in which they take part. 

3 (3) REPORT.—The Attorney General shall 

4 transmit to Congress and make publicly available an 

5 annual progress report regarding the implementation 

6 and effectiveness of the strategy described in para7 graph (1). The progress report shall include an eval8 uation of the implementation of the strategy using 

9 the monitoring system and performance indicators 

10 provided for in subparagraphs (K) and (L) of para11 graph (2). 

12 (e) AUTHORIZATION OF APPROPRIATIONS.— 

13 (1) IN GENERAL.—There are authorized to be 

14 appropriated such sums as may be necessary to 

15 carry out this section for each of fiscal years 2015 

16 through 2020. 

17 (2) AVAILABILITY OF FUNDS.—Amounts made 

18 available under paragraph (1) are authorized to re19 main available until expended. 

20 (f) DEFINITIONS.—For the purposes of this section: 

21 (1) COMMUNITY ORGANIZATION.—The term 

22 ‘‘community organization’’ means a public health 

23 care facility or a nonprofit organization which pro24 vides health- or STI-related services according to es25 tablished public health standards. 


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1 (2) COMPREHENSIVE SEXUALITY EDUCATION.— 

2 The term ‘‘comprehensive sexuality education’’ 

3 means sexuality education that includes information 

4 about abstinence and about the proper use and dis5 posal of sexual barrier protection devices and which 

6 is— 

7 (A) evidence-based; 

8 (B) medically accurate; 

9 (C) age and developmentally appropriate; 

10 (D) gender and identity sensitive; 

11 (E) culturally and linguistically appro12 priate; and 

13 (F) structured to promote critical thinking, 

14 self-esteem, respect for others, and the develop15 ment of healthy attitudes and relationships. 

16 (3) CORRECTIONAL FACILITY.—The term ‘‘cor17 rectional facility’’ means any prison, penitentiary, 

18 adult detention facility, juvenile detention facility, 

19 jail, or other facility to which persons may be sent 

20 after conviction of a crime or act of juvenile delin21 quency within the United States. 

22 (4) INCARCERATED PERSON.—The term ‘‘incar23 cerated person’’ means any person who is serving a 

24 sentence in a correctional facility after conviction of 

25 a crime. 


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1 (5) SEXUALLY TRANSMITTED INFECTION.—The 

2 term ‘‘sexually transmitted infection’’ or ‘‘STI’’ 

3 means any disease or infection that is commonly 

4 transmitted through sexual activity, including HIV/ 

5 AIDS, gonorrhea, chlamydia, syphilis, genital her6 pes, viral hepatitis, and human papillomavirus. 

7 (6) SEXUAL BARRIER PROTECTION DEVICE.— 

8 The term ‘‘sexual barrier protection device’’ means 

9 any FDA-approved physical device which has not 

10 been tampered with and which reduces the prob11 ability of STI transmission or infection between sex12 ual partners, including female condoms, male 

13 condoms, and dental dams. 

14 (7) STATE.—The term ‘‘State’’ includes the 

15 District of Columbia, American Samoa, the Com16 monwealth of the Northern Mariana Islands, Guam, 

17 Puerto Rico, and the United States Virgin Islands. 

18 SEC. 760. AUTOMATIC REINSTATEMENT OR ENROLLMENT 

19 IN MEDICAID FOR PEOPLE WHO TEST POSI20 TIVE FOR HIV BEFORE REENTERING COMMU21 NITIES. 

22 (a) IN GENERAL.—Section 1902(e) of the Social Se23 curity Act (42 U.S.C. 1396a(e)) is amended by adding at 

24 the end the following: 

25 ‘‘(15) ENROLLMENT OF EX-OFFENDERS.— 


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1 ‘‘(A) AUTOMATIC ENROLLMENT OR REIN2 STATEMENT.— 

3 ‘‘(i) IN GENERAL.—The State plan 

4 shall provide for the automatic enrollment 

5 or reinstatement of enrollment of an eligi6 ble individual— 

7 ‘‘(I) if such individual is sched8 uled to be released from a public insti9 tution due to the completion of sen10 tence, not less than 30 days prior to 

11 the scheduled date of the release; and 

12 ‘‘(II) if such individual is to be 

13 released from a public institution on 

14 parole or on probation, as soon as 

15 possible after the date on which the 

16 determination to release such indi17 vidual was made, and before the date 

18 such individual is released. 

19 ‘‘(ii) EXCEPTION.—If a State makes a 

20 determination that an individual is not eli21 gible to be enrolled under the State plan— 

22 ‘‘(I) on or before the date by 

23 which the individual would be enrolled 

24 under clause (i), such clause shall not 

25 apply to such individual; or 


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1 ‘‘(II) after such date, the State 

2 may terminate the enrollment of such 

3 individual. 

4 ‘‘(B) RELATIONSHIP OF ENROLLMENT TO

5 PAYMENT FOR SERVICES.— 

6 ‘‘(i) IN GENERAL.—Subject to sub7 paragraph (A)(ii), an eligible individual 

8 who is enrolled, or whose enrollment is re9 instated, under subparagraph (A) shall be 

10 eligible for medical assistance that is pro11 vided after the date that the eligible indi12 vidual is released from the public institu13 tion. 

14 ‘‘(ii) RELATIONSHIP TO PAYMENT

15 PROHIBITION FOR INMATES.—No provision 

16 of this paragraph may be construed to per17 mit payment for care or services for which 

18 payment is excluded under the subdivision 

19 (A) that follows paragraph (29) of section 

20 1905(a). 

21 ‘‘(C) TREATMENT OF CONTINUOUS ELIGI22 BILITY.— 

23 ‘‘(i) SUSPENSION FOR INMATES.—Any 

24 period of continuous eligibility under this 

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1 dividual enrolled under this title becomes 

2 an inmate of a public institution (except as 

3 a patient of a medical institution). 

4 ‘‘(ii) DETERMINATION OF REMAINING

5 PERIOD.—Notwithstanding any changes to 

6 State law related to continuous eligibility 

7 during the time that an individual is an in8 mate of a public institution (except as a 

9 patient of a medical institution), subject to 

10 clause (iii), with respect to an eligible indi11 vidual who was subject to a suspension 

12 under clause (i), on the date that such in13 dividual is released from a public institu14 tion the suspension of continuous eligibility 

15 under such clause shall be lifted for a pe16 riod that is equal to the time remaining in 

17 the period of continuous eligibility for such 

18 individual on the date that such period was 

19 suspended under such clause. 

20 ‘‘(iii) EXCEPTION.—If a State makes 

21 a determination that an individual is not 

22 eligible to be enrolled under the State 

23 plan— 

24 ‘‘(I) on or before the date that 

25 the suspension of continuous eligibility 


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1 is lifted under clause (ii), such clause 

2 shall not apply to such individual; or 

3 ‘‘(II) after such date, the State 

4 may terminate the enrollment of such 

5 individual. 

6 ‘‘(D) AUTOMATIC ENROLLMENT OR REIN7 STATEMENT OF ENROLLMENT DEFINED.—For 

8 purposes of this paragraph, the term ‘automatic 

9 enrollment or reinstatement of enrollment’ 

10 means that the State determines eligibility for 

11 medical assistance under the State plan without 

12 a program application from, or on behalf of, the 

13 eligible individual, but an individual can only be 

14 automatically enrolled in the State Medicaid 

15 plan if the individual affirmatively consents to 

16 being enrolled through affirmation in writing, 

17 by telephone, orally, through electronic signa18 ture, or through any other means specified by 

19 the Secretary. 

20 ‘‘(E) ELIGIBLE INDIVIDUAL DEFINED.— 

21 For purposes of this paragraph, the term ‘eligi22 ble individual’ means an individual who is an 

23 inmate of a public institution (except as a pa24 tient in a medical institution)— 


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1 ‘‘(i) who was enrolled under the State 

2 plan for medical assistance immediately be3 fore becoming an inmate of such an insti4 tution; or 

5 ‘‘(ii) is diagnosed with human im6 munodeficiency virus.’’. 

7 (b) SUPPLEMENTAL FUNDING FOR STATE IMPLE8 MENTATION OF AUTOMATIC REINSTATEMENT OF MED9 ICAID BENEFITS.— 

10 (1) IN GENERAL.—Subject to paragraph (6), 

11 for each State for which the Secretary of Health and 

12 Human Services has approved an application under 

13 paragraph (3), the Federal matching payments (in14 cluding payments based on the Federal medical as15 sistance percentage) made to such State under sec16 tion 1903 of the Social Security Act (42 U.S.C. 

17 1396b) shall be increased by 5.0 percentage points 

18 for payments to the State for the activities per19 mitted under paragraph (2) or a period of one year. 

20 (2) USE OF FUNDS.—A State may only use in21 creased matching payments authorized under para22 graph (1)— 

23 (A) to strengthen the State’s enrollment 

24 and administrative resources for the purpose of 

25 improving processes for enrolling (or reinstating 


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1 the enrollment of) eligible individuals (as such 

2 term is defined in subparagraph (E) of para3 graph (15) of section 1902(e) of the Social Se4 curity Act (as amended by subsection (a))); and 

5 (B) for medical assistance (as such term is 

6 defined in section 1905(a) of the Social Secu7 rity Act) provided to such eligible individuals. 

8 (3) APPLICATION AND AGREEMENT.—The Sec9 retary may only make payments to a State in the in10 creased amount if— 

11 (A) the State has amended the State plan 

12 under section 1902(e) of the Social Security 

13 Act to incorporate the requirements of para14 graph (15) of such section (as added by sub15 section (a)); 

16 (B) the State has submitted an application 

17 to the Secretary that includes a plan for imple18 menting the requirements of section 

19 1902(e)(15) of the Social Security Act under 

20 the State’s amended State plan before the end 

21 of the 90-day period beginning on the date that 

22 the State receives increased matching payments 

23 under paragraph (1); 

24 (C) the State’s application meets the satis25 faction of the Secretary; and 


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1 (D) the State enters an agreement with 

2 the Secretary that states that— 

3 (i) the State will only use the in4 creased matching funds for the uses per5 mitted under paragraph (2); and 

6 (ii) at the end of the period under 

7 paragraph (1), the State will submit to the 

8 Secretary, and make publicly available, a 

9 report that contains the information re10 quired under paragraph (4). 

11 (4) REQUIRED REPORT INFORMATION.—The in12 formation that is required in the report under para13 graph (3)(D)(ii) includes— 

14 (A) the results of an evaluation of the im15 pact of the implementation of the requirements 

16 of section 1902(e)(15) of the Social Security 

17 Act on improving the State’s processes for en18 rolling of individuals who are released from 

19 public institutions into the Medicaid program; 

20 (B) the number of individuals who were 

21 automatically enrolled (or whose enrollment is 

22 reinstated) under such section 1902(e)(15) dur23 ing the period under paragraph (1); and 

24 (C) any other information that is required 

25 by the Secretary. 


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1 (5) INCREASE IN CAP ON MEDICAID PAYMENTS

2 TO TERRITORIES.—Subject to paragraph (6), the 

3 amounts otherwise determined for Puerto Rico, the 

4 United States Virgin Islands, Guam, the Northern 

5 Mariana Islands, and American Samoa under sub6 sections (f) and (g) of section 1108 of the Social Se7 curity Act (42 U.S.C. 1308) shall each be increased 

8 by the necessary amount to allow for the increase in 

9 the Federal matching payments under paragraph 

10 (1), but only for the period under such paragraph 

11 for such State. In the case of such an increase for 

12 a territory, subsection (a)(1) of such section 1108 

13 shall be applied without regard to any increase in 

14 payment made to the territory under part E of title 

15 IV of such Act that is attributable to the increase 

16 in Federal medical assistance percentage effected 

17 under paragraph (1) for the territory. 

18 (6) LIMITATIONS.— 

19 (A) TIMING.—With respect to a State, at 

20 the end of the period under paragraph (1), no 

21 increased matching payments may be made to 

22 such State under this subsection. 

23 (B) MAINTENANCE OF ELIGIBILITY.— 

24 (i) IN GENERAL.—Subject to clause 

25 (ii), a State is not eligible for an increase 


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1 in its Federal matching payments under 

2 paragraph (1), or an increase in a cap 

3 amount under paragraph (5), if eligibility 

4 standards, methodologies, or procedures 

5 under its State plan under title XIX of the 

6 Social Security Act (including any waiver 

7 under such title or under section 1115 of 

8 such Act (42 U.S.C. 1315)) are more re9 strictive than the eligibility standards, 

10 methodologies, or procedures, respectively, 

11 under such plan (or waiver) as in effect on 

12 the date of enactment of this Act. 

13 (ii) STATE REINSTATEMENT OF ELIGI14 BILITY PERMITTED.—A State that has re15 stricted eligibility standards, methodolo16 gies, or procedures under its State plan 

17 under title XIX of the Social Security Act 

18 (including any waiver under such title or 

19 under section 1115 of such Act (42 U.S.C. 

20 1315)) after the date of enactment of this 

21 Act, is no longer ineligible under subpara22 graph (A) beginning with the first calendar 

23 quarter in which the State has reinstated 

24 eligibility standards, methodologies, or pro25 cedures that are no more restrictive than 


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1 the eligibility standards, methodologies, or 

2 procedures, respectively, under such plan 

3 (or waiver) as in effect on such date. 

4 (C) NO WAIVER AUTHORITY.—The Sec5 retary may not waive the application of this 

6 subsection under section 1115 of the Social Se7 curity Act or otherwise. 

8 (D) LIMITATION OF MATCHING PAYMENTS

9 TO 100 PERCENT.—In no case shall an increase 

10 in Federal matching payments under this sub11 section result in Federal matching payments 

12 that exceed 100 percent. 

13 (c) EFFECTIVE DATE.— 

14 (1) IN GENERAL.—Except as provided in para15 graph (2), the amendments made by subsection (a) 

16 shall take effect 180 days after the date of the en17 actment of this Act and shall apply to services fur18 nished on or after such date. 

19 (2) RULE FOR CHANGES REQUIRING STATE

20 LEGISLATION.—In the case of a State plan for med21 ical assistance under title XIX of the Social Security 

22 Act which the Secretary of Health and Human Serv23 ices determines requires State legislation (other than 

24 legislation appropriating funds) in order for the plan 

25 to meet the additional requirement imposed by the 


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1 amendments made by this section, the State plan 

2 shall not be regarded as failing to comply with the 

3 requirements of such title solely on the basis of its 

4 failure to meet this additional requirement before 

5 the first day of the first calendar quarter beginning 

6 after the close of the first regular session of the 

7 State legislature that begins after the date of the en8 actment of this Act. For purposes of the previous 

9 sentence, in the case of a State that has a 2-year 

10 legislative session, each year of such session shall be 

11 deemed to be a separate regular session of the State 

12 legislature. 

13 SEC. 761. STOP AIDS IN PRISON. 

14 (a) SHORT TITLE.—This section may be cited as the 

15 ‘‘Stop AIDS in Prison Act’’. 

16 (b) IN GENERAL.—The Bureau of Prisons (herein17 after in this section referred to as the ‘‘Bureau’’) shall 

18 develop a comprehensive policy to provide HIV testing, 

19 treatment, and prevention for inmates within the correc20 tional setting and upon reentry. 

21 (c) PURPOSE.—The purposes of this policy shall be 

22 as follows: 

23 (1) To stop the spread of HIV/AIDS among in24 mates. 


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1 (2) To protect prison guards and other per2 sonnel from HIV/AIDS infection. 

3 (3) To provide comprehensive medical treat4 ment to inmates who are living with HIV/AIDS. 

5 (4) To promote HIV/AIDS awareness and pre6 vention among inmates. 

7 (5) To encourage inmates to take personal re8 sponsibility for their health. 

9 (6) To reduce the risk that inmates will trans10 mit HIV/AIDS to other persons in the community 

11 following their release from prison. 

12 (d) CONSULTATION.—The Bureau shall consult with 

13 appropriate officials of the Department of Health and 

14 Human Services, the Office of National Drug Control Pol15 icy, the Office of National AIDS Policy, and the Centers 

16 for Disease Control and Prevention regarding the develop17 ment of this policy. 

18 (e) TIME LIMIT.—The Bureau shall draft appro19 priate regulations to implement this policy not later than 

20 1 year after the date of the enactment of this Act. 

21 (f) REQUIREMENTS FOR POLICY.—The policy created 

22 under subsection (b) shall provide for the following: 

23 (1) TESTING AND COUNSELING UPON IN24 TAKE.— 


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1 (A) Health care personnel shall provide 

2 routine HIV testing to all inmates as a part of 

3 a comprehensive medical examination imme4 diately following admission to a facility. (Health 

5 care personnel need not provide routine HIV 

6 testing to an inmate who is transferred to a fa7 cility from another facility if the inmate’s med8 ical records are transferred with the inmate and 

9 indicate that the inmate has been tested pre10 viously.) 

11 (B) To all inmates admitted to a facility 

12 prior to the effective date of this policy, health 

13 care personnel shall provide routine HIV testing 

14 within no more than 6 months. HIV testing for 

15 these inmates may be performed in conjunction 

16 with other health services provided to these in17 mates by health care personnel. 

18 (C) All HIV tests under this paragraph 

19 shall comply with the opt-out provision. 

20 (2) PRE-TEST AND POST-TEST COUNSELING.— 

21 Health care personnel shall provide confidential pre22 test and post-test counseling to all inmates who are 

23 tested for HIV. Counseling may be included with 

24 other general health counseling provided to inmates 

25 by health care personnel. 


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1 (3) HIV/AIDS PREVENTION EDUCATION.— 

2 (A) Health care personnel shall improve 

3 HIV/AIDS awareness through frequent edu4 cational programs for all inmates. HIV/AIDS 

5 educational programs may be provided by com6 munity-based organizations, local health depart7 ments, and inmate peer educators. 

8 (B) HIV/AIDS educational materials shall 

9 be made available to all inmates at orientation, 

10 at health care clinics, at regular educational 

11 programs, and prior to release. Both written 

12 and audiovisual materials shall be made avail13 able to all inmates. 

14 (C)(i) The HIV/AIDS educational pro15 grams and materials under this paragraph shall 

16 include information on— 

17 (I) modes of transmission, including 

18 transmission through tattooing, sexual con19 tact, and intravenous drug use; 

20 (II) prevention methods; 

21 (III) treatment; and 

22 (IV) disease progression. 

23 (ii) The programs and materials shall be 

24 culturally sensitive, written or designed for low25 literacy levels, available in a variety of lanVerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00591 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294

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1 guages, and present scientifically accurate in2 formation in a clear and understandable man3 ner. 

4 (4) HIV TESTING UPON REQUEST.— 

5 (A) Health care personnel shall allow in6 mates to obtain HIV tests upon request once 

7 per year or whenever an inmate has a reason to 

8 believe the inmate may have been exposed to 

9 HIV. Health care personnel shall, both orally 

10 and in writing, inform inmates, during orienta11 tion and periodically throughout incarceration, 

12 of their right to obtain HIV tests. 

13 (B) Health care personnel shall encourage 

14 inmates to request HIV tests if the inmate is 

15 sexually active, has been raped, uses intra16 venous drugs, receives a tattoo, or if the inmate 

17 is concerned that the inmate may have been ex18 posed to HIV/AIDS. 

19 (C) An inmate’s request for an HIV test 

20 shall not be considered an indication that the 

21 inmate has put him/herself at risk of infection 

22 and/or committed a violation of prison rules. 

23 (5) HIV TESTING OF PREGNANT WOMAN.— 


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1 (A) Health care personnel shall provide 

2 routine HIV testing to all inmates who become 

3 pregnant. 

4 (B) All HIV tests under this paragraph 

5 shall comply with the opt-out provision. 

6 (6) COMPREHENSIVE TREATMENT.— 

7 (A) Health care personnel shall provide all 

8 inmates who test positive for HIV— 

9 (i) timely, comprehensive medical 

10 treatment; 

11 (ii) confidential counseling on man12 aging their medical condition and pre13 venting its transmission to other persons; 

14 and 

15 (iii) voluntary partner notification 

16 services. 

17 (B) Health care provided under this para18 graph shall be consistent with current Depart19 ment of Health and Human Services guidelines 

20 and standard medical practice. Health care per21 sonnel shall discuss treatment options, the im22 portance of adherence to antiretroviral therapy, 

23 and the side effects of medications with inmates 

24 receiving treatment. 


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1 (C) Health care personnel and pharmacy 

2 personnel shall ensure that the facility for3 mulary contains all Food and Drug Administra4 tion-approved medications necessary to provide 

5 comprehensive treatment for inmates living with 

6 HIV/AIDS, and that the facility maintains ade7 quate supplies of such medications to meet in8 mates’ medical needs. Health care personnel 

9 and pharmacy personnel shall also develop and 

10 implement automatic renewal systems for these 

11 medications to prevent interruptions in care. 

12 (D) Correctional staff, health care per13 sonnel, and pharmacy personnel shall develop 

14 and implement distribution procedures to en15 sure timely and confidential access to medica16 tions. 

17 (7) PROTECTION OF CONFIDENTIALITY.— 

18 (A) Health care personnel shall develop 

19 and implement procedures to ensure the con20 fidentiality of inmate tests, diagnoses, and 

21 treatment. Health care personnel and correc22 tional staff shall receive regular training on the 

23 implementation of these procedures. Penalties 

24 for violations of inmate confidentiality by health 


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1 care personnel or correctional staff shall be 

2 specified and strictly enforced. 

3 (B) HIV testing, counseling, and treat4 ment shall be provided in a confidential setting 

5 where other routine health services are provided 

6 and in a manner that allows the inmate to re7 quest and obtain these services as routine med8 ical services. 

9 (8) TESTING, COUNSELING, AND REFERRAL

10 PRIOR TO REENTRY.— 

11 (A) Health care personnel shall provide 

12 routine HIV testing to all inmates no more 

13 than 3 months prior to their release and re14 entry into the community. (Inmates who are al15 ready known to be infected need not be tested 

16 again.) This requirement may be waived if an 

17 inmate’s release occurs without sufficient notice 

18 to the Bureau to allow health care personnel to 

19 perform a routine HIV test and notify the in20 mate of the results. 

21 (B) All HIV tests under this paragraph 

22 shall comply with the opt-out provision. 

23 (C) To all inmates who test positive for 

24 HIV and all inmates who already are known to 


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1 have HIV/AIDS, health care personnel shall 

2 provide— 

3 (i) confidential prerelease counseling 

4 on managing their medical condition in the 

5 community, accessing appropriate treat6 ment and services in the community, and 

7 preventing the transmission of their condi8 tion to family members and other persons 

9 in the community; 

10 (ii) referrals to appropriate health 

11 care providers and social service agencies 

12 in the community that meet the inmate’s 

13 individual needs, including voluntary part14 ner notification services and prevention 

15 counseling services for people living with 

16 HIV/AIDS; and 

17 (iii) a 30-day supply of any medically 

18 necessary medications the inmate is cur19 rently receiving. 

20 (9) OPT-OUT PROVISION.—Inmates shall have 

21 the right to refuse routine HIV testing. Inmates 

22 shall be informed both orally and in writing of this 

23 right. Oral and written disclosure of this right may 

24 be included with other general health information 

25 and counseling provided to inmates by health care 


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1 personnel. If an inmate refuses a routine test for 

2 HIV, health care personnel shall make a note of the 

3 inmate’s refusal in the inmate’s confidential medical 

4 records. However, the inmate’s refusal shall not be 

5 considered a violation of prison rules or result in dis6 ciplinary action. Any reference in this section to the 

7 ‘‘opt-out provision’’ shall be deemed a reference to 

8 the requirement of this paragraph. 

9 (10) EXCLUSION OF TESTS PERFORMED UNDER

10 SECTION 4014(b) FROM THE DEFINITION OF ROUTINE

11 HIV TESTING.—HIV testing of an inmate under sec12 tion 4014(b) of title 18, United States Code, is not 

13 routine HIV testing for the purposes of the opt-out 

14 provision. Health care personnel shall document the 

15 reason for testing under section 4014(b) of title 18, 

16 United States Code, in the inmate’s confidential 

17 medical records. 

18 (11) TIMELY NOTIFICATION OF TEST RE19 SULTS.—Health care personnel shall provide timely 

20 notification to inmates of the results of HIV tests. 

21 (g) CHANGES IN EXISTING LAW.— 

22 (1) SCREENING IN GENERA.—Section 4014(a) 

23 of title 18, United States Code, is amended— 

24 (A) by striking ‘‘for a period of 6 months 

25 or more’’; 


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1 (B) by striking ‘‘, as appropriate,’’; and 

2 (C) by striking ‘‘if such individual is deter3 mined to be at risk for infection with such virus 

4 in accordance with the guidelines issued by the 

5 Bureau of Prisons relating to infectious disease 

6 management’’ and inserting ‘‘unless the indi7 vidual declines. The Attorney General shall also 

8 cause such individual to be so tested before re9 lease unless the individual declines.’’. 

10 (2) INADMISSIBILITY OF HIV TEST RESULTS IN

11 CIVIL AND CRIMINAL PROCEEDINGS.—Section 

12 4014(d) of title 18, United States Code, is amended 

13 by inserting ‘‘or under the Stop AIDS in Prison 

14 Act’’ after ‘‘under this section’’. 

15 (3) SCREENING AS PART OF ROUTINE SCREEN16 ING.—Section 4014(e) of title 18, United States 

17 Code, is amended by adding at the end the fol18 lowing: ‘‘Such rules shall also provide that the initial 

19 test under this section be performed as part of the 

20 routine health screening conducted at intake.’’. 

21 (h) REPORTING REQUIREMENTS.— 

22 (1) REPORT ON HEPATITIS AND OTHER DIS23 EASES.—Not later than 1 year after the date of the 

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1 dures to provide testing, treatment, and prevention 

2 education programs for hepatitis and other diseases 

3 transmitted through sexual activity and intravenous 

4 drug use. The Bureau shall consult with appropriate 

5 officials of the Department of Health and Human 

6 Services, the Office of National Drug Control Policy, 

7 the Office of National AIDS Policy, and the Centers 

8 for Disease Control and Prevention regarding the 

9 development of this report. 

10 (2) ANNUAL REPORTS.— 

11 (A) GENERALLY.—Not later than 2 years 

12 after the date of the enactment of this Act, and 

13 then annually thereafter, the Bureau shall re14 port to Congress on the incidence among in15 mates of diseases transmitted through sexual 

16 activity and intravenous drug use. 

17 (B) MATTERS PERTAINING TO VARIOUS

18 DISEASES.—Reports under paragraph (1) shall 

19 discuss— 

20 (i) the incidence among inmates of 

21 HIV/AIDS, hepatitis, and other diseases 

22 transmitted through sexual activity and in23 travenous drug use; and 


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1 (ii) updates on Bureau testing, treat2 ment, and prevention education programs 

3 for these diseases. 

4 (C) MATTERS PERTAINING TO HIV/AIDS

5 ONLY.—Reports under paragraph (1) shall also 

6 include— 

7 (i) the number of inmates who tested 

8 positive for HIV upon intake; 

9 (ii) the number of inmates who tested 

10 positive prior to reentry; 

11 (iii) the number of inmates who were 

12 not tested prior to reentry because they 

13 were released without sufficient notice; 

14 (ix) the number of inmates who opted15 out of taking the test; 

16 (x) the number of inmates who were 

17 tested under section 4014(b) of title 18, 

18 United States Code; and 

19 (xi) the number of inmates under 

20 treatment for HIV/AIDS. 

21 (D) CONSULTATION.—The Bureau shall 

22 consult with appropriate officials of the Depart23 ment of Health and Human Services, the Office 

24 of National Drug Control Policy, the Office of 

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1 ease Control and Prevention regarding the de2 velopment of reports under paragraph (1). 

3 SEC. 762. SUPPORT DATA SYSTEM REVIEW AND INDICA4 TORS FOR MONITORING HIV CARE. 

5 The Secretary of Health and Human Services, in col6 laboration with the Assistant Secretary for Health, the Di7 rector of the Office of HIV/AIDS and Infectious Disease 

8 Policy, the Director of the Centers for Disease Control and 

9 Prevention, the Administrator of the Substance Abuse and 

10 Mental Health Services Administration, the Director of 

11 the Department of Housing and Urban Development, the 

12 Director of the Office of AIDS Research, the Adminis13 trator of the Health Resources and Services Administra14 tion, and the Administrator of the Centers for Medicare 

15 & Medicaid Services, shall expand and coordinate efforts 

16 to align metrics across agencies and modify Federal data 

17 systems, to— 

18 (1) adopt the Institute of Medicine’s clinical 

19 HIV care indicators as the core metrics for moni20 toring the quality of HIV care, mental health, sub21 stance abuse, and supportive services; 

22 (2) better enable assessment of the impact of 

23 the National HIV/AIDS Strategy and the Patient 

24 Protection and Affordable Care Act on improving 


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1 HIV/AIDS care and access to supportive services for 

2 individuals with HIV; 

3 (3) expand the demographic data elements to be 

4 captured by Federal data systems relevant to HIV 

5 care to permit calculation of the indicators for sub6 groups of the population of people with diagnosed 

7 HIV infection, including— 

8 (A) age; 

9 (B) race; 

10 (C) ethnicity; 

11 (D) sex (assigned at birth); 

12 (E) gender identity; 

13 (F) sexual orientation; 

14 (G) current geographic marker of resi15 dence; 

16 (H) income or poverty level; and 

17 (I) primary means of reimbursement for 

18 medical services (including Medicaid, Medicare, 

19 the Ryan White HIV/AIDS Program, private 

20 insurance, health maintenance organizations, 

21 and no coverage); and 

22 (4) streamline data collection and systematically 

23 review all existing reporting requirements for feder24 ally funded HIV/AIDS programs to ensure that only 

25 essential data are collected. 


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1 SEC. 763. TRANSFER OF FUNDS FOR IMPLEMENTATION OF 

2 NATIONAL HIV/AIDS STRATEGY. 

3 Title II of the Public Health Service Act (42 U.S.C. 

4 202 et seq.) is amended by inserting after section 241 the 

5 following: 

6 ‘‘SEC. 241A. TRANSFER OF FUNDS FOR IMPLEMENTATION 

7 OF NATIONAL HIV/AIDS STRATEGY. 

8 ‘‘(a) TRANSFER AUTHORIZATION.—Of the discre9 tionary appropriations made available to the Department 

10 of Health and Human Services for any fiscal year for pro11 grams and activities that, as determined by the Secretary 

12 of Health and Human Services, pertain to HIV/AIDS, the 

13 Secretary, in coordination with the Director of the Office 

14 of National HIV/AIDS Policy, may transfer up to 1 per15 cent of such appropriations to the Office of the Assistant 

16 Secretary for Health for implementation of the National 

17 HIV/AIDS Strategy. 

18 ‘‘(b) CONGRESSIONAL NOTIFICATION.—Not less than 

19 30 days before making any transfer under this section, 

20 the Secretary shall give notice of the transfer to the Con21 gress. 

22 ‘‘(c) DEFINITIONS.—In this section: 

23 ‘‘(1) The term ‘HIV/AIDS’ has the meaning 

24 given to such term in section 2689. 

25 ‘‘(2) The term ‘National HIV/AIDS Strategy’ 

26 means the National HIV/AIDS Strategy for the 


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1 United States issued by the President in July 2010 

2 and includes any subsequent revisions to such Strat3 egy.’’. 

4 SEC. 764. HIV INTEGRATED SERVICES DELIVERY MODEL 

5 DEMONSTRATION. 

6 (a) IN GENERAL.—Consistent with the National 

7 HIV/AIDS Strategy for the United States and in accord8 ance with this section, the Secretary of Health and 

9 Human Services acting through the Center for Medicare 

10 & Medicaid Innovation and in cooperation with CDC, 

11 HRSA, SAMHSA, and HUD, shall conduct a 3-year dem12 onstration project that is designed to integrate services 

13 and funding under the Medicare and Medicaid programs, 

14 under HIV-related programs conducted by the CDC, and 

15 under the Ryan White HIV/AIDS Program, to reduce new 

16 HIV infections, to increase the proportion of people who 

17 know their status, to increase access to care, to improve 

18 health outcomes, to reduce HIV-related health disparities 

19 among Medicaid and Medicare beneficiaries, and to reduce 

20 the cost of care provided to HIV positive Medicare and 

21 Medicaid beneficiaries. 

22 (b) OBJECTIVES.—The objectives of the demonstra23 tion are the following: 

24 (1) To ensure the early identification of HIV 

25 positive beneficiaries to reduce costly HIV-related 


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1 clinical conditions through HIV screening and rapid 

2 linkage to high quality HIV medical care. 

3 (2) To reduce new HIV infections among Med4 icaid and Medicare beneficiaries through routine 

5 HIV testing, prevention services for HIV negative 

6 beneficiaries, and intensive ‘‘prevention for positive’’ 

7 services for HIV positive beneficiaries. 

8 (3) To reduce morbidity, mortality, and high 

9 cost inpatient and specialty care among HIV positive 

10 beneficiaries by ensuring access to high quality HIV 

11 medical care, HIV medications, and support services. 

12 (4) To promote HIV treatment adherence and 

13 retention in care through intensive case manage14 ment, treatment education, and outreach services. 

15 (5) To effectively treat behavioral health condi16 tions among HIV positive beneficiaries that impair 

17 their HIV treatment adherence and lead to sec18 ondary HIV infections through services funded 

19 under Medicare and Medicaid and programs admin20 istered by SAMHSA. 

21 (6) To promote independence, treatment adher22 ence, and stable housing for HIV positive bene23 ficiaries through highly coordinated HIV health, 

24 housing, and support services funded by HRSA and 

25 HUD. 


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1 (c) DEMONSTRATION DESIGN.— 

2 (1) IN GENERAL.—The Secretary shall design 

3 the demonstration to test both— 

4 (A) the service delivery model described in 

5 paragraph (2); and 

6 (B) the payment model described in para7 graph (3). 

8 (2) SERVICE DELIVERY MODEL.— 

9 (A) IN GENERAL.—Under the service deliv10 ery model described in this paragraph, the dem11 onstration shall test comprehensive HIV test12 ing, linkage to care, HIV medical care, and an13 cillary services to individuals enrolled under 

14 Medicare, Medicaid, or both. The service deliv15 ery model will integrate services furnished 

16 under Medicare and Medicaid with prevention 

17 services funded by CDC for HIV positive bene18 ficiaries, intensive case management services 

19 funded by HRSA, behavioral services funded by 

20 SAMHSA, and housing assistance services 

21 funded through HUD. 

22 (B) CORE ELEMENTS.—The model under 

23 this paragraph shall have the following 8 core 

24 elements: 


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1 (i) HIV testing services that apply the 

2 CDC’s 2006 recommendations for uni3 versal opt-out testing among Medicare and 

4 Medicaid beneficiary populations. 

5 (ii) Rapid linkage from HIV testing 

6 settings to treatment for HIV positive 

7 beneficiaries to ensure they are engaged in 

8 care in a timely basis. 

9 (iii) Access to high quality HIV expe10 rienced medical care, laboratory moni11 toring, HIV medications, and other re12 quired services. 

13 (iv) Routine screening and treatment 

14 for HIV-related and other chronic condi15 tions, including behavioral health. 

16 (v) Prevention and treatment edu17 cation services, including an adapted Medi18 cation Therapy Management (MTM) pro19 gram model, to optimize the benefit of 

20 HIV therapeutics. 

21 (vi) Risk-stratified medical case man22 agement. 

23 (vii) Provision of preventive care, in24 cluding counseling to prevent secondary 

25 HIV infection. 


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1 (viii) Wrap-around support and hous2 ing services. 

3 (3) PAYMENT MODEL.—Under the payment 

4 model described in this paragraph, the demonstra5 tion shall test the following: 

6 (A) A prepaid capitated payment model 

7 that adjusts payment for HIV and behavioral 

8 health acuity, to be applied under contracts 

9 with managed care organizations with dem10 onstrated HIV experience. 

11 (B) Use of funds under the Ryan White 

12 HIV/AIDS Program to purchase capitated serv13 ices from the contracted managed care organi14 zations. 

15 (C) Provision of additional funds to sup16 port services to the extent that Medicaid and 

17 Medicare coverage is limited, including for serv18 ices such as HIV testing (for Medicaid bene19 ficiaries), medical case management, prevention 

20 case management, treatment education, case 

21 finding, behavioral health services, and housing 

22 assistance. 

23 (d) BENEFICIARY CRITERIA.—Beneficiaries eligible 

24 for participation in the demonstration are the following: 


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1 (1) MEDICAID FFS BENEFICIARIES.—Fee-for2 service Medicaid beneficiaries 18 years of age or 

3 older. 

4 (2) DUAL ELIGIBLES.—Individuals who are— 

5 (A) entitled to medical assistance under 

6 Medicaid; and 

7 (B) entitled to benefits under part A, and 

8 enrolled under part B, of Medicare but are not 

9 enrolled under a Medicare Advantage plan 

10 under Medicare. 

11 (e) ROLES AND RESPONSIBILITIES IN DEMONSTRA12 TION.— 

13 (1) IN GENERAL.—Consistent with the National 

14 HIV/AIDS Strategy for the United States, Federal 

15 agencies shall coordinate their funding for the se16 lected States or cities covered under the demonstra17 tion to provide resources to fund the delivery of serv18 ices within the demonstration. 

19 (2) HHS.—In carrying out the demonstration, 

20 the Secretary shall— 

21 (A) design the application process; 

22 (B) solicit applications from 5 to 7 State 

23 Medicaid agencies to host the demonstration; 

24 (C) with respect to the service delivery 

25 model described in subsection (c)(2), collaborate 


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1 with the CDC, HRSA, and the National Insti2 tutes of Health to design a minimum service de3 livery model that reflects the current standard 

4 of care as established by the Public Health 

5 Service and CDC guidelines and recommenda6 tions; and 

7 (D) fund an evaluation of the demonstra8 tion to ensure collection of system, provider, 

9 and beneficiary-level data to address their rou10 tine reporting requirements. 

11 The Secretary may carry out the Secretary’s author12 ity under this paragraph through CMMI. 

13 (3) CDC.—The CDC shall collaborate with the 

14 Secretary and CDC-funded HIV prevention grantees 

15 in the selected States and cities to provide technical 

16 assistance to design cost-effective HIV and sexually 

17 transmitted infection (STI) screening and testing 

18 services for Medicaid and Medicare beneficiaries, in19 cluding partner notification services and commu20 nicable disease reporting. CDC and CMS shall deter21 mine the extent to which testing funds shall be sup22 ported jointly or separately by these agencies. 

23 (4) HRSA.—HRSA shall allocate funds avail24 able through the Special Projects of National Sig25 nificance (SPNS) Initiative Program (under subpart 


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1 I of part F of the Ryan White HIV/AIDS Program) 

2 to support wrap-around core and support services 

3 not covered under Medicare or Medicaid and shall 

4 authorize the use of Ryan White HIV/AIDS Pro5 gram funds to purchase services through capitated 

6 managed care programs that meet or exceed the 

7 services covered by the Ryan White HIV/AIDS Pro8 gram at rates that are no greater than current per 

9 capita expenditures. HRSA is authorized to use 

10 funds under SPNS, and to waive such requirements 

11 of SPNS as may be necessary, to carry out the dem12 onstration. 

13 (5) SAMHSA.—SAMHSA shall allocate funds 

14 through the Minority HIV/AIDS Initiative or other 

15 programs to support behavioral health services not 

16 covered under Medicare or Medicaid. 

17 (6) HOPWA.—HUD shall directly allocate 

18 funds under the Housing Opportunities for People 

19 With AIDS (HOPWA) program to the States or cit20 ies participating in the demonstration to provide 

21 supportive housing and other housing assistance to 

22 beneficiaries who otherwise meet HOPWA eligibility 

23 criteria. HUD is authorized to use such HOPWA 

24 funds, and to waive such requirements under 


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1 HOPWA as may be necessary, to carry out the dem2 onstration. 

3 (7) STATE MEDICAID AGENCIES.—Single State 

4 agencies responsible for administration of the Med5 icaid program for individuals who are accepted to 

6 participate in the demonstration shall— 

7 (A) collaborate with CMS to design or re8 fine a prepaid capitated payment model, to allo9 cate and award contracts with capitated man10 aged care plans, to ensure such plans meet 

11 State statutory or regulatory requirements, to 

12 contract with a coordinating agency to organize 

13 and deliver integrated HIV testing, medical 

14 care, support, and housing services funded 

15 under Medicare and Medicaid, other Federal, 

16 State, and local government sponsors, and to 

17 coordinate their activities with the State HIV/ 

18 AIDS program; and 

19 (B) identify and contract with a coordi20 nating agency to organize the demonstration in 

21 the State, to establish a coordinating body rep22 resenting State, local, and provider agencies 

23 participating in the demonstration, to establish 

24 systems of care that integrate HIV prevention, 

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1 ices, to establish mechanisms to gather evalua2 tion data for reporting to CMMI and other par3 ticipating Federal agencies, and to establish a 

4 quality management program to monitor pro5 vider performance in delivering the services pro6 vided to participating beneficiaries under the 

7 demonstration. 

8 (8) MANAGED CARE ORGANIZATIONS.— 

9 Capitated managed care organizations participating 

10 in the demonstration shall organize and deliver serv11 ices as specified by the minimum service delivery 

12 model established by CMMI through a network of 

13 providers with demonstrated HIV experience, high 

14 quality, and sufficient provider capacity. 

15 (f) DEFINITIONS.—In this section: 

16 (1) CDC.—The term ‘‘CDC’’ means the Direc17 tor of the Centers for Disease Control and Preven18 tion. 

19 (2) CMMI.—The term ‘‘CMMI’’ means the Di20 rector of the Center for Medicare & Medicaid Inno21 vation. 

22 (3) CMS.—The term ‘‘CMS’’ means the Ad23 ministrator of the Centers for Medicare & Medicaid 

24 Services. 


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1 (4) DEMONSTRATION.—The term ‘‘demonstra2 tion’’ means the demonstration conducted under this 

3 section. 

4 (5) HRSA.—The term ‘‘HRSA’’ means the Ad5 ministrator of the Health Resources and Services 

6 Administration. 

7 (6) HUD.—The term ‘‘HUD’’ means the Sec8 retary of Housing and Urban Development. 

9 (7) MEDICARE; MEDICAID.—The terms ‘‘Medi10 care’’ and ‘‘Medicaid’’ mean the programs under ti11 tles XVIII and XIX, respectively, of the Social Secu12 rity Act. 

13 (8) NATIONAL HIV/AIDS STRATEGY FOR THE

14 UNITED STATES.—The term ‘‘National HIV/AIDS 

15 Strategy for the United States’’ has the meaning 

16 given such term under section 241A(b) of the Public 

17 Health Service Act. 

18 (9) RYAN WHITE HIV/AIDS PROGRAM.—The 

19 term ‘‘Ryan White HIV/AIDS Program’’ means the 

20 program under title XXVI of the Public Health 

21 Service Act. 

22 (10) SAMHSA.—The term ‘‘SAMHSA’’ means 

23 the Substance Abuse and Mental Health Services 

24 Administration. 


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1 (11) SECRETARY.—The term ‘‘Secretary’’ 

2 means the Secretary of Health and Human Services, 

3 acting through CMMI. 

4 SEC. 765. REPORT ON THE IMPLEMENTATION OF GOAL 4 

5 (IMPROVED COORDINATION) OF THE NA6 TIONAL HIV/AIDS STRATEGY. 

7 (a) REPORT REQUIRED.—The President, in consulta8 tion with the heads of all relevant Federal departments 

9 and agencies including the Department of Education, the 

10 Department of Health and Human Services, the Depart11 ment of Housing and Urban Development, the Depart12 ment of Justice, the Department of Labor, the Depart13 ment of Veteran Affairs, and the Social Security Adminis14 tration, shall transmit to the Congress and make publicly 

15 available a report on the status of implementation of Goal 

16 4 of the National HIV/AIDS Strategy. 

17 (b) CONTENTS.—The report required by subsection 

18 (a) shall include a description, an analysis, and an evalua19 tion of— 

20 (1) the extent to which the National HIV/AIDS 

21 Strategy has improved coordination of efforts, en22 hanced capacity, and strengthened infrastructure in 

23 order to maximize the effective delivery of HIV/ 

24 AIDS prevention, care, and treatment services at the 

25 community level, including coordination— 


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1 (A) within and among Federal agencies 

2 and departments; 

3 (B) between the Federal Government and 

4 State and local governments and health depart5 ments; 

6 (C) between the Federal Government and 

7 nonprofit foundations and civil society organiza8 tions, including community- and faith-based or9 ganizations focused on addressing the issue of 

10 HIV/AIDS; and 

11 (D) between the Federal Government and 

12 private businesses; and 

13 (2) efforts by the Federal Government to edu14 cate, involve, and establish and strengthen partner15 ships with civil society organizations, including 

16 community- and faith-based organizations, in order 

17 to implement the National HIV/AIDS Strategy and 

18 achieve its goals. 

19 (c) DEFINITION.—In this section, the term ‘‘National 

20 HIV/AIDS Strategy’’ means the National HIV/AIDS 

21 Strategy for the United States issued by the President in 

22 July 2010 and includes any subsequent revisions to such 

23 Strategy. 


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1 Subtitle F—Diabetes 

2 SEC. 771. RESEARCH, TREATMENT, AND EDUCATION. 

3 Subpart 3 of part C of title IV of the Public Health 

4 Service Act (42 U.S.C. 285c et seq.) is amended by adding 

5 at the end the following new section: 

6 ‘‘SEC. 434B. DIABETES IN MINORITY POPULATIONS. 

7 ‘‘(a) IN GENERAL.—The Director of NIH shall ex8 pand, intensify, and support ongoing research and other 

9 activities with respect to prediabetes and diabetes, particu10 larly type 2, in minority populations. 

11 ‘‘(b) RESEARCH.— 

12 ‘‘(1) DESCRIPTION.—Research under subsection 

13 (a) shall include investigation into— 

14 ‘‘(A) the causes of diabetes, including so15 cioeconomic, geographic, clinical, environmental, 

16 genetic, and other factors that may contribute 

17 to increased rates of diabetes in minority popu18 lations; and 

19 ‘‘(B) the causes of increased incidence of 

20 diabetes complications in minority populations, 

21 and possible interventions to decrease such inci22 dence. 

23 ‘‘(2) INCLUSION OF MINORITY PARTICIPANTS.— 

24 In conducting and supporting research described in 

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1 clude minority participants as study subjects in clin2 ical trials. 

3 ‘‘(c) REPORT; COMPREHENSIVE PLAN.— 

4 ‘‘(1) IN GENERAL.—The Diabetes Mellitus 

5 Interagency Coordinating Committee shall— 

6 ‘‘(A) prepare and submit to the Congress, 

7 not later than 6 months after the date of enact8 ment of this section, a report on Federal re9 search and public health activities with respect 

10 to prediabetes and diabetes in minority popu11 lations; and 

12 ‘‘(B) develop and submit to the Congress, 

13 not later than 1 year after the date of enact14 ment of this section, an effective and com15 prehensive Federal plan (including all appro16 priate Federal health programs) to address 

17 prediabetes and diabetes in minority popu18 lations. 

19 ‘‘(2) CONTENTS.—The report under paragraph 

20 (1)(A) shall at minimum address each of the fol21 lowing: 

22 ‘‘(A) Research on diabetes and prediabetes 

23 in minority populations, including such research 

24 on— 


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1 ‘‘(i) genetic, behavioral, and environ2 mental factors; and 

3 ‘‘(ii) prevention and complications 

4 among individuals within these populations 

5 who have already developed diabetes. 

6 ‘‘(B) Surveillance and data collection on 

7 diabetes and prediabetes in minority popu8 lations, including with respect to— 

9 ‘‘(i) efforts to better determine the 

10 prevalence of diabetes among Asian-Amer11 ican and Pacific Islander subgroups; and 

12 ‘‘(ii) efforts to coordinate data collec13 tion on the American Indian population. 

14 ‘‘(C) Community-based interventions to ad15 dress diabetes and prediabetes targeting minor16 ity populations, including— 

17 ‘‘(i) the evidence base for such inter18 ventions; 

19 ‘‘(ii) the cultural appropriateness of 

20 such interventions; and 

21 ‘‘(iii) efforts to educate the public on 

22 the causes and consequences of diabetes. 

23 ‘‘(D) Education and training programs for 

24 health professionals (including community 

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1 ment of diabetes and its related complications 

2 that is supported by the Health Resources and 

3 Services Administration, including such pro4 grams supported by— 

5 ‘‘(i) the National Health Service 

6 Corps; or 

7 ‘‘(ii) the community health centers 

8 program under section 330. 

9 ‘‘(d) EDUCATION.—The Director of NIH shall— 

10 ‘‘(1) through the National Institute on Minority 

11 Health and Health Disparities and the National Di12 abetes Education Program— 

13 ‘‘(A) make grants to programs funded 

14 under section 464z–4 (relating to centers of ex15 cellence) for the purpose of establishing a men16 toring program for health care professionals to 

17 be more involved in weight counseling, obesity 

18 research, and nutrition; and 

19 ‘‘(B) provide for the participation of mi20 nority health professionals in diabetes-focused 

21 research programs; and 

22 ‘‘(2) make grants for programs to establish a 

23 pipeline from high school to professional school that 

24 will increase minority representation in diabetes-fo25 cused health fields by expanding Minority Access to 


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1 Research Careers (MARC) program internships and 

2 mentoring opportunities for recruitment. 

3 ‘‘(e) DEFINITIONS.—For purposes of this section: 

4 ‘‘(1) The ‘Diabetes Mellitus Interagency Coordi5 nating Committee’ means the Diabetes Mellitus 

6 Interagency Coordinating Committee established 

7 under section 429. 

8 ‘‘(2) The term ‘minority population’ means a 

9 racial and ethnic minority group, as defined in sec10 tion 1707.’’. 

11 SEC. 772. RESEARCH, EDUCATION, AND OTHER ACTIVITIES. 

12 Part B of title III of the Public Health Service Act 

13 (42 U.S.C. 243 et seq.) is amended by inserting after sec14 tion 317T the following section: 

15 ‘‘SEC. 317U. DIABETES IN MINORITY POPULATIONS. 

16 ‘‘(a) RESEARCH AND OTHER ACTIVITIES.— 

17 ‘‘(1) IN GENERAL.—The Secretary, acting 

18 through the Director of the Centers for Disease 

19 Control and Prevention, shall conduct and support 

20 research and public health activities with respect to 

21 diabetes in minority populations. 

22 ‘‘(2) CERTAIN ACTIVITIES.—Activities under 

23 paragraph (1) regarding diabetes in minority popu24 lations shall include the following: 


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1 ‘‘(A) Further enhancing the National 

2 Health and Nutrition Examination Survey by 

3 over-sampling Asian-American, Native Hawai4 ian, and Other Pacific Islanders in appropriate 

5 geographic areas to better determine the preva6 lence of diabetes in such populations as well as 

7 to improve the data collection of diabetes pene8 tration disaggregated into major ethnic groups 

9 within such populations. The Secretary shall en10 sure that any such oversampling does not re11 duce the oversampling of other minority popu12 lations including African-American and Latino 

13 populations. 

14 ‘‘(B) Through the Division of Diabetes 

15 Translation— 

16 ‘‘(i) providing for prevention research 

17 to better understand how to influence 

18 health care systems changes to improve 

19 quality of care being delivered to such pop20 ulations; 

21 ‘‘(ii) carrying out model demonstra22 tion projects to design, implement, and 

23 evaluate effective diabetes prevention and 

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1 lations, including culturally appropriate 

2 community-based interventions; 

3 ‘‘(iii) developing and implementing a 

4 strategic plan to reduce diabetes in minor5 ity populations through applied research to 

6 reduce disparities and culturally and lin7 guistically appropriate community-based 

8 interventions; 

9 ‘‘(iv) supporting, through the national 

10 diabetes prevention program under section 

11 399V–3, diabetes prevention program sites 

12 in underserved regions highly impacted by 

13 diabetes; and 

14 ‘‘(v) implementing, through the na15 tional diabetes prevention program under 

16 section 399V–3, a demonstration program 

17 developing new metrics measuring health 

18 outcomes related to diabetes that can be 

19 stratified by specific minority populations. 

20 ‘‘(b) EDUCATION.—The Secretary, acting through 

21 the Director of the Centers for Disease Control and Pre22 vention, shall direct the Division of Diabetes Translation 

23 to conduct and support both programs to educate the pub24 lic on diabetes in minority populations and programs to 


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1 educate minority populations about the causes and effects 

2 of diabetes. 

3 ‘‘(c) DIABETES; HEALTH PROMOTION, PREVENTION

4 ACTIVITIES, AND ACCESS.—The Secretary, acting through 

5 the Director of the Centers for Disease Control and Pre6 vention and the National Diabetes Education Program, 

7 shall conduct and support programs to educate specific 

8 minority populations through culturally appropriate and 

9 linguistically appropriate information campaigns about 

10 prevention of, and managing, diabetes. 

11 ‘‘(d) DEFINITION.—For purposes of this section, the 

12 term ‘minority population’ means a racial and ethnic mi13 nority group, as defined in section 1707.’’. 

14 SEC. 773. RESEARCH, EDUCATION, AND OTHER ACTIVITIES. 

15 Part P of title III of the Public Health Service Act 

16 (42 U.S.C. 280g et seq.), as amended, is further amended 

17 by adding at the end the following new section: 

18 ‘‘SEC. 399V–7. PROGRAMS TO EDUCATE HEALTH PRO19 VIDERS ON THE CAUSES AND EFFECTS OF DI20 ABETES IN MINORITY POPULATIONS. 

21 ‘‘(a) IN GENERAL.—The Secretary, acting through 

22 the Director of the Health Resources and Services Admin23 istration, shall conduct and support programs described 

24 in subsection (b) to educate health professionals on the 

25 causes and effects of diabetes in minority populations. 


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1 ‘‘(b) PROGRAMS.—Programs described in this sub2 section, with respect to education on diabetes in minority 

3 populations, shall include the following: 

4 ‘‘(1) Giving priority, under the primary care 

5 training and enhancement program under section 

6 747— 

7 ‘‘(A) to awarding grants to focus on or ad8 dress diabetes; and 

9 ‘‘(B) adding minority populations to the 

10 list of vulnerable populations that should be 

11 served by such grants. 

12 ‘‘(2) Providing additional funds for the Health 

13 Careers Opportunity Program, Centers for Excel14 lence, and the Minority Faculty Fellowship Program 

15 to partner with the Office of Minority Health under 

16 section 1707 and the National Institutes of Health 

17 to strengthen programs for career opportunities fo18 cused on diabetes treatment and care within under19 served regions highly impacted by diabetes. 

20 ‘‘(3) Developing a diabetes focus within, and 

21 providing additional funds for, the National Health 

22 Service Corps Scholarship Program— 

23 ‘‘(A) to place individuals in areas that are 

24 disproportionately affected by diabetes and to 


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1 provide diabetes treatment and care in such 

2 areas; and 

3 ‘‘(B) to provide such individuals continuing 

4 medical education specific to diabetes care.’’. 

5 SEC. 774. RESEARCH, EDUCATION, AND OTHER ACTIVITIES. 

6 Part P of title III of the Public Health Service Act 

7 (42 U.S.C. 280g et seq.), as amended, is further amended 

8 by adding at the end the following section: 

9 ‘‘SEC. 399V–8. RESEARCH, EDUCATION, AND OTHER ACTIVI10 TIES REGARDING DIABETES IN AMERICAN IN11 DIAN POPULATIONS. 

12 ‘‘In addition to activities under sections 317V–6 and 

13 434B, the Secretary, acting through the Indian Health 

14 Service and in collaboration with other appropriate Fed15 eral agencies, shall— 

16 ‘‘(1) conduct and support research and other 

17 activities with respect to diabetes; and 

18 ‘‘(2) coordinate the collection of data on clini19 cally and culturally appropriate diabetes treatment, 

20 care, prevention, and services by health care profes21 sionals to the American Indian population.’’. 

22 SEC. 775. UPDATED REPORT ON HEALTH DISPARITIES. 

23 The Secretary of Health and Human Services shall 

24 seek to enter into an arrangement with the Institute of 

25 Medicine under which the Institute will— 


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1 (1) not later than 1 year after the date of en2 actment of this Act, submit to the Congress an up3 dated version of the Institute’s 2002 report entitled 

4 ‘‘Unequal Treatment: Confronting Racial and Ethnic 

5 Disparities in Health Care’’; and 

6 (2) in such updated version, address how racial 

7 and ethnic health disparities have changed since the 

8 publication of the original report. 

9 Subtitle G—Lung Disease 

10 SEC. 776. EXPANSION OF THE NATIONAL ASTHMA EDU11 CATION AND PREVENTION PROGRAM. 

12 (a) IN GENERAL.—Not later than 2 years after the 

13 date of the enactment of this Act, the Secretary of Health 

14 and Human Services shall convene a working group com15 prised of patient groups, nonprofit organizations, medical 

16 societies, and other relevant governmental and nongovern17 mental entities, including those that participate in the Na18 tional Asthma Education and Prevention Program, to de19 velop a report to Congress that— 

20 (1) catalogs, with respect to asthma prevention, 

21 management, and surveillance— 

22 (A) the activities of the Federal Govern23 ment, including identifying all Federal pro24 grams that carry out asthma-related activities, 

25 as well as assessment of the progress of the 


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1 Federal Government and States, with respect to 

2 achieving the goals of the Healthy People 2020 

3 initiative; and 

4 (B) the activities of other entities that par5 ticipate in the program, including nonprofit or6 ganizations, patient advocacy groups, and med7 ical societies; and 

8 (2) makes recommendations for the future di9 rection of asthma activities, in consultation with re10 searchers from the National Institutes of Health and 

11 other member bodies of the National Asthma Edu12 cation and Prevention Program who are qualified to 

13 review and analyze data and evaluate interventions, 

14 including— 

15 (A) description of how the Federal Govern16 ment may better coordinate and improve its re17 sponse to asthma including identifying any bar18 riers that may exist; 

19 (B) description of how the Federal Govern20 ment may continue, expand, and improve its 

21 private-public partnerships with respect to asth22 ma including identifying any barriers that may 

23 exist; 

24 (C) identification of steps that may be 

25 taken to reduce the— 


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1 (i) morbidity, mortality, and overall 

2 prevalence of asthma; 

3 (ii) financial burden of asthma on so4 ciety; 

5 (iii) burden of asthma on dispropor6 tionately affected areas, particularly those 

7 in medically underserved populations (as 

8 defined in section 330(b)(3) of the Public 

9 Health Service Act (42 U.S.C. 

10 254b(b)(3))); and 

11 (iv) burden of asthma as a chronic 

12 disease; 

13 (D) identification of programs and policies 

14 that have achieved the steps described in sub15 paragraph (C), and steps that may be taken to 

16 expand such programs and policies to benefit 

17 larger populations; and 

18 (E) recommendations for future research 

19 and interventions. 

20 (b) REPORT TO CONGRESS.—At the end of the 5-year 

21 period following the submission of the report under sub22 section (a), the National Asthma Education and Preven23 tion Program shall evaluate the analyses and rec24 ommendations under such report and determine whether 


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1 a new report to the Congress is necessary, and make ap2 propriate recommendations to the Congress. 

3 SEC. 777. ASTHMA-RELATED ACTIVITIES OF THE CENTERS 

4 FOR DISEASE CONTROL AND PREVENTION. 

5 Section 317I of the Public Health Service Act (42 

6 U.S.C. 247b–10) is amended to read as follows: 

7 ‘‘SEC. 317I. ASTHMA-RELATED ACTIVITIES OF THE CENTERS 

8 FOR DISEASE CONTROL AND PREVENTION. 

9 ‘‘(a) PROGRAM FOR PROVIDING INFORMATION AND

10 EDUCATION TO THE PUBLIC.—The Secretary, acting 

11 through the Director of the Centers for Disease Control 

12 and Prevention, shall collaborate with State and local 

13 health departments to conduct activities, including the 

14 provision of information and education to the public re15 garding asthma including— 

16 ‘‘(1) deterring the harmful consequences of un17 controlled asthma; and 

18 ‘‘(2) disseminating health education and infor19 mation regarding prevention of asthma episodes and 

20 strategies for managing asthma. 

21 ‘‘(b) DEVELOPMENT OF STATE ASTHMA PLANS.— 

22 The Secretary, acting through the Director of the Centers 

23 for Disease Control and Prevention, shall collaborate with 

24 State and local health departments to develop State plans 

25 incorporating public health responses to reduce the burden 


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1 of asthma, particularly regarding disproportionately af2 fected populations. 

3 ‘‘(c) COMPILATION OF DATA.—The Secretary, acting 

4 through the Director of the Centers for Disease Control 

5 and Prevention, shall, in cooperation with State and local 

6 public health officials— 

7 ‘‘(1) conduct asthma surveillance activities to 

8 collect data on the prevalence and severity of asth9 ma, the effectiveness of public health asthma inter10 ventions, and the quality of asthma management, in11 cluding— 

12 ‘‘(A) collection of household data on the 

13 local burden of asthma; 

14 ‘‘(B) surveillance of health care facilities; 

15 and 

16 ‘‘(C) collection of data not containing indi17 vidually identifiable information from electronic 

18 health records or other electronic communica19 tions; 

20 ‘‘(2) compile and annually publish data regard21 ing the prevalence and incidence of childhood asth22 ma, the child mortality rate, and the number of hos23 pital admissions and emergency department visits by 

24 children associated with asthma nationally and in 

25 each State and at the county level by age, sex, race, 


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1 and ethnicity, as well as lifetime and current preva2 lence; and 

3 ‘‘(3) compile and annually publish data regard4 ing the prevalence and incidence of adult asthma, 

5 the adult mortality rate, and the number of hospital 

6 admissions and emergency department visits by 

7 adults associated with asthma nationally and in each 

8 State and at the county level by age, sex, race, eth9 nicity, industry, and occupation, as well as lifetime 

10 and current prevalence. 

11 ‘‘(d) COORDINATION OF DATA COLLECTION.—The 

12 Director of the Centers for Disease Control and Preven13 tion, in conjunction with State and local health depart14 ments, shall coordinate data collection activities under 

15 subsection (c)(2) so as to maximize comparability of re16 sults. 

17 ‘‘(e) COLLABORATION.—The Centers for Disease 

18 Control and Prevention are encouraged to collaborate with 

19 national, State, and local nonprofit organizations to pro20 vide information and education about asthma, and to 

21 strengthen such collaborations when possible. 

22 ‘‘(f) ADDITIONAL FUNDING.—In addition to any 

23 other authorization of appropriations that is available to 

24 the Centers for Disease Control and Prevention for the 

25 purpose of carrying out this section, there are authorized 


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1 to be appropriated to such Centers such sums as may be 

2 necessary for each of fiscal years 2015 through 2019 for 

3 the purpose of carrying out this section.’’. 

4 SEC. 778. INFLUENZA AND PNEUMONIA VACCINATION CAM5 PAIGN. 

6 (a) IN GENERAL.—The Secretary of Health and 

7 Human Services shall— 

8 (1) enhance the annual campaign by the De9 partment of Health and Human Services to increase 

10 the number of people vaccinated each year for influ11 enza and pneumonia; and 

12 (2) include in such campaign the use of written 

13 educational materials, public service announcements, 

14 physician education, and any other means which the 

15 Secretary deems effective. 

16 (b) MATERIALS AND ANNOUNCEMENTS.—In carrying 

17 out the annual campaign described in subsection (a), the 

18 Secretary of Health and Human Services shall ensure 

19 that— 

20 (1) educational materials and public service an21 nouncements are readily and widely available in 

22 communities experiencing disparities in the incidence 

23 and mortality rates of influenza and pneumonia; and 


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1 (2) the campaign uses targeted, culturally ap2 propriate messages and messengers to reach under3 served communities. 

4 (c) AUTHORIZATION OF APPROPRIATIONS.—There 

5 are authorized to be appropriated to carry out this section 

6 such sums as may be necessary for each of fiscal years 

7 2015 through 2019. 

8 SEC. 779. CHRONIC OBSTRUCTIVE PULMONARY DISEASE 

9 ACTION PLAN. 

10 (a) IN GENERAL.—The Director of the Centers for 

11 Disease Control and Prevention shall conduct, support, 

12 and expand public health strategies, prevention, diagnosis, 

13 surveillance, and public and professional awareness activi14 ties regarding chronic obstructive pulmonary disease. 

15 (b) NATIONAL ACTION PLAN.— 

16 (1) DEVELOPMENT.—Not later than 2 years 

17 after the date of the enactment of this Act, the Di18 rector of the National Heart, Lung, and Blood Insti19 tute, in consultation with the Director of the Centers 

20 for Disease Control and Prevention, shall develop a 

21 national action plan to address chronic obstructive 

22 pulmonary disease in the United States with partici23 pation from patients, caregivers, health profes24 sionals, patient advocacy organizations, researchers, 


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1 providers, public health professionals, and other 

2 stakeholders. 

3 (2) CONTENTS.—At a minimum, such plan 

4 shall include recommendations for— 

5 (A) public health interventions for the pur6 pose of implementation of the national plan; 

7 (B) biomedical, health services, and public 

8 health research on chronic obstructive pul9 monary disease; and 

10 (C) inclusion of chronic obstructive pul11 monary disease in the health data collections of 

12 all Federal agencies. 

13 (3) CONSIDERATION.—In developing such plan, 

14 the Director of the National Heart, Lung, and Blood 

15 Institute shall consider the recommendations and 

16 findings of the Institute of Medicine in the report 

17 entitled ‘‘A Nationwide Framework for Surveillance 

18 of Cardiovascular and Chronic Lung Diseases’’ (July 

19 22, 2011). 

20 (c) CHRONIC DISEASE PREVENTION PROGRAMS.— 

21 The Director of the National Heart, Lung, and Blood In22 stitute shall carry out the following: 

23 (1) Conduct public education and awareness ac24 tivities with patient and professional organizations 

25 to stimulate earlier diagnosis and improve patient 


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1 outcomes from treatment of chronic obstructive pul2 monary disease. To the extent known and relevant, 

3 such public education and awareness activities shall 

4 reflect differences in chronic obstructive pulmonary 

5 disease by cause (tobacco, environmental, occupa6 tional, biological, and genetic) and include a focus 

7 on outreach to undiagnosed and, as appropriate, mi8 nority populations. 

9 (2) Supplement and expand upon the activities 

10 of the National Heart, Lung, and Blood Institute by 

11 making grants to nonprofit organizations, State and 

12 local jurisdictions, and Indian tribes for the purpose 

13 of reducing the burden of chronic obstructive pul14 monary disease, especially in disproportionately im15 pacted communities, through public health interven16 tions and related activities. 

17 (3) Coordinate with the Centers for Disease 

18 Control and Prevention, the Indian Health Service, 

19 the Health Resources and Services Administration, 

20 and the Department of Veterans Affairs to develop 

21 pilot programs to demonstrate best practices for the 

22 diagnosis and management of chronic obstructive 

23 pulmonary disease. 

24 (4) Develop improved techniques and identify 

25 best practices, in coordination with the Secretary of 


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1 Veterans Affairs, for assisting chronic obstructive 

2 pulmonary disease patients to successfully stop 

3 smoking, including identification of subpopulations 

4 with different needs. Initiatives under this para5 graph may include research to determine whether 

6 successful smoking cessation strategies are different 

7 for chronic obstructive pulmonary disease patients 

8 compared to such strategies for patients with other 

9 chronic diseases. 

10 (d) ENVIRONMENTAL AND OCCUPATIONAL HEALTH

11 PROGRAMS.—The Director of the Centers for Disease 

12 Control and Prevention shall— 

13 (1) support research into the environmental and 

14 occupational causes and biological mechanisms that 

15 contribute to chronic obstructive pulmonary disease; 

16 and 

17 (2) develop and disseminate public health inter18 ventions that will lessen the impact of environmental 

19 and occupational causes of chronic obstructive pul20 monary disease. 

21 (e) DATA COLLECTION.—Not later than 180 days 

22 after the enactment of this Act, the Director of the Na23 tional Heart, Lung, and Blood Institute and the Director 

24 of the Centers for Disease Control and Prevention, acting 

25 jointly, shall assess the depth and quality of information 


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1 on chronic obstructive pulmonary disease that is collected 

2 in surveys and population studies conducted by the Cen3 ters for Disease Control and Prevention, including wheth4 er there are additional opportunities for information to be 

5 collected in the National Health and Nutrition Examina6 tion Survey, the National Health Interview Survey, and 

7 the Behavioral Risk Factors Surveillance System surveys. 

8 The Director of the National Heart, Lung, and Blood In9 stitute shall include the results of such assessment in the 

10 national action plan under subsection (b). 

11 (f) AUTHORIZATION OF APPROPRIATIONS.—There 

12 are authorized to be appropriated to carry out this section 

13 such sums as may be necessary for each of fiscal years 

14 2015 through 2019. 

15 Subtitle H—Osteoarthritis and 

16 Musculoskeletal Diseases 

17 SEC. 781. FINDINGS. 

18 The Congress finds as follows: 

19 (1) Eighty percent of African-American women 

20 and nearly 74 percent of Hispanic men are either 

21 overweight or obese, speeding the onset and progres22 sion of arthritis. 

23 (2) Arthritis affects 46 million Americans, and 

24 that number will rise to 67 million by the year 2030. 


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1 (3) Twenty-seven million Americans suffer from 

2 osteoarthritis, the most common form of arthritis, 

3 making it the leading cause of disability in the 

4 United States. Osteoarthritis is sometimes referred 

5 to as degenerative joint disease. 

6 (4) Obesity accelerates the onset of arthritis: 70 

7 percent of obese adults with mild osteoarthritis of 

8 the knee at age 60 will develop advanced end-stage 

9 disease by age 80. In contrast, just 43 percent of 

10 non-obese adults will have end-stage disease over the 

11 same time period. 

12 (5) Arthritis affects one in five Americans, and 

13 is the single greatest cause of chronic pain and dis14 ability in the United States. 

15 (6) Women, African-Americans, and Hispanics 

16 have more severe arthritis and functional limitations. 

17 These same individuals are more likely to be obese, 

18 diabetic, and have higher incidence of heart dis19 ease—medical conditions that can be improved with 

20 physical activity. Instead of moving; however, these 

21 groups have an inactivity rate of 40 to 50 percent, 

22 which continues to increase. 

23 (7) Arthritis costs $128 billion a year, including 

24 $81 billion in direct costs (medical) and $47 billion 

25 in indirect costs (lost earnings). Each year, $309 bilVerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00639 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294

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1 lion in direct and indirect costs is lost due to dis2 parities in osteoarthritis and musculoskeletal dis3 eases. 

4 (8) Obesity and other chronic health conditions 

5 exacerbate the debilitating impact of arthritis, lead6 ing to inactivity, loss of independence, and a per7 petual cycle of comorbid chronic conditions. 

8 (9) Sixty-one percent of arthritis sufferers are 

9 women, and women represent 64 percent of an esti10 mated 43 million annual visits to physicians’ offices 

11 and outpatient clinics where arthritis was the pri12 mary diagnosis. Women also represented 60 percent 

13 of approximately 1 million hospitalizations that oc14 curred in 2003 for which arthritis was the primary 

15 diagnosis. 

(10) Women ages 65 and older have up to 21 16 ⁄2

17 times more disabilities than men of the same age. 

18 Higher rates of obesity and arthritis among this 

19 group explained up to 48 percent of the gender gap 

20 in disability, above all other common chronic health 

21 conditions. 

22 (11) The primary indication for total knee 

23 arthroplasty (TKA), also known as knee replace24 ment, is relief of significant, disabling pain caused 

25 by severe arthritis. 


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1 (12) Knee replacement is surgery for people 

2 with severe knee damage. Knee replacement can re3 lieve pain and allow you to be more active. When 

4 you have a total knee replacement, the surgeon re5 moves damaged cartilage and bone from the surface 

6 of your knee joint and replaces them with a man7 made surface of metal and plastic. In a partial knee 

8 replacement, the surgeon only replaces one part of 

9 your knee joint. 

10 (13) Total hip replacement, also called total hip 

11 arthroplasty (THA), is used if your hip pain inter12 feres with daily activities and more-conservative 

13 treatments have not helped. Arthritis damage is the 

14 most common reason to need hip replacement. 

15 (14) The odds of a family practice physician 

16 recommending TKA to a male patient with moderate 

17 arthritis are twice that of a female patient, while the 

18 odds of an orthopaedic surgeon recommending TKA 

19 to a male patient with moderate arthritis are 22 

20 times that of a female patient. 

21 (15) African-Americans with doctor-diagnosed 

22 arthritis have a higher prevalence of severe pain at23 tributable to arthritis, compared with Whites (34.0 

24 percent versus 22.6 percent). African-Americans, 

25 compared to Whites, report a higher proportion of 


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1 work limitations (39.5 percent versus 28.0 percent) 

2 and a higher prevalence of arthritis-attributable 

3 work limitation (6.6 percent versus 4.6 percent). 

4 (16) Hispanics are 50 percent more likely than 

5 non-Hispanic Whites to report needing assistance 

6 with at least one instrumental activity of daily living 

7 and to have difficulty walking. 

8 (17) African-Americans and Hispanics were 1.3 

9 times more likely to have activity limitation, 1.6 

10 times more likely to have work limitations, and 1.9 

11 times more likely to have severe joint pain than 

12 Whites. 

13 (18) In 2003, the Institute of Medicine reported 

14 that the rates of TKA and THA among African15 American and Hispanic patients are significantly 

16 lower than for Whites—even for those with equitable 

17 health care coverage such as through Medicare or 

18 the Department of Veterans Affairs. 

19 (19) According to the Centers for Disease Con20 trol and Prevention, in 2000, African-American 

21 Medicare enrollees were 37 percent less likely than 

22 White Medicare enrollees to undergo total knee re23 placements. In 2006, the disparity increased to 39 

24 percent. 


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1 (20) Even after adjusting for insurance and 

2 health access, Hispanics and African-Americans are 

3 almost 50 percent less likely to undergo total knee 

4 replacement than Whites. 

5 SEC. 782. OSTEOARTHRITIS AND OTHER MUSCULO6 SKELETAL HEALTH-RELATED ACTIVITIES OF 

7 THE CENTERS FOR DISEASE CONTROL AND 

8 PREVENTION. 

9 (a) EDUCATION AND AWARENESS ACTIVITIES.—The 

10 Secretary of Health and Human Services, acting through 

11 the Director of the Centers for Disease Control and Pre12 vention, shall direct the National Center for Chronic Dis13 ease Prevention and Health Promotion to conduct and ex14 pand the Health Community Program and Arthritis Pro15 gram to educate the public on— 

16 (1) the causes of, preventive health actions for, 

17 and effects of arthritis and other musculoskeletal 

18 conditions in minority patient populations; and 

19 (2) the effects of such conditions on other 

20 comorbidities including obesity, hypertension, and 

21 cardiovascular disease. 

22 (b) PROGRAMS ON ARTHRITIS AND MUSCULO23 SKELETAL CONDITIONS.—Education and awareness pro24 grams of the Centers for Disease Control and Prevention 


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1 on arthritis and other musculoskeletal conditions in minor2 ity communities shall— 

3 (1) be culturally and linguistically appropriate 

4 to minority patients, targeting musculoskeletal 

5 health promotion and prevention programs of each 

6 major ethnic group, including— 

7 (A) Native Americans and Alaska Natives; 

8 (B) Asian-Americans; 

9 (C) African-Americans/Blacks; 

10 (D) Hispanic/Latino-Americans; and 

11 (E) Native Hawaiians and Pacific Island12 ers; and 

13 (2) include public awareness campaigns directed 

14 toward these patient populations that emphasize the 

15 importance of musculoskeletal health, physical activ16 ity, diet and healthy lifestyle, and weight reduction 

17 for overweight and obese patients. 

18 (c) AUTHORIZATION OF APPROPRIATIONS.—To carry 

19 out this section, there are authorized to be appropriated 

20 such sums as necessary for fiscal year 2015 and each sub21 sequent fiscal year. 


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1 Subtitle I—Sleep and Circadian 

2 Rhythm Disorders 

3 SEC. 791. SHORT TITLE; FINDINGS. 

4 (a) SHORT TITLE.—This subtitle may be cited as the 

5 ‘‘Sleep and Circadian Rhythm Disorders Health Dispari6 ties Act’’. 

7 (b) FINDINGS.—The Congress finds the following: 

8 (1) Decrements in sleep health such as sleep 

9 apnea, insufficient sleep time, and insomnia, affect 

10 50–70 million United States adults. Twelve to eight11 een million United States adults have sleep apnea, a 

12 chronic disorder characterized by one or more 

13 pauses in breathing which can last from a few sec14 onds to minutes. They may occur 30 times or more 

15 an hour, disrupting sleep and resulting in excessive 

16 daytime sleepiness and loss in productivity. 

17 (2) Seventy percent of high school students are 

18 not getting enough sleep on school nights, while 33 

19 percent of Americans get fewer than 7 hours of sleep 

20 per night and roughly 6,000 fatal motor vehicle 

21 crashes are caused by drowsy drivers. 

22 (3) Insufficient sleep and insomnia are more 

23 prevalent in women. Women who are pregnant and 

24 have sleep apnea are at an increased risk of cardio25 vascular complications during pregnancy. The imVerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00645 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294

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1 pact of disparities in sleep health is associated with 

2 a growing number of health problems, including the 

3 following: 

4 (A) Hypertension. 

5 (B) Cancer. 

6 (C) Stroke. 

7 (D) Cardiac arrhythmia. 

8 (E) Chronic heart failure and heart dis9 ease. 

10 (F) Diabetes. 

11 (G) Cognitive functioning and behavior. 

12 (H) Depression and bipolar disorder. 

13 (I) Substance abuse. 

14 (4) A ‘‘sleep disparity’’ exists in that poor sleep 

15 quality is strongly associated with poverty and race. 

16 Factors such as employment, education, and health 

17 status, amongst others, significantly mediated this 

18 effect only in poor subjects, suggesting a differential 

19 vulnerability to these factors in poor relative to non20 poor individuals in the context of sleep quality. 

21 (5) African-Americans sleep worse than Cauca22 sian Americans. African-Americans take longer to 

23 fall asleep, report poorer sleep quality, have more 

24 light and less deep sleep, and nap more often and 

25 longer. 


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1 (6) African-Americans and individuals in lower 

2 socioeconomic status groups may be at an increased 

3 risk for sleep disturbances and associated health 

4 consequences. 

5 (7) Among young African-Americans, the likeli6 hood of having sleep disordered breathing and exhib7 iting risk factors for poor sleep is twice that in 

8 young Caucasians. Frequent snoring is more com9 mon among African-American and Hispanic women 

10 and Hispanic men compared to non-Hispanic Cauca11 sians, independent of other factors including obesity. 

12 (8) African-Americans with sleep disordered 

13 breathing develop symptoms at a younger age than 

14 Caucasians but appear less likely to be diagnosed 

15 and treated in a timely manner. This delay may at 

16 least in part be due to reduced access to care. 

17 (9) Sleep loss contributes to increased risk for 

18 chronic conditions such as obesity, diabetes, and hy19 pertension, all of which have increased prevalence in 

20 underserved, underrepresented minorities. Racial 

21 and ethnic disparities related to obesity may also 

22 contribute to disparities in health outcomes related 

23 to sleep disordered breathing. 


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1 (10) Non-Caucasian adults report an insomnia 

2 rate of 12.9 percent compared to only 6.6 percent 

3 for Caucasians. 

4 (11) African-American women have a higher in5 cidence of insomnia than African-American men, 

6 perhaps related in part to higher risk for chronic 

7 persisting symptoms. 

8 SEC. 792. SLEEP AND CIRCADIAN RHYTHM DISORDERS RE9 SEARCH ACTIVITIES OF THE NATIONAL IN10 STITUTES OF HEALTH. 

11 (a) IN GENERAL.—The Director of the National In12 stitutes of Health, acting through the Director of the Na13 tional Heart, Lung, and Blood Institute, shall— 

14 (1) continue to expand research activities ad15 dressing sleep health disparities; and 

16 (2) continue implementation of the ‘‘NIH Sleep 

17 Disorders Research Plan’’ across all institutes and 

18 centers of the National Institutes of Health to im19 prove treatment and prevention of sleep health dis20 parities. 

21 (b) REQUIRED RESEARCH ACTIVITIES.—In con22 ducting or supporting research relating to sleep and circa23 dian rhythm, the Director of the National Heart, Lung, 

24 and Blood Institute shall— 


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1 (1) advance epidemiology and clinical research 

2 to achieve a more complete understanding of dispari3 ties in domains of sleep health and across population 

4 subgroups for which cardiovascular and metabolic 

5 health disparities exist, including— 

6 (A) prevalence and severity of sleep apnea; 

7 (B) habitual sleep duration; 

8 (C) sleep timing and regularity; and 

9 (D) insomnia; 

10 (2) develop study designs and analytical ap11 proaches to explain and predict multilevel and life12 course determinants of sleep health and to elucidate 

13 the sleep-related causes of cardiovascular and meta14 bolic health disparities across the age spectrum, in15 cluding such determinants and causes that are— 

16 (A) environmental; 

17 (B) biological or genetic; 

18 (C) psychosocial; 

19 (D) societal; 

20 (E) political; or 

21 (F) economic; 

22 (3) determine the contribution of sleep impair23 ments such as sleep apnea, insufficient sleep dura24 tion, irregular sleep schedules, and insomnia to unVerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00649 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294

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1 explained disparities in cardiovascular and metabolic 

2 risk and disease outcomes; 

3 (4) develop study designs, data sampling and 

4 collection tools, and analytical approaches to opti5 mize understanding of mediating and moderating 

6 factors, and feedback mechanisms coupling sleep to 

7 cardiovascular and metabolic health disparities; 

8 (5) advance research to understand cultural 

9 and linguistic barriers (on the person, provider, or 

10 system level) to access to care, medical diagnosis, 

11 and treatment of sleep disorders in diverse popu12 lation groups; 

13 (6) develop and test multilevel interventions (in14 cluding sleep health education in diverse commu15 nities) to reduce disparities in sleep health that will 

16 impact ability to improve disparities in cardio17 vascular and metabolic risk or disease; 

18 (7) create opportunities to integrate sleep and 

19 health disparity science by strategically utilizing re20 sources (existing or anticipated cohorts), exchanging 

21 scientific data and ideas (cross-over into scientific 

22 meetings), and develop multidisciplinary investi23 gator-initiated grant applications; and 


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1 (8) enhance the diversity and foster career de2 velopment of young investigators involved in sleep 

3 and health disparities science. 

4 (c) AUTHORIZATION OF APPROPRIATIONS.—To carry 

5 out this section, there are authorized to be appropriated 

6 such sums as may be necessary for fiscal year 2015 and 

7 each subsequent fiscal year. 

8 SEC. 793. SLEEP AND CIRCADIAN RHYTHM HEALTH DIS9 PARITIES-RELATED ACTIVITIES OF THE CEN10 TERS FOR DISEASE CONTROL AND PREVEN11 TION. 

12 (a) IN GENERAL.—The Director of the Centers for 

13 Disease Control and Prevention shall conduct, support, 

14 and expand public health strategies and prevention, diag15 nosis, surveillance, and public and professional awareness 

16 activities regarding sleep and circadian rhythm disorders. 

17 (b) FINDINGS.—The Congress finds as follows: 

18 (1) Sleep disorders and sleep deficiency unre19 lated to a primary sleep disorder are underdiagnosed 

20 and are increasingly detrimental to health status. 

21 (2) The consequences to society include addi22 tional diseases, motor vehicle accidents, decreased 

23 longevity, elevated direct medical costs, and indirect 

24 costs related to work absenteeism and property dam25 age. 


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1 (c) REQUIRED SURVEILLANCE AND EDUCATION

2 AWARENESS ACTIVITIES.—In conducting or supporting 

3 research relating to sleep and circadian rhythm disorders 

4 surveillance and education awareness activities, the Direc5 tor of the Centers for Disease Control and Prevention 

6 shall— 

7 (1) ensure that such activities are culturally 

8 and linguistically appropriate to minority patients, 

9 targeting sleep and circadian rhythm health pro10 motion and prevention programs of each major eth11 nic group, including— 

12 (A) Native Americans and Alaska Natives; 

13 (B) Asian-Americans; 

14 (C) African-Americans/Blacks; 

15 (D) Hispanic/Latino-Americans; and 

16 (E) Native Hawaiians and Pacific Island17 ers; 

18 (2) collect and compile national and State sur19 veillance data on sleep disorders health disparities; 

20 (3) continue to develop and implement new 

21 sleep questions in public health surveillance systems 

22 to increase public awareness of sleep health and 

23 sleep disorders and their impact on health; 

24 (4) publish monthly reports highlighting geo25 graphic, racial, and ethnic disparities in sleep health, 


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1 as well as relationships between insufficient sleep 

2 and chronic disease, health risk behaviors, and other 

3 outcomes as determined necessary by the Director; 

4 and 

5 (5) include public awareness campaigns that in6 form patient populations from major ethnic groups 

7 about the prevalence of sleep and circadian rhythm 

8 disorders and emphasize the importance of sleep 

9 health. 

10 (d) AUTHORIZATION OF APPROPRIATIONS.—To carry 

11 out this section, there are authorized to be appropriated 

12 such sums as may be necessary for fiscal year 2015 and 

13 each subsequent fiscal year. 

14 TITLE VIII—HEALTH 

15 INFORMATION TECHNOLOGY 

16 SEC. 800. DEFINITIONS. 

17 In this title: 

18 (1) The term ‘‘certified EHR technology’’ has 

19 the meaning given to that term in section 3000 of 

20 the Public Health Service Act (42 U.S.C. 300jj). 

21 (2) The term ‘‘EHR’’ means an electronic 

22 health record. 


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1 Subtitle A—Reducing Health 

2 Disparities Through Health IT 

3 SEC. 801. HRSA ASSISTANCE TO HEALTH CENTERS FOR 

4 PROMOTION OF HEALTH IT. 

5 The Secretary of Health and Human Services, acting 

6 through the Administrator of the Health Resources and 

7 Services Administration, shall expand and intensify the 

8 programs and activities of the Administration (directly or 

9 through grants or contracts) to provide technical assist10 ance and resources to health centers (as defined in section 

11 330(a) of the Public Health Service Act (42 U.S.C. 

12 254b(a)) to adopt and meaningfully use certified EHR 

13 technology for the management of chronic diseases and 

14 health conditions and reduction of health disparities. 

15 SEC. 802. ASSESSMENT OF IMPACT OF HEALTH IT ON RA16 CIAL AND ETHNIC MINORITY COMMUNITIES; 

17 OUTREACH AND ADOPTION OF HEALTH IT IN 

18 SUCH COMMUNITIES. 

19 (a) NATIONAL COORDINATOR FOR HEALTH INFOR20 MATION TECHNOLOGY.— 

21 (1) IN GENERAL.—The National Coordinator 

22 for Health Information Technology shall conduct an 

23 evaluation of the level of use and accessibility of 

24 electronic health records in racial and ethnic minor25 ity communities focusing on whether patients in 


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1 those communities have providers with EHRs, 

2 stratified by disparity variables. 

3 (2) CONTENT.—In conducting the evaluation 

4 under paragraph (1), the National Coordinator shall 

5 publish the results of a study regarding the 100,000 

6 providers recruited by the Regional Extension Cen7 ter established under section 3012 of the Public 

8 Health Service Act (42 U.S.C. 300jj–32), including 

9 the race and ethnicity of such providers and the pop10 ulations served by such providers, with the popu11 lations stratified by disparity variables. 

12 (b) NATIONAL CENTER FOR HEALTH STATISTICS.— 

13 As soon as practicable after the date of enactment of this 

14 Act, the Director of the National Center for Health Statis15 tics shall provide to Congress a more detailed analysis of 

16 the data presented in the Data Brief 79 published by such 

17 Center in November 2011 (entitled ‘‘Electronic Health 

18 Record Systems and Intent to Apply for Meaningful Use 

19 Incentives Among Office-Based Physician Practices’’). 

20 (c) INSTITUTE OF MEDICINE.—The Secretary of 

21 Health and Human Services may enter into an agreement 

22 with the Institute of Medicine of the National Academies 

23 that provides such Institute will— 


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1 (1) evaluate the impact of health information 

2 technology in racial and ethnic minority commu3 nities; and 

4 (2) publish a report regarding such evaluation. 

5 (d) CENTERS FOR MEDICARE & MEDICAID SERV6 ICES.— 

7 (1) IN GENERAL.—As part of the process of 

8 collecting information, with respect to a provider, at 

9 registration and attestation for purposes of the 

10 Medicare and Medicaid Electronic Health Records 

11 Incentive Programs, the Secretary of Health and 

12 Human Services shall collect the race and ethnicity 

13 of such provider. 

14 (2) MEDICARE AND MEDICAID ELECTRONIC

15 HEALTH RECORDS INCENTIVE PROGRAMS DE16 FINED.—For purposes of paragraph (1), the term 

17 ‘‘Medicare and Medicaid Electronic Health Records 

18 Incentive Programs’’ means the incentive programs 

19 under section 1814(l)(3), subsections (a)(7) and (o) 

20 of section 1848, subsections (l) and (m) of section 

21 1853, subsections (b)(3)(B)(ix)(I) and (n) of section 

22 1886, and subsections (a)(3)(F) and (t) of section 

23 1903 of the Social Security Act (42 U.S.C. 

24 1395f(l)(3), 1395w–4, 1395w–23, 1395ww, and 

25 1396b). 


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1 (e) NATIONAL COORDINATOR’S ASSESSMENT OF IM2 PACT OF HIT.—Section 3001(c)(6)(C) of the Public 

3 Health Service Act (42 U.S.C. 300jj–11(c)(6)(C)) is 

4 amended— 

5 (1) in the heading by inserting ‘‘, RACIAL AND

6 ETHNIC MINORITY COMMUNITIES,’’ after ‘‘HEALTH

7 DISPARITIES’’; 

8 (2) by inserting ‘‘, in communities with a high 

9 proportion of individuals from racial and ethnic mi10 nority groups (as defined in section 1707(g)), in11 cluding people with disabilities in these groups,’’ 

12 after ‘‘communities with health disparities’’; and 

13 (3) by adding at the end the following new sen14 tence: ‘‘In any publication under the previous sen15 tence, the National Coordinator shall include best 

16 practices for encouraging partnerships between the 

17 Federal Government, States, and private entities to 

18 expand outreach for and the adoption of certified 

19 EHR technology in communities with a high propor20 tion of individuals from racial and ethnic minority 

21 groups (as so defined), while also maintaining the 

22 accessibility requirements of section 508 of the Re23 habilitation Act to encourage patient involvement in 

24 their own health care. The National Coordinator 

25 shall— 


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1 ‘‘(i) not later than 6 months after the 

2 submission to the Congress of the report 

3 required by section 832 of the Health Eq4 uity and Accountability Act of 2014, estab5 lish criteria for evaluating the impact of 

6 health information technology on commu7 nities with a high proportion of individuals 

8 from racial and ethnic minority groups (as 

9 so defined) taking into account the find10 ings in such report; and 

11 ‘‘(ii) not later than 12 months after 

12 the submission to the Congress of such re13 ports, conduct and publish the results of 

14 an evaluation of such impact.’’. 

15 Subtitle B—Modifications To 

16 Achieve Parity in Existing Pro17 grams 

18 SEC. 811. EXTENDING FUNDING TO STRENGTHEN THE 

19 HEALTH IT INFRASTRUCTURE IN RACIAL 

20 AND ETHNIC MINORITY COMMUNITIES. 

21 Section 3011 of the Public Health Service Act (42 

22 U.S.C. 300jj–31) is amended— 

23 (1) in subsection (a), by adding at the end the 

24 following new paragraph: 


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1 ‘‘(8) Activities described in the previous para2 graphs of this subsection with respect to commu3 nities with a high proportion of individuals from ra4 cial and ethnic minority groups (as defined in sec5 tion 1707(g)).’’; and 

6 (2) by adding at the end the following new sub7 section: 

8 ‘‘(e) ANNUAL REPORT ON EXPENDITURES.—The 

9 National Coordinator shall report annually to the Con10 gress on activities and expenditures under this section.’’. 

11 SEC. 812. PRIORITIZING REGIONAL EXTENSION CENTER AS12 SISTANCE TO RACIAL AND ETHNIC MINORITY 

13 GROUPS. 

14 (a) IN GENERAL.—Section 3012(c)(4)(C) of the Pub15 lic Health Service Act (42 U.S.C. 300jj–32(c)(4)(C)) is 

16 amended by inserting ‘‘or individuals from racial and eth17 nic minority groups (as defined in section 1707(g))’’ after 

18 ‘‘medically underserved individuals’’. 

19 (b) BIENNIAL EVALUATION.—Section 3012(c)(8) of 

20 such Act (42 U.S.C. 300jj–32(c)(8)) is amended— 

21 (1) by inserting: ‘‘Each evaluation panel shall 

22 include at least one consumer advocate from a racial 

23 and ethnic minority community served by the center 

24 involved, at least one patient or family caregiver, 


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1 and at least one representative of a minority-serving 

2 institution.’’ after ‘‘ ‘and of Federal officials.’’; and 

3 (2) by inserting ‘‘and shall determine the de4 gree to which such center provides outreach and as5 sistance to providers predominantly serving racial 

6 and ethnic minority groups (as defined in section 

7 1707(g))’’ after ‘‘specified in paragraph (3)’’. 

8 SEC. 813. EXTENDING COMPETITIVE GRANTS FOR THE DE9 VELOPMENT OF LOAN PROGRAMS TO FACILI10 TATE ADOPTION OF CERTIFIED EHR TECH11 NOLOGY BY PROVIDERS SERVING RACIAL 

12 AND ETHNIC MINORITY GROUPS. 

13 Section 3014(e) of the Public Health Service Act (42 

14 U.S.C. 300jj–34(e)) is amended— 

15 (1) in paragraph (3), by striking at the end 

16 ‘‘or’’; 

17 (2) in paragraph (4), by striking the period at 

18 the end and inserting ‘‘; or’’; and 

19 (3) by adding at the end the following new 

20 paragraph: 

21 ‘‘(5) carry out any of the activities described in 

22 a previous paragraph of this subsection with respect 

23 to communities with a high proportion of individuals 

24 from racial and ethnic minority groups (as defined 

25 in section 1707(g)).’’. 


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1 SEC. 814. AUTHORIZATION OF APPROPRIATIONS. 

2 Section 3018 of the Public Health Service Act (42 

3 U.S.C. 300jj–38) is amended by striking ‘‘fiscal years 

4 2009 through 2013’’ and inserting ‘‘fiscal years 2014 

5 through 2021’’. 

6 Subtitle C—Additional Research 

7 and Studies 

8 SEC. 831. DATA COLLECTION AND ASSESSMENTS CON9 DUCTED IN COORDINATION WITH MINORITY10 SERVING INSTITUTIONS. 

11 Section 3001(c)(6) of the Public Health Service Act 

12 (42 U.S.C. 300jj–11(c)(6)) is amended by adding at the 

13 end the following new subparagraph: 

14 ‘‘(F) DATA COLLECTION AND ASSESS15 MENTS CONDUCTED IN COORDINATION WITH

16 MINORITY-SERVING INSTITUTIONS.— 

17 ‘‘(i) IN GENERAL.—In carrying out 

18 subparagraph (C) with respect to commu19 nities with a high proportion of individuals 

20 from racial and ethnic minority groups (as 

21 defined in section 1707(g)), the National 

22 Coordinator shall, to the greatest extent 

23 possible, coordinate with an entity de24 scribed in clause (ii). 

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1 tity described in this clause is a historically 

2 Black college or university, a Hispanic3 serving institution, a tribal college or uni4 versity, or an Asian-American-, Native 

5 American-, and Pacific Islander-serving in6 stitution with an accredited public health, 

7 health policy, or health services research 

8 program.’’. 

9 SEC. 832. STUDY OF HEALTH INFORMATION TECHNOLOGY 

10 IN MEDICALLY UNDERSERVED COMMU11 NITIES. 

12 (a) IN GENERAL.—Not later than 24 months after 

13 the date of enactment of this Act, the Secretary of Health 

14 and Human Services shall— 

15 (1) enter into an agreement with the Institute 

16 of Medicine of the National Academies (or, if the In17 stitute of Medicine declines, another appropriate 

18 public or nonprofit private entity) to conduct a study 

19 on the development, implementation, and effective20 ness of health information technology within medi21 cally underserved areas (as described in subsection 

22 (c)); and 

23 (2) submit a report to Congress describing the 

24 results of such study, including any recommenda25 tions for legislative or administrative action. 


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1 (b) STUDY.—The study described in subsection 

2 (a)(1) shall— 

3 (1) identify barriers to successful implementa4 tion of health information technology in medically 

5 underserved areas; 

6 (2) examine the impact of health information 

7 technology on providing quality care and reducing 

8 the cost of care to individuals in such areas, includ9 ing the impact of such technology on improved 

10 health outcomes for individuals, including which 

11 technology worked for which population and how it 

12 improved health outcomes for that population; 

13 (3) examine the impact of health information 

14 technology on improving health-care-related deci15 sions by both patients and providers in such areas; 

16 (4) identify specific best practices for using 

17 health information technology to foster the con18 sistent provision of physical accessibility and reason19 able policy accommodations in health care to individ20 uals with disabilities in such areas; 

21 (5) assess the feasibility and costs associated 

22 with the use of health information technology in 

23 such areas; 

24 (6) evaluate whether the adoption and use of 

25 qualified electronic health records (as described in 


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1 section 3000(13) of the Public Health Service Act 

2 (42 U.S.C. 300jj(13)) is effective in reducing health 

3 disparities, including analysis of clinical quality 

4 measures reported by Medicare and Medicaid pro5 viders pursuant to programs to encourage the adop6 tion and use of certified EHR technology; 

7 (7) identify providers in medically underserved 

8 areas that are not electing to adopt and use elec9 tronic health records and determine what barriers 

10 are preventing those providers from adopting and 

11 using such records; and 

12 (8) examine urban and rural community health 

13 systems and determine the impact that health infor14 mation technology may have on the capacity of pri15 mary health providers in those systems. 

16 (c) MEDICALLY UNDERSERVED AREA.—The term 

17 ‘‘medically underserved area’’ means— 

18 (1) a population that has been designated as a 

19 medically underserved population under section 

20 330(b)(3) of the Public Health Service Act (42 

21 U.S.C. 254b(b)(3)); 

22 (2) an area that has been designated as a 

23 health professional shortage area under section 332 

24 of the Public Health Service Act (42 U.S.C. 254e); 


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1 (3) an area or population that has been des2 ignated as a medically underserved community under 

3 section 799B(6) of the Public Health Service Act 

4 (42 U.S.C. 295p(6)); or 

5 (4) an area or population that— 

6 (A) is not described in paragraphs (1) 

7 through (3) of this subsection; 

8 (B) experiences significant barriers to ac9 cessing quality health services; and 

10 (C) has a high prevalence of diseases or 

11 conditions described in title VII of this Act, 

12 with such diseases or conditions having a dis13 proportionate impact on racial and ethnic mi14 nority groups (as defined in section 1707(g) of 

15 the Public Health Service Act (42 U.S.C. 300u16 6(g))) or a subgroup of people with disabilities 

17 who have specific functional impairments. 

18 Subtitle D—Closing Gaps in 

19 Funding To Adopt Certified EHRs 

20 SEC. 841. APPLICATION OF MEDICARE HITECH PAYMENTS 

21 TO HOSPITALS IN PUERTO RICO. 

22 (a) IN GENERAL.—Subsection (n)(6)(B) of section 

23 1886 of the Social Security Act (42 U.S.C. 1395ww) is 

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1 ing ‘‘hospital that is a subsection (d) hospital or a sub2 section (d) Puerto Rico hospital’’. 

3 (b) OFFSETTING REDUCTION.—Subsection (n)(2) of 

4 section 1886 of the Social Security Act (42 U.S.C. 

5 1395ww) is amended by adding at the end the following 

6 new subparagraph: 

7 ‘‘(H) BUDGET NEUTRALITY ADJUST8 MENT.—The Secretary shall reduce the applica9 ble amounts that would otherwise be deter10 mined under this subsection with respect to— 

11 ‘‘(i) the first fiscal year to which this 

12 subparagraph applies by an amount that 

13 the Secretary estimates would ensure that 

14 estimated aggregate payments under this 

15 subsection for such fiscal year are not in16 creased as a result of the amendments 

17 made by subsection (a) of section 841 of 

18 the Health Equity and Accountability Act 

19 of 2014; or 

20 ‘‘(ii) a succeeding fiscal year by an 

21 amount that the Secretary estimates would 

22 ensure that estimated aggregate payments 

23 under this subsection for such fiscal year 

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1 ments made by subsections (a) and (c) of 

2 such section.’’. 

3 (c) CONFORMING AMENDMENTS.—(1) Subsection 

4 (b)(3)(B)(ix) of such section is amended— 

5 (A) in subclause (I), by striking ‘‘(n)(6)(A)’’ 

6 and inserting ‘‘(n)(6)(B)’’; and 

7 (B) in subclause (II), by striking ‘‘subsection 

8 (d) hospital’’ and inserting ‘‘an eligible hospital’’. 

9 (2) Paragraphs (2) and (4)(A) of section 1853(m) of 

10 the Social Security Act (42 U.S.C. 1395w–23(m)) are 

11 each amended by striking ‘‘1886(n)(6)(A)’’ and inserting 

12 ‘‘1886(n)(6)(B)’’. 

13 (d) IMPLEMENTATION.—Notwithstanding any other 

14 provision of law, the Secretary of Health and Human 

15 Services may implement the amendments made by sub16 sections (a), (b) and (c) by program instruction or other17 wise. 

18 (e) EFFECTIVE DATE.—The amendments made by 

19 this section shall apply to payments for payment years for 

20 fiscal years beginning after the date of the enactment of 

21 this Act. 


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1 SEC. 842. EXTENDING MEDICAID EHR INCENTIVE PAY2 MENTS TO REHABILITATION FACILITIES, 

3 LONG-TERM CARE FACILITIES, AND HOME 

4 HEALTH AGENCIES. 

5 Section 1903(t)(2)(B) of the Social Security Act (42 

6 U.S.C. 1396b(t)(2)(B)) is amended— 

7 (1) in clause (i), by striking ‘‘, or’’ and insert8 ing a semicolon; 

9 (2) in clause (ii), by striking the period at the 

10 end and inserting a semicolon; and 

11 (3) by inserting after clause (ii) the following 

12 new clauses: 

13 ‘‘(iii) a rehabilitation facility (as defined in 

14 section 1886(j)(1)) that furnishes acute or 

15 subacute rehabilitation services; 

16 ‘‘(iv) a long-term care hospital (as defined 

17 in section 1886(d)(1)(B)(iv)(I)); or 

18 ‘‘(v) a home health agency (as defined in 

19 section 1861(o)).’’. 

20 SEC. 843. EXTENDING PHYSICIAN ASSISTANT ELIGIBILITY 

21 FOR MEDICAID ELECTRONIC HEALTH 

22 RECORD INCENTIVE PAYMENTS. 

23 (a) IN GENERAL.—Section 1903(t)(3)(B)(v) of the 

24 Social Security Act (42 U.S.C. 1396b(t)(3)(B)(v)) is 

25 amended to read as follows: 


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1 ‘‘(v) physician assistant, in the case 

2 that the assistant is a primary care pro3 vider, including an assistant who practices 

4 in a rural health clinic that is led by a phy5 sician assistant or practices in a federally 

6 qualified health center that is so led.’’. 

7 (b) EFFECTIVE DATE.—The amendment made by 

8 subsection (a) shall apply with respect to amounts ex9 pended under section 1903(a)(3)(F) of the Social Security 

10 Act (42 U.S.C. 1396b(a)(3)(F)) for calendar quarters be11 ginning on or after the date of the enactment of this Act. 

12 TITLE IX—ACCOUNTABILITY 

13 AND EVALUATION 

14 SEC. 901. PROHIBITION ON DISCRIMINATION IN FEDERAL 

15 ASSISTED HEALTH CARE SERVICES AND RE16 SEARCH PROGRAMS ON THE BASIS OF SEX, 

17 RACE, COLOR, NATIONAL ORIGIN, MARITAL 

18 STATUS, FAMILIAL STATUS, SEXUAL ORI19 ENTATION, GENDER IDENTITY, OR DIS20 ABILITY STATUS. 

21 (a) IN GENERAL.—No person in the United States 

22 shall, on the basis of sex, race, color, national origin, mar23 ital status, familial status, sexual orientation, gender iden24 tity, or disability status, be excluded from participation 

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1 tion under any health program or activity, including any 

2 health research program or activity, receiving Federal fi3 nancial assistance. 

4 (b) DEFINITION.—In this section, the term ‘‘familial 

5 status’’ means, with respect to one or more individuals— 

6 (1) being domiciled with any individual related 

7 by blood or affinity whose close association with the 

8 individual is the equivalent of a family relationship; 

9 (2) being in the process of securing legal cus10 tody of any individual; or 

11 (3) being pregnant. 

12 SEC. 902. TREATMENT OF MEDICARE PAYMENTS UNDER 

13 TITLE VI OF THE CIVIL RIGHTS ACT OF 1964. 

14 A payment to a provider of services, physician, or 

15 other supplier under part B, C, or D of title XVIII of 

16 the Social Security Act shall be deemed a grant, and not 

17 a contract of insurance or guaranty, for the purposes of 

18 title VI of the Civil Rights Act of 1964. 

19 SEC. 903. ACCOUNTABILITY AND TRANSPARENCY WITHIN 

20 THE DEPARTMENT OF HEALTH AND HUMAN 

21 SERVICES. 

22 Title XXXIV of the Public Health Service Act, as 

23 amended by titles I, II, and III of this Act, is further 

24 amended by inserting after subtitle B the following: 


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1 ‘‘Subtitle C—Strengthening 

2 Accountability 

3 ‘‘SEC. 3441. ELEVATION OF THE OFFICE OF CIVIL RIGHTS. 

4 ‘‘(a) IN GENERAL.—The Secretary shall establish 

5 within the Office for Civil Rights an Office of Health Dis6 parities, which shall be headed by a director to be ap7 pointed by the Secretary. 

8 ‘‘(b) PURPOSE.—The Office of Health Disparities 

9 shall ensure that the health programs, activities, and oper10 ations of health entities which receive Federal financial as11 sistance are in compliance with title VI of the Civil Rights 

12 Act, which prohibits discrimination on the basis of race, 

13 color, or national origin. The activities of the Office shall 

14 include the following: 

15 ‘‘(1) The development and implementation of 

16 an action plan to address racial and ethnic health 

17 care disparities, which shall address concerns relat18 ing to the Office for Civil Rights as released by the 

19 United States Commission on Civil Rights in the re20 port entitled ‘Health Care Challenge: Acknowledging 

21 Disparity, Confronting Discrimination, and Ensur22 ing Equity’ (September 1999) in conjunction with 

23 the reports by the Institute of Medicine entitled ‘Un24 equal Treatment: Confronting Racial and Ethnic 

25 Disparities in Health Care’, ‘Crossing the Quality 


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1 Chasm: A New Health System for the 21st Cen2 tury’, ‘In the Nation’s Compelling Interest: Ensur3 ing Diversity in the Health Care Workforce’, ‘The 

4 National Partnership for Action to End Health Dis5 parities’, and ‘The Health of Lesbian, Gay, Bisexual, 

6 and Transgender People’, and other related reports 

7 by the Institute of Medicine. This plan shall be pub8 licly disclosed for review and comment and the final 

9 plan shall address any comments or concerns that 

10 are received by the Office. 

11 ‘‘(2) Investigative and enforcement actions 

12 against intentional discrimination and policies and 

13 practices that have a disparate impact on minorities. 

14 ‘‘(3) The review of racial, ethnic, gender iden15 tity, sexual orientation, sex, disability status, socio16 economic status, and primary language health data 

17 collected by Federal health agencies to assess health 

18 care disparities related to intentional discrimination 

19 and policies and practices that have a disparate im20 pact on minorities. 

21 ‘‘(4) Outreach and education activities relating 

22 to compliance with title VI of the Civil Rights Act. 

23 ‘‘(5) The provision of technical assistance for 

24 health entities to facilitate compliance with title VI 

25 of the Civil Rights Act. 


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1 ‘‘(6) Coordination and oversight of activities of 

2 the civil rights compliance offices established under 

3 section 3442. 

4 ‘‘(7) Ensuring— 

5 ‘‘(A) at a minimum, compliance with the 

6 1997 Office of Management and Budget Stand7 ards for Maintaining, Collecting, and Pre8 senting Federal Data on Race and Ethnicity; 

9 and 

10 ‘‘(B) consideration of available data and 

11 language standards such as— 

12 ‘‘(i) the standards for collecting and 

13 reporting data under section 3101; and 

14 ‘‘(ii) the National Standards on Cul15 turally and Linguistically Appropriate 

16 Services of the Office of Minority Health 

17 within the Department of Health and 

18 Human Services. 

19 ‘‘(c) FUNDING AND STAFF.—The Secretary shall en20 sure the effectiveness of the Office of Health Disparities 

21 by ensuring that the Office is provided with— 

22 ‘‘(1) adequate funding to enable the Office to 

23 carry out its duties under this section; and 

24 ‘‘(2) staff with expertise in— 

25 ‘‘(A) epidemiology; 


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1 ‘‘(B) statistics; 

2 ‘‘(C) health quality assurance; 

3 ‘‘(D) minority health and health dispari4 ties; 

5 ‘‘(E) cultural and linguistic competency; 

6 ‘‘(F) civil rights; and 

7 ‘‘(G) social, behavioral, and economic de8 terminants of health. 

9 ‘‘(d) REPORT.—Not later than December 31, 2015, 

10 and annually thereafter, the Secretary, in collaboration 

11 with the Director of the Office for Civil Rights and the 

12 Deputy Assistant Secretary for Minority Health, shall 

13 submit a report to the Committee on Health, Education, 

14 Labor, and Pensions of the Senate and the Committee on 

15 Energy and Commerce of the House of Representatives 

16 that includes— 

17 ‘‘(1) the number of cases filed, broken down by 

18 category; 

19 ‘‘(2) the number of cases investigated and 

20 closed by the office; 

21 ‘‘(3) the outcomes of cases investigated; 

22 ‘‘(4) the staffing levels of the office including 

23 staff credentials; 


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1 ‘‘(5) the number of other lingering and emerg2 ing cases in which civil rights inequities can be dem3 onstrated; and 

4 ‘‘(6) the number of cases remaining open and 

5 an explanation for their open status. 

6 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 

7 are authorized to be appropriated to carry out this section 

8 such sums as may be necessary for each of fiscal years 

9 2015 through 2020. 

10 ‘‘SEC. 3442. ESTABLISHMENT OF HEALTH PROGRAM OF11 FICES FOR CIVIL RIGHTS WITHIN FEDERAL 

12 HEALTH AND HUMAN SERVICES AGENCIES. 

13 ‘‘(a) IN GENERAL.—The Secretary shall establish 

14 civil rights compliance offices in each agency within the 

15 Department of Health and Human Services that admin16 isters health programs. 

17 ‘‘(b) PURPOSE OF OFFICES.—Each office established 

18 under subsection (a) shall ensure that recipients of Fed19 eral financial assistance under Federal health programs 

20 administer their programs, services, and activities in a 

21 manner that— 

22 ‘‘(1) does not discriminate, either intentionally 

23 or in effect, on the basis of race, national origin, lan24 guage, ethnicity, sex, age, disability, sexual orienta25 tion, and gender identity; and 


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1 ‘‘(2) promotes the reduction and elimination of 

2 disparities in health and health care based on race, 

3 national origin, language, ethnicity, sex, age, dis4 ability, sexual orientation, and gender identity. 

5 ‘‘(c) POWERS AND DUTIES.—The offices established 

6 in subsection (a) shall have the following powers and du7 ties: 

8 ‘‘(1) The establishment of compliance and pro9 gram participation standards for recipients of Fed10 eral financial assistance under each program admin11 istered by an agency within the Department of 

12 Health and Human Services including the establish13 ment of disparity reduction standards to encompass 

14 disparities in health and health care related to race, 

15 national origin, language, ethnicity, sex, age, dis16 ability, sexual orientation, and gender identity. 

17 ‘‘(2) The development and implementation of 

18 program-specific guidelines that interpret and apply 

19 Department of Health and Human Services guid20 ance under title VI of the Civil Rights Act of 1964 

21 and section 1557 of the Patient Protection and Af22 fordable Care Act to each Federal health program 

23 administered by the agency. 

24 ‘‘(3) The development of a disparity-reduction 

25 impact analysis methodology that shall be applied to 


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1 every rule issued by the agency and published as 

2 part of the formal rulemaking process under sections 

3 555, 556, and 557 of title 5, United States Code. 

4 ‘‘(4) Oversight of data collection, analysis, and 

5 publication requirements for all recipients of Federal 

6 financial assistance under each Federal health pro7 gram administered by the agency; compliance with, 

8 at a minimum, the 1997 Office of Management and 

9 Budget Standards for Maintaining, Collecting, and 

10 Presenting Federal Data on Race and Ethnicity; and 

11 consideration of available data and language stand12 ards such as— 

13 ‘‘(A) the standards for collecting and re14 porting data under section 3101; and 

15 ‘‘(B) the National Standards on Culturally 

16 and Linguistically Appropriate Services of the 

17 Office of Minority Health within the Depart18 ment of Health and Human Services. 

19 ‘‘(5) The conduct of publicly available studies 

20 regarding discrimination within Federal health pro21 grams administered by the agency as well as dis22 parity reduction initiatives by recipients of Federal 

23 financial assistance under Federal health programs. 

24 ‘‘(6) Annual reports to the Committee on 

25 Health, Education, Labor, and Pensions and the 


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1 Committee on Finance of the Senate and the Com2 mittee on Energy and Commerce and the Committee 

3 on Ways and Means of the House of Representatives 

4 on the progress in reducing disparities in health and 

5 health care through the Federal programs adminis6 tered by the agency. 

7 ‘‘(d) RELATIONSHIP TO OFFICE FOR CIVIL RIGHTS

8 IN THE DEPARTMENT OF JUSTICE.— 

9 ‘‘(1) DEPARTMENT OF HEALTH AND HUMAN

10 SERVICES.—The Office for Civil Rights in the De11 partment of Health and Human Services shall pro12 vide standard-setting and compliance review inves13 tigation support services to the Civil Rights Compli14 ance Office for each agency. 

15 ‘‘(2) DEPARTMENT OF JUSTICE.—The Office 

16 for Civil Rights in the Department of Justice shall 

17 continue to maintain the power to institute formal 

18 proceedings when an agency Office for Civil Rights 

19 determines that a recipient of Federal financial as20 sistance is not in compliance with the disparity re21 duction standards of the agency. 

22 ‘‘(e) DEFINITION.—In this section, the term ‘Federal 

23 health programs’ mean programs— 


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1 ‘‘(1) under the Social Security Act (42 U.S.C. 

2 301 et seq.) that pay for health care and services; 

3 and 

4 ‘‘(2) under this Act that provide Federal finan5 cial assistance for health care, biomedical research, 

6 health services research, and programs designed to 

7 improve the public’s health, including health service 

8 programs.’’. 

9 SEC. 904. UNITED STATES COMMISSION ON CIVIL RIGHTS. 

10 (a) COORDINATION WITHIN DEPARTMENT OF JUS11 TICE OF ACTIVITIES REGARDING HEALTH DISPARI12 TIES.—Section 3(a) of the Civil Rights Commission Act 

13 of 1983 (42 U.S.C. 1975a(a)) is amended— 

14 (1) in paragraph (1), by striking ‘‘and’’ at the 

15 end; 

16 (2) in paragraph (2), by striking the period at 

17 the end and inserting ‘‘; and’’; and 

18 (3) by adding at the end the following: 

19 ‘‘(3) shall, with respect to activities carried out 

20 in health care and correctional facilities toward the 

21 goal of eliminating health disparities between the 

22 general population and members of racial or ethnic 

23 minority groups, coordinate such activities of— 

24 ‘‘(A) the Office for Civil Rights within the 

25 Department of Justice; 


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1 ‘‘(B) the Office of Justice Programs within 

2 the Department of Justice; 

3 ‘‘(C) the Office for Civil Rights within the 

4 Department of Health and Human Services; 

5 and 

6 ‘‘(D) the Office of Minority Health within 

7 the Department of Health and Human Services 

8 (headed by the Deputy Assistant Secretary for 

9 Minority Health).’’. 

10 (b) AUTHORIZATION OF APPROPRIATIONS.—Section 

11 5 of the Civil Rights Commission Act of 1983 (42 U.S.C. 

12 1975c) is amended by striking the first sentence and in13 serting the following: ‘‘For the purpose of carrying out 

14 this Act, there are authorized to be appropriated 

15 $30,000,000 for fiscal year 2015, and such sums as may 

16 be necessary for each of the fiscal years 2016 through 

17 2020.’’. 

18 SEC. 905. SENSE OF CONGRESS CONCERNING FULL FUND19 ING OF ACTIVITIES TO ELIMINATE RACIAL 

20 AND ETHNIC HEALTH DISPARITIES. 

21 (a) FINDINGS.—Congress makes the following find22 ings: 

23 (1) The health status of the American populace 

24 is declining and the United States currently ranks 


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1 below most industrialized nations in health status 

2 measured by longevity, sickness, and mortality. 

3 (2) Racial and ethnic minority populations tend 

4 have the poorest health status and face substantial 

5 cultural, social, and economic barriers to obtaining 

6 quality health care. 

7 (3) Lesbian, gay, bisexual and transgender 

8 (LGBT) populations experience significant personal 

9 and structural barriers to obtaining high-quality 

10 health care. 

11 (4) Efforts to improve minority health have 

12 been limited by inadequate resources (funding, staff13 ing, and stewardship) and lack of accountability. 

14 (b) SENSE OF CONGRESS.—It is the sense of Con15 gress that— 

16 (1) funding should be doubled by fiscal year 

17 2016 for the National Institute for Minority Health 

18 Disparities, the Office of Civil Rights in the Depart19 ment of Health and Human Services, the National 

20 Institute of Nursing Research, and the Office of Mi21 nority Health; 

22 (2) adequate funding by fiscal year 2016, and 

23 subsequent funding increases, should be provided for 

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1 munity Health (REACH) Initiative at the Centers 

2 for Disease Control and Prevention, the Minority 

3 HIV/AIDS Initiative, and the Excellence Centers to 

4 Eliminate Ethnic/Racial Disparities (EXCEED) 

5 Program at the Agency for Healthcare Research and 

6 Quality; 

7 (3) funding should be fully restored to the Ra8 cial and Ethnic Approaches to Community Health 

9 (REACH) Initiative at the Centers for Disease Con10 trol and Prevention, which has been a successful 

11 program at the community health level, and efforts 

12 should continue to place a strong emphasis on build13 ing community capacity to secure financial resources 

14 and technical assistance to eliminate health dispari15 ties; 

16 (4) adequate funding for fiscal year 2016 and 

17 increased funding for future years should be pro18 vided for the REACH Initiative’s United States Risk 

19 Factor Survey to ensure adequate data collection to 

20 track health disparities, and there should be appro21 priate avenues provided to disseminate findings to 

22 the general public; 

23 (5) current and newly created health disparity 

24 elimination incentives, programs, agencies, and de25 partments under this Act (and the amendments 


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1 made by this Act) should receive adequate staffing 

2 and funding by fiscal year 2016; and 

3 (6) stewardship and accountability should be 

4 provided to the Congress and the President for 

5 measurable and sustainable progress toward health 

6 disparity elimination. 

7 SEC. 906. GAO AND NIH REPORTS. 

8 (a) GAO REPORT ON NIH GRANT RACIAL AND ETH9 NIC DIVERSITY.— 

10 (1) IN GENERAL.—The Comptroller General of 

11 the United States shall conduct a study on the racial 

12 and ethnic diversity among the following groups: 

13 (A) All applicants for grants, contracts, 

14 and cooperative agreements awarded by the Na15 tional Institutes of Health during the period be16 ginning on January 1, 1990, and ending De17 cember 31, 2013. 

18 (B) All recipients of such grants, con19 tracts, and cooperative agreements. 

20 (C) All members of the peer review panels 

21 of such applicants and recipients, respectively. 

22 (2) REPORT.—Not later than six months after 

23 the date of the enactment of this Act, the Comp24 troller General shall complete the study under paraVerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00683 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294

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1 graph (1) and submit to Congress a report con2 taining the results of such study. 

3 (b) NIH REPORT ON CERTAIN AUTHORITY OF NA4 TIONAL INSTITUTE ON MINORITY HEALTH AND HEALTH

5 DISPARITIES.—Not later than six months after the date 

6 of the enactment of this Act, and biennially thereafter, the 

7 Director of the National Institutes of Health, in collabora8 tion with the Director of the National Institute on Minor9 ity Health and Health Disparities, shall submit to Con10 gress a report that details and evaluates— 

11 (1) the steps taken during the applicable report 

12 period by the Director of the National Institutes of 

13 Health to enforce the expanded planning, coordina14 tion, review, and evaluation authority provided the 

15 National Institute on Minority Health and Health 

16 Disparities under section 464z–3(h) of the Public 

17 Health Service Act (42 U.S.C. 285(h)), as added by 

18 section 10334(c) of the Patient Protection and Af19 fordable Care Act, over all minority health and 

20 health disparity research that is conducted or sup21 ported by the Institutes and Centers at the National 

22 Institutes of Health; and 

23 (2) the outcomes of such steps. 

24 (c) GAO REPORT RELATED TO RECIPIENTS OF

25 PPACA FUNDING.—Not later than one year after the 


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1 date of the enactment of this Act and biennially thereafter 

2 until 2024, the Comptroller General of the United States 

3 shall submit to Congress a report that identifies, with re4 spect to minority community-based organizations that ap5 plied during the applicable report period for Federal fund6 ing provided pursuant to the provisions of (and amend7 ments made by) the Patient Protection and Affordable 

8 Care Act for purposes of achieving health equity and elimi9 nating health disparities, the percentage of such organiza10 tions that were awarded such funding. 

11 (d) ANNUAL REPORT ON ACTIVITIES OF NATIONAL

12 INSTITUTE ON MINORITY HEALTH AND HEALTH DIS13 PARITIES.—The Director of the National Institute on Mi14 nority Health and Health Disparities shall prepare an an15 nual report on the activities carried out or to be carried 

16 out by the Institute, and shall submit each such report 

17 to the Committee on Health, Education, Labor, and Pen18 sions of the Senate, the Committee on Energy and Com19 merce of the House of Representatives, the Secretary of 

20 Health and Human Services, and the Director of the Na21 tional Institutes of Health. With respect to the fiscal year 

22 involved, the report shall— 

23 (1) describe and evaluate the progress made in 

24 health disparities research conducted or supported 


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1 by institutes and centers of the National Institutes 

2 of Health; 

3 (2) summarize and analyze expenditures made 

4 for activities with respect to health disparities re5 search conducted or supported by the National Insti6 tutes of Health; 

7 (3) include a separate statement applying the 

8 requirements of paragraphs (1) and (2) specifically 

9 to minority health disparities research; and 

10 (4) contain such recommendations as the Direc11 tor of the Institute considers appropriate. 

12 TITLE X—ADDRESSING SOCIAL 

13 DETERMINANTS AND IM14 PROVING ENVIRONMENTAL 

15 JUSTICE 

16 SEC. 1001. DEFINITIONS. 

17 (a) DETERMINANTS OF HEALTH.—The term ‘‘deter18 minants of health’’— 

19 (1) refers to the range of personal, social, eco20 nomic, and environmental factors that influence 

21 health status; and 

22 (2) includes social determinants of health 

23 (which are sometimes referred to as ‘‘social and eco24 nomic determinants of health’’ or ‘‘socioeconomic deVerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00686 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294

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1 terminants of health’’), environmental determinants 

2 of health, and personal determinants of health. 

3 (b) ENVIRONMENTAL DETERMINANTS OF

4 HEALTH.—The term ‘‘environmental determinants of 

5 health’’ refers to the broad physical, psychological, social, 

6 and aesthetic environment. 

7 (c) PERSONAL DETERMINANTS OF HEALTH.—The 

8 term ‘‘personal determinants of health’’ refers to an indi9 vidual’s behavior, biology, and genetics. 

10 (d) SOCIAL DETERMINANTS OF HEALTH .—The term 

11 ‘‘social determinants of health’’ refers to a subset of deter12 minants of the health of individuals and environments 

13 (such as communities, neighborhoods, and societies) that 

14 describe people’s social identity, describe the social and 

15 economic resources to which people have access, and de16 scribe the conditions in which people work, live, and play. 

17 SEC. 1002. FINDINGS. 

18 The Congress finds as follows: 

19 (1) There are more opportunities to improve 

20 health for everyone when we understand that health 

21 starts, first, not in a medical setting, but in our 

22 families, in our schools and workplaces, in our 

23 neighborhoods, and in the air we breathe and water 

24 we drink. 


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1 (2) The social determinants of health are the 

2 largest predictors of health outcomes. 

3 (3) Healthy People 2020 identifies health and 

4 health care quality as a function of not only access 

5 to health care, but also the social determinants of 

6 health, categorized into the following: neighborhoods 

7 and the built environment; social and community 

8 context; education; and economic stability. The fol9 lowing examples illustrate the nexus between the un10 equal distribution of the social determinants of 

11 health and health disparities: 

12 (A) The built environment influences resi13 dents’ level of physical activity. Neighborhoods 

14 with high levels of poverty are significantly less 

15 likely to have places where children can be 

16 physically active, such as parks, green spaces, 

17 and bike paths and lanes. Neighborhoods and 

18 communities can provide opportunities for phys19 ical activity and support active lifestyles 

20 through accessible and safe parks and open 

21 spaces and through land use policy, zoning, and 

22 healthy community design. 

23 (B) Emotional and physical health and 

24 well-being are directly impacted by perceived 

25 levels of safety, such as unlit streets at night. 


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1 Community members have expressed that safety 

2 is not only a barrier to accessing programs and 

3 services that increase quality of life but they 

4 are also not able to access physical activity in 

5 their community through the built environment. 

6 (C) In many workplace environments, toxic 

7 chemicals have lasting detrimental effects on 

8 employees’ health. The hazardous compounds 

9 found in most nail salon products affect the 

10 respiratory system, reproductive system, and 

11 central nervous system, and also cause kidney 

12 and liver damage. Recognizing the importance 

13 of addressing occupational hazards as a matter 

14 of public health, especially for Asian-American 

15 women who constitute 40 percent of nail salon 

16 technicians—with Vietnamese-American women 

17 accounting for 37 percent of this—the White 

18 House Initiative on Asian American Pacific Is19 landers has created an interagency working 

20 group to coordinate efforts by the Environ21 mental Protection Agency, Occupational and 

22 Safety Health Administration, Food and Drug 

23 Administration, and other Federal agencies to 

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1 duct more outreach on educating workers on 

2 health and safety issues. 

3 (D) Historical and institutional discrimina4 tion against certain racial groups in the United 

5 States has shaped the way in which social and 

6 economic resources and exposure to health pro7 moting environments are distributed. Income, 

8 education, occupation, neighborhood conditions, 

9 schools, workplaces, the use of and health and 

10 social services, and experiences with the crimi11 nal justice system are all highly patterned by 

12 race, with racial minorities (compared to 

13 Whites) experiencing more that is health harm14 ing. Finding ways to uncouple the link between 

15 race and access to resources and healthy envi16 ronments is a principal means of reducing 

17 health disparities. Additionally, the anticipation 

18 of racism itself causes higher psychological and 

19 cardiovascular stress levels that are linked to 

20 poor health outcomes. Remedying discrimina21 tory practices at the individual and systemic 

22 levels will likely reduce health disparities caused 

23 by this unequal distribution of stress. 

24 (E) Poor health among Native Americans 

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1 sion and historical trauma. The expropriation of 

2 native lands and territories to the American 

3 state had severe consequences on Native Amer4 ican health. This resulted in the deprivation of 

5 traditional food sources—and nutrients—for 

6 Native Americans and also the destruction of 

7 traditional economies and community organiza8 tion. Today, Native Americans have twice the 

9 rate of diabetes than non-Hispanic Whites. Rec10 ognition of the origins of the diabetes as having 

11 a social and community context, rather than 

12 just individual responsibility and genetic pre13 disposition, will shape better policy to provide 

14 food security. 

15 (F) In the context of prisons, overcrowding 

16 has led to the deterioration of the physical and 

17 mental health of individuals after they leave 

18 prison. In particular, the mass incarceration of 

19 African-American males as a result of unequal 

20 contact with and treatment in the criminal jus21 tice system has contributed to an overburdening 

22 of certain infectious diseases within the African23 American community. As a social institution, 

24 incarceration amplifies existing adverse health 

25 conditions by concentrating diseases and harm 


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1 health behaviors such as tobacco use, drug use, 

2 and violence. 

3 (G) Educational attainment is the strong4 est predictor of adult mortality. It is a basic 

5 component of socioeconomic status by shaping 

6 earning potential to access resources that pro7 mote health. People with more education are 

8 less likely to report that they are in poor health, 

9 and are also less likely to have diabetes and 

10 other chronic diseases. 

11 (H) Similarly, reading ability is a strong 

12 predictor of adult health status and is often 

13 correlated with other child health issues, such 

14 as developmental problems, vision and hearing 

15 impairments, and frequent school absence due 

16 to illness. 

17 (I) Individuals with lower levels of edu18 cational attainment are much more likely to re19 port to be current smokers. In 2011, smoking 

20 prevalence was 45.3 percent among adults with 

21 a GED diploma, 34.6 percent with nine to 11 

22 years of education, and 23.8 percent with a 

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1 dergraduate college degree and 5.0 percent with 

2 a postgraduate college degree. 

3 (J) Social class differences account for a 

4 large part of health disparities. For example, 

5 children living in poverty experience poorer 

6 housing conditions, increased exposure to in7 door allergens and toxins (such as pesticides, 

8 lead, mercury, radon, air pollution, and carcino9 gens), and more psychological stress. These ex10 periences culminate in worse adult health as 

11 compared with children with higher socio12 economic status. Specifically, children living in 

13 socioeconomic neighborhoods have higher rates 

14 of asthma due to higher rates of psychological 

15 stress resulting from higher rates of violence. 

16 (K) Lesbian, gay, bisexual, and 

17 transgender (LGBT) individuals face health 

18 disparities linked to societal stigma, discrimina19 tion, and denial of their civil and human rights. 

20 Discrimination against LGBT individuals has 

21 been associated with high rates of psychiatric 

22 disorders, substance abuse, and suicide. Experi23 ences of violence and victimization are frequent 

24 for LGBT individuals, and have long-lasting ef25 fects on the individual and the community. PerVerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00693 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294

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1 sonal, family, and social acceptance of sexual 

2 orientation and gender identity affects the men3 tal health and personal safety of LGBT individ4 uals. 

5 (4) Laws and regulations that improve opportu6 nities to live in safe neighborhoods, with more social 

7 cohesion, attain higher education, sustain stable em8 ployment, and bridge class differences help foster 

9 the health and safety of individuals. 

10 (5) The global public health community has 

11 reached consensus through the Rio Political Declara12 tion of Social Determinants of Health that 

13 ‘‘[c]ollaboration in coordinated and intersectoral pol14 icy actions has proven to be effective. Health in All 

15 Policies, together with intersectoral cooperation and 

16 action, is one promising approach to enhance ac17 countability in other sectors of health, as well as the 

18 promotion of health equity and more inclusive and 

19 productive societies.’’ 

20 SEC. 1003. HEALTH IMPACT ASSESSMENTS. 

21 (a) FINDINGS.—Congress makes the following find22 ings: 

23 (1) Health Impact Assessment is a tool to help 

24 planners, health officials, decisionmakers, and the 

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1 tential health effects of proposed plans, policies, pro2 grams, and projects in order to maximize health 

3 benefits and minimize harms. 

4 (2) Health Impact Assessments can be done at 

5 a fraction of the cost and time typically required for 

6 other planning and permitting reviews. 

7 (3) Health Impact Assessments can build com8 munity support and reduce opposition to a project or 

9 policy, thereby facilitating economic growth by aid10 ing the development of consensus regarding new de11 velopment proposals. 

12 (4) Health Impact Assessments facilitate col13 laboration across sectors. 

14 (b) PURPOSES.—It is the purpose of this section to— 

15 (1) provide more information about the poten16 tial human health effects of policy decisions and the 

17 distribution of those effects; 

18 (2) improve how health is considered in plan19 ning and decisionmaking processes; and 

20 (3) build stronger, healthier communities 

21 through the use of Health Impact Assessment. 

22 (c) HEALTH IMPACT ASSESSMENTS.—Part P of title 

23 III of the Public Health Service Act (42 U.S.C. 280g et 

24 seq.), as amended, is further amended by adding at the 

25 end the following: 


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1 ‘‘SEC. 399V–9. HEALTH IMPACT ASSESSMENTS. 

2 ‘‘(a) DEFINITIONS.—In this section and section 

3 399V–10: 

4 ‘‘(1) ADMINISTRATOR.—The term ‘Adminis5 trator’ means the Administrator of the Environ6 mental Protection Agency. 

7 ‘‘(2) BUILT ENVIRONMENT.—The term ‘built 

8 environment’ means the components of the environ9 ment, and the location of these components in a geo10 graphically defined space, that are created or modi11 fied by individuals to form the physical and social 

12 characteristics of a community or enhance quality of 

13 human life, including— 

14 ‘‘(A) homes, schools, and places of work 

15 and worship; 

16 ‘‘(B) parks, recreation areas, and green17 ways; 

18 ‘‘(C) transportation systems; 

19 ‘‘(D) business, industry, and agriculture; 

20 and 

21 ‘‘(E) land-use plans, projects, and policies 

22 that impact the physical or social characteris23 tics of a community, including access to services 

24 and amenities. 


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1 ‘‘(3) DIRECTOR.—The term ‘Director’ means 

2 the Director of the Centers for Disease Control and 

3 Prevention. 

4 ‘‘(4) ELIGIBLE ENTITY.—The term ‘eligible en5 tity’ means a unit of State or tribal government the 

6 jurisdiction of which includes individuals or popu7 lations the health of which are, or will be, affected 

8 by an activity or a proposed activity. 

9 ‘‘(5) ELIGIBLE INSTITUTION.—The term ‘eligi10 ble institution’ means a public agency or private 

11 nonprofit institution that submits to the Secretary, 

12 in consultation with the Administrator, an applica13 tion for a grant authorized under such section at 

14 such time, in such manner, and containing such 

15 agreements, assurances, and information as the Sec16 retary and Administrator may require. 

17 ‘‘(6) HEALTH IMPACT ASSESSMENT.—The term 

18 ‘Health Impact Assessment’ means a systematic 

19 process that uses an array of data sources and ana20 lytic methods and considers input from stakeholders 

21 to determine the potential effects of a proposed pol22 icy, plan, program, or project on the health of a pop23 ulation and the distribution of those effects within 

24 the population. Such term includes identifying and 

25 recommending appropriate actions on monitoring 


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1 and maximizing potential benefits and minimizing 

2 the potential harms. 

3 ‘‘(7) HEALTH DISPARITIES.—The term ‘health 

4 disparities’ are a particular type of health dif5 ferences that are closely linked with social, economic, 

6 and/or environmental disadvantage. Health dispari7 ties adversely affect groups of people who have sys8 tematically experienced greater obstacles to health 

9 based on their racial or ethnic group; religion; socio10 economic status; gender; age; mental health; cog11 nitive, sensory, or physical disability; sexual orienta12 tion or gender identity; geographic location; or other 

13 characterisitics historically linked to discrimination 

14 or exclusion. 

15 ‘‘(8) PROPOSED ACTIVITY.—The term ‘proposed 

16 activity’ means a proposed policy, program, plan, or 

17 project currently under consideration by a local, 

18 State, tribal, or Federal agency or government. 

19 ‘‘(b) ESTABLISHMENT.—The Secretary, acting 

20 through the Director and in collaboration with the Admin21 istrator, shall carry out the following: 

22 ‘‘(1) Establish a program at the National Cen23 ter for Environmental Health at the Centers for Dis24 ease Control and Prevention focused on advancing 

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1 oping and implementing the program, the Director 

2 of the National Center for Environmental Health 

3 shall consult with the Director of the National Cen4 ter for Chronic Disease Prevention and Health Pro5 motion as well as relevant offices within the Depart6 ment of Housing and Urban Development, the De7 partment of Transportation, and the Department of 

8 Agriculture. The program shall include— 

9 ‘‘(A) collecting and disseminating best 

10 practices; 

11 ‘‘(B) administering capacity building 

12 grants to States to support grantees in initi13 ating Health Impact Assessments, in accord14 ance with subsection (d); 

15 ‘‘(C) providing technical assistance; 

16 ‘‘(D) developing training tools and pro17 viding training on conducting Health Impact 

18 Assessment and the implementation of built en19 vironment and health indicators; 

20 ‘‘(E) making information available, as ap21 propriate, regarding the existence of other com22 munity healthy living tools, checklists, and indi23 ces that help connect public health to other sec24 tors, and tools to help examine the effect of the 


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1 indoor built environment and building codes on 

2 population health; 

3 ‘‘(F) conducting research and evaluations 

4 of Health Impact Assessments; and 

5 ‘‘(G) awarding competitive extramural re6 search grants. 

7 ‘‘(2) In accordance with subsection (c), develop 

8 guidance and guidelines to conduct Health Impact 

9 Assessments. 

10 ‘‘(3) In accordance with subsection (d), estab11 lish a grant program to allow States to fund eligible 

12 entities to conduct Health Impact Assessments. 

13 ‘‘(c) GUIDANCE.—The Director, in consultation with 

14 the Director of the National Center for Environmental 

15 Health and, the Director of the National Center for 

16 Chronic Disease Prevention and Health Promotion, and 

17 relevant offices within the Department of Housing and 

18 Urban Development, the Department of Transportation, 

19 and the Department of Agriculture, shall— 

20 ‘‘(1) develop guidance for conducting Health 

21 Impact Assessment, including— 

22 ‘‘(A) background on national and inter23 national efforts to bridge urban planning and 

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1 cluding a review of Health Impact Assessment 

2 best practices internationally; 

3 ‘‘(B) evidence-based direct and indirect 

4 pathways that link land-use planning, transpor5 tation, and housing policy and objectives to 

6 human health outcomes; 

7 ‘‘(C) data resources and quantitative and 

8 qualitative forecasting methods to evaluate both 

9 the status of health determinants and health ef10 fects, including identification of existing pro11 grams that can disseminate these resources; 

12 ‘‘(D) best practices for inclusive public in13 volvement in conducting Health Impact Assess14 ments; and 

15 ‘‘(E) technical assistance for other agen16 cies seeking to develop their own guidelines and 

17 procedures for Health Impact Assessment; 

18 ‘‘(2) in developing the guidance, consider avail19 able international Health Impact Assessment guid20 ance, North American Health Impact Assessment 

21 Practice Standards, and recommendations from the 

22 National Academy of Science; and 

23 ‘‘(3) not later than 1 year after the date of en24 actment of this section, publish the guidance. 


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1 ‘‘(d) GRANT PROGRAM.—The Secretary, acting 

2 through the Director and in collaboration with the Admin3 istrator, shall establish a program under which the Sec4 retary shall award grants to States to fund eligible entities 

5 for capacity building or to prepare Health Impact Assess6 ments, and shall ensure that States receiving a grant 

7 under this subsection further support training and tech8 nical assistance for grantees under the program by fund9 ing and overseeing appropriate local, State, tribal, Fed10 eral, university, or nonprofit Health Impact Assessment 

11 experts to provide technical assistance. Such assessments 

12 shall— 

13 ‘‘(1) ensure that appropriate health factors are 

14 taken into consideration as early as practicable dur15 ing the planning, review, or decisionmaking proc16 esses; 

17 ‘‘(2) assess the effect on the health of individ18 uals and populations of proposed policies, projects, 

19 or plans that result in modifications to the built en20 vironment; and 

21 ‘‘(3) assess the distribution of health effects 

22 across various factors, such as race, income, eth23 nicity, age, disability status, gender, and geography. 

24 ‘‘(e) APPLICATIONS.— 


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1 ‘‘(1) IN GENERAL.—To be eligible to receive a 

2 grant under this section, an eligible entity shall sub3 mit to the Secretary an application in accordance 

4 with this subsection, at such time, in such manner, 

5 and containing such additional information as the 

6 Secretary may require. 

7 ‘‘(2) INCLUSION.—An application under this 

8 subsection shall include a list of proposed activities 

9 that require or would benefit from conducting a 

10 Health Impact Assessment within six months of 

11 awarding funds. The list should be accompanied by 

12 supporting documentation, including letters of sup13 port, from potential conductors of Health Impact 

14 Assessments for the listed proposed activities. Each 

15 application should also include an assessment by the 

16 eligible entity of the health of the population of its 

17 jurisdiction and describe potential adverse or positive 

18 effects on health that the proposed activities may 

19 create. 

20 ‘‘(3) PREFERENCE.—Preference in awarding 

21 funds under this section may be given to eligible en22 tities that demonstrate the potential to significantly 

23 improve population health or lower health care costs 

24 as a result of potential Health Impact Assessment 

25 work. 


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1 ‘‘(f) USE OF FUNDS.— 

2 ‘‘(1) IN GENERAL.—An eligible entity shall use 

3 amounts provided under a grant under this section 

4 to conduct Health Impact Assessment capacity 

5 building or to conduct or fund subgrantees to con6 duct a Health Impact Assessment for a proposed ac7 tivity in accordance with this subsection. 

8 ‘‘(2) PURPOSES.—The purposes of a Health 

9 Impact Assessment under this subsection are— 

10 ‘‘(A) to facilitate the involvement of tribal, 

11 State, and local public health officials in com12 munity planning, transportation, housing, and 

13 land use decisions and other decisions affecting 

14 the built environment to identify any potential 

15 health concern or health benefit relating to an 

16 activity or proposed activity; 

17 ‘‘(B) to provide for an investigation of any 

18 health-related issue of concern raised in a plan19 ning process, an environmental impact assess20 ment process, or policy appraisal relating to a 

21 proposed activity; 

22 ‘‘(C) to describe and compare alternatives 

23 (including no-action alternatives) to a proposed 

24 activity to provide clarification with respect to 

25 the potential health outcomes associated with 


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1 the proposed activity and, where appropriate, to 

2 the related benefit-cost or cost-effectiveness of 

3 the proposed activity and alternatives; 

4 ‘‘(D) to contribute, when applicable, to the 

5 findings of a planning process, policy appraisal, 

6 or an environmental impact statement with re7 spect to the terms and conditions of imple8 menting a proposed activity or related mitiga9 tion recommendations, as necessary; 

10 ‘‘(E) to ensure that the disproportionate 

11 distribution of negative impacts among vulner12 able populations is minimized as much as pos13 sible; 

14 ‘‘(F) to engage affected community mem15 bers and ensure adequate opportunity for public 

16 comment on all stages of the Health Impact As17 sessment; and 

18 ‘‘(G) where appropriate, to consult with 

19 local and county health departments and appro20 priate organizations, including planning, trans21 portation, and housing organizations and pro22 viding them with information and tools regard23 ing how to conduct and integrate Health Im24 pact Assessment into their work. 

25 ‘‘(3) ELIGIBLE ACTIVITIES.— 


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1 ‘‘(A) IN GENERAL.—Eligible entities fund2 ed under this subsection shall conduct an eval3 uation of any proposed activity to determine 

4 whether it will have a significant adverse or 

5 positive effect on the health of the affected pop6 ulation in the jurisdiction of the eligible entity, 

7 based on the criteria described in subparagraph 

8 (B). 

9 ‘‘(B) CRITERIA.—The criteria described in 

10 this subparagraph include, as applicable to the 

11 proposed activity, the following: 

12 ‘‘(i) Any substantial adverse effect or 

13 significant health benefit on health out14 comes or factors known to influence health, 

15 including the following: 

16 ‘‘(I) Physical activity. 

17 ‘‘(II) Injury. 

18 ‘‘(III) Mental health. 

19 ‘‘(IV) Accessibility to health-pro20 moting goods and services. 

21 ‘‘(V) Respiratory health. 

22 ‘‘(VI) Chronic disease. 

23 ‘‘(VII) Nutrition. 


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1 ‘‘(VIII) Land use changes that 

2 promote local, sustainable food 

3 sources. 

4 ‘‘(IX) Infectious disease. 

5 ‘‘(X) Health disparities. 

6 ‘‘(XI) Existing air quality, 

7 ground or surface water quality or 

8 quantity, or noise levels; and 

9 ‘‘(ii) Other factors that may be con10 sidered, including— 

11 ‘‘(I) the potential for a proposed 

12 activity to result in systems failure 

13 that leads to a public health emer14 gency; 

15 ‘‘(II) the probability that the pro16 posed activity will result in a signifi17 cant increase in tourism, economic de18 velopment, or employment in the ju19 risdiction of the eligible entity; 

20 ‘‘(III) any other significant po21 tential hazard or enhancement to 

22 human health, as determined by the 

23 eligible entity; or 

24 ‘‘(IV) whether the evaluation of a 

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1 other analysis or study being under2 taken in conjunction with the pro3 posed activity. 

4 ‘‘(C) FACTORS FOR CONSIDERATION.—In 

5 evaluating a proposed activity under subpara6 graph (A), an eligible entity may take into con7 sideration any reasonable, direct, indirect, or 

8 cumulative effect that can be clearly related to 

9 potential health effects and that is related to 

10 the proposed activity, including the effect of 

11 any action that is— 

12 ‘‘(i) included in the long-range plan 

13 relating to the proposed activity; 

14 ‘‘(ii) likely to be carried out in coordi15 nation with the proposed activity; 

16 ‘‘(iii) dependent on the occurrence of 

17 the proposed activity; or 

18 ‘‘(iv) likely to have a disproportionate 

19 impact on high-risk or vulnerable popu20 lations. 

21 ‘‘(4) REQUIREMENTS.—A Health Impact As22 sessment prepared with funds awarded under this 

23 subsection shall incorporate the following, after con24 ducting the screening phase (identifying projects or 

25 policies for which a Health Impact Assessment 


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1 would be valuable and feasible) through the applica2 tion process: 

3 ‘‘(A) SCOPING.—Identifying which health 

4 effects to consider and the research methods to 

5 be utilized. 

6 ‘‘(B) ASSESSING RISKS AND BENEFITS.— 

7 Assessing the baseline health status and factors 

8 known to influence the health status in the af9 fected community, which may include aggre10 gating and synthesizing existing health assess11 ment evidence and data from the community. 

12 ‘‘(C) DEVELOPING RECOMMENDATIONS.— 

13 Suggesting changes to proposals to promote 

14 positive or mitigate adverse health effects. 

15 ‘‘(D) REPORTING.—Synthesizing the as16 sessment and recommendations and commu17 nicating the results to decisionmakers. 

18 ‘‘(E) MONITORING AND EVALUATING.— 

19 Tracking the decision and implementation effect 

20 on health determinants and health status. 

21 ‘‘(5) PLAN.—An eligible entity that is awarded 

22 a grant under this section shall develop and imple23 ment a plan, to be approved by the Director, for 

24 meaningful and inclusive stakeholder involvement in 

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1 holders may include community-based organizations, 

2 youth-serving organizations, planners, public health 

3 experts, State and local public health departments 

4 and officials, health care experts or officials, housing 

5 experts or officials, and transportation experts or of6 ficials. 

7 ‘‘(6) SUBMISSION OF FINDINGS.—An eligible 

8 entity that is awarded a grant under this section 

9 shall submit the findings of any funded Health Im10 pact Assessment activities to the Secretary and 

11 make these findings publicly available. 

12 ‘‘(7) ASSESSMENT OF IMPACTS.—An eligible en13 tity that is awarded a grant under this section shall 

14 ensure the assessment of the distribution of health 

15 impacts (related to the proposed activity) across 

16 race, ethnicity, income, age, gender, disability status, 

17 and geography. 

18 ‘‘(8) CONDUCT OF ASSESSMENT.—To the great19 est extent feasible, a Health Impact Assessment 

20 shall be conducted under this section in a manner 

21 that respects the needs and timing of the decision22 making process it evaluates. 

23 ‘‘(9) METHODOLOGY.—In preparing a Health 

24 Impact Assessment under this subsection, an eligible 


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1 entity or partner shall follow the guidance published 

2 under subsection (c). 

3 ‘‘(g) HEALTH IMPACT ASSESSMENT DATABASE.— 

4 The Secretary, acting through the Director and in collabo5 ration with the Administrator, shall establish, maintain, 

6 and make publicly available a Health Impact Assessment 

7 database, including— 

8 ‘‘(1) a catalog of Health Impact Assessments 

9 received under this section; 

10 ‘‘(2) an inventory of tools used by eligible enti11 ties to conduct Health Impact Assessments; and 

12 ‘‘(3) guidance for eligible entities with respect 

13 to the selection of appropriate tools described in 

14 paragraph (2). 

15 ‘‘(h) EVALUATION OF GRANTEE ACTIVITIES.—The 

16 Secretary shall award competitive grants to Prevention 

17 Research Centers, or nonprofit organizations or academic 

18 institutions with expertise in Health Impact Assessments 

19 to— 

20 ‘‘(1) assist grantees with the provision of train21 ing and technical assistance in the conducting of 

22 Health Impact Assessments; 

23 ‘‘(2) evaluate the activities carried out with 

24 grants under subsection (d); and 


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1 ‘‘(3) assist the Secretary in disseminating evi2 dence, best practices, and lessons learned from 

3 grantees. 

4 ‘‘(i) REPORT TO CONGRESS.—Not later than 1 year 

5 after the date of enactment of this section, the Secretary 

6 shall submit to Congress a report concerning the evalua7 tion of the programs under this section, including rec8 ommendations as to how lessons learned from such pro9 grams can be incorporated into future guidance docu10 ments developed and provided by the Secretary and other 

11 Federal agencies, as appropriate. 

12 ‘‘(j) AUTHORIZATION OF APPROPRIATIONS.—There 

13 are authorized to be appropriated to carry out this section 

14 such sums as may be necessary. 

15 ‘‘SEC. 399V–10. ADDITIONAL RESEARCH ON THE RELATION16 SHIP BETWEEN THE BUILT ENVIRONMENT 

17 AND HEALTH OUTCOMES. 

18 ‘‘(a) RESEARCH GRANT PROGRAM.— 

19 ‘‘(1) GRANTS.—The Secretary, in collaboration 

20 with the Administrator, shall award grants to eligi21 ble institutions to conduct and coordinate research 

22 on the built environment and its influence on human 

23 health. Factors that influence health that may be 

24 considered include— 

25 ‘‘(A) levels of physical activity; 


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1 ‘‘(B) consumption of nutritional foods; 

2 ‘‘(C) rates of crime; 

3 ‘‘(D) air, water, and soil quality; 

4 ‘‘(E) risk or rate of injury; 

5 ‘‘(F) accessibility to health-promoting 

6 goods and services; 

7 ‘‘(G) chronic disease rates; 

8 ‘‘(H) community design; 

9 ‘‘(I) housing; and 

10 ‘‘(J) other indicators as determined appro11 priate by the Secretary. 

12 ‘‘(2) RESEARCH.—The Secretary, in consulta13 tion with the Administrator, shall support research 

14 under this section that— 

15 ‘‘(A) investigates and defines links between 

16 the built environment and human health and 

17 identifies causal relationships; 

18 ‘‘(B) examines— 

19 ‘‘(i) the scope and intensity of the im20 pact that the built environment (including 

21 the various characteristics of the built en22 vironment) has on the human health; or 

23 ‘‘(ii) the distribution of such impacts 

24 by— 

25 ‘‘(I) location; and 


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1 ‘‘(II) population subgroup; 

2 ‘‘(C) is used to develop— 

3 ‘‘(i) measures and indicators to ad4 dress health impacts and the connection of 

5 health to the built environment; 

6 ‘‘(ii) efforts to link the measures to 

7 transportation, land use, and health data8 bases; and 

9 ‘‘(iii) efforts to enhance the collection 

10 of built environment surveillance data; 

11 ‘‘(D) distinguishes carefully between per12 sonal attitudes and choices and external influ13 ences on behavior to determine how much the 

14 association between the built environment and 

15 the health of residents, versus the lifestyle pref16 erences of the people that choose to live in the 

17 neighborhood, reflects the physical characteris18 tics of the neighborhood; and 

19 ‘‘(E)(i) identifies or develops effective 

20 intervention strategies focusing on enhance21 ments to the built environment that promote in22 creased use physical activity, access to nutri23 tious foods, or other health-promoting activities 

24 by residents; and 


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1 ‘‘(ii) in developing the intervention strate2 gies under clause (i), ensures that the interven3 tion strategies will reach out to high-risk or vul4 nerable populations, including low-income urban 

5 and rural communities and aging populations, 

6 in addition to the general population. 

7 ‘‘(3) SURVEYS.—The Secretary may use funds 

8 appropriated under this section to support the ex9 pansion of national surveys and data tracking sys10 tems to provide more detailed information about the 

11 connection between the built environment and 

12 health. 

13 ‘‘(4) PRIORITY.—In providing assistance under 

14 the grant program under this section, the Secretary 

15 and the Administrator shall give priority to research 

16 that incorporates— 

17 ‘‘(A) interdisciplinary approaches; or 

18 ‘‘(B) the expertise of the public health, 

19 physical activity, urban planning, land use, and 

20 transportation research communities in the 

21 United States and abroad. 

22 ‘‘(b) AUTHORIZATION OF APPROPRIATIONS.—There 

23 are authorized to be appropriated such sums as may be 

24 necessary to carry out this section. Not to exceed 20 per25 cent of amounts appropriated for each fiscal year under 


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1 this subsection may be used for the research component 

2 of the program under this section.’’. 

3 SEC. 1004. IMPLEMENTATION OF RECOMMENDATIONS BY 

4 ENVIRONMENTAL PROTECTION AGENCY. 

5 (a) INSPECTOR GENERAL RECOMMENDATIONS.—The 

6 Administrator of the Environmental Protection Agency 

7 shall, as promptly as practicable, carry out each of the 

8 following recommendations of the Inspector General of the 

9 Agency as set forth in Report No. 2006–P–00034 entitled 

10 ‘‘EPA needs to conduct environmental justice reviews of 

11 its programs, policies and activities’’: 

12 (1) The recommendation that the Agency’s pro13 gram and regional offices identify which programs, 

14 policies, and activities need environmental justice re15 views and require these offices to establish a plan to 

16 complete the necessary reviews. 

17 (2) The recommendation that the Administrator 

18 of the Agency ensure that these reviews determine 

19 whether the programs, policies, and activities may 

20 have a disproportionately high and adverse health or 

21 environmental impact on minority and low-income 

22 populations. 

23 (3) The recommendation that each program 

24 and regional office develop specific environmental 


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1 justice review guidance for conducting environmental 

2 justice reviews. 

3 (4) The recommendation that the Administrator 

4 designate a responsible office to compile results of 

5 environmental justice reviews and recommend appro6 priate actions. 

7 (b) GAO RECOMMENDATIONS.—In developing rules 

8 under laws administered by the Environmental Protection 

9 Agency, the Administrator of the Agency shall, as prompt10 ly as practicable, carry out each of the following rec11 ommendations of the Comptroller General of the United 

12 States as set forth in GAO Report numbered GAO–05– 

13 289 entitled ‘‘EPA Should Devote More Attention to En14 vironmental Justice when Developing Clean Air Rules’’: 

15 (1) The recommendation that the Administrator 

16 ensure that workgroups involved in developing a rule 

17 devote attention to environmental justice while draft18 ing and finalizing the rule. 

19 (2) The recommendation that the Administrator 

20 enhance the ability of such workgroups to identify 

21 potential environmental justice issues through such 

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1 mental justice coordinators in the workgroups when 

2 appropriate. 

3 (3) The recommendation that the Administrator 

4 improve assessments of potential environmental jus5 tice impacts in economic reviews by identifying the 

6 data and developing the modeling techniques needed 

7 to assess such impacts. 

8 (4) The recommendation that the Administrator 

9 direct appropriate Agency officers and employees to 

10 respond fully when feasible to public comments on 

11 environmental justice, including improving the Agen12 cy’s explanation of the basis for its conclusions, to13 gether with supporting data. 

14 (c) 2004 INSPECTOR GENERAL REPORT.—The Ad15 ministrator of the Environmental Protection Agency shall, 

16 as promptly as practicable, carry out each of the following 

17 recommendations of the Inspector General of the Agency 

18 as set forth in the report entitled ‘‘EPA Needs to Consist19 ently Implement the Intent of the Executive Order on En20 vironmental Justice’’ (Report No. 2004–P–00007): 

21 (1) The recommendation that the Agency clear22 ly define the mission of the Office of Environmental 

23 Justice (OEJ) and provide Agency staff with an un24 derstanding of the roles and responsibilities of the 

25 Office. 


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1 (2) The recommendation that the Agency estab2 lish (through issuing guidance or a policy statement 

3 from the Administrator) specific timeframes for the 

4 development of definitions, goals, and measurements 

5 regarding environmental justice and provide the re6 gions and program offices a standard and consistent 

7 definition for a minority and low-income community, 

8 with instructions on how the Agency will implement 

9 and put into operation environmental justice in the 

10 Agency’s daily activities. 

11 (3) The recommendation that the Agency en12 sure the comprehensive training program currently 

13 under development includes standard and consistent 

14 definitions of the key environmental justice concepts 

15 (such as ‘‘low-income’’, ‘‘minority’’, and ‘‘dispropor16 tionately impacted’’) and instructions for implemen17 tation of those concepts. 

18 The Administrator shall submit an initial report to Con19 gress within 6 months after the enactment of this Act re20 garding the Administrator’s strategy for implementing the 

21 recommendations referred to in paragraphs (1), (2), and 

22 (3). Thereafter, the Administrator shall provide semi23 annual reports to Congress regarding the Administrator’s 

24 progress in implementing such recommendations and 

25 modifying the Administrator’s emergency management 


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1 procedures to incorporate environmental justice in the 

2 Agency’s Incident Command Structure (in accordance 

3 with the December 18, 2006, letter from the Deputy Ad4 ministrator to the Acting Inspector General of the Agen5 cy). 

6 (d) FEDERAL ACTION PLAN FOR SAVING LIVES, 

7 PROTECTING PEOPLE AND THEIR FAMILIES FROM

8 RADON.— 

9 (1) IN GENERAL.—Because radon is a naturally 

10 occurring radioactive gas that is recognized as the 

11 leading cause of lung cancer among nonsmokers and 

12 is a particular environmental threat for low-income 

13 and minority individuals because of the lack of infor14 mation about radon levels in their own homes, the 

15 Administrator of the Environmental Protection 

16 Agency shall within 6 months after the date of the 

17 enactment of this Act, implement the action plan en18 titled ‘‘Protecting People and Families from Radon: 

19 A Federal Action Plan for Saving Lives’’ (June 20, 

20 2011), working with the Secretary of Health and 

21 Human Services acting through the Director of the 

22 Centers for Disease Control and Prevention, and 

23 with the other Federal agencies mentioned in and as 

24 set forth in the action plan. 


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1 (2) SPECIFIC STEPS.—In carrying out para2 graph (1), the Administrator shall take steps to 

3 achieve each of the following: 

4 (A) The recommendation that the 

5 workgroup comprised of the Federal agencies 

6 participating in the development of the action 

7 plan referred to in paragraph (1) implement 

8 specific steps within the current authority and 

9 activities of each Federal agency to reduce ex10 posure to radon. 

11 (B) The recommendation that such 

12 workgroup meet on the 1-year anniversary of 

13 the plan to assess and recognize achievements 

14 of the plan. 

15 (3) REPORT.—The Administrator shall report 

16 to the Congress on the 1-year assessment of the 

17 plan’s implementation, including the challenges re18 maining and the progress in reducing radon expo19 sure particularly to low-income and minority fami20 lies. 

21 SEC. 1005. GRANT PROGRAM TO CONDUCT ENVIRON22 MENTAL HEALTH IMPROVEMENT ACTIVITIES 

23 AND TO IMPROVE SOCIAL DETERMINANTS OF 

24 HEALTH. 

25 (a) DEFINITIONS.—In this section: 


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1 (1) DIRECTOR.—The term ‘‘Director’’ means 

2 the Director of the Centers for Disease Control and 

3 Prevention, acting in collaboration with the Adminis4 trator of the Environmental Protection Agency and 

5 the Director of the National Institute of Environ6 mental Health Sciences. 

7 (2) ELIGIBLE ENTITY.—The term ‘‘eligible enti8 ty’’ means a State or local community that— 

9 (A) bears a disproportionate burden of ex10 posure to environmental health hazards; 

11 (B) bears a disproportionate burden of ex12 posure to unhealthy living conditions, low 

13 standard housing conditions, low socioeconomic 

14 status, poor nutrition, less opportunity for edu15 cational attainment, disproportionate unemploy16 ment rates, or lower literacy levels; 

17 (C) has established a coalition— 

18 (i) with not less than 1 community19 based organization or demonstration pro20 gram; and 

21 (ii) with not less than 1— 

22 (I) public health entity; 

23 (II) health care provider organi24 zation; 


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1 (III) academic institution, includ2 ing any minority-serving institution 

3 (including a Hispanic-serving institu4 tion, a historically Black college or 

5 university, and a tribal college or uni6 versity); or 

7 (IV) child-serving institution; 

8 (D) ensures planned activities and funding 

9 streams are coordinated to improve community 

10 health; and 

11 (E) submits an application in accordance 

12 with subsection (c). 

13 (b) ESTABLISHMENT.—The Director shall establish a 

14 grant program under which eligible entities shall receive 

15 grants to conduct environmental health improvement ac16 tivities and to improve social determinants of health. 

17 (c) APPLICATION.—To receive a grant under this sec18 tion, an eligible entity shall submit an application to the 

19 Director at such time, in such manner, and accompanied 

20 by such information as the Director may require. 

21 (d) COOPERATIVE AGREEMENTS.—An eligible entity 

22 may use a grant under this section— 

23 (1) to promote environmental health; 

24 (2) to address environmental health disparities 

25 among all populations, including children; and 


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1 (3) to address racial and ethnic disparities in 

2 social determinants of health. 

3 (e) AMOUNT OF COOPERATIVE AGREEMENT.— 

4 (1) IN GENERAL.—The Director shall award 

5 grants to eligible entities at the 3 different funding 

6 levels described in this subsection. 

7 (2) LEVEL 1 COOPERATIVE AGREEMENTS.— 

8 (A) IN GENERAL.—An eligible entity 

9 awarded a grant under this paragraph shall use 

10 the funds to identify environmental health prob11 lems and solutions by— 

12 (i) establishing a planning and 

13 prioritizing council in accordance with sub14 paragraph (B); and 

15 (ii) conducting an environmental 

16 health assessment in accordance with sub17 paragraph (C). 

18 (B) PLANNING AND PRIORITIZING COUN19 CIL.— 

20 (i) IN GENERAL.—A prioritizing and 

21 planning council established under sub22 paragraph (A)(i) (referred to in this para23 graph as a ‘‘PPC’’) shall assist the envi24 ronmental health assessment process and 


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1 environmental health promotion activities 

2 of the eligible entity. 

3 (ii) MEMBERSHIP.—Membership of a 

4 PPC shall consist of representatives from 

5 various organizations within public health, 

6 planning, development, and environmental 

7 services and shall include stakeholders 

8 from vulnerable groups such as children, 

9 the elderly, disabled, and minority ethnic 

10 groups that are often not actively involved 

11 in democratic or decisionmaking processes. 

12 (iii) DUTIES.—A PPC shall— 

13 (I) identify key stakeholders and 

14 engage and coordinate potential part15 ners in the planning process; 

16 (II) establish a formal advisory 

17 group to plan for the establishment of 

18 services; 

19 (III) conduct an in-depth review 

20 of the nature and extent of the need 

21 for an environmental health assess22 ment, including a local epidemiological 

23 profile, an evaluation of the service 

24 provider capacity of the community, 


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1 and a profile of any target popu2 lations; and 

3 (IV) define the components of 

4 care and form essential programmatic 

5 linkages with related providers in the 

6 community. 

7 (C) ENVIRONMENTAL HEALTH ASSESS8 MENT.— 

9 (i) IN GENERAL.—A PPC shall carry 

10 out an environmental health assessment to 

11 identify environmental health concerns. 

12 (ii) ASSESSMENT PROCESS.—The 

13 PPC shall— 

14 (I) define the goals of the assess15 ment; 

16 (II) generate the environmental 

17 health issue list; 

18 (III) analyze issues with a sys19 tems framework; 

20 (IV) develop appropriate commu21 nity environmental health indicators; 

22 (V) rank the environmental 

23 health issues; 

24 (VI) set priorities for action; 

25 (VII) develop an action plan; 


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1 (VIII) implement the plan; and 

2 (IX) evaluate progress and plan3 ning for the future. 

4 (D) EVALUATION.—Each eligible entity 

5 that receives a grant under this paragraph shall 

6 evaluate, report, and disseminate program find7 ings and outcomes. 

8 (E) TECHNICAL ASSISTANCE.—The Direc9 tor may provide such technical and other non10 financial assistance to eligible entities as the 

11 Director determines to be necessary. 

12 (3) LEVEL 2 COOPERATIVE AGREEMENTS.— 

13 (A) ELIGIBILITY.— 

14 (i) IN GENERAL.—The Director shall 

15 award grants under this paragraph to eli16 gible entities that have already— 

17 (I) established broad-based col18 laborative partnerships; and 

19 (II) completed environmental as20 sessments. 

21 (ii) NO LEVEL 1 REQUIREMENT.—To 

22 be eligible to receive a grant under this 

23 paragraph, an eligible entity is not re24 quired to have successfully completed a 


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1 Level 1 Cooperative Agreement (as de2 scribed in paragraph (2)). 

3 (B) USE OF GRANT FUNDS.—An eligible 

4 entity awarded a grant under this paragraph 

5 shall use the funds to further activities to carry 

6 out environmental health improvement activi7 ties, including— 

8 (i) addressing community environ9 mental health priorities in accordance with 

10 paragraph (2)(C)(ii), including— 

11 (I) geography; 

12 (II) the built environment; 

13 (III) air quality; 

14 (IV) water quality; 

15 (V) land use; 

16 (VI) solid waste; 

17 (VII) housing; 

18 (VIII) crime; 

19 (IX) socioeconomic status; 

20 (X) ethnicity, social construct 

21 and language preference; 

22 (XI) educational attainment; 

23 (XII) employment; 

24 (XIII) food safety; 

25 (XIV) nutrition; 


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1 (XV) health care services; and 

2 (XVI) injuries; 

3 (ii) building partnerships between 

4 planning, public health, and other sectors, 

5 including child-serving institutions, to ad6 dress how the built environment impacts 

7 food availability and access and physical 

8 activity to promote healthy behaviors and 

9 lifestyles and reduce overweight and obe10 sity, musculoskeletal diseases, respiratory 

11 conditions, dental, oral and mental health 

12 conditions, poverty, and related co13 morbidities; 

14 (iii) establishing programs to ad15 dress— 

16 (I) how environmental and social 

17 conditions of work and living choices 

18 influence physical activity and dietary 

19 intake; or 

20 (II) how those conditions influ21 ence the concerns and needs of people 

22 who have impaired mobility and use 

23 assistance devices, including wheel24 chairs, lower limb prostheses, and hip, 


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1 knee, and other joint replacements; 

2 and 

3 (iv) convening intervention and dem4 onstration programs that examine the role 

5 of the social environment in connection 

6 with the physical and chemical environ7 ment in— 

8 (I) determining access to nutri9 tional food; and 

10 (II) improving physical activity to 

11 reduce overweight, obesity, and co12 morbidities and increase quality of 

13 life. 

14 (4) LEVEL 3 COOPERATIVE AGREEMENTS.— 

15 (A) IN GENERAL.—An eligible entity 

16 awarded a grant under this paragraph shall use 

17 the funds to identify and address racial and 

18 ethnic disparities in social determinants of 

19 health by creating demonstration programs that 

20 assess the feasibility of establishing a federally 

21 funded comprehensive program and describe 

22 key outcomes that address racial and ethnic dis23 parities in social determinants of health. 

24 (B) PROGRAM DESIGN.— 


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1 (i) EVALUATION.—No later than 1 

2 year after enactment of this Act, the Di3 rector shall evaluate the best practices of 

4 existing programs from the private, public, 

5 community based, and academically sup6 ported initiatives focused on reducing dis7 parities in the social determinants of 

8 health for racial and ethnic populations. 

9 (ii) DEMONSTRATION PROJECTS.— 

10 Not later than two years after the date of 

11 enactment of this Act, the Director shall 

12 implement at least ten demonstration 

13 projects including at least one project for 

14 each major racial and ethnic minority 

15 group, each of which is unique to the cul16 tural and linguistic needs of each of the 

17 following groups: 

18 (I) Native Americans and Alaska 

19 Natives. 

20 (II) Asian-Americans. 

21 (III) African-Americans/Blacks. 

22 (IV) Hispanic/Latino-Americans. 

23 (V) Native Hawaiians and Pacific 

24 Islanders. 


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1 (iii) REPORT TO CONGRESS.—No later 

2 than 2 years after the implementation of 

3 the initial demonstration projects, the Di4 rector shall submit to Congress a report 

5 which includes— 

6 (I) a description of each dem7 onstration project and design; 

8 (II) an evaluation of the cost ef9 fectiveness of each project’s preven10 tion and treatment efforts; 

11 (III) an evaluation of the cultural 

12 and linguistic appropriateness of each 

13 project by racial and ethnic group; 

14 and 

15 (IV) an evaluation of the bene16 ficiary’s health status improvement 

17 under the demonstration project. 

18 (iv) ANY OTHER INFORMATION

19 DEEMED APPROPRIATE BY THE DIREC20 TOR.—The Director shall require any other 

21 information deemed appropriate to be 

22 shared by or developed by eligible entities 

23 awarded a grant under this paragraph, in24 cluding the following: 


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1 (I) Developing models and evalu2 ating methods that improve the cul3 tural and linguistically appropriate 

4 services provided through the Centers 

5 for Disease Control and Prevention to 

6 target individuals impacted by health 

7 disparities based on their race, eth8 nicity, and gender. 

9 (II) Promoting the collaboration 

10 between primary and specialty care 

11 health care providers and patients, to 

12 ensure patients impacted by health 

13 disparities based on race, ethnicity, 

14 and gender are receiving comprehen15 sive and organized treatment and 

16 care. 

17 (III) Educating health care pro18 fessionals on the causes and effects of 

19 disparities in the social determinants 

20 of health as it relates to minority and 

21 racial and ethnic communities and the 

22 need for culturally and linguistically 

23 appropriate care in the prevention and 

24 treatment of high-impact diseases. 


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1 (IV) Encouraging collaboration 

2 among community and patient-based 

3 organizations which work to address 

4 disparities in the social determinants 

5 of health as it relates to high-impact 

6 diseases in minority and racial and 

7 ethnic populations. 

8 (f) AUTHORIZATION OF APPROPRIATIONS.—There 

9 are authorized to be appropriated to carry out this sec10 tion— 

11 (1) $25,000,000 for fiscal year 2015; and 

12 (2) such sums as may be necessary for fiscal 

13 years 2016 through 2018. 

14 SEC. 1006. ADDITIONAL RESEARCH ON THE RELATIONSHIP 

15 BETWEEN THE BUILT ENVIRONMENT AND 

16 THE HEALTH OF COMMUNITY RESIDENTS. 

17 (a) DEFINITION OF ELIGIBLE INSTITUTION.—In this 

18 section, the term ‘‘eligible institution’’ means a public or 

19 private nonprofit institution that submits to the Secretary 

20 of Health and Human Services (in this section referred 

21 to as the ‘‘Secretary’’) and the Administrator of the Envi22 ronmental Protection Agency (in this section referred to 

23 as the ‘‘Administrator’’) an application for a grant under 

24 the grant program authorized under subsection (b)(2) at 

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1 ments, assurances, and information as the Secretary and 

2 Administrator may require. 

3 (b) RESEARCH GRANT PROGRAM.— 

4 (1) DEFINITION OF HEALTH.—In this section, 

5 the term ‘‘health’’ includes— 

6 (A) levels of physical activity; 

7 (B) degree of mobility due to factors such 

8 as musculoskeletal diseases, arthritis, and obe9 sity; 

10 (C) consumption of nutritional foods; 

11 (D) rates of crime; 

12 (E) air, water, and soil quality; 

13 (F) risk of injury; 

14 (G) accessibility to health care services; 

15 (H) levels of educational attainment; and 

16 (I) other indicators as determined appro17 priate by the Secretary. 

18 (2) GRANTS.—The Secretary, in collaboration 

19 with the Administrator, shall provide grants to eligi20 ble institutions to conduct and coordinate research 

21 on the built environment and its influence on indi22 vidual and population-based health. 

23 (3) RESEARCH.—The Secretary shall support 

24 research that— 


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1 (A) investigates and defines the causal 

2 links between all aspects of the built environ3 ment and the health of residents; 

4 (B) examines— 

5 (i) the extent of the impact of the 

6 built environment (including the various 

7 characteristics of the built environment) on 

8 the health of residents; 

9 (ii) the variance in the health of resi10 dents by— 

11 (I) location (such as inner cities, 

12 inner suburbs, and outer suburbs); 

13 and 

14 (II) population subgroup (includ15 ing children, the elderly, the disadvan16 taged); or 

17 (iii) the importance of the built envi18 ronment to the total health of residents, 

19 which is the primary variable of interest 

20 from a public health perspective; 

21 (C) is used to develop— 

22 (i) measures to address health and the 

23 connection of health to the built environ24 ment; and 


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1 (ii) efforts to link the measures to 

2 travel and health databases; and 

3 (D) distinguishes carefully between per4 sonal attitudes and choices and external influ5 ences on observed behavior to determine how 

6 much an observed association between the built 

7 environment and the health of residents, versus 

8 the lifestyle preferences of the people that 

9 choose to live in the neighborhood, reflects the 

10 physical characteristics of the neighborhood; 

11 and 

12 (E)(i) identifies or develops effective inter13 vention strategies to promote better health 

14 among residents with a focus on behavioral 

15 interventions and enhancements of the built en16 vironment that promote increased use by resi17 dents; and 

18 (ii) in developing the intervention strate19 gies under clause (i), ensures that the interven20 tion strategies will reach out to high-risk popu21 lations, including racial and ethnic minorities, 

22 low-income urban and rural communities, and 

23 children. 

24 (4) PRIORITY.—In providing assistance under 

25 the grant program authorized under paragraph (2), 


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1 the Secretary and the Administrator shall give pri2 ority to research that incorporates— 

3 (A) minority-serving institutions as grant4 ees; 

5 (B) interdisciplinary approaches; or 

6 (C) the expertise of the public health, 

7 physical activity, nutrition and health care (in8 cluding child health), urban planning, and 

9 transportation research communities in the 

10 United States and abroad. 

11 SEC. 1007. ENVIRONMENT AND PUBLIC HEALTH RESTORA12 TION. 

13 (a) FINDINGS.— 

14 (1) GENERAL FINDINGS.—The Congress finds 

15 as follows: 

16 (A) As human beings, we share our envi17 ronment with a wide variety of habitats and 

18 ecosystems that nurture and sustain a diversity 

19 of species. 

20 (B) The abundance of natural resources in 

21 our environment forms the basis for our econ22 omy and has greatly contributed to human de23 velopment throughout history. 

24 (C) The accelerated pace of human devel25 opment over the last several hundred years has 


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1 significantly impacted our natural environment 

2 and its resources, the health and diversity of 

3 plant and animal wildlife, the availability of 

4 critical habitats, the quality of our air and our 

5 water, and our global climate. 

6 (D) The intervention of the Federal Gov7 ernment is necessary to minimize and mitigate 

8 human impact on the environment for the ben9 efit of public health, to maintain air quality and 

10 water quality, to sustain the diversity of plants 

11 and animals, to combat global climate change, 

12 and to protect the environment. 

13 (E) Laws and regulations in the United 

14 States have been created and promulgated to 

15 minimize and mitigate human impact on the en16 vironment for the benefit of public health, to 

17 maintain air quality and water quality, to sus18 tain wildlife, and to protect the environment. 

19 (F) Such laws include the Antiquities Act 

20 of 1906 (16 U.S.C. 431 et seq.) initiated by 

21 President Theodore Roosevelt to create the na22 tional park system, the National Environmental 

23 Policy Act of 1969 (42 U.S.C. 4321 et seq.), 

24 the Clean Air Act (42 U.S.C. 7401 et seq.), the 

25 Federal Water Pollution Control Act (33 U.S.C. 


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1 1251 et seq.), the Comprehensive Environ2 mental Response, Compensation, and Liability 

3 Act of 1980 (Public Law 96–510), the Endan4 gered Species Act of 1973 (Public Law 93– 

5 205), and the National Forest Management Act 

6 of 1976 (Public Law 94–588). 

7 (G) Attempts to repeal or weaken key envi8 ronmental safeguards pose dangers to the pub9 lic health, air quality, water quality, wildlife, 

10 and the environment. 

11 (2) FINDINGS ON CHANGES AND PROPOSED

12 CHANGES IN LAW.—The Congress finds that, since 

13 2001, the following changes and proposed changes 

14 to existing law or regulations have negatively im15 pacted or will negatively impact the environment and 

16 public health: 

17 (A) CLEAN WATER.— 

18 (i) On May 9, 2002, the Environ19 mental Protection Agency (EPA) and the 

20 Army Corps of Engineers put forth a final 

21 rule that reconciled regulations imple22 menting section 404 of the Federal Water 

23 Pollution Control Act by redefining the 

24 term ‘‘fill material’’ and amending the def25 inition of the term ‘‘discharge of fill mateVerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00740 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294

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1 rial’’, reversing a 25-year-old regulation. 

2 The new rule fails to restrict the dumping 

3 of hardrock mining waste, construction de4 bris, and other industrial wastes into riv5 ers, streams, lakes, and wetlands. The rule 

6 further allows destructive mountaintop re7 moval coal mining companies to dump 

8 waste into streams and lakes, polluting the 

9 surrounding natural habitat and poisoning 

10 plants and animals that depend on those 

11 water sources. 

12 (ii) On February 12, 2003, the Envi13 ronmental Protection Agency published the 

14 rule ‘‘National Pollutant Discharge Elimi15 nation System Permit Regulation and Ef16 fluent Limitation Guidelines and Stand17 ards for Concentrated Animal Feeding Op18 erations’’, new livestock waste regulations 

19 that aimed to control factory farm pollu20 tion but which would severely undermine 

21 existing protections under the Federal 

22 Water Pollution Control Act. This regula23 tion allows large-scale animal factories to 

24 foul the Nation’s waters with animal 

25 waste, allows livestock owners to draft 


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1 their own pollution-management plans and 

2 avoid ground water monitoring, legalizes 

3 the discharge of contaminated runoff water 

4 rich in nitrogen, phosphorus, bacteria, and 

5 metals, and ensures that large factory 

6 farms are not held liable for the environ7 mental damage they cause. In a 2005 Fed8 eral court decision (‘‘Waterkeeper Alliance, 

9 et al. v. Enviromental Protection Agency’’, 

10 399 F.3d 486 (2nd Cir. 2005)), major 

11 parts of the rule were upheld, others va12 cated, and still others remanded back to 

13 the EPA. On November 20, 2008, the En14 vironmental Protection Agency published a 

15 revised final rule which undermines envi16 ronmental protection provisions by remov17 ing mandatory permitting requirements 

18 and allowing large animal farms to self19 certify the absence of pollutant discharge 

20 activity. 

21 (iii) On March 19, 2003, the Environ22 mental Protection Agency published a new 

23 rule regarding the Total Maximum Daily 

24 Load program of the Federal Water Pollu25 tion Control Act that regulates the maxVerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00742 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294

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1 imum amount of a particular pollutant 

2 that can be present in a body of water and 

3 still meet water quality standards. The new 

4 rule withdrew the existing regulation put 

5 forth on July 13, 2000, and halted mo6 mentum in cleaning up polluted waterways 

7 throughout the Nation. By abandoning the 

8 existing rule, the Environmental Protection 

9 Agency is undermining the effectiveness of 

10 cleanup plans and is allowing States to 

11 avoid cleaning polluted waters entirely by 

12 dropping them from their cleanup lists. 

13 Waterways play a crucial role in the lives 

14 of the people of the United States and are 

15 critical to the livelihood of fish and wildlife. 

16 The result of dropping the July 2000 rule 

17 is that the restoration of polluted rivers, 

18 shorelines, and lakes will be delayed, harm19 ing more fish and wildlife and worsening 

20 the quality of drinking water. 

21 (iv) On December 2, 2008, the Envi22 ronmental Protection Agency and the 

23 Army Corps of Engineers jointly issued a 

24 guidance document in the form of a legal 

25 memorandum, titled ‘‘Clean Water Act JuVerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00743 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294

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1 risdiction Following the U.S. Supreme 

2 Court’s Decision in Rapanos v. United 

3 States & Carabell v. United States’’. This 

4 new guidance dictates enforcement actions 

5 under the Federal Water Pollution Control 

6 Act and calls for a complicated ‘‘case-by7 case’’ analysis to determine jurisdiction for 

8 waterways that do not flow all year. Such 

9 actions endanger small streams and wet10 lands that serve as important habitats for 

11 aquatic life, which play a fundamental role 

12 in safeguarding sources of clean drinking 

13 water and mitigate the risks and effects of 

14 floods and droughts. Further, the defini15 tion provided therein for ‘‘waters of the 

16 United States’’ is applicable to the Federal 

17 Water Pollution Control Act as a whole, 

18 potentially affecting programs that control 

19 industrial pollution and sewage levels, pre20 vent oil spills, and set water quality stand21 ards for all waters in the United States 

22 protected under the Federal Water Pollu23 tion Control Act. 

24 (B) FORESTS AND LAND MANAGEMENT.— 


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1 (i) On December 3, 2003, the Presi2 dent signed into law the Healthy Forests 

3 Restoration Act of 2003 (Public Law 108– 

4 148; 16 U.S.C. 6501 et seq.). Although the 

5 law attempts to reduce the risk of cata6 strophic forest fires, it provides a boon to 

7 timber companies by accelerating the ag8 gressive thinning of backcountry forests 

9 that are far from at-risk communities. The 

10 law allows for increased logging of large, 

11 fire-resistant trees that are not in close 

12 proximity of homes and communities; it 

13 undermines critical protections for endan14 gered species by exempting Federal land 

15 management agencies from consulting with 

16 the United States Fish and Wildlife Serv17 ice before approving any action that could 

18 harm endangered plants or wildlife; and it 

19 limits public participation by reducing the 

20 number of environmental project reviews. 

21 (ii) On April 21, 2008, the Depart22 ment of Agriculture issued a Final Plan23 ning Rule and Record of Decision for Na24 tional Forest System Land Management 

25 Planning. Similar to rules enacted by the 


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1 Administration on January 5, 2005, later 

2 remanded back to the agency in Federal 

3 district court for violating the National 

4 Environmental Policy Act of 1969, the En5 dangered Species Act of 1973, and the Ad6 ministrative Procedure Act (‘‘Citizens for 

7 Better Forestry v. United States Depart8 ment of Agriculture’’, 481 F. Supp. 2d 

9 1059 (N.D. Cal. 2007)), this revised rule 

10 eliminates strict forest planning standards 

11 established in 1982, and opens millions of 

12 acres of public lands to damaging and 

13 invasive logging, mining, and drilling oper14 ations. These regulations would reverse 

15 more than 20 years of protection for wild16 life and national forests by removing the 

17 overall goal of ensuring ecological sustain18 ability in managing the national forest sys19 tem, weakening the National Forest Man20 agement Act of 1976, and effectively end21 ing the review of forest management plans 

22 under the National Environmental Policy 

23 Act of 1969. 

24 (iii) On September 20, 2006, the Dis25 trict Court for the Northern District of 


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1 California vacated the Protection of Inven2 toried Roadless Areas rule, enacted on May 

3 13, 2005, which gave State Governors 18 

4 months to petition the Federal Government 

5 to either restore the previous rule for their 

6 States, or submit a new management and 

7 development plan for national forest areas 

8 inventoried under the rule. Despite the 

9 enjoinment of the Administration’s 2005 

10 rule, and the subsequent restoration of the 

11 original Roadless Area Conservation Rule, 

12 the United States Forest Service has con13 tinued to allow States to petition for a spe14 cial rule under the authority of the Admin15 istrative Procedure Act, publishing a final 

16 special rule for Idaho on October 16, 2008. 

17 As a result, 58.5 million acres of wild na18 tional forests are still vulnerable to log19 ging, road building, and other develop20 ments that may fragment natural habitats 

21 and negatively impact fish and wildlife. 

22 (iv) On November 17, 2008, the De23 partment of the Interior’s Bureau of Land 

24 Management (BLM) signed the Record of 

25 Decision (ROD) amending 12 resource 


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1 management plans in Colorado, Utah, and 

2 Wyoming, opening 2,000,000 acres of pub3 lic lands to commercial tar sands and oil 

4 shale exploration and development. On No5 vember 18, 2008, the BLM published a 

6 final rule for Oil Shale Management set7 ting the policies and procedures for a com8 mercial leasing program for the manage9 ment of federally owned oil shale in those 

10 three States. Previously barred by a con11 gressional moratorium on the commercial 

12 leasing regulations for oil shale until Sep13 tember 30, 2008, the development of oil 

14 shale on public lands poses a serious threat 

15 to land conservation, endangered and 

16 threatened species, and critical habitat. 

17 Domestic shale oil production allowed by 

18 these regulations is highly water and en19 ergy intensive, the impacts of which will in20 tensify existing water scarcity in the arid 

21 Western Region and potentially degrade 

22 air and water quality for surrounding pop23 ulations. 

24 (C) SCIENTIFIC REVIEW.—On December 

25 16, 2008, the United States Fish and Wildlife 


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1 Service of the Department of the Interior and 

2 the National Oceanic and Atmospheric Admin3 istration of the Department of Commerce joint4 ly issued a new rule amending regulations gov5 erning interagency cooperation under section 7 

6 of the Endangered Species Act of 1973 (ESA). 

7 This rule undermines the intention of the ESA 

8 to protect species and the ecosystems upon 

9 which they depend by allowing Federal agencies 

10 to carry out, permit, or fund an action without 

11 proper environmental review and expert third12 party consultation from Federal wildlife ex13 perts. Under this new rule, Federal agencies 

14 can unilaterally circumvent the formal review 

15 process, eliminating longstanding and scientif16 ically grounded safeguards that serve to protect 

17 the biodiversity of our Nation’s ecosystems and 

18 avert harm to thousands of endangered and 

19 threatened species. 

20 (b) STATEMENT OF POLICY.—It is the policy of the 

21 United States Government to work in conjunction with 

22 States, territories, tribal governments, international orga23 nizations, and foreign governments in order to act as a 

24 steward of the environment for the benefit of public 

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1 tain the diversity of plant and animal species, to combat 

2 global climate change, and to protect the environment for 

3 future generations to enjoy. 

4 (c) STUDY AND REPORT ON PUBLIC HEALTH OR EN5 VIRONMENTAL IMPACT OF REVISED RULES, REGULA6 TIONS, LAWS, OR PROPOSED LAWS.— 

7 (1) STUDY.—Not later than 30 days after the 

8 date of enactment of this Act, the President shall 

9 enter into an arrangement under which the National 

10 Academy of Sciences will conduct a study to deter11 mine the impact on public health, air quality, water 

12 quality, wildlife, and the environment of the fol13 lowing regulations, laws, and proposed laws: 

14 (A) CLEAN WATER.— 

15 (i) Final revisions to the Federal 

16 Water Pollution Control Act regulatory 

17 definitions of ‘‘fill material’’ and ‘‘dis18 charge of fill material’’, finalized and pub19 lished in the Federal Register on May 9, 

20 2002 (67 Fed. Reg. 31129), amending 

21 part 232 of title 40, Code of Federal Regu22 lations. 

23 (ii) Revised National Pollutant Dis24 charge Elimination System Permit Regula25 tion and Effluent Limitation Guidelines 


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1 and Standards for Concentrated Animal 

2 Feeding Operations in response to the 

3 ‘‘Waterkeeper Alliance, et al. v. 

4 Enviromental Protection Agency’’ decision, 

5 finalized and published in the Federal Reg6 ister on November 20, 2008 (73 Fed. Reg. 

7 225), amending parts 9, 122, and 412 of 

8 title 40, Code of Federal Regulations. 

9 (iii) A March 19, 2003, rule published 

10 in the Federal Register (68 Fed. Reg. 

11 13608) withdrawing a July 13, 2000, rule 

12 revising the Total Maximum Daily Load 

13 program of the Federal Water Pollution 

14 Control Act (65 Fed. Reg. 43586), amend15 ing parts 9, 122, 123, 124, and 130 of 

16 title 40, Code of Federal Regulations. 

17 (iv) Official Guidance Document, 

18 ‘‘Clean Water Act Jurisdiction Following 

19 the United States Supreme Court’s Deci20 sion in Rapanos v. United States & 

21 Carabell v. United States’’, issued on De22 cember 2, 2008, relating to jurisdiction 

23 under section 404 of the Federal Water 

24 Pollution Control Act. 

25 (B) FORESTS AND LAND MANAGEMENT.— 


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1 (i) Healthy Forests Restoration Act of 

2 2003, signed into law on December 3, 

3 2003 (Public Law 108–148; 16 U.S.C. 

4 6501 et seq.). 

5 (ii) National Forest System Land 

6 Management Planning Rule, finalized and 

7 published in the Federal Register on April 

8 21, 2008 (73 Fed. Reg. 21468), replacing 

9 the 2005 final rule (70 Fed. Reg. 1022, 

10 Jan. 5, 2005), as amended March 3, 2006 

11 (71 Fed. Reg. 10837) and the 2000 final 

12 rule adopted on November 9, 2000 (65 

13 Fed. Reg. 67514) as amended on Sep14 tember 29, 2004 (69 Fed. Reg. 58055), 

15 amending title 36, Code of Federal Regula16 tions, part 219. 

17 (iii) The application of the Adminis18 trative Procedure Act (5 U.S.C. 551 to 

19 559, 701 to 706, et seq.), such that States 

20 may petition for a special rule for the 

21 roadless areas in all or part of said State. 

22 (iv) Record of Decision, ‘‘Oil Shale 

23 and Tar Sands Resources Resource Man24 agement Plan Amendments’’, issued on 

25 November 17, 2008, along with the Final 


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1 Rule, Oil Shale Management-General, pub2 lished in the Federal Register on Novem3 ber 18, 2008 (73 Fed. Reg. 223), amend4 ing title 43, Code of Federal Regulations, 

5 parts 3900, 3910, 3920, and 3930. 

6 (C) SCIENTIFIC REVIEW.—Final Rule, 

7 Interagency Cooperation Under the Endangered 

8 Species Act, published in the Federal Register 

9 on December 16, 2008, amending title 50, Code 

10 of Federal Regulations, part 402. 

11 (2) METHOD.—In conducting the study under 

12 paragraph (1), the National Academy of Sciences 

13 may utilize and compare existing scientific studies 

14 regarding the regulations, laws, and proposed laws 

15 listed in paragraph (1). 

16 (3) REPORT.—Under the arrangement entered 

17 into under paragraph (1), not later than 270 days 

18 after the date on which such arrangement is entered 

19 into, the National Academy of Sciences shall make 

20 publicly available and shall submit to the Congress 

21 and to the head of each department and agency of 

22 the Federal Government that issued, implements, or 

23 would implement a regulation, law, or proposed law 

24 listed in paragraph (1), a report containing— 


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1 (A) a description of the impact of all such 

2 regulations, laws, and proposed laws on public 

3 health, air quality, water quality, wildlife, and 

4 the environment, compared to the impact of 

5 preexisting regulations, or laws in effect, includ6 ing— 

7 (i) any negative impacts to air quality 

8 or water quality; 

9 (ii) any negative impacts to wildlife; 

10 (iii) any delays in hazardous waste 

11 cleanup that are projected to be hazardous 

12 to public health; and 

13 (iv) any other negative impact on pub14 lic health or the environment; and 

15 (B) any recommendations that the Na16 tional Academy of Sciences considers appro17 priate to maintain, restore, or improve in whole 

18 or in part protections for public health, air 

19 quality, water quality, wildlife, and the environ20 ment for each of the regulations, laws, and pro21 posed laws listed in paragraph (1), which may 

22 include recommendations for the adoption of 

23 any regulation or law in place or proposed prior 

24 to January 1, 2001. 


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1 (d) DEPARTMENT AND AGENCY REVISION OF EXIST2 ING RULES, REGULATIONS, OR LAWS.—Not later than 

3 180 days after the date on which the report is submitted 

4 pursuant to subsection (c)(3), the head of each depart5 ment and agency that has issued or implemented a regula6 tion or law listed in subsection (c)(1) shall submit to the 

7 Congress a plan describing the steps such department or 

8 such agency will take, or has taken, to restore or improve 

9 protections for public health and the environment in whole 

10 or in part that were in existence prior to the issuance of 

11 such regulation or law. 

12 SEC. 1008. GAO REPORT ON HEALTH EFFECTS OF DEEP13 WATER HORIZON OIL RIG EXPLOSION IN THE 

14 GULF COAST. 

15 (a) STUDY.—The Comptroller General of the United 

16 States shall conduct a study on the type and scope of 

17 health care services administered through the Department 

18 of Health and Human Services addressing the provision 

19 of health care to racial and ethnic minorities (whether 

20 residents, cleanup workers, or volunteers) affected by the 

21 explosion of the mobile offshore drilling unit Deepwater 

22 Horizon that occurred on April 20, 2010. 

23 (b) SPECIFIC COMPONENTS; REPORTING.—In car24 rying out subsection (a), the Comptroller General shall— 


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1 (1) assess the type, size, and scope of programs 

2 administered by the Department of Health and 

3 Human Services that focus on provision of health 

4 care to communities in the Gulf Coast; 

5 (2) identify the merits and disadvantages asso6 ciated with each the programs; 

7 (3) perform an analysis of the costs and bene8 fits of the programs; 

9 (4) determine whether there is any duplication 

10 of programs; and 

11 (5) not later than 180 days after the date of 

12 the enactment of this Act, report findings and rec13 ommendations for improving access to health care 

14 for racial and ethnic minorities to the Congress. 

Æ 


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