II 

113TH CONGRESS 

2D SESSION S. 2841 

To provide for a study by the Institute of Medicine on health disparities, 

to direct the Secretary of Health and Human Services to develop guidelines on reducing health disparities, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

SEPTEMBER 17 (legislative day, SEPTEMBER 16), 2014 

Mr. BOOKER introduced the following bill; which was read twice and referred 

to the Committee on Health, Education, Labor, and Pensions 

A BILL 

To provide for a study by the Institute of Medicine on 

health disparities, to direct the Secretary of Health and 

Human Services to develop guidelines on reducing health 

disparities, 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 ‘‘Reducing Disparities 

5 Using Care Models and Education Act of 2014’’. 

6 SEC. 2. FINDINGS. 

7 The Congress finds as follows: 


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1 (1) The infant death rate among African-Amer2 icans is more than double that of Whites. 

3 (2) The death rate for all cancers is 30 percent 

4 higher for African-Americans than for Whites; for 

5 prostate cancer, it is more than double that for 

6 Whites. 

7 (3) Black women have a higher death rate from 

8 breast cancer despite having a mammography 

9 screening rate that is nearly the same as the rate for 

10 White women. 

11 (4) Diabetes incidence is highest among Native 

12 Americans, at 15.9 percent, followed by 13.2 percent 

13 for African-Americans, 12.8 percent for Hispanics, 

14 9.0 percent for Asians, and 7.6 percent for Whites. 

15 (5) New cases of hepatitis and tuberculosis are 

16 higher in Asians and Pacific Islanders living in the 

17 United States than in Whites. 

18 (6) Individuals in same-sex couples were more 

19 likely than individuals in different-sex couples to re20 port a delay in getting necessary prescriptions. 

21 (7) Infants born to Black women are 1.5 to 3 

22 times more likely to die than those born to women 

23 of other races or ethnicities, and American Indian 

24 and Alaska Native infants die from sudden infant 


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1 death syndrome (SIDS) at nearly 2.5 times the rate 

2 of White infants. 

3 (8) Low-income children have higher rates of 

4 mortality (even with the same condition), have high5 er rates of disability, and are more likely to have 

6 multiple conditions. 

7 (9) White children are half as likely as Black 

8 and Latino children not to be in excellent or very 

9 good health. 

10 (10) As of 2012, 38.9 percent of United States 

11 adults were obese, with the highest rate among Afri12 can-Americans at 47.9 percent, followed by His13 panics at 42.5 percent, Whites at 32.6 percent, and 

14 Asians at 10.8 percent. 

15 (11) The risk of stroke is twice as high for Af16 rican-Americans as for Whites, and African-Ameri17 cans are more likely to die of stroke. Other ethnic 

18 minorities also have higher risk than Whites. Over19 all, strokes are most prevalent in the Southeast 

20 United States, and less so in the Northeast. 

21 (12) African-Americans accounted for 44 per22 cent of all those infected with HIV, despite being 

23 only 12 percent of the United States population. 


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1 (13) Black men who have sex with men (MSM) 

2 ages 13 to 24 had the most new infections among 

3 youth. 

4 (14) One study found that among heterosexuals 

5 living in the same urban community, those below the 

6 poverty line were twice as likely to contract human 

7 immunodeficiency virus (HIV). 

8 (15) Persons with less than a high school di9 ploma (6.7 percent) and high school graduates (4.0 

10 percent) were more likely to report major depression 

11 than those with at least some college education (2.5 

12 percent). 

13 (16) Only about 10 percent of physicians prac14 tice in rural America despite the fact that nearly 

15 one-fourth of the population lives in these areas. 

16 (17) Rural residents are less likely to have em17 ployer-provided health care coverage or prescription 

18 drug coverage, and the rural poor are less likely to 

19 be covered by Medicaid benefits than their urban 

20 counterparts. 

21 (18) Twenty percent of nonmetropolitan coun22 ties lack mental health services versus 5 percent of 

23 metropolitan counties. 


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1 (19) Fifteen percent of persons with disabilities 

2 report not seeing a doctor due to cost in comparison 

3 to 6 percent of the general population. 

4 SEC. 3. INSTITUTE OF MEDICINE STUDY. 

5 (a) IN GENERAL.—Not later than 60 days after the 

6 date of the enactment of this Act, the Secretary shall enter 

7 into an arrangement with the Institute of Medicine under 

8 which the Institute agrees to study— 

9 (1) the extent of health disparities in the type 

10 and quality of preventive interventions, health serv11 ices, and outcomes in the United States; 

12 (2) the factors that may contribute to inequities 

13 in such disparities; 

14 (3) existing programs and policies intended to 

15 reduce such disparities; 

16 (4) best practices and successful strategies in 

17 programs that aim to reduce such disparities; 

18 (5) priorities for successful intervention pro19 grams targeting such disparities; and 

20 (6) potential opportunities for expanding or 

21 replicating such programs. 

22 (b) REPORT.—The arrangement under subsection (a) 

23 shall provide for submission by the Institute of Medicine 

24 to the Secretary and Congress, not later than 20 months 


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1 after the date of enactment of this Act, of a report on 

2 the results of the study. 

3 SEC. 4. GUIDELINES FOR DEVELOPMENT AND IMPLEMEN4 TATION OF HEALTH DISPARITIES REDUC5 TION PROGRAMS AND ACTIVITIES. 

6 (a) GUIDELINES.—Not later than 90 days after the 

7 submission of the report described in section 3(b), and 

8 taking such report into consideration, the Secretary shall 

9 develop guidelines for entities to develop and implement 

10 programs and activities to reduce health disparities. 

11 (b) USE BY HHS.—The Secretary shall, where ap12 propriate, incorporate the use of the guidelines developed 

13 under subsection (a) into the programs and activities of 

14 the Department of Health and Human Services. 

15 (c) GRANTS FOR DISPARITIES REDUCTION ACTIVI16 TIES.— 

17 (1) IN GENERAL.—The Secretary may award 

18 grants to entities for the development and implemen19 tation of programs and activities to reduce health 

20 disparities in accordance with the guidelines de21 scribed in subparagraph (a). 

22 (2) APPLICATIONS.—To seek a grant under this 

23 subsection, an entity shall submit an application to 

24 the Secretary at such time, in such manner, and 


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1 containing such information as the Secretary may 

2 require. 

3 (3) MINIMUM CONTENTS.—The Secretary shall 

4 require that an application for a grant under this 

5 subsection contains at a minimum— 

6 (A) a description of the population and 

7 public health concern the program will target 

8 and an outreach plan to ensure that the most 

9 in need populations will benefit; 

10 (B) a description of the strategies the enti11 ty will use— 

12 (i) to develop and implement its pro13 grams and activities in accordance with the 

14 guidelines developed under subsection (a); 

15 and 

16 (ii) to make the interventions sustain17 able; and 

18 (C) an agreement by the entities to peri19 odically provide data with respect to— 

20 (i) the population served; 

21 (ii) improvements in reducing health 

22 disparities; and 

23 (iii) effectiveness of the interventions 

24 used. 


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1 (d) APPROPRIATIONS.—To carry out this section, 

2 there are authorized to be appropriated $5,000,000 for fis3 cal year 2016 and such sums as may be necessary for each 

4 of fiscal years 2017 through 2020. 

5 SEC. 5. TESTING ALTERNATIVE PAYMENT AND DELIVERY 

6 MODELS TO REDUCE HEALTH DISPARITIES. 

7 (a) IN GENERAL.—The Secretary acting through the 

8 Centers for Medicare and Medicaid Innovation under sec9 tion 1115A of the Social Security Act (42 U.S.C. 1315a) 

10 shall provide for the testing of a payment and service de11 livery model that includes incentives for reducing health 

12 disparities consistent with the cost and quality criteria 

13 otherwise applicable to the testing of models under such 

14 section. 

15 (b) DOCUMENTATION REQUIREMENT FOR MODEL

16 TESTING.—In carrying out subsection (a), the Secretary 

17 shall require that an application to conduct such testing 

18 of such a model include at least— 

19 (1) documentation of at least one health dis20 parity targeted for reduction; 

21 (2) a root-cause analysis of the health disparity 

22 targeted for reduction; 

23 (3) identification and selection of performance 

24 targets for such reduction; 


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1 (4) a proposal to make payments in some way 

2 contingent on a reduction in health disparities; and 

3 (5) a reliable method for monitoring progress in 

4 achieving such a reduction. 

5 SEC. 6. DEFINITIONS. 

6 In this Act: 

7 (1) The term ‘‘health disparity’’ means signifi8 cant disparity in the overall rate of disease inci9 dence, prevalence, morbidity, mortality, or survival 

10 rates in a population as compared to the health sta11 tus of the general population. 

12 (2) The term ‘‘intervention’’ means an activity 

13 taken by an entity on behalf of individuals or popu14 lations to reduce health disparities. 

15 (3) The term ‘‘Secretary’’ means the Secretary 

16 of Health and Human Services. 

Æ 


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