II 

108TH CONGRESS 

2D SESSION S. 2217

To improve the health of health disparity populations. 

IN THE SENATE OF THE UNITED STATES 

MARCH 12, 2004

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

to the Committee on Finance 

A BILL

To improve the health of health disparity populations.

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

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

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

5 ‘‘Closing the Health Care Gap Act of 2004’’. 

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

7 this Act is as follows:

Sec. 1. Short title; table of contents. 

Sec. 2. Findings. 

TITLE I—IMPROVED HEALTH CARE QUALITY AND EFFECTIVE 

DATA COLLECTION AND ANALYSIS 

Sec. 101. Standardized measures of quality health care. 

Sec. 102. Data collection. 

TITLE II—EXPANDED ACCESS TO QUALITY HEALTH CARE 
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Subtitle A—Access, Awareness, and Outreach 

Sec. 201. Access and awareness grants. 

Sec. 202. Innovative outreach programs. 

Subtitle B—Refundable Health Insurance Credit 

Sec. 211. Refundable health insurance costs credit. 

Sec. 212. Advance payment of credit to issuers of qualified health insurance. 

TITLE III—STRONG NATIONAL LEADERSHIP, COOPERATION, AND 

COORDINATION 

Sec. 301. Office of Minority Health and Health Disparities. 

TITLE IV—PROFESSIONAL EDUCATION, AWARENESS, AND 

TRAINING 

Sec. 401. Workforce diversity and training. 

Sec. 402. Higher education technical amendments. 

Sec. 403. Model cultural competency curriculum development. 

Sec. 404. Internet cultural competency clearinghouse. 

TITLE V—ENHANCED RESEARCH 

Sec. 501. Agency for Healthcare Research and Quality. 

Sec. 502. National Institutes of Health. 

TITLE VI—MISCELLANEOUS PROVISIONS 

Sec. 601. Definitions.

1 SEC. 2. FINDINGS. 

2 Congress makes the following findings: 

3 (1) The overall health of Americans has dra4 matically improved over the last century, and Ameri5 cans are justifiably proud of the great strides that 

6 have been made in the health and medical sciences. 

7 (2) As medical science and technology have ad8 vanced at a rapid pace, however, the health care de9 livery system has not been able to provide consist10 ently high quality care to all Americans. 

11 (3) In particular, people of lower socioeconomic 

12 status, racial and ethnic minorities, and medically 
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1 underserved populations have experienced poor 

2 health and challenges in accessing high quality 

3 health care. 

4 (4) Recent studies have raised significant ques5 tions regarding differences in clinical care provided 

6 to racial and ethnic minorities and other health dis7 parity populations. These differences are often 

8 grouped together under the broad heading of ‘‘health 

9 disparities’’. 

10 (5) Studies indicate that a gap exists between 

11 ideal health care and the actual health care that 

12 some Americans receive. 

13 (6) Data collection, analysis, and reporting by 

14 race, ethnicity, and primary language across feder15 ally supported health programs are essential for 

16 identifying, understanding the causes of, monitoring, 

17 and eventually eliminating health disparities. 

18 (7) Current health related data collection and 

19 reporting activities largely reflect the efforts of the 

20 Department of Health and Human Services. Despite 

21 considerable efforts by the Department, data collec22 tion efforts governing racial, ethnic, and health dis23 parity populations remain inconsistent and inad24 equate. They often quantify disparities but shed lit25 tle light on their causes. 
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1 (8) Many Americans, and particularly racial 

2 and ethnic minorities and other health disparity pop3 ulations, miss opportunities for preventive medical 

4 care. Similarly, management of chronic illnesses in 

5 these populations presents unique challenges to the 

6 nation’s health care system. 

7 (9) The largest numbers of the medically under8 served are white individuals, and many of them have 

9 the same health care access problems as do members 

10 of minority groups. Nearly 22,000,000 white individ11 uals live below the poverty line with many living in 

12 nonmetropolitan, rural areas such as Appalachia, 

13 where the high percentage of countries designated as 

14 health professional shortage areas (47 percent) and 

15 the high rate of poverty contribute to disparity out16 comes. However, there is a higher proportion of ra17 cial and ethnic minorities in the United States rep18 resented among the medically underserved. 

19 (10) While much research examines the ques20 tion of racial and ethnic differences in health care, 

21 less is known about the magnitude and extent of dif22 ferences in the quality of health care related to non23 socioeconomic factors. Only recently have scientists 

24 and quality improvement experts begun to address 

25 the issue of how best to measure, track, and improve 
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1 quality of health care in diverse populations. Addi2 tional research in order to understand the causes of 

3 disparities and develop effective approaches to elimi4 nate these gaps in health care quality will be nec5 essary. 

6 (11) There is a need to ensure appropriate rep7 resentation of racial and ethnic minorities, and other 

8 health disparity populations, in the health care pro9 fessions and in the fields of biomedical, clinical, be10 havioral, and health services research. 

11 (12) Preventable disparities in access to and 

12 quality of health care are unacceptable. Health care 

13 delivered in the United States should be care that is 

14 as safe, effective, patient-centered, timely, efficient 

15 and equitable as possible. 

16 TITLE I—IMPROVED HEALTH 

17 CARE QUALITY AND EFFEC18 TIVE DATA COLLECTION AND 

19 ANALYSIS 

20 SEC. 101. STANDARDIZED MEASURES OF QUALITY HEALTH 

21 CARE. 

22 (a) IN GENERAL.—

23 (1) COLLABORATION.—The Secretary of Health 

24 and Human Services, the Secretary of Defense, the 

25 Secretary of Veterans Affairs, the Director of the
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1 Indian Health Service, and the Director of the Of2 fice of Personnel Management (referred to in this 

3 section as the ‘‘Secretaries’’) shall work collabo4 ratively to establish uniform, standardized health 

5 care quality measures across all Federal Government 

6 health programs. Such measures shall be designed 

7 to assess quality improvement efforts with regard to 

8 the safety, timeliness, effectiveness, patient9 centeredness, and efficiency of health care delivered 

10 across all federally supported health care delivery 

11 programs including those in which health care serv12 ices are delivered to health disparity populations. 

13 (2) DEVELOPMENT OF MEASURES.—Relying on 

14 earlier work by the Secretary of Health and Human 

15 Services or others (including work such as the 

16 Healthy People 2010 or the IOM Quality Chasm re17 ports) and with an emphasis on health conditions 

18 disproportionately affecting health disparity popu19 lations and taking into account health literacy and 

20 primary language and cultural factors, the Secre21 taries shall develop standardized sets of quality 

22 measures for—

23 (A) 5 common health conditions by not 

24 later than January 1, 2006; and 
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1 (B) an additional 10 common health condi2 tions by not later than January 1, 2007. 

3 (3) PILOT TESTING.—Each federally adminis4 tered health care program may conduct a pilot test 

5 of the quality measures developed under paragraph 

6 (2) that shall include a collection of patient-level 

7 data and a public release of comparative perform8 ance reports. 

9 (b) PUBLIC REPORTING REQUIREMENTS.—The Sec10 retaries shall work collaboratively to establish standard11 ized public reporting requirements for clinicians, institu12 tional providers, and health plans in each of the health 

13 programs described in subsection (a). 

14 (c) FULL IMPLEMENTATION.—The Secretaries shall 

15 work collaboratively to prepare for the full implementation 

16 of all standardized sets of quality measures and reporting 

17 systems developed under subsections (a) and (b) by not 

18 later than January 1, 2009. 

19 (d) PROGRESS REPORT.—The Secretary of Health 

20 and Human Services shall prepare an annual progress re21 port that details the collaborative efforts carried out under 

22 subsection (a). 

23 (e) COMPARATIVE QUALITY REPORTS.—Beginning 

24 on January 1, 2008, in order to make comparative quality 

25 information available to health care consumers, including 
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1 members of health disparity populations, health profes2 sionals, public health officials, researchers, and other ap3 propriate individuals and entities, the Secretaries shall 

4 provide for the pooling and analysis of quality measures 

5 collected under this section. Nothing in this section shall 

6 be construed as modifying the privacy standards under the 

7 Health Insurance Portability and Accountability Act of 

8 1996 (Public Law 104–191). 

9 (f) ONGOING EVALUATION OF USE.—The Secretary 

10 of Health and Human Services shall ensure the ongoing 

11 evaluation of the use of the health care quality measures 

12 established under this section. 

13 (g) EXISTING ACTIVITIES.—Notwithstanding any 

14 other provision of law, the standardized measures and re15 porting activities described in this section shall replace, 

16 to the extent practicable and appropriate, any existing 

17 measurement and reporting activities currently utilized by 

18 federally supported health care delivery programs. 

19 (h) EVALUATION.—

20 (1) INSTITUTE OF MEDICINE.—

21 (A) IN GENERAL.—The Secretary of 

22 Health and Human Services shall request the 

23 Institute of Medicine to conduct an evaluation 

24 of the collaborative efforts of the Secretaries to 

25 establish uniform, standardized health care 
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1 quality measures and reporting requirements 

2 for federally supported health care delivery pro3 grams as required under this section. 

4 (B) REPORT.—Not later than 2 years after 

5 the date of enactment of this Act, the Institute 

6 of Medicine shall submit a report concerning 

7 the results of the evaluation under subpara8 graph (A) to the Secretary. 

9 (2) REGULATIONS.—

10 (A) PROPOSED.—Not later than 18 

11 months after the date on which the report is 

12 submitted under paragraph (1)(B), the Sec13 retary shall publish proposed regulations re14 garding the uniform, standardized health care 

15 quality measures and reporting requirements 

16 described in this section. 

17 (B) FINAL REGULATIONS.—Not later than 

18 3 years after the date on which the report is 

19 submitted under paragraph (1)(B), the Sec20 retary shall publish final regulations regarding 

21 the uniform, standardized health care quality 

22 measures and reporting requirements described 

23 in this section. 
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1 SEC. 102. DATA COLLECTION. 

2 (a) IN GENERAL.—The Secretary of Health and 

3 Human Services (referred to in this section as the ‘‘Sec4 retary’’) shall—

5 (1) ensure that data collected under the medi6 care program under title XVIII of the Social Secu7 rity Act (42 U.S.C. 1395 et seq.) are accurate by 

8 race, ethnicity, and primary language and available 

9 for inclusion in the National Health Disparities Re10 port; 

11 (2) enforce State data collection and reporting 

12 by race, ethnicity, and primary language for enroll13 ees in the medicaid program under title XIX of the 

14 Social Security Act (42 U.S.C. 1396 et seq.) and the 

15 State Children’s Health Insurance Program under 

16 title XXI of such Act (42 U.S.C. 1397aa et seq.) 

17 and ensure that such data are available for inclusion 

18 in the National Health Disparities Report; 

19 (3) ensure that ongoing and any new program 

20 initiatives—

21 (A) collect and report data by race, eth22 nicity, and primary language and provide tech23 nical assistance to promote compliance; 

24 (B) address technological difficulties; 

25 (C) ensure privacy and confidentiality of 

26 data collected; and
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1 (D) implement effective educational strate2 gies; 

3 (4) expand educational programs to inform in4 surers, providers, agencies and the public of the im5 portance of data collection by race, ethnicity, and 

6 primary language to improving health care access 

7 and quality; 

8 (5) raise awareness that these data are critical 

9 for achieving Healthy People 2010 goals and essen10 tial to the nondiscrimination requirements of title VI 

11 of the Civil Rights Act (42 U.S.C. 2000d et seq.); 

12 and 

13 (6) support research on existing best practices 

14 for data collection. 

15 (b) GRANTS FOR DATA COLLECTION BY HEALTH

16 PLANS, HEALTH CENTERS, AND HOSPITALS.—

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

18 through the Director of the Agency for Healthcare 

19 Research and Quality, may support or conduct not 

20 to exceed 20 demonstration programs to enhance the 

21 collection, analysis, and reporting of the data re22 quired under this section. 

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 health plan, federally qualified 

2 health center or health center network, or hos3 pital; and 

4 (B) prepare and submit to the Secretary 

5 an application at such time, in such manner, 

6 and containing such as information as the Sec7 retary may require. 

8 (3) USE OF FUNDS.—A grantee shall use 

9 amounts received under a grant under this sub10 section to—

11 (A) collect, analyze, and report data by 

12 race, ethnicity, or other health disparity cat13 egory for patients served by the grantee, includ14 ing—

15 (i) in the case of a hospital, emer16 gency room patients and patients served on 

17 an inpatient or outpatient basis; 

18 (ii) in the case of a health plan, data 

19 for enrollees; and 

20 (iii) in the case of a federally qualified 

21 health center or health center network, pri22 mary care, specialty care, and referrals; 

23 (B) provide analyses of racial, ethnic and 

24 other disparities in health and health care, in-
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1 cluding specific disease conditions, diagnostic 

2 and therapeutic procedures, or outcomes; 

3 (C) improve health data collection and 

4 analysis for additional population groups be5 yond the Office of Management and Budget 

6 categories if such groups can be aggregated into 

7 the minimum race and ethnicity categories; 

8 (D) develop mechanisms for sharing col9 lected data, subject to applicable privacy and 

10 confidentiality regulations; 

11 (E) develop educational programs to in12 form health insurance issuers, health plans, 

13 health providers, health-related agencies, pa14 tients, enrollees, and the general public that 

15 data collection, analysis, and reporting by race, 

16 ethnicity, and preferred language are legal and 

17 essential for eliminating disparities in health 

18 and health care; and 

19 (F) ensure the evaluation of activities con20 ducted under this section. 
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1 TITLE II—EXPANDED ACCESS TO 

2 QUALITY HEALTH CARE 

3 Subtitle A—Access, Awareness, and 

4 Outreach 

5 SEC. 201. ACCESS AND AWARENESS GRANTS. 

6 (a) DEMONSTRATION PROJECTS.—The Secretary of 

7 Health and Human Services (in this section referred to 

8 as the ‘‘Secretary’’) may award contracts or competitive 

9 grants to eligible entities to support demonstration 

10 projects designed to improve the health and health care 

11 of health disparity populations through improved access 

12 to health care, health care navigation assistance, and 

13 health literacy education. 

14 (b) ELIGIBLE ENTITY DEFINED.—In this section the 

15 term ‘‘eligible entity’’ means—

16 (1) a hospital; 

17 (2) an academic institution; 

18 (3) a State health agency; 

19 (4) an Indian Health Service hospital or clinic, 

20 Indian tribal health facility, or urban Indian facility; 

21 (5) a nonprofit organization including a faith22 based organization or consortia, to the extent that a 

23 grant awarded to such an entity is consistent with 

24 the requirements of section 1955 of the Public 
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1 Health Service Act (42 U.S.C. 300x–65) relating to 

2 grant award to nongovernmental entities; 

3 (6) a primary care practice-based research net4 work as defined by the Director of the Agency for 

5 Healthcare Research and Quality; 

6 (7) a federally qualified health center (as de7 fined in section 1905(l)(2)(B) of the Social Security 

8 Act (42 U.S.C. 1396d(l)(2)(B))); or 

9 (8) any other entity determined to be appro10 priate by the Secretary. 

11 (c) APPLICATION.—An eligible entity seeking a grant 

12 under this section shall submit an application to the Sec13 retary at such time, in such manner, and containing such 

14 information as the Secretary may require, including assur15 ances that the eligible entity will—

16 (1) target patient populations that are members 

17 of racial and ethnic minority groups or health dis18 parity populations through specific outreach activi19 ties; 

20 (2) coordinate with appropriate community or21 ganizations and include appropriate community par22 ticipation in planning and implementation of activi23 ties; 

24 (3) coordinate culturally competent and appro25 priate care;
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1 (4) include a plan to ensure that the entity will 

2 become self-sustaining when funding under the grant 

3 terminates; and 

4 (5) include quality and outcomes performance 

5 measures to evaluate the effectiveness of activities 

6 funded under this section to ensure that the activi7 ties are meeting their goals, and disseminate find8 ings from such evaluations. 

9 (d) PRIORITIES.—In awarding contracts and grants 

10 under this section, the Secretary shall give priority to ap11 plicants that intend to use amounts received under this 

12 section to carry out all programs specified under sub13 section (e). 

14 (e) USE OF FUNDS.—An eligible entity shall use 

15 amounts received under this section to carry out programs 

16 that involve at least 2 of the following: 

17 (1) Providing resources and guidance to individ18 uals regarding sources of health insurance coverage, 

19 as well as information on how to obtain health cov20 erage in the private insurance market, through Fed21 eral and State programs, and through other avail22 able coverage options. 

23 (2) Providing patient navigator services to help 

24 individuals better utilize their health coverage by 
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1 working through the health system to obtain appro2 priate quality care, including programs in which—

3 (A) trained individuals (such as represent4 atives from the community, nurses, social work5 ers, physicians, or patient advocates) are as6 signed to act as contacts—

7 (i) within the community; or 

8 (ii) within the health care system, to 

9 facilitate access to health care services; 

10 (B) partnerships are created with commu11 nity organizations (which may include hospitals, 

12 federally qualified health centers or health cen13 ter networks, faith-based organizations, primary 

14 care providers, home care, nonprofit organiza15 tions, health plans, or other health providers 

16 determined appropriate by the Secretary) to 

17 help facilitate access or to improve the quality 

18 of care; 

19 (C) activities are conducted to coordinate 

20 care and preventive services and referrals; 

21 (D) services are provided for translation, 

22 interpretation, and other such linguistic services 

23 for patients with limited English proficiency; or 

24 (E) an entity receiving a grant under this 

25 section negotiates on behalf of the patient with 
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1 relevant entities, or provides referrals and 

2 guides the patient through the mediation or ar3 bitration process, to resolve issues that impede 

4 access to care. 

5 (3) Promoting broad health awareness and pre6 vention efforts, including patient education and 

7 health literacy programs to help increase a patient’s 

8 knowledge of how to best participate in such pa9 tient’s and such patient’s children’s treatment deci10 sions. 

11 (4) Enhancing preventive services and coordi12 nated, multidisciplinary disease management of 

13 chronic conditions, such as diabetes mellitus, HIV/

14 AIDS, asthma, cancer, cardiovascular disease, and 

15 obesity. 

16 (f) REPORT.—Not later than 3 years after the date 

17 an entity receives a grant under this section and annually 

18 thereafter, the entity shall provide to the Secretary a re19 port containing the results of any evaluation conducted 

20 pursuant to subsection (c)(5). 

21 (g) 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 2005 through 2009. 
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1 SEC. 202. INNOVATIVE OUTREACH PROGRAMS. 

2 (a) GRANTS TO PROMOTE INNOVATIVE OUTREACH

3 AND ENROLLMENT UNDER MEDICAID AND SCHIP.—Sec4 tion 2104(e) of the Social Security Act (42 U.S.C. 

5 1397dd(e)) is amended—

6 (1) by striking ‘‘Amounts allotted’’ and insert7 ing the following: 

8 ‘‘(1) IN GENERAL.—Subject to paragraph (2), 

9 amounts allotted’’; and 

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

11 ‘‘(2) GRANTS TO PROMOTE INNOVATIVE OUT12 REACH AND ENROLLMENT EFFORTS.—

13 ‘‘(A) IN GENERAL.—Prior to September 30 

14 of each fiscal year, beginning with fiscal year 

15 2004, the Secretary shall reserve from any un16 expended allotments made to States under sub17 section (b) or (c) (including any portion of such 

18 allotments that were redistributed under sub19 section (f) or (g)) for a fiscal year that would 

20 revert to the Treasury on October 1 of the suc21 ceeding fiscal year but for the application of 

22 this paragraph, the lesser of $50,000,000 or the 

23 total amount of such unexpended allotments for 

24 purposes of awarding grants under this para25 graph for such succeeding fiscal year to States 

26 or national, local, and community-based public 
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1 or nonprofit private organizations to conduct 

2 innovative outreach and enrollment efforts that 

3 are designed to increase the enrollment and 

4 participation of eligible children under this title 

5 and title XIX. 

6 ‘‘(B) PRIORITY FOR GRANTS IN CERTAIN

7 AREAS.—In making grants under subparagraph 

8 (A)(ii), the Secretary shall give priority to grant 

9 applicants that propose to target geographic 

10 areas—

11 ‘‘(i) with high rates of eligible but 

12 unenrolled children, including such chil13 dren who reside in rural areas; 

14 ‘‘(ii) with high rates of families for 

15 whom English is not their primary lan16 guage; or 

17 ‘‘(iii) with high rates of racial and 

18 ethnic minorities and health disparity pop19 ulations. 

20 ‘‘(C) APPLICATION.—An organization that 

21 desires to receive a grant under this paragraph 

22 shall submit an application to the Secretary in 

23 such form and manner, and containing such in24 formation, as the Secretary may decide. Such 

25 application shall include quality and outcomes
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1 performance measures to evaluate the effective2 ness of activities funded by a grant under this 

3 paragraph to ensure that the activities are 

4 meeting their goals, and disseminate findings 

5 from such evaluations.’’. 

6 (b) DEMONSTRATIONS TO REDUCE HEALTH DIS7 PARITIES.—

8 (1) IN GENERAL.—The Secretary of Health and 

9 Human Services shall, through contracts or grants 

10 to public and private entities, support demonstration 

11 programs for the purpose of conducting interven12 tions among health disparity populations to—

13 (A) target, identify, and reduce or prevent 

14 behavioral risk factors that contribute to health 

15 disparities; 

16 (B) promote translation, interpretation, 

17 and other such linguistic services for patients 

18 with limited English speaking proficiency; 

19 (C) promote preventive services; or 

20 (D) enhance coordinated, multidisciplinary 

21 disease management of chronic conditions, such 

22 as diabetes mellitus, HIV/AIDS, asthma, can23 cer, and obesity. 

24 (2) APPLICATION.—An entity desiring a con25 tract or grant under paragraph (1) shall submit an 
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1 application to the Secretary of Health and Human 

2 Services in such form and manner, and containing 

3 such information, as the Secretary may require. 

4 (3) AUTHORIZATION OF APPROPRIATIONS.—

5 There are authorized to be appropriated to carry out 

6 this subsection such sums as may be necessary for 

7 each of fiscal years 2005 through 2009. 

8 Subtitle B—Refundable Health 

9 Insurance Credit 

10 SEC. 211. REFUNDABLE HEALTH INSURANCE COSTS CRED11 IT. 

12 (a) ALLOWANCE OF CREDIT.—

13 (1) IN GENERAL.—Subpart C of part IV of sub14 chapter A of chapter 1 of the Internal Revenue Code 

15 of 1986 (relating to refundable personal credits) is 

16 amended by redesignating section 36 as section 37 

17 and by inserting after section 35 the following new 

18 section:

19 ‘‘SEC. 36. HEALTH INSURANCE COSTS FOR UNINSURED IN20 DIVIDUALS. 

21 ‘‘(a) ALLOWANCE OF CREDIT.—In the case of an in22 dividual, there shall be allowed as a credit against the tax 

23 imposed by this subtitle for the taxable year an amount 

24 equal to the amount paid by the taxpayer during such tax-
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1 able year for qualified health insurance for the taxpayer 

2 and the taxpayer’s spouse and dependents. 

3 ‘‘(b) LIMITATIONS.—

4 ‘‘(1) IN GENERAL.—The amount allowed as a 

5 credit under subsection (a) to the taxpayer for the 

6 taxable year shall not exceed the lesser of—

7 ‘‘(A) the sum of the monthly limitations 

8 for coverage months during such taxable year 

9 for the individuals referred to in subsection (a) 

10 for whom the taxpayer paid during the taxable 

11 year any amount for coverage under qualified 

12 health insurance, or 

13 ‘‘(B) 90 percent of the sum of the amounts 

14 paid by the taxpayer for qualified health insur15 ance for each such individual for coverage 

16 months of the individual during the taxable 

17 year. 

18 ‘‘(2) MONTHLY LIMITATION.—

19 ‘‘(A) IN GENERAL.—The monthly limita20 tion for an individual for each coverage month 

21 of such individual during the taxable year is the 

amount equal to 1 22 ⁄12 of—

23 ‘‘(i) $1,000 if such individual is the 

24 taxpayer, 

25 ‘‘(ii) $1,000 if—
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1 ‘‘(I) such individual is the spouse 

2 of the taxpayer, 

3 ‘‘(II) the taxpayer and such 

4 spouse are married as of the first day 

5 of such month, and

6 ‘‘(III) the taxpayer files a joint 

7 return for the taxable year, and 

8 ‘‘(iii) $500 if such individual is an in9 dividual for whom a deduction under sec10 tion 151(c) is allowable to the taxpayer for 

11 such taxable year. 

12 ‘‘(B) LIMITATION TO 2 DEPENDENTS.—

13 Not more than 2 individuals may be taken into 

14 account by the taxpayer under subparagraph 

15 (A)(iii). 

16 ‘‘(C) SPECIAL RULE FOR MARRIED INDI17 VIDUALS.—In the case of a taxpayer—

18 ‘‘(i) who is married (within the mean19 ing of section 7703) as of the close of the 

20 taxable year but does not file a joint return 

21 for such year, and 

22 ‘‘(ii) who does not live apart from 

23 such taxpayer’s spouse at all times during 

24 the taxable year, 
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1 the dollar limitation imposed under subpara2 graph (A)(iii) shall be divided equally between 

3 the taxpayer and the taxpayer’s spouse unless 

4 they agree on a different division. 

5 ‘‘(3) INCOME PHASEOUT OF CREDIT PERCENT6 AGE.—

7 ‘‘(A) PHASEOUT FOR SINGLE COVERAGE.—

8 If a taxpayer with self-only coverage has modi9 fied adjusted gross income in excess of $15,000 

10 for a taxable year, the 90 percent under para11 graph (1)(B) shall be reduced (but not below 

12 zero) by—

13 ‘‘(i) 2 percentage points for each $250 

14 of such income in excess of $15,000 but 

15 not in excess of $20,000, and 

16 ‘‘(ii) 1.25 percentage points for each 

17 $250 of such income in excess of $20,000. 

18 ‘‘(B) AMOUNT OF REDUCTION FOR FAMILY

19 COVERAGE.—If a taxpayer with family coverage 

20 has modified adjusted gross income in excess of 

21 $25,000 for a taxable year, the 90 percent 

22 under paragraph (1)(B) shall be reduced (but 

23 not below zero) by—
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1 ‘‘(i) in the case of family coverage 

2 covering only 1 adult, 1.5 percentage 

3 points for each $250 of such excess, and 

4 ‘‘(ii) in the case of family coverage 

5 covering more than 1 adult, 0.643 percent6 age points for each $250 of such excess. 

7 Any percentage resulting from a reduction 

8 under clause (ii) shall be rounded to the nearest 

9 one-tenth of a percent. 

10 ‘‘(C) MODIFIED ADJUSTED GROSS IN11 COME.—The term ‘modified adjusted gross in12 come’ means adjusted gross income deter13 mined—

14 ‘‘(i) without regard to this section and 

15 sections 911, 931, and 933, and 

16 ‘‘(ii) after application of sections 86, 

17 135, 137, 219, 221, and 469. 

18 ‘‘(c) COVERAGE MONTH.—For purposes of this sec19 tion—

20 ‘‘(1) IN GENERAL.—The term ‘coverage month’ 

21 means, with respect to an individual, any month if—

22 ‘‘(A) as of the first day of such month 

23 such individual is covered by qualified health in24 surance, and 
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1 ‘‘(B) the premium for coverage under such 

2 insurance for such month is paid by the tax3 payer. 

4 ‘‘(2) EMPLOYER-SUBSIDIZED COVERAGE.—

5 ‘‘(A) IN GENERAL.—The term ‘coverage 

6 month’ shall not include any month for which 

7 such individual is eligible to participate in any 

8 subsidized health plan (within the meaning of 

9 section 162(l)(2)) maintained by any employer 

10 of the taxpayer or of the spouse of the tax11 payer. A subsidized health plan shall not in12 clude a plan substantially all of the coverage of 

13 which is of excepted benefits described in sec14 tion 9832(c). 

15 ‘‘(B) PREMIUMS TO NONSUBSIDIZED

16 PLANS.—If an employer of the taxpayer or the 

17 spouse of the taxpayer maintains a health plan 

18 which is not a subsidized health plan (as so de19 fined) and which constitutes qualified health in20 surance, employee contributions to the plan 

21 shall be treated as amounts paid for qualified 

22 health insurance. 

23 ‘‘(3) CAFETERIA PLAN AND FLEXIBLE SPEND24 ING ACCOUNT BENEFICIARIES.—The term ‘coverage 

25 month’ shall not include any month during a taxable 
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1 year if any amount is not includible in the gross in2 come of the taxpayer for such year under section 

3 106 with respect to—

4 ‘‘(A) a benefit chosen under a cafeteria 

5 plan (as defined in section 125(d)), or

6 ‘‘(B) a benefit provided under a flexible 

7 spending or similar arrangement. 

8 ‘‘(4) MEDICARE, MEDICAID, AND SCHIP.—The 

9 term ‘coverage month’ shall not include any month 

10 with respect to an individual if, as of the first day 

11 of such month, such individual—

12 ‘‘(A) is entitled to any benefits under part 

13 A of title XVIII of the Social Security Act or 

14 is enrolled under part B of such title, or 

15 ‘‘(B) is enrolled in the program under title 

16 XIX or XXI of such Act (other than under sec17 tion 1928 of such Act). 

18 ‘‘(5) CERTAIN OTHER COVERAGE.—The term 

19 ‘coverage month’ shall not include any month during 

20 a taxable year with respect to an individual if, at 

21 any time during such year, any benefit is provided 

22 to such individual under—

23 ‘‘(A) chapter 89 of title 5, United States 

24 Code, 
29

•S 2217 IS 

1 ‘‘(B) chapter 55 of title 10, United States 

2 Code, 

3 ‘‘(C) chapter 17 of title 38, United States 

4 Code, or 

5 ‘‘(D) any medical care program under the 

6 Indian Health Care Improvement Act. 

7 ‘‘(6) PRISONERS.—The term ‘coverage month’ 

8 shall not include any month with respect to an indi9 vidual if, as of the first day of such month, such in10 dividual is imprisoned under Federal, State, or local 

11 authority. 

12 ‘‘(7) INSUFFICIENT PRESENCE IN UNITED

13 STATES.—The term ‘coverage month’ shall not in14 clude any month during a taxable year with respect 

15 to an individual if such individual is present in the 

16 United States on fewer than 183 days during such 

17 year (determined in accordance with section 

18 7701(b)(7)).

19 ‘‘(d) QUALIFIED HEALTH INSURANCE.—For pur20 poses of this section—

21 ‘‘(1) IN GENERAL.—The term ‘qualified health 

22 insurance’ means health insurance coverage (as de23 fined in section 9832(b)(1)) which—

24 ‘‘(A) is coverage described in paragraph 

25 (2), and 
30

•S 2217 IS 

1 ‘‘(B) meets the requirements of paragraph 

2 (3). 

3 ‘‘(2) ELIGIBLE COVERAGE.—Coverage described 

4 in this paragraph is the following: 

5 ‘‘(A) Coverage under individual health in6 surance. 

7 ‘‘(B) Coverage under a group health plan 

8 (as defined in section 5000 without regard to 

9 subsection (d)). 

10 ‘‘(C) Coverage through a private sector 

11 health care coverage purchasing pool. 

12 ‘‘(D) Coverage under a State high risk 

13 pool described in subparagraph (C) of section 

14 35(e)(1). 

15 ‘‘(E) Continuation coverage described in 

16 subparagraph (A) or (B) of section 35(a)(1). 

17 ‘‘(F) Coverage under an eligible State 

18 buyin program. 

19 ‘‘(3) REQUIREMENTS.—The requirements of 

20 this paragraph are as follows: 

21 ‘‘(A) COST LIMITS.—Under the coverage, 

22 the sum of the annual deductible and the other 

23 annual out-of-pocket expenses required to be 

24 paid (other than premiums) for covered benefits 

25 does not exceed—
31

•S 2217 IS 

1 ‘‘(i) $5,000 for self-only coverage, and 

2 ‘‘(ii) twice the dollar amount in clause 

3 (i) for family coverage, or 

4 ‘‘(B) MAXIMUM BENEFITS.—Under the 

5 coverage, the annual and lifetime maximum 

6 benefits are not less than $700,000. 

7 ‘‘(4) ELIGIBLE STATE BUYIN PROGRAM.—For 

8 purposes of paragraph (2)(F)—

9 ‘‘(A) IN GENERAL.—The term ‘eligible 

10 State buyin program’ means a State program 

11 under which an individual not otherwise eligible 

12 for assistance under the State medicaid pro13 gram under title XIX of the Social Security Act 

14 or the State children’s health insurance pro15 gram under title XXI of such Act is able to buy 

16 health insurance coverage through a purchasing 

17 arrangement entered into between the State 

18 and a private sector health care purchasing 

19 group or health plan for purposes of providing 

20 health insurance coverage to recipients of as21 sistance under such program or for purposes of 

22 providing such coverage to State employees. 

23 ‘‘(B) REQUIREMENTS.—Subparagraph (A) 

24 shall only apply to a State program if—
32

•S 2217 IS 

1 ‘‘(i) the program uses private sector 

2 health care purchasing groups or health 

3 plans, and 

4 ‘‘(ii) the State maintains separate risk 

5 pools for participants under the State pro6 gram. 

7 ‘‘(e) ARCHER MSA CONTRIBUTIONS; HSA CON8 TRIBUTIONS.—If a deduction would be allowed under sec9 tion 220 to the taxpayer for a payment for the taxable 

10 year to the Archer MSA of an individual or under section 

11 223 to the taxpayer for a payment for the taxable year 

12 to the Health Savings Account of such individual, sub13 section (a) shall not apply to the taxpayer for any month 

14 during such taxable year for which the taxpayer, spouse, 

15 or dependent is an eligible individual for purposes of either 

16 such section. 

17 ‘‘(f) INFLATION ADJUSTMENT.—

18 ‘‘(1) IN GENERAL.—In the case of any taxable 

19 year beginning after 2004, each dollar amount re20 ferred to in subsections (b)(2)(A) and (d)(3) shall be 

21 increased by an amount equal to—

22 ‘‘(A) such dollar amount, multiplied by 

23 ‘‘(B) the cost-of-living adjustment deter24 mined under section 213(d)(10)(B)(ii) for the 

25 calendar year in which the taxable year begins, 
33

•S 2217 IS 

1 except that ‘2003’ shall be substituted for 

2 ‘1996’ in subclause (II) thereof. 

3 ‘‘(2) ROUNDING.—If any amount as adjusted 

4 under paragraph (1) is not a multiple of $10, such 

5 amount shall be rounded to the next lowest multiple 

6 of $10. 

7 ‘‘(g) SPECIAL RULES.—

8 ‘‘(1) COORDINATION WITH MEDICAL EXPENSE

9 DEDUCTION.—The amount which would (but for this 

10 paragraph) be taken into account by the taxpayer 

11 under section 213 for the taxable year shall be re12 duced by the credit (if any) allowed by this section 

13 to the taxpayer for such year.

14 ‘‘(2) COORDINATION WITH DEDUCTION FOR

15 HEALTH INSURANCE COSTS OF SELF-EMPLOYED IN16 DIVIDUALS.—In the case of a taxpayer who is eligi17 ble to deduct any amount under section 162(l) for 

18 the taxable year, this section shall apply only if the 

19 taxpayer elects not to claim any amount as a deduc20 tion under such section for such year. 

21 ‘‘(3) DENIAL OF CREDIT TO DEPENDENTS.—No 

22 credit shall be allowed under this section to any indi23 vidual with respect to whom a deduction under sec24 tion 151 is allowable to another taxpayer for a tax-
34

•S 2217 IS 

1 able year beginning in the calendar year in which 

2 such individual’s taxable year begins. 

3 ‘‘(4) COORDINATION WITH ADVANCE PAY4 MENT.—Rules similar to the rules of section 

5 35(g)(1) shall apply to any credit to which this sec6 tion applies. 

7 ‘‘(5) COORDINATION WITH SECTION 35.—If a 

8 taxpayer is eligible for the credit allowed under this 

9 section and section 35 for any taxable year, the tax10 payer shall elect which credit is to be allowed. 

11 ‘‘(h) EXPENSES MUST BE SUBSTANTIATED.—A pay12 ment for insurance to which subsection (a) applies may 

13 be taken into account under this section only if the tax14 payer substantiates such payment in such form as the Sec15 retary may prescribe. 

16 ‘‘(i) REGULATIONS.—The Secretary shall prescribe 

17 such regulations as may be necessary to carry out the pur18 poses of this section.’’. 

19 (b) INFORMATION REPORTING.—

20 (1) IN GENERAL.—Subpart B of part III of 

21 subchapter A of chapter 61 of the Internal Revenue 

22 Code of 1986 (relating to information concerning 

23 transactions with other persons) is amended by in24 serting after section 6050T the following: 
35

•S 2217 IS 

1 ‘‘SEC. 6050U. RETURNS RELATING TO PAYMENTS FOR 

2 QUALIFIED HEALTH INSURANCE. 

3 ‘‘(a) IN GENERAL.—Any person who, in connection 

4 with a trade or business conducted by such person, re5 ceives payments during any calendar year from any indi6 vidual for coverage of such individual or any other indi7 vidual under creditable health insurance, shall make the 

8 return described in subsection (b) (at such time as the 

9 Secretary may by regulations prescribe) with respect to 

10 each individual from whom such payments were received. 

11 ‘‘(b) FORM AND MANNER OF RETURNS.—A return 

12 is described in this subsection if such return—

13 ‘‘(1) is in such form as the Secretary may pre14 scribe, and 

15 ‘‘(2) contains—

16 ‘‘(A) the name, address, and TIN of the 

17 individual from whom payments described in 

18 subsection (a) were received, 

19 ‘‘(B) the name, address, and TIN of each 

20 individual who was provided by such person 

21 with coverage under creditable health insurance 

22 by reason of such payments and the period of 

23 such coverage, 

24 ‘‘(C) the aggregate amount of payments 

25 described in subsection (a), and
36

•S 2217 IS 

1 ‘‘(D) such other information as the Sec2 retary may reasonably prescribe. 

3 ‘‘(c) CREDITABLE HEALTH INSURANCE.—For pur4 poses of this section, the term ‘creditable health insurance’ 

5 means qualified health insurance (as defined in section 

6 36(d)).

7 ‘‘(d) STATEMENTS TO BE FURNISHED TO INDIVID8 UALS WITH RESPECT TO WHOM INFORMATION IS RE9 QUIRED.—Every person required to make a return under 

10 subsection (a) shall furnish to each individual whose name 

11 is required under subsection (b)(2)(A) to be set forth in 

12 such return a written statement showing—

13 ‘‘(1) the name and address of the person re14 quired to make such return and the phone number 

15 of the information contact for such person, 

16 ‘‘(2) the aggregate amount of payments de17 scribed in subsection (a) received by the person re18 quired to make such return from the individual to 

19 whom the statement is required to be furnished, and 

20 ‘‘(3) the information required under subsection 

21 (b)(2)(B) with respect to such payments. 

22 The written statement required under the preceding sen23 tence shall be furnished on or before January 31 of the 

24 year following the calendar year for which the return 

25 under subsection (a) is required to be made. 
37

•S 2217 IS 

1 ‘‘(e) RETURNS WHICH WOULD BE REQUIRED TO BE

2 MADE BY 2 OR MORE PERSONS.—Except to the extent 

3 provided in regulations prescribed by the Secretary, in the 

4 case of any amount received by any person on behalf of 

5 another person, only the person first receiving such 

6 amount shall be required to make the return under sub7 section (a).’’. 

8 (2) ASSESSABLE PENALTIES.—

9 (A) Subparagraph (B) of section 

10 6724(d)(1) of such Code (relating to defini11 tions) is amended by redesignating clauses (xii) 

12 through (xviii) as clauses (xiii) through (xix), 

13 respectively, and by inserting after clause (xi) 

14 the following: 

15 ‘‘(xii) section 6050U (relating to re16 turns relating to payments for qualified 

17 health insurance),’’.

18 (B) Paragraph (2) of section 6724(d) of 

19 such Code is amended by striking ‘‘or’’ at the 

20 end of subparagraph (AA), by striking the pe21 riod at the end of the subparagraph (BB) and 

22 inserting ‘‘, or’’, and by adding at the end the 

23 following: 
38

•S 2217 IS 

1 ‘‘(CC) section 6050U(d) (relating to re2 turns relating to payments for qualified health 

3 insurance).’’. 

4 (3) CLERICAL AMENDMENT.—The table of sec5 tions for subpart B of part III of subchapter A of 

6 chapter 61 of such Code is amended by inserting 

7 after the item relating to section 6050T the fol8 lowing:

‘‘Sec. 6050U. Returns relating to payments for qualified health 

insurance.’’.

9 (c) CRIMINAL PENALTY FOR FRAUD.—Subchapter B 

10 of chapter 75 of the Internal Revenue Code of 1986 (relat11 ing to other offenses) is amended by adding at the end 

12 the following: 

13 ‘‘SEC. 7276. PENALTIES FOR OFFENSES RELATING TO 

14 HEALTH INSURANCE TAX CREDIT. 

15 ‘‘Any person who knowingly misuses Department of 

16 the Treasury names, symbols, titles, or initials to convey 

17 the false impression of association with, or approval or en18 dorsement by, the Department of the Treasury of any in19 surance products or group health coverage in connection 

20 with the credit for health insurance costs under section 

21 36 shall on conviction thereof be fined not more than 

22 $10,000, or imprisoned not more than 1 year, or both.’’.

23 (d) CONFORMING AMENDMENTS.—
39

•S 2217 IS 

1 (1) Section 162(l) of the Internal Revenue Code 

2 of 1986 is amended by adding at the end the fol3 lowing: 

4 ‘‘(6) ELECTION TO HAVE SUBSECTION

5 APPLY.—No deduction shall be allowed under para6 graph (1) for a taxable year unless the taxpayer 

7 elects to have this subsection apply for such year.’’. 

8 (2) Paragraph (2) of section 1324(b) of title 

9 31, United States Code, is amended by inserting be10 fore the period ‘‘, or from section 36 of such Code’’. 

11 (3) The table of sections for subpart C of part 

12 IV of subchapter A of chapter 1 of the Internal Rev13 enue Code of 1986 is amended by striking the last 

14 item and inserting the following:

‘‘Sec. 36. Health insurance costs for uninsured individuals. 

‘‘Sec. 37. Overpayments of tax.’’

15 (4) The table of sections for subchapter B of 

16 chapter 75 of such Code is amended by adding at 

17 the end the following:

‘‘Sec. 7276. Penalties for offenses relating to health insurance tax 

credit.’’

18 (e) EFFECTIVE DATES.—

19 (1) IN GENERAL.—Except as provided in para20 graph (2), the amendments made by this section 

21 shall apply to taxable years beginning after Decem22 ber 31, 2003, without regard to whether final regu-
40

•S 2217 IS 

1 lations to carry out such amendments have been pro2 mulgated by such date. 

3 (2) PENALTIES.—The amendments made by 

4 subsections (c) and (d)(4) shall take effect on the 

5 date of the enactment of this Act. 

6 SEC. 212. ADVANCE PAYMENT OF CREDIT TO ISSUERS OF 

7 QUALIFIED HEALTH INSURANCE. 

8 (a) IN GENERAL.—Chapter 77 of the Internal Rev9 enue Code of 1986 (relating to miscellaneous provisions) 

10 is amended by adding at the end the following: 

11 ‘‘SEC. 7529. ADVANCE PAYMENT OF CREDIT FOR HEALTH 

12 INSURANCE COSTS OF ELIGIBLE INDIVID13 UALS. 

14 ‘‘(a) GENERAL RULE.—Not later than January 1, 

15 2005, the Secretary shall establish a program for making 

16 payments on behalf of certified individuals to providers of 

17 qualified health insurance (as defined in section 36(d)) for 

18 such individuals. 

19 ‘‘(b) PROGRAM OPTIONS.—The program under sub20 section (a) may—

21 ‘‘(1) provide that payments may be made on 

22 the basis of modified adjusted gross income of cer23 tified individuals for the preceding taxable year, and 

24 ‘‘(2) provide that, in lieu of payments to pro25 viders, the following amounts may be offset:
41

•S 2217 IS 

1 ‘‘(A) Amounts required to be deposited by 

2 the provider as estimated income tax under sec3 tion 6654 or 6655. 

4 ‘‘(B) Amounts required to be deducted and 

5 withheld under section 3401 (relating to wage 

6 withholding). 

7 ‘‘(C) Taxes imposed under section 3111(a) 

8 or 50 percent of taxes imposed under section 

9 1401(a) (relating to FICA employer taxes). 

10 ‘‘(D) Amounts required to be deducted 

11 under section 3102 with respect to taxes im12 posed under section 3101(a) or 50 percent of 

13 taxes imposed under section 1401(a) (relating 

14 to FICA employee taxes). 

15 ‘‘(c) CERTIFIED INDIVIDUAL.—For purposes of this 

16 section, the term ‘certified individual’ means any indi17 vidual for whom a qualified health insurance credit eligi18 bility certificate is in effect. 

19 ‘‘(d) QUALIFIED HEALTH INSURANCE CREDIT ELI20 GIBILITY CERTIFICATE.—For purposes of this section, a 

21 qualified health insurance credit eligibility certificate is a 

22 statement furnished by an individual to a provider of 

23 qualified health insurance which—
42

•S 2217 IS 

1 ‘‘(1) certifies that the individual will be eligible 

2 to receive the credit provided by section 36 for the 

3 taxable year, 

4 ‘‘(2) estimates the amount of such credit for 

5 such taxable year, and

6 ‘‘(3) provides such other information as the 

7 Secretary may require for purposes of this section.’’

8 (b) CLERICAL AMENDMENT.—The table of sections 

9 for chapter 77 of the Internal Revenue Code of 1986 is 

10 amended by adding at the end the following:

‘‘Sec. 7529. Advance payment of health insurance credit for purchasers of qualified health insurance.’’

11 (c) EFFECTIVE DATE.—The amendments made by 

12 this section shall take effect on July 1, 2005, without re13 gard to whether final regulations to carry out such amend14 ments have been promulgated by such date. 

15 TITLE III—STRONG NATIONAL 

16 LEADERSHIP, COOPERATION, 

17 AND COORDINATION 

18 SEC. 301. OFFICE OF MINORITY HEALTH AND HEALTH DIS19 PARITIES. 

20 (a) IN GENERAL.—Section 1707 of the Public Health 

21 Service Act (42 U.S.C. 300u–6) is amended—

22 (1) by striking the section heading and insert23 ing the following: 
43

•S 2217 IS 

1 ‘‘OFFICE OF MINORITY HEALTH AND HEALTH

2 DISPARITIES’’; and 

3 (2) in subsection (a)—

4 (A) by striking ‘‘Office of Minority 

5 Health’’ each place that such appears and in6 serting ‘‘Office of Minority Health and Health 

7 Disparities’’; and 

8 (B) by striking ‘‘for Minority Health’’ and 

9 inserting ‘‘for Minority Health and Health Dis10 parities’’. 

11 (b) DUTIES.—Section 1707(b) of the Public Health 

12 Service Act (42 U.S.C. 300u–6(b)) is amended—

13 (1) in the matter preceding paragraph (1)—

14 (A) by inserting ‘‘and health disparity pop15 ulations’’ after ‘‘groups’’ and 

16 (B) by striking ‘‘for Minority Health’’ and 

17 inserting ‘‘for Minority Health and Health Dis18 parities’’; 

19 (2) in paragraph (1)—

20 (A) by striking ‘‘Establish’’ and all that 

21 follows through ‘‘coordinate’’ and inserting ‘‘Co22 ordinate’’; and 

23 (B) by striking ‘‘such individuals’’ and inserting 

24 ‘‘health disparities’’; 

25 (4) in paragraph (1) 
44

•S 2217 IS 

1 (3) in paragraph (5), by inserting ‘‘or health 

2 disparity populations’’ after ‘‘minority groups’’; 

3 (4) in paragraph (6), by inserting ‘‘or health 

4 disparity population’’ after ‘‘minority group’’; 

5 (5) by striking paragraphs (7) and (9); 

6 (6) by redesignating paragraphs (1), (2), (3), 

7 (4), (5), (6), (8), and (10) as paragraphs (3), (4), 

8 (6), (7), (9), (10), (11), and (12), respectively; 

9 (7) by inserting before paragraph (3) (as so re10 designated) the following: 

11 ‘‘(1) Establish specific short- and long-term 

12 goals and objectives for analyzing the causes of 

13 health disparities and addressing them, with a par14 ticular focus on the areas of health promotion, dis15 ease prevention, chronic care and research. 

16 ‘‘(2) Work with agencies within the Department 

17 of Health and Human Services and with the Sur18 geon General to establish a strategic plan to analyze 

19 and address the causes of health disparities. The 

20 plan shall include recommendations to improve the 

21 collection, analysis, and reporting of data at the 

22 Federal, State, territorial, Tribal, and local levels, 

23 including how to—
45

•S 2217 IS 

1 ‘‘(A) implement data collection while mini2 mizing the cost and administrative burdens of 

3 data collection and reporting; 

4 ‘‘(B) expand awareness of the importance 

5 of such data collection to improving health care 

6 quality; and 

7 ‘‘(C) provide researchers with greater ac8 cess to racial, ethnic, and other health disparity 

9 data.’’; 

10 (8) by inserting after paragraph (4) (as so re11 designated), the following: 

12 ‘‘(5) Increase awareness of disparities in health 

13 care among health care providers, health plans, and 

14 the public.’’; 

15 (9) in paragraph (6) (as so redesignated)—

16 (A) by striking ‘‘Support’’ and inserting 

17 ‘‘In cooperation with the appropriate agencies, 

18 support’’; 

19 (B) by inserting before the period the fol20 lowing: ‘‘for— 

21 ‘‘(A) expanding health care access; 

22 ‘‘(B) improving health care quality; and 

23 ‘‘(C) increasing health care educational op24 portunity.’’;
46

•S 2217 IS 

1 (10) by inserting after paragraph (7) (as so re2 designated), the following: 

3 ‘‘(8) Consistent with section 102 of the Closing 

4 the Health Care Gap Act of 2004, coordinate the 

5 classification and collection of health care data to 

6 allow for the ongoing analysis of the causes of dis7 parities and monitoring of progress toward the elimi8 nation of disparities.’’; and 

9 (11) by inserting after paragraph (12), as so 

10 redesignated, the following: 

11 ‘‘(13) Work with Federal agencies and depart12 ments outside of the Department of Health and 

13 Human Services to maximize program resources 

14 available to understand why disparities exist, and ef15 fective ways to reduce and eliminate disparities. 

16 ‘‘(14) Support a center for linguistic and cul17 tural competence to carry out the following: 

18 ‘‘(A) With respect to individuals who lack 

19 proficiency in speaking the English language, 

20 enter into contracts with public and nonprofit 

21 private providers of primary health services for 

22 the purpose of increasing the access of such in23 dividuals to such services by developing and 

24 carrying out programs to provide bilingual or 

25 interpretive services. 
47

•S 2217 IS 

1 ‘‘(B) Carry out programs to improve ac2 cess to health care services for individuals with 

3 limited proficiency in speaking the English lan4 guage. Activities under this subparagraph shall 

5 include developing and evaluating model 

6 projects.’’. 

7 (c) ADVISORY COMMITTEE.—Section 1707(c) of the 

8 Public Health Service Act (42 U.S.C. 300u–6(c)) is 

9 amended—

10 (1) in paragraph (1), by inserting ‘‘and Health 

11 Disparities’’ after ‘‘Minority Health’’; 

12 (2) in paragraph (2), by inserting ‘‘and health 

13 disparity populations’’ after ‘‘minority group’’; and 

14 (3) in paragraph (4)(B)—

15 (A) by inserting ‘‘and health disparities’’ 

16 after ‘‘minority health’’; and 

17 (B) by inserting ‘‘and health disparity pop18 ulations’’ after ‘‘minority groups’’. 

19 (d) DUTY REQUIREMENTS.—Section 1707(d) of the 

20 Public Health Service Act (42 U.S.C. 300u–6(d)) is 

21 amended—

22 (1) in paragraph (1)(A), by striking ‘‘(b)(9)’’ 

23 and inserting ‘‘(b)(14); 

24 (2) in paragraph (1)(B), by striking ‘‘(b)(10)’’ 

25 and inserting ‘‘(b)(13)’’; and 
48

•S 2217 IS 

1 (3) in paragraph (3), insert ‘‘take into account 

2 the unique cultural or linguistic issues facing such 

3 populations and’’ after ‘‘subsection (b)’’. 

4 (e) REPORTS.—Section 1707(f) of the Public Health 

5 Service Act (42 U.S.C. 300u–6(f)) is amended—

6 (1) in paragraph (1)—

7 (A) by striking the subsection heading and 

8 inserting ‘‘REPORT ON ACTIVITIES.—’’; 

9 (B) by striking ‘‘1999’’ and inserting 

10 ‘‘2006’’; 

11 (C) by striking ‘‘Committee on Energy and 

12 Commerce of the House of Representatives, and 

13 to the Committee on Labor and Human Re14 sources of the Senate’’ and inserting ‘‘appro15 priate committees of Congress’’; and 

16 (D) by inserting ‘‘and health disparity pop17 ulations’’ after ‘‘racial and ethnic minority 

18 groups’’; 

19 (2) in paragraph (2)—

20 (A) by striking ‘‘1999’’ and inserting 

21 ‘‘2005’’; and 

22 (B) by inserting ‘‘and health disparity’’ 

23 after ‘‘minority health’’; 

24 (3) by redesignating paragraph (1) and (2) as 

25 paragraphs (2) and (3), respectively; and 
49

•S 2217 IS 

1 (4) by inserting after the subsection heading, 

2 the following: 

3 ‘‘(1) IN GENERAL.—Not later than 1 year after 

4 the date of enactment of the Closing the Health 

5 Care Gap Act of 2004, the Secretary shall submit to 

6 the appropriate committees of Congress, a report on 

7 the plan developed under subsection (b)(2).’’. 

8 (f) AUTHORIZATION OF APPROPRIATIONS.—Section 

9 1707(h) of the Public Health Service Act (42 U.S.C. 

10 300u–6(h)) is amended—

11 (1) by striking ‘‘FUNDING.—’’ and all that fol12 lows through the paragraph designation in para13 graph (1); and 

14 (2) by striking ‘‘$30,000,000’’ and all that fol15 lows through the period and inserting ‘‘$50,000,000 

16 for fiscal year 2005, such sums as may be necessary 

17 for each of fiscal years 2006 through 2009.’’. 

18 TITLE IV—PROFESSIONAL EDU19 CATION, AWARENESS, AND 

20 TRAINING 

21 SEC. 401. WORKFORCE DIVERSITY AND TRAINING. 

22 (a) PURPOSE.—Part B of title VII of the Public 

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

24 by inserting before section 736 the following: 
50

•S 2217 IS 

1 ‘‘SEC. 736A. PURPOSE OF PROGRAM. 

2 ‘‘It is the purpose of this part to improve health care 

3 quality and access in medically underserved communities, 

4 to improve the cultural competence of health care pro5 viders by increasing minority representation in the health 

6 professions, and to strengthen the research and education 

7 programs of designated health professions schools that 

8 disproportionately serve health disparity populations.’’. 

9 (b) CENTERS OF EXCELLENCE.—Section 736 of the 

10 Public Health Service Act (42 U.S.C. 293) is amended—

11 (1) by striking subsection (a) and inserting the 

12 following: 

13 ‘‘(a) IN GENERAL.—The Secretary shall make grants 

14 to, and enter into contracts with, public and nonprofit pri15 vate health or educational entities, including designated 

16 health professions schools described in subsection (c), for 

17 the purpose of assisting the schools in supporting pro18 grams of excellence in health professions education for ra19 cial or ethnic minority or health disparity populations.’’; 

20 (2) in subsection (b)—

21 (A) in paragraph (2), by striking ‘‘under22 represented minority’’ and inserting ‘‘racial or 

23 ethnic minority’’; 

24 (B) in paragraph (3), by striking ‘‘under25 represented minority’’ and inserting ‘‘racial or 

26 ethnic minority’’;
51

•S 2217 IS 

1 (C) in paragraph (4), by striking ‘‘minority 

2 health’’ and inserting ‘‘health disparity’’; 

3 (D) in paragraph (5), by striking ‘‘under4 represented minority groups’’ and inserting ‘‘ra5 cial or ethnic minorities and health disparity 

6 populations’’; 

7 (E) in paragraph (6)—

8 (i) in the matter preceding subpara9 graph (A), by striking ‘‘under-represented 

10 minority’’ and inserting ‘‘individuals from 

11 racial or ethnic minorities or health dis12 parity populations’’; and 

13 (ii) by striking ‘‘and’’ at the end; 

14 (F) in paragraph (7), by striking the pe15 riod and inserting ‘‘; and’’; and 

16 (G) by adding at the end the following: 

17 ‘‘(8) to conduct accountability and other report18 ing activities, as required by the Secretary.’’; 

19 (3) in subsection (c)—

20 (A) in paragraph (1)(B)—

21 (i) in clause (i), by striking ‘‘under22 represented minority’’ and inserting ‘‘indi23 viduals from racial or ethnic minorities or 

24 health disparity populations’’; 
52

•S 2217 IS 

1 (ii) in clause (ii), by striking ‘‘under2 represented minority’’ and inserting 

3 ‘‘such’’; 

4 (iii) in clause (iii)—

5 (I) by striking ‘‘under-rep6 resented minority individuals’’ the 

7 first place that such appears and in8 serting ‘‘such students’’; 

9 (II) by striking ‘‘such individ10 uals’’ and inserting ‘‘such students’’; 

11 and 

12 (III) by striking ‘‘under-rep13 resented minority’’ the second place 

14 that such appears and inserting 

15 ‘‘such’’; and 

16 (iv) in clause (iv), by striking ‘‘under17 represented minority individuals’’ and in18 serting ‘‘individuals from racial or ethnic 

19 minorities or health disparity populations’’; 

20 and 

21 (B) in paragraph (2)(B)—

22 (i) in clause (i), by striking ‘‘under23 represented’’ and inserting ‘‘racial or’’; and 

24 (C) in paragraph (5)(B)—
53

•S 2217 IS 

1 (i) by striking ‘‘under-represented’’ 

2 and inserting ‘‘racial or’’; and 

3 (ii) by inserting ‘‘or a health disparity 

4 population’’ after ‘‘minorities’’; 

5 (4) in subsection (d)(1), by striking ‘‘Under6 Represented Minority Health’’ and inserting ‘‘Minor7 ity Health and Health Disparity’’; 

8 (5) in subsection (h)—

9 (A) in paragraph (1), by striking 

10 ‘‘$26,000,000’’ and all that follows and insert11 ing ‘‘$50,000,000 for fiscal year 2005, and 

12 such sums as may be necessary for each of fis13 cal years 2006 through 2009’’; and 

14 (B) in paragraph (2)—

15 (i) in subparagraph (C)—

16 (I) in the matter preceding clause 

17 (i), by striking ‘‘are $30,000,000 or 

18 more’’ and inserting ‘‘exceed 

19 $30,000,000 but are less than 

20 $40,000,000’’; and 

21 (II) in clause (iv), by striking 

22 ‘‘any remaining funds’’ and inserting 

23 ‘‘any remaining excess amount’’; and 

24 (ii) by adding at the end the fol25 lowing: 
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•S 2217 IS 

1 ‘‘(D) FUNDING IN EXCESS OF

2 $40,000,000.—If amounts appropriated under 

3 paragraph (1) for a fiscal year are $40,000,000 

4 or more, the Secretary shall make available—

5 ‘‘(i) not less than $16,000,000 for 

6 grants under subsection (a) to health pro7 fessions schools that meet the conditions 

8 described in subsection (c)(2)(A); 

9 ‘‘(ii) not less than $16,000,000 for 

10 grants under subsection (a) to health pro11 fessions schools that meet the conditions 

12 described in paragraph (3) or (4) of sub13 section (c) (including meeting conditions 

14 pursuant to subsection (e)); 

15 ‘‘(iii) not less than $8,000,000 for 

16 grants under subsection (a) to health pro17 fessions schools that meet the conditions 

18 described in subsection (c)(5); and 

19 ‘‘(iv) after grants are made with 

20 funds under clauses (i) through (iii), any 

21 remaining funds for grants under sub22 section (a) to health professions schools 

23 that meet the conditions described in para24 graph (2)(A), (3), (4), or (5) of subsection 

25 (c).’’; and 
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•S 2217 IS 

1 (6) by adding at the end the following: 

2 ‘‘(i) EVALUATION.—

3 ‘‘(1) IN GENERAL.—Not later than 1 year after 

4 the date of enactment of the Closing the Health 

5 Care Gap Act of 2004, the Secretary shall request 

6 that the Institute of Medicine evaluate the effective7 ness of the programs under this section in meeting 

8 the purpose of this part. The Institute of Medicine 

9 shall submit a report on the evaluation to the Sec10 retary. 

11 ‘‘(2) WORKING GROUP.—Upon submission of 

12 the report under paragraph (1), the Secretary shall 

13 convene a working group composed of stakeholders, 

14 including designated health professions schools de15 scribed in subsection (c), to define quality perform16 ance measures and reporting requirements of grant 

17 recipients that shall be tied to the purpose of this 

18 part. 

19 ‘‘(3) REGULATIONS.—Not later than 18 months 

20 after the date the Institute of Medicine submits the 

21 report under paragraph (1), the Secretary shall pub22 lish proposed regulations regarding the quality per23 formance measures and reporting requirements de24 scribed in paragraph (2). Not later than 3 years 

25 after the date the Institute of Medicine submits the 
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•S 2217 IS 

1 report under paragraph (1), the Secretary shall pub2 lish final regulations regarding the quality perform3 ance measures and reporting requirements described 

4 in paragraph (2).’’. 

5 (c) SCHOLARSHIPS FOR DISADVANTAGED STU6 DENTS.—Section 737 of the Public Health Service Act (42 

7 U.S.C. 293a) is amended—

8 (1) in subsection (c), by striking ‘‘under-rep9 resented minority’’ and inserting ‘‘minority and 

10 health disparity’’; and 

11 (2) in subsection (d)(1)(B), by inserting ‘‘or 

12 health disparity’’ after ‘‘minority’’. 

13 (d) LOAN REPAYMENTS AND FELLOWSHIPS REGARD14 ING FACULTY POSITIONS.—Section 738(b) of the Public 

15 Health Service Act (42 U.S.C. 293b(b)) is amended—

16 (1) in paragraph (1), by striking ‘‘underrep17 resented’’; 

18 (2) in paragraph (3)(A), by striking ‘‘underrep19 resented minority individuals’’ and inserting ‘‘indi20 viduals from racial or ethnic minorities or health dis21 parity populations’’; and 

22 (3) by striking paragraph (5). 

23 (e) NATIONAL HEALTH SERVICE CORPS.—
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•S 2217 IS 

1 (1) ASSIGNMENT.—Section 333(a)(3) of the 

2 Public Health Service Act (42 U.S.C. 254f(a)(3)) is 

3 amended—

4 (A) in the second sentence—

5 (i) by striking ‘‘shall give preference’’ 

6 and inserting the following: ‘‘shall—

7 ‘‘(A) give preference’’; and 

8 (ii) by striking the period and insert9 ing ‘‘; and’’; and 

10 (B) by adding at the end the following: 

11 ‘‘(B) give preference to applications from enti12 ties described in subparagraph (A) that serve indi13 viduals a majority of whom are members of a racial 

14 or ethnic minority or other health disparity popu15 lation with annual incomes at or below twice those 

16 set forth in the most recent poverty guidelines issued 

17 by the Secretary pursuant to section 402(2) of the 

18 Community Services Block Grant Act.’’. 

19 (2) PRIORITIES.—Section 333A(a) of the Public 

20 Health Service Act (42 U.S.C. 254f-1(a)) is amend21 ed—

22 (A) by redesignating paragraphs (1) 

23 through (3) as paragraphs (2) through (4), re24 spectively; and 
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•S 2217 IS 

1 (B) by inserting before paragraph (2) (as 

2 so redesignated), the following: 

3 ‘‘(1) give preference to applications as described 

4 in section 333(a)(3);’’. 

5 (e) AUTHORIZATION OF APPROPRIATIONS.—Section 

6 740 of the Public Health Service Act (42 U.S.C. 293d) 

7 is amended—

8 (1) in subsection (a), by striking ‘‘2002’’ and 

9 inserting ‘‘2009’’; 

10 (2) in subsection (b), by striking ‘‘2002’’ and 

11 inserting ‘‘2009’’; 

12 (3) in subsection (c), by striking ‘‘2002’’ and 

13 inserting ‘‘2009’’; and 

14 (4) by striking subsection (d). 

15 (f) GRANTS FOR HEALTH PROFESSIONS EDU16 CATION.—Section 741 of the Public Health Service Act 

17 (42 U.S.C. 293e) is amended—

18 (1) in subsection (a)(2), in the first sentence by 

19 striking ‘‘Unless’’ and all that follows through ‘‘the 

20 Secretary’’ and inserting ‘‘The Secretary’’; and 

21 (2) in subsection (b), by striking ‘‘$3,500,000’’ 

22 and all that follows through the period and inserting 

23 ‘‘such sums as may be necessary for each of fiscal 

24 years 2005 through 2009.’’. 
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•S 2217 IS 

1 (g) HEALTH CAREERS OPPORTUNITY PROGRAM.—

2 Subpart 2 of part E of title VII of the Public Health Serv3 ice Act (42 U.S.C. 295 et seq.) is amended—

4 (1) in section 770 by inserting ‘‘(other than 

5 section 771)’’ after ‘‘this subpart’’; 

6 (2) by redesignating section 770 as section 771; 

7 and 

8 (3) by inserting after section 769 the following: 

9 ‘‘SEC. 770. HEALTH CAREERS OPPORTUNITY PROGRAM. 

10 ‘‘(a) IN GENERAL.—The Secretary may make grants 

11 and enter into cooperative agreements and contracts with 

12 eligible entities for any of the following purposes: 

13 ‘‘(1) Identifying and recruiting students who—

14 ‘‘(A) are from disadvantaged backgrounds 

15 or health disparity populations; and 

16 ‘‘(B) are interested in a career in the 

17 health professions. 

18 ‘‘(2) Providing counseling or other services de19 signed to assist such individuals in entering a health 

20 professions school and successfully completing their 

21 education at such a school. 

22 ‘‘(3) Providing, for a period prior to the entry 

23 of such individuals into the regular course of edu24 cation of such a school, preliminary education de25 signed to assist the individuals in successfully com-
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•S 2217 IS 

1 pleting such regular course of education at such a 

2 school, or referring such individuals to institutions 

3 providing such preliminary education. 

4 ‘‘(b) RECEIPT OF AWARD.—

5 ‘‘(1) ELIGIBLE ENTITIES; REQUIREMENT OF

6 CONSORTIUM.—The Secretary may make an award 

7 under subsection (a) only if an eligible entity meets 

8 the following conditions: 

9 ‘‘(A) The eligible entity is a public or pri10 vate entity, and such entity has established a 

11 consortium consisting of private community12 based organizations and health professions 

13 schools. 

14 ‘‘(B) The health professions schools in the 

15 consortium are schools of medicine or osteo16 pathic medicine, public health, nursing, den17 tistry, optometry, pharmacy, allied health, or 

18 podiatric medicine, or graduate programs in 

19 mental health practice (including programs in 

20 clinical psychology). 

21 ‘‘(C)(i) Except as provided in clause (ii), 

22 the membership of the consortium includes not 

23 less than 1 nonprofit private community-based 

24 organization and not less than 3 health profes25 sions schools. 
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•S 2217 IS 

1 ‘‘(ii) In the case of an eligible entity whose 

2 exclusive activity under the award will be car3 rying out 1 or more programs described in sub4 section (a)(5), the membership of the consor5 tium includes not less than 1 nonprofit private 

6 community-based organization and not less 

7 than 1 health professions school. 

8 ‘‘(D) The members of the consortium have 

9 entered into an agreement specifying—

10 ‘‘(i) that each of the members will 

11 comply with the conditions upon which the 

12 award is made; and 

13 ‘‘(ii) whether and to what extent the 

14 award will be allocated among the mem15 bers. 

16 ‘‘(2) REQUIREMENT OF COMPETITIVE

17 AWARDS.—Awards under subsection (a) shall be 

18 made on a competitive basis. 

19 ‘‘(c) REQUIREMENTS.—The Secretary may make an 

20 award under subsection (a) only if the Secretary deter21 mines that, in the case of activities carried out under the 

22 award that prove to be effective toward achieving the pur23 poses of the activities—

24 ‘‘(1) the members of the consortium involved 

25 have or will have the financial capacity to continue
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•S 2217 IS 

1 the activities, regardless of whether financial assist2 ance under subsection (a) continues to be available; 

3 and 

4 ‘‘(2) the members of the consortium dem5 onstrate to the satisfaction of the Secretary a com6 mitment to continue such activities, regardless of 

7 whether such assistance continues to be available. 

8 ‘‘(d) OBJECTIVES UNDER AWARDS.—Before making 

9 a first award to an eligible entity under subsection (a), 

10 the Secretary shall establish objectives regarding the ac11 tivities to be carried out under the award, which objectives 

12 are applicable until the next fiscal year for which such 

13 award is made after a competitive process of review. In 

14 making an award after such a review, the Secretary shall 

15 establish additional objectives for the applicant. 

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

17 purpose of carrying out this section, there are authorized 

18 to be appropriated, such sums as may be necessary for 

19 each of fiscal years 2005 through 2009.’’. 

20 SEC. 402. HIGHER EDUCATION TECHNICAL AMENDMENTS. 

21 Section 326(c) of the Higher Education Act of 1965 

22 (20 U.S.C. 1063b(c)) is amended—

23 (1) in paragraph (2), by inserting before the 

24 semicolon, the following: ‘‘, and for the acquisition 
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•S 2217 IS 

1 and development of real property that is adjacent to 

2 the campus to improve the academic environment’’; 

3 (2) in paragraph (6), by striking ‘‘and’’ at the 

4 end; 

5 (3) in paragraph (7), by striking the period and 

6 inserting a semicolon; and 

7 (4) by adding at the end the following: 

8 ‘‘(8) Support of faculty exchanges, development, 

9 and fellowship to enable attainment of advanced de10 grees in their field of instruction; and 

11 ‘‘(9) Tutoring, counseling, and student service 

12 programs designed to improve academic success.’’. 

13 SEC. 403. MODEL CULTURAL COMPETENCY CURRICULUM 

14 DEVELOPMENT. 

15 (a) CURRICULA DEVELOPMENT AND MODEL CUR16 RICULA.—The Secretary of Health and Human Services 

17 (in this section referred to as the ‘‘Secretary’’) may award 

18 grants to eligible entities for curricula development for the 

19 training of health care providers and health professions 

20 students regarding cultural competency, and for dem21 onstration projects to test new innovations for cultural 

22 competence education model curricula for and identify ad23 ditional barriers to culturally appropriate care. 

24 (b) APPLICATION.—Each eligible entity desiring a 

25 grant under subsection (a) shall submit an application to 
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•S 2217 IS 

1 the Secretary at such time, in such manner, and con2 taining such information as the Secretary may require. 

3 (c) AUTHORIZATION OF APPROPRIATIONS.—There 

4 are authorized to be appropriated to carry out this section 

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

6 2005 through 2009. 

7 SEC. 404. INTERNET CULTURAL COMPETENCY CLEARING8 HOUSE. 

9 (a) DEVELOPMENT.—The Director of the Office of 

10 Minority Health and Health Disparities, with assistance 

11 from the Administrator of the Agency for Healthcare Re12 search and Quality, shall develop and maintain an Internet 

13 clearinghouse to improve health care quality for individ14 uals with specific cultural needs or with limited English 

15 proficiency or low functional health literacy and to reduce 

16 or eliminate the duplication of effort to translate mate17 rials. 

18 (b) TEMPLATES.—In developing the clearinghouse 

19 under subsection (a), the Director of the Office of Minor20 ity Health and Health Disparities shall develop, test, and 

21 make available templates for standard documents that are 

22 necessary for patients and consumers to access and make 

23 educated decisions about their health care, including—

24 (1) administrative and legal documents; 
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•S 2217 IS 

1 (2) clinical information such as how to take 

2 medications, how to prevent transmission of a con3 tagious disease, and other prevention and treatment 

4 instructions; and 

5 (3) patient education and outreach materials 

6 such as immunization notices, health warnings, or 

7 screening notices. 

8 (c) ONLINE LIBRARY OR DATABASE.—The Director 

9 of the Office of Minority Health and Health Disparities 

10 shall develop a readily accessible online library or database 

11 with searchable clinically relevant cultural information 

12 that is important for health care providers to have on hand 

13 in the direct provision of medical care to individuals from 

14 specific minority, ethnic, or other health disparity groups. 

15 TITLE V—ENHANCED RESEARCH 

16 SEC. 501. AGENCY FOR HEALTHCARE RESEARCH AND 

17 QUALITY. 

18 Part B of title IX of the Public Health Service Act 

19 (42 U.S.C. 299b) is amended by adding at the end the 

20 following: 

21 ‘‘SEC. 918. ENHANCED RESEARCH WITH RESPECT TO 

22 HEALTH DISPARITIES. 

23 ‘‘(a) ACCELERATING THE ELIMINATION OF DISPARI24 TIES.—
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•S 2217 IS 

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

2 through the Director, may award grants or contracts 

3 to eligible entities (as defined in paragraph (4)) for 

4 short-term research to analyze the causes of dispari5 ties and identify or develop and evaluate effective 

6 strategies in closing the health care gap between mi7 nority and health disparity populations and non8 minority populations or non-health disparity popu9 lations. 

10 ‘‘(2) PROMPT USE OF RESEARCH.—To ensure 

11 that research described in paragraph (1) is effective 

12 and is disseminated and applied promptly, the Direc13 tor shall—

14 ‘‘(A) expand practice-based research net15 works (primary care and larger delivery sys16 tems) to include networks of delivery sites serv17 ing large numbers of minority and health dis18 parity populations including—

19 ‘‘(i) public hospitals; 

20 ‘‘(ii) health centers; and 

21 ‘‘(iii) other sites as determined appro22 priate by the Director; 

23 ‘‘(B) work with health care providers to 

24 identify and develop those interventions for mi25 nority and health disparity populations for
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•S 2217 IS 

1 which effective implementation strategies are 

2 not clear; and 

3 ‘‘(C) develop a broad virtual network of 

4 continuous learning among health care pro5 viders (including institutions that did not re6 ceive a grant or contract under paragraph (1)) 

7 so that those participating in research can 

8 share findings and experience throughout the 

9 duration of such research and to facilitate inter10 est in and prompt adoption of such findings 

11 and experience. 

12 ‘‘(3) TECHNICAL ASSISTANCE.—The Director of 

13 the Agency for Healthcare Research and Quality 

14 shall provide technical assistance to assist in the im15 plementation of strategies of evidence-based prac16 tices that will reduce health care disparities. 

17 ‘‘(4) ELIGIBLE ENTITIES.—In paragraph (1), 

18 the term ‘eligible entities’ means institutions with re19 searchers who have experience in conducting re20 search relating to minority health and health dis21 parity populations. 

22 ‘‘(5) PUBLIC HOSPITALS.—In this subsection, 

23 the term ‘public hospitals’ means a hospital (as de24 fined in section 1886(d)(1)(B) of the Social Security 

25 Act) that—
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•S 2217 IS 

1 ‘‘(A) is owned or operated by a unit of 

2 State or local government, is a public or private 

3 non-profit corporation which is formally granted 

4 governmental powers by a unit of State or local 

5 government, or is a private non-profit hospital 

6 that has a contract with a State or local gov7 ernment to provide health care services to low 

8 income individuals who are not entitled to bene9 fits under title XVIII of the Social Security Act 

10 or eligible for assistance under the State plan 

11 under title XIX of the Social Security Act; and 

12 ‘‘(B) for the most recent cost reporting pe13 riod that ended before the calendar quarter in14 volved, had a disproportionate share adjustment 

15 percentage (as determined under section 

16 1886(d)(5)(F) of the Social Security Act) 

17 greater than 11.75 percent or was described in 

18 section 1886(d)(5)F)(i)(II) of such Act. 

19 ‘‘(b) REALIZING THE POTENTIAL OF DISEASE MAN20 AGEMENT.—

21 ‘‘(1) PUBLIC-PRIVATE SECTOR PARTNERSHIP

22 TO ASSESS EFFECTIVENESS OF EXISTING DATA MAN23 AGEMENT STRATEGIES.—The Director shall estab24 lish a public-private partnership to assess the effec25 tiveness of disease management strategies and iden-
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•S 2217 IS 

1 tify effective interventions and support strategies 

2 with respect to minority and health disparity popu3 lations. 

4 ‘‘(2) EFFECTIVE MANAGEMENT OF PATIENTS

5 WITH MULTIPLE CHRONIC DISEASES.—

6 ‘‘(A) INITIATIVE FOR DISEASE MANAGE7 MENT STRATEGIES.—The Director shall coordi8 nate an initiative to identify those chronic con9 ditions for which disease-specific disease man10 agement strategies pose conflicts in preferred 

11 clinical interventions. 

12 ‘‘(B) RESEARCH.—The Director, with sup13 port from other agencies within the Department 

14 of Health and Human Services shall conduct a 

15 program of research based in community and 

16 primary-care settings to test and evaluate the 

17 implications for patient outcomes of alternative 

18 approaches for reconciling conflicts from dis19 ease-specific disease management initiatives. 

20 ‘‘(c) DEVELOPMENT OF EFFECTIVE MEASUREMENT

21 OF DISPARITIES.—

22 ‘‘(1) IN GENERAL.—The Director shall conduct 

23 a demonstration project to—
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1 ‘‘(A) assess alternative strategies for iden2 tifying population subgroups at highest risk of 

3 poor quality and poor health; 

4 ‘‘(B) improve data collection for health 

5 care priority populations (as described in sec6 tion 901(c)(1)(B)); 

7 ‘‘(C) improve the ability to identify the 

8 causes of disparities; and 

9 ‘‘(D) track progress in reducing health 

10 care disparities with a focus on—

11 ‘‘(i) the minimum data set necessary 

12 to track such progress; and 

13 ‘‘(ii) the identification of measures for 

14 which data currently being collected are in15 sufficient. 

16 ‘‘(2) REPORT.—Not later than 3 years after the 

17 date the demonstration project described in para18 graph (1) receives funding, the Director shall submit 

19 to the appropriate committees of Congress a report 

20 containing the findings of the demonstration project 

21 together with any policy recommendations. 

22 ‘‘(d) ANALYSIS OF RACIAL, ETHNIC, AND OTHER

23 HEALTH DISPARITY DATA.—The Secretary, acting 

24 through the Director of the Agency for Healthcare Re25 search and Quality, and in coordination with the Adminis-
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1 trator of the Centers for Medicare & Medicaid Services 

2 and the Director of the Centers for Disease Control and 

3 Prevention, shall provide technical assistance to agencies 

4 of the Department of Health and Human Services in 

5 meeting Federal standards for race, ethnicity, and other 

6 health disparity data collection and analysis of racial, eth7 nic, and other disparities in health and health care in Fed8 erally-administered programs by—

9 ‘‘(1) identifying appropriate quality assurance 

10 mechanisms to monitor for health disparities; 

11 ‘‘(2) specifying the clinical, diagnostic, or thera12 peutic measures which should be monitored; 

13 ‘‘(3) developing new quality measures relating 

14 to racial, ethnic, or other health disparities; 

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

16 should be conducted; and 

17 ‘‘(5) sharing data with external organizations 

18 for research and quality improvement purposes.’’. 

19 SEC. 502. NATIONAL INSTITUTES OF HEALTH. 

20 The Director of the National Institutes of Health, in 

21 consultation with the Director of the National Center on 

22 Minority Health and Health Disparities, shall expand and 

23 intensify research at the National Institutes of Health re24 lating to the sources of health and health care disparities, 

25 and increase efforts to recruit minority scientists and re-
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1 search professionals into the field of health disparity re2 search. 

3 TITLE VI—MISCELLANEOUS 

4 PROVISIONS 

5 SEC. 601. DEFINITIONS. 

6 (a) IN GENERAL.—In this Act, including the amend7 ments made by this Act: 

8 (1) CULTURALLY COMPETENT.—

9 (A) IN GENERAL.—The term ‘‘culturally 

10 competent’’, with respect to the manner in 

11 which health-related services, education, and 

12 training are provided, means providing the serv13 ices, education, and training in the language 

14 and cultural context that is most appropriate 

15 for the individuals for whom the services, edu16 cation, and training are intended, including as 

17 necessary the provision of bilingual services. 

18 (B) MODIFICATION.—The definition estab19 lished in subparagraph (A) may be modified as 

20 needed at the discretion of the Secretary after 

21 providing a 30-day notice to Congress. 

22 (2) MINORITY HEALTH CONDITIONS.—The term 

23 ‘‘minority health conditions’’, with respect to individ24 uals who are members of minority groups, means all 
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1 diseases, disorders, and conditions (including with 

2 respect to mental health and substance abuse)—

3 (A) unique to, more serious, or more prev4 alent in such groups; 

5 (B) for which the factors of medical risk or 

6 types of medical intervention may be different 

7 for such groups, or for which it is unknown 

8 whether such factors or types are different for 

9 such individuals; or 

10 (C) with respect to which there has been 

11 insufficient research involving such individual 

12 members of such groups as subjects or insuffi13 cient data on such individuals. 

14 (3) MINORITY HEALTH DISPARITIES RE15 SEARCH.—The term ‘‘minority health disparities re16 search’’ means basic, clinical, behavioral and health 

17 services research on minority health conditions (as 

18 defined in paragraph (2)), including research to pre19 vent, diagnose, and treat such conditions. 

20 (4) MINORITY.—The terms ‘‘minority’’ and 

21 ‘‘minorities’’ refer to individuals from a minority 

22 group. 

23 (5) MINORITY GROUP.—The term ‘‘minority 

24 group’’ has the meaning given the term ‘‘racial and 
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•S 2217 IS 

1 ethnic minority group’’ in section 1707 of the Public 

2 Health Service Act (42 U.S.C. 300u–6). 

3 (b) HEALTH DISPARITY POPULATIONS.—In this Act, 

4 including the amendments made by this Act: 

5 (1) HEALTH DISPARITY POPULATION.—The 

6 term ‘‘health disparity population’’ has the meaning 

7 given such term in section 903(d)(1) of the Public 

8 Health Service Act (42 U.S.C. 299a–1(d)(1)). 

9 (2) HEALTH DISPARITIES RESEARCH.—The 

10 term ‘‘health disparities research’’ shall include 

11 basic, clinical, behavioral, and health services re12 search on health disparity populations (including in13 dividual members and communities of such popu14 lations) that relates to health disparities as defined 

15 under paragraph (1), including the causes of such 

16 disparities and methods to prevent, diagnose, and 

17 treat such disparities.

Æ