II 

108TH CONGRESS 

1ST SESSION S. 1833

To improve the health of minority individuals. 

IN THE SENATE OF THE UNITED STATES 

NOVEMBER 6, 2003

Mr. DASCHLE (for himself, Mr. KENNEDY, Mr. BINGAMAN, Mr. AKAKA, Mrs. 

CLINTON, Mr. CORZINE, Mr. DODD, Mr. DURBIN, Mr. EDWARDS, Mr. 

INOUYE, Mr. KERRY, Mr. LAUTENBERG, Mr. LIEBERMAN, Ms. MIKULSKI, Mrs. MURRAY, and Mr. SCHUMER) introduced the following bill; 

which was read twice and referred to the Committee on Health, Education, Labor, and Pensions 

A BILL

To improve the health of minority individuals.

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

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

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

5 ‘‘Healthcare Equality and Accountability Act’’. 

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 and purpose. 

TITLE I—COVERAGE OF THE UNINSURED 

Subtitle A—FamilyCare 
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Sec. 101. Short title. 

Sec. 102. Renaming of title XXI program. 

Sec. 103. Familycare coverage of parents under the medicaid program and title 

XXI. 

Sec. 104. Automatic enrollment of children born to title XXI parents. 

Sec. 105. Optional coverage of children through age 20 under the medicaid program and title XXI. 

Sec. 106. Allowing States to simplify rules for families. 

Sec. 107. Demonstration programs to improve medicaid and CHIP outreach to 

homeless individuals and families. 

Sec. 108. Additional CHIP revisions. 

Sec. 109. Coordination of title XXI with the maternal and child health program. 

Subtitle B—State Option To Provide Coverage for All Residents With Income 

At or Below the Poverty Line 

Sec. 121. State option to provide coverage for all residents with income at or 

below the poverty line. 

Subtitle C—Optional Coverage of Legal Immigrants under the Medicaid 

Program and Title XXI 

Sec. 131. Equal access to health coverage for legal immigrants. 

Subtitle D—Indian Healthcare Funding 

CHAPTER 1—GUARANTEED FUNDING

Sec. 141. Guaranteed adequate funding for Indian healthcare. 

CHAPTER 2—INDIAN HEALTHCARE PROGRAMS

Sec. 145. Programs operated by Indian tribes and tribal organizations. 

Sec. 146. Licensing. 

Sec. 147. Authorization for emergency contract health services. 

Sec. 148. Prompt action on payment of claims. 

Sec. 149. Liability for payment. 

Sec. 150. Health services for ineligible persons. 

Sec. 151. Definitions. 

Sec. 152. Authorization of appropriations. 

Subtitle E—Territories 

Sec. 161. Funding for territories. 

Subtitle F—Migrant Workers and Farmworkers Health 

Sec. 171. Demonstration project regarding continuity of coverage of migrant 

workers and farmworkers under medicaid and CHIP. 

Subtitle G—Expanded Access to Health Care 

Sec. 181. National Commission for Expanded Access to Health Care. 

TITLE II—CULTURALLY AND LINGUISTICALLY APPROPRIATE 

HEALTHCARE 

Sec. 201. Amendment to the Public Health Service Act. 
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‘‘TITLE XXIX—MINORITY HEALTH 

‘‘Sec. 2900. Definitions. 

‘‘Subtitle A—Culturally and Linguistically Appropriate Healthcare 

‘‘Sec. 2901. Improving access to services for individuals with Limited 

English Proficiency. 

‘‘Sec. 2902. National standards for culturally and linguistically appropriate 

services in healthcare. 

‘‘Sec. 2903. Center for Cultural and Linguistic Competence in Healthcare. 

‘‘Sec. 2904. Innovations in language access grants. 

‘‘Sec. 2905. Research on language access. 

‘‘Sec. 2906. Toll-free telephone number. 

Sec. 203. Standards for language access services. 

Sec. 204. Federal reimbursement for culturally and linguistically appropriate 

services under the medicare, medicaid and State Children’s 

Health Insurance Program. 

Sec. 205. Increasing understanding of health literacy. 

Sec. 206. Report on Federal efforts to provide culturally and linguistically appropriate healthcare services. 

Sec. 207. General Accounting Office report on impact of language access services. 

TITLE III—HEALTH WORKFORCE DIVERSITY 

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

‘‘Subtitle B—Workforce Diversity 

‘‘Sec. 2911. Report on workforce diversity. 

‘‘Sec. 2912. National working group on workforce diversity. 

‘‘Sec. 2913. Technical clearinghouse for health workforce diversity. 

‘‘Sec. 2914. Evaluation of workforce diversity initiatives. 

‘‘Sec. 2915. Data collection and reporting by health professional schools. 

‘‘Sec. 2916. Support for institutions committed to workforce diversity. 

‘‘Sec. 2917. Career development for scientists and researchers. 

‘‘Sec. 2918. Career support for non-research health professionals. 

‘‘Sec. 2919. Research on the effect of workforce diversity on quality. 

‘‘Sec. 2920. Health disparities education program. 

‘‘Sec. 2920A. Cultural competence training for healthcare professionals. 

Sec. 302. Health careers opportunity program. 

Sec. 303. Program of excellence in health professions education for underrepresented minorities. 

Sec. 304. Hispanic-serving health professions schools. 

Sec. 305. Health professions student loan fund; authorizations of appropriations regarding students from disadvantaged backgrounds. 

Sec. 306. National Health Service Corps; recruitment and fellowships for individuals from disadvantaged backgrounds. 

Sec. 307. Loan repayment program of Centers for Disease Control and Prevention. 

Sec. 308. Cooperative agreements for online degree programs at schools of public health and schools of allied health. 

Sec. 309. Mid-career health professions scholarship program. 

Sec. 310. National report on the preparedness of health professionals to care 

for diverse populations. 

Sec. 311. Scholarship and fellowship programs. 
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‘‘Sec. 2920B. David Satcher Public Health and Health Services Corps. 

‘‘Sec. 2920C. Louis Stokes Public Health Scholars Program. 

‘‘Sec. 2920D. Patsy Mink Health and Gender Research Fellowship Program. 

‘‘Sec. 2920E. Paul David Wellstone International Health Fellowship Program. 

‘‘Sec. 2920F. Edward R. Roybal Healthcare Scholar Program. 

TITLE IV—REDUCING DISEASE AND DISEASE-RELATED 

COMPLICATIONS 

Subtitle A—Eliminating Disparities in Prevention, Detection, and Treatment 

of Disease 

CHAPTER 1—GENERAL PROVISIONS

Sec. 401. Guidelines for disease screening for minority patients. 

Sec. 402. Preventive health services block grants, use of allotments. 

Sec. 403. Program for increasing immunization rates for adults and adolescents; collection of additional immunization data. 

Sec. 404. Innovative chronic disease management programs. 

Sec. 405. Grants for racial and ethnic approaches to community health. 

Sec. 406. IOM study request. 

Sec. 407. Strategic plan. 

CHAPTER 2—ENVIRONMENTAL JUSTICE

Sec. 410. Short title; purposes. 

Sec. 411. Definitions. 

Sec. 412. Environmental justice responsibilities of Federal agencies. 

Sec. 413. Interagency environmental justice working group. 

Sec. 414. Federal agency strategies. 

Sec. 415. Federal Environmental Justice Advisory Committee. 

Sec. 416. Human health and environmental research, data collection and analysis. 

CHAPTER 3—BORDER HEALTH

Sec. 421. Short title.

Sec. 422. Definitions. 

Sec. 423. Border health grants. 

Sec. 424. United States-Mexico Border Health Commission Act Amendments. 

‘‘Sec. 9. Authorization of appropriations. 

CHAPTER 4—PATIENT NAVIGATOR, OUTREACH, AND CHRONIC DISEASE

PREVENTION

Sec. 425. Short title. 

Sec. 426. HRSA grants for model community cancer and chronic disease care 

and prevention; HRSA grants for patient navigators. 

Sec. 427. NCI grants for model community cancer and chronic disease care and 

prevention; NCI grants for patient navigators. 

Sec. 428. IHS grants for model community cancer and chronic disease care and 

prevention; IHS grants for patient navigators. 

CHAPTER 5—COMMUNITY HEALTH WORKERS

Sec. 431. Short title. 
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Sec. 432. Grants to promote positive health behaviors in women. 

CHAPTER 6—HEALTH EMPOWERMENT ZONES

Sec. 440. Health empowerment zones. 

Subtitle B—Targeting Diseases and Conditions with Particularly Disparate 

Impact 

CHAPTER 1—CANCER REDUCTION

Sec. 441. Cancer reduction. 

CHAPTER 2—HIV/AIDS REDUCTION

Sec. 442. HIV/AIDS reduction. 

CHAPTER 3—INFANT MORTALITY REDUCTION

Sec. 443. Infant mortality reduction. 

CHAPTER 4—FETAL ALCOHOL SYNDROME TREATMENT AND DIAGNOSIS

Sec. 444. Fetal alcohol syndrome. 

CHAPTER 5—DIABETES PREVENTION AND TREATMENT

Sec. 445. Monitoring the quality of and disparities in diabetes care. 

Sec. 446. Diabetes prevention, treatment, and control. 

Sec. 447. Genetics of diabetes. 

Sec. 448. Research and training on diabetes in underserved and minority populations. 

Sec. 449. Authorization of appropriations. 

Sec. 450. Model community diabetes and chronic disease care and prevention 

among Pacific Islanders and Native Hawaiians. 

Sec. 451. Programs of Centers for Disease Control and Prevention. 

CHAPTER 6—STROKE AND HEART DISEASE PREVENTION AND TREATMENT

Sec. 455. Systems for heart disease and stroke. 

‘‘Subtitle D—Systems for Heart Disease and Stroke 

‘‘CHAPTER 1—HEART DISEASE

‘‘Sec. 2941. Heart disease. 

‘‘CHAPTER 2—STROKE EDUCATION CAMPAIGN

‘‘Sec. 2945. Stroke education campaign. 

CHAPTER 7—OBESITY AND OVERWEIGHT REDUCTION

Sec. 461. Overweight and obesity prevention and treatment. 

CHAPTER 8—TUBERCULOSIS CONTROL, PREVENTION, AND TREATMENT

Sec. 465. Advisory council for the elimination of tuberculosis. 

Sec. 466. National program for tuberculosis elimination. 

Sec. 467. Inclusion of inpatient hospital services for the treatment of TB-infected individuals. 
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CHAPTER 9—ASTHMA

Sec. 471. Provisions regarding national asthma education and prevention program of National Heart, Lung, and Blood Institute. 

Sec. 472. Asthma-related activities of Centers for Disease Control and Prevention. 

Sec. 473. Grants for community outreach regarding asthma information, education, and services. 

Sec. 474. Action plans of local educational agencies regarding asthma. 

CHAPTER 10—SICKLE CELL DISEASE

Sec. 481. Demonstration program for the development and establishment of 

systemic mechanisms for the prevention and treatment of sickle 

cell disease. 

CHAPTER 11—AUTOIMMUNE DISEASE IN MINORITY POPULATIONS

Sec. 482. Research funding for autoimmune disease in minority populations. 

CHAPTER 12—PREVENTION AND CONTROL OF SEXUALLY TRANSMITTED

DISEASES

Sec. 485. Prevention and control of sexually transmitted diseases. 

CHAPTER 13—DENTAL DISEASE

Sec. 486. Grants to improve the provision of dental services under medicaid 

and SCHIP. 

Sec. 487. State option to provide wrap-around SCHIP coverage to children who 

have other health coverage. 

Sec. 488. Grants to improve the provision of dental health services through 

community health centers and public health departments. 

CHAPTER 14—PREVENTION AND CONTROL OF INJURIES

Sec. 491. Prevention and control of injuries. 

CHAPTER 15—UTERINE FIBROID RESEARCH AND EDUCATION

Sec. 495. Research with respect to uterine fibroids. 

Sec. 496. Information and education with respect to uterine fibroids. 

TITLE V—DATA COLLECTION AND REPORTING 

Subtitle A—General Provisions 

Sec. 501. Amendment to the Public Health Service Act. 

‘‘Subtitle E—Data Collection and Reporting 

‘‘Sec. 2951. Data on race, ethnicity and primary language. 

‘‘Sec. 2952. Provisions relating to Native Americans. 

Sec. 502. Collection of race and ethnicity data by the Social Security Administration. 

Sec. 503. Revision of HIPAA claims standards. 

Sec. 504. National Center for Health Statistics. 

Subtitle B—Minority Health and Genomics Commission 
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Sec. 511. Short title. 

Sec. 512. Minority Health and Genomics Commission. 

Sec. 513. Report. 

Sec. 514. Membership. 

Sec. 515. Powers of Commission. 

Sec. 516. Termination. 

TITLE VI—ACCOUNTABILITY 

Sec. 601. Report on workforce diversity. 

Sec. 602. Federal agency plan to eliminate disparities and improve the health 

of minority populations. 

Sec. 603. Accountability within the Department of Health and Human Services. 

‘‘Subtitle F—Accountability 

‘‘Sec. 2961. Elevation of the Office of Civil Rights. 

‘‘Sec. 2962. Establishment of Health Program Offices for Civil Rights 

within Federal health and human services agencies. 

Sec. 604. Office of Minority Health. 

Sec. 605. Establishment of the Indian Health Service as an agency of the Public Health Service. 

Sec. 606. Office of Minority Health at the Centers for Medicare and Medicaid 

Services. 

Sec. 607. Office of Minority Affairs at the Food and Drug Administration. 

Sec. 608. Safety and effectiveness of drugs with respect to racial and ethnic 

background. 

Sec. 609. United States Commission on Civil Rights. 

Sec. 610. Sense of Congress concerning full funding of activities to eliminate 

racial and ethnic health disparities. 

TITLE VII—STRENGTHENING HEALTH INSTITUTIONS THAT 

PROVIDE HEALTHCARE TO MINORITY POPULATIONS 

Sec. 701. Amendment to the Public Health Service Act. 

‘‘Subtitle G—Strengthening Health Institutions that Provide Healthcare to 

Minority Populations 

‘‘CHAPTER 1—GENERAL PROGRAMS

‘‘Sec. 2971. Grant support for quality improvement initiatives. 

‘‘Sec. 2971A. Centers of excellence. 

‘‘Sec. 2971B. Consultation, construction and renovation of American Indian and Alaska Native facilities; reports. 

‘‘Sec. 2971C. Reconstruction and improvement grants for public health 

care facilities serving Pacific Islanders and the insular 

areas. 

‘‘CHAPTER 2—NATIONAL HEALTH SAFETY NET INFRASTRUCTURE

‘‘SUBCHAPTER A—GENERAL PROVISIONS

‘‘Sec. 2972. Payments to healthcare facilities. 

‘‘Sec. 2972A. Application for assistance. 

‘‘Sec. 2972B. Public service responsibilities. 

‘‘Sec. 2972C. Health Safety Net Infrastructure Trust Fund. 

‘‘Sec. 2972D. Administration. 
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‘‘SUBCHAPTER B—LOAN GUARANTEES

‘‘Sec. 2973. Provision of loan guarantees to safety net healthcare facilities. 

‘‘Sec. 2973A. Eligible loans. 

‘‘Sec. 2973B. Guarantee allotments. 

‘‘Sec. 2973C. Terms and conditions of loan guarantees. 

‘‘Sec. 2973D. Premiums for loan guarantees. 

‘‘Sec. 2973E. Procedures in the event of loan default. 

‘‘SUBCHAPTER C—GRANTS FOR URGENT CAPITAL NEEDS

‘‘Sec. 2976. Provision of grants. 

‘‘Sec. 2976B. Eligible projects. 

TITLE VIII—MISCELLANEOUS PROVISIONS 

Sec. 801. Definitions. 

Sec. 802. Davis-Bacon Act.

1 SEC. 2. FINDINGS AND PURPOSE. 

2 (a) FINDINGS.—Congress makes the following find3 ings: 

4 (1) Despite significant advances in public 

5 health and health care, the health status of racial 

6 and ethnic minority populations continues to lag be7 hind that of the white population. 

8 (2) The United States is becoming increasingly 

9 diverse. According to the 2000 United States Cen10 sus, African Americans, American Indians and Alas11 ka Natives, Asians, Hispanics, and Native Hawai12 ians and other Pacific Islanders comprise 30 percent 

13 of the United States population. Racial and ethnic 

14 minorities are expected to comprise 40 percent of 

15 the United States population by 2030. 

16 (3) To improve the health care of racial and 

17 ethnic minorities and to reduce and eliminate dis-
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1 parities in health care and health outcomes, the fol2 lowing issues must be addressed: 

3 (A) NEED FOR INSURANCE COVERAGE.—

4 (i) Disparities in health status can be 

5 attributed largely to underlying differences 

6 in socioeconomic status and insurance cov7 erage. Minorities are at a greater risk of 

8 being uninsured than their white counter9 parts. Lack of health insurance has con10 sistently been associated with worse health 

11 outcomes. 

12 (ii) Even after adjusting for dif13 ferences in socioeconomic and insurance 

14 status, however, racial and ethnic health 

15 and health care disparities remain. 

16 (iii) Through treaties and Federal 

17 statutes, the Federal Government has es18 tablished a trust responsibility to provide 

19 health care to American Indians and Alas20 ka Natives. In the Indian Health Amend21 ments of 1992, Congress specifically 

22 pledged to ‘‘assure the highest possible 

23 health status for Indians and urban Indi24 ans and to provide all resources necessary 

25 to effect that policy.’’ Despite those com-
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1 mitments, the unmet health needs of 

2 American Indians and Alaska Natives re3 main alarmingly severe and their health 

4 status is far below the health status of the 

5 general population of the United States. 

6 The critical shortfall of funding for the In7 dian Health Service is a major source of 

8 this problem. 

9 (B) NEED FOR CULTURALLY AND LINGUIS10 TICALLY APPROPRIATE CARE.—

11 (i) Limited English proficiency ad12 versely affects the care of many racial and 

13 ethnic minority patients. The lack of avail14 able interpretation and translation services 

15 or bilingual providers contributes to racial 

16 and ethnic disparities in health and health 

17 care. The Federal Government provides 

18 and funds an array of services that should 

19 be made accessible to eligible persons who 

20 are not proficient in the English language. 

21 (ii) Title VI of the Civil Rights Act of 

22 1964 (42 U.S.C. 2000d et seq.) prohibits 

23 discrimination on the basis of race, color, 

24 and national origin in programs and activi25 ties receiving Federal financial assistance. 
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1 Discrimination on the basis of primary lan2 guage has consistently been interpreted as 

3 discrimination on the basis of national ori4 gin. 

5 (iii) The provision of effective lan6 guage services has been shown to improve 

7 care for limited English proficient (re8 ferred to in this section as ‘‘LEP’’) pa9 tients by increasing patient satisfaction, 

10 access to care, compliance with rec11 ommended medical advice, and appropriate 

12 utilization. 

13 (iv) A 2002 study by the Office of 

14 Management and Budget found that lan15 guage assistance services can substantially 

16 improve the health and quality of life of 

17 LEP individuals and their families, in18 crease the efficiency of distribution of gov19 ernment services to LEP individuals, and 

20 measurably increase the effectiveness of 

21 public health and safety programs. 

22 (v) The same study estimated that 

23 language translation services would only 

24 increase the cost of the average health care 

25 visit by less than one percent. 
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1 (C) NEED FOR HEALTH WORKFORCE DI2 VERSITY.—

3 (i) Research has demonstrated that 

4 minority health professionals dramatically 

5 increase access to care for minority pa6 tients and improve the quality of care that 

7 they receive. African Americans, American 

8 Indians and Alaska Natives, Hispanics, 

9 Native Hawaiians and other Pacific Island10 ers, and Southeast Asians are significantly 

11 underrepresented in the health professions, 

12 exacerbating health disparities. 

13 (ii) Minority physicians are more like14 ly than white physicians to serve minority 

15 populations. Nearly 40 percent of all mi16 nority medical school graduates will prac17 tice medicine in underserved areas, com18 pared to 10 percent of their white col19 leagues. 

20 (iii) Minorities often report experi21 ences with discrimination when seeking 

22 health care. 

23 (iv) There is substantial evidence to 

24 demonstrate that race concordance be25 tween physicians and patients increases 
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1 patient satisfaction and participation in 

2 health decisionmaking. 

3 (v) Minority health care providers can 

4 bridge linguistic, cultural, and other bar5 riers that hamper access to care. 

6 (vi) African Americans, Hispanics, 

7 and American Indians remain severely 

8 underrepresented in health professions 

9 schools. African Americans and Hispanics 

10 constitute 20 percent and 16 percent, re11 spectively, of the students in public health 

12 and baccalaureate nursing programs, and 

13 less than 15 percent of students in all 

14 other health professions. 

15 (vi) The number of minorities enroll16 ing in health professional schools has re17 mained stagnant. For example, in 1994, 

18 1,307 African American and 1,090 His19 panic students enrolled in American med20 ical colleges. In 2000, the figures were es21 sentially unchanged at 1,307 African 

22 American and 1,033 Hispanic students. 

23 (D) NEED FOR REDUCTION OF DISEASE

24 OCCURRENCE AND DISEASE-RELATED COM25 PLICATIONS AMONG MINORITIES.—
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1 (i) Despite notable progress in the 

2 overall health of the Nation, there are con3 tinuing disparities in the burden of illness 

4 and death experienced by minorities com5 pared to the United States population as a 

6 whole. Minority populations are dispropor7 tionately impacted by acute and chronic 

8 diseases. 

9 (ii) Despite suffering a greater burden 

10 of acute and chronic disease, minorities are 

11 less likely to receive needed health care. 

12 Numerous studies have documented that 

13 minorities receive less preventive care, 

14 medical therapy, and surgical interven15 tions. 

16 (E) NEED FOR MINORITY HEALTH DATA

17 COLLECTION AND REPORTING.—

18 (i) Efforts to study disparities in 

19 health and health care for minorities have 

20 been hampered by the lack of available 

21 data on race, ethnicity, and primary lan22 guage. 

23 (ii) Data collection, analysis, and re24 porting by race, ethnicity, and primary lan25 guage is permissible under the law and 
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1 necessary to assure equity and non2 discrimination in the quality of health care 

3 services. Collection, analysis, and reporting 

4 of such data is authorized under Title VI 

5 of the Civil Rights Act of 1964 (42 U.S.C. 

6 2000d et seq.). Such collection, analysis, 

7 and reporting should be conducted with ap8 propriate privacy protections in place. 

9 (F) NEED FOR GREATER ACCOUNTABILITY

10 IN GOVERNMENT INSTITUTIONS.—A number of 

11 studies have shown that differences in health 

12 care quality contribute to health disparities 

13 among minority populations. These differences 

14 may result from bias, stereotyping, and dis15 crimination. Government institutions must be 

16 held accountable for the quality of healthcare 

17 delivered to all patient populations and result18 ant health outcomes. 

19 (G) NEED FOR STRENGTHENING HEALTH

20 INSTITUTIONS THAT PROVIDE CARE TO MINOR21 ITY POPULATIONS.—

22 (i) A small segment of health care in23 stitutions provide a disproportionate 

24 amount of health care to minority popu25 lations. 
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1 (ii) Safety net institutions, including 

2 public hospitals, community health centers 

3 and community clinics, provide a dis4 proportionate share of health care to mi5 nority and underserved populations. 

6 (iii) Financial stress, negative oper7 ating margins, and the overall burden of 

8 caring for the uninsured and delivering 

9 high-cost specialty care to the entire com10 munity place undue pressure on core safety 

11 net providers. These providers are increas12 ingly challenged in their ability to meet the 

13 day-to-day needs of their patients. 

14 (b) PURPOSES.—It is the purpose of this Act to im15 prove the health and healthcare of minority populations 

16 and to eliminate racial and ethnic disparities in health and 

17 healthcare by—

18 (1) increasing access to health care for all pop19 ulations; 

20 (2) expanding culturally and linguistically ap21 propriate health services for all populations; 

22 (3) promoting health workforce diversity; 

23 (4) supporting and expanding programs and ac24 tivities that will improve the prevention, diagnosis, 

25 and management of disease in minority populations; 
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1 (5) enhancing racial, ethnic, and primary lan2 guage health data collection at the local, State, and 

3 Federal level; 

4 (6) ensuring accountability for the quality of 

5 health care and health outcomes for minority popu6 lations; and 

7 (7) strengthening the technical and financial re8 sources of the safety net institutions of the United 

9 States. 

10 TITLE I—COVERAGE OF THE 

11 UNINSURED 

12 Subtitle A—FamilyCare 

13 SEC 101. SHORT TITLE. 

14 This subtitle may be cited as the ‘‘FamilyCare Act 

15 of 2003’’. 

16 SEC. 102. RENAMING OF TITLE XXI PROGRAM. 

17 (a) IN GENERAL.—The heading of title XXI of the 

18 Social Security Act (42 U.S.C. 1397aa et seq.) is amended 

19 to read as follows: 

20 ‘‘TITLE XXI—FAMILYCARE PROGRAM’’. 

21 (b) PROGRAM REFERENCES.—Any reference in any 

22 provision of Federal law or regulation to ‘‘SCHIP’’ or 

23 ‘‘State children’s health insurance program’’ under title 

24 XXI of the Social Security Act shall be deemed a reference 

25 to the FamilyCare program under such title. 
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1 SEC. 103. FAMILYCARE COVERAGE OF PARENTS UNDER 

2 THE MEDICAID PROGRAM AND TITLE XXI. 

3 (a) INCENTIVES TO IMPLEMENT FAMILYCARE COV4 ERAGE.—

5 (1) UNDER MEDICAID.—

6 (A) ESTABLISHMENT OF NEW OPTIONAL

7 ELIGIBILITY CATEGORY.—Section 1902(a)(10) 

8 (A)(ii) of the Social Security Act (42 U.S.C. 

9 1396a(a)(10)(A)(ii)) is amended—

10 (i) by striking ‘‘or’’ at the end of sub11 clause (XVII); 

12 (ii) by adding ‘‘or’’ at the end of sub13 clause (XVIII); and 

14 (iii) by adding at the end the fol15 lowing: 

16 ‘‘(XIX) who are individuals de17 scribed in subsection (k)(1) (relating 

18 to parents of categorically eligible chil19 dren);’’. 

20 (B) PARENTS DESCRIBED.—Section 1902 

21 of the Social Security Act is further amended 

22 by inserting after subsection (j) the following: 

23 ‘‘(k)(1)(A) Individuals described in this paragraph 

24 are individuals—

25 ‘‘(i) who are the parents of an individual who 

26 is under 19 years of age (or such higher age as the 
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•S 1833 IS 

1 State may have elected under section 1902(l)(1)(D)) 

2 and who is eligible for medical assistance under sub3 section (a)(10)(A); 

4 ‘‘(ii) who are not otherwise eligible for medical 

5 assistance under such subsection or under a waiver 

6 approved under section 1115 or otherwise (except 

7 under section 1931 or under subsection 

8 (a)(10)(A)(ii)(XIX)); and 

9 ‘‘(iii) whose family income or resources exceeds 

10 the effective income level or resource level applicable 

11 under the State plan under part A of title IV as in 

12 effect as of July 16, 1996, but does not exceed the 

13 highest effective income or resource level (if any) ap14 plicable to a child in the family under this title. 

15 ‘‘(B) In establishing an income eligibility level for in16 dividuals described in this paragraph, a State may vary 

17 such level consistent with the various income levels estab18 lished under subsection (l)(2) in order to ensure, to the 

19 maximum extent possible, that such individuals shall be 

20 enrolled in the same program as their children. 

21 ‘‘(C) An individual may not be treated as being de22 scribed in this paragraph unless, at the time of the individ23 ual’s enrollment under this title, the child referred to in 

24 subparagraph (A)(i) of the individual is also enrolled 

25 under this title or otherwise insured. 
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1 ‘‘(D) In this subsection, the term ‘parent’ includes 

2 an individual treated as a caretaker for purposes of car3 rying out section 1931. 

4 ‘‘(E) In this subsection, the term ‘effective income 

5 level’ means the income level expressed as a percent of 

6 the poverty line and considering applicable income dis7 regards. 

8 ‘‘(2) The State shall provide for coverage of a parent 

9 described in paragraph (1) or section 2111 of a child who 

10 is covered under this title or title XXI under the same 

11 title as the title as such child is covered. In the case of 

12 a parent described in paragraph (1) who is also the parent 

13 of a child who is eligible for child health assistance under 

14 title XXI, the State may elect (on a uniform basis) to 

15 cover all such parents under section 2111 or under this 

16 title.’’. 

17 (C) ENHANCED MATCHING FUNDS AVAIL18 ABLE IF CERTAIN CONDITIONS MET.—Section 

19 1905 of the Social Security Act (42 U.S.C. 

20 1396d) is amended—

21 (i) in the fourth sentence of sub22 section (b), by striking ‘‘or subsection 

23 (u)(3)’’ and inserting ‘‘, (u)(3), or (u)(4)’’; 

24 and 

25 (ii) in subsection (u)—
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•S 1833 IS 

1 (I) by redesignating paragraph 

2 (4) as paragraph (6), and 

3 (II) by inserting after paragraph 

4 (3) the following:

5 ‘‘(4) For purposes of subsection (b) and section 

6 2105(a)(1): 

7 ‘‘(A) FAMILYCARE PARENTS.—The expendi8 tures described in this subparagraph are the expend9 itures described in the following clauses (i) and (ii): 

10 ‘‘(i) PARENTS.—If the conditions described 

11 in clauses (iii) and (iv) are met, expenditures 

12 for medical assistance for parents described in 

13 section 1902(k)(1) and for parents who would 

14 be described in such section but for the fact 

15 that they are eligible for medical assistance 

16 under section 1931 or under a waiver approved 

17 under section 1115. 

18 ‘‘(ii) CERTAIN PREGNANT WOMEN.—If the 

19 conditions described in clause (v) are met, ex20 penditures for medical assistance for pregnant 

21 women described in subsection (n) or under sec22 tion 1902(l)(1)(A) in a family the income of 

23 which exceeds the effective income level applica24 ble under subsection (a)(10)(A)(i)(III) or 
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1 (l)(2)(A) of section 1902 to a family of the size 

2 involved as of January 1, 2004. 

3 ‘‘(iii) CONDITIONS RELATING TO ENSURING

4 CHILDREN’S COVERAGE FOR ENHANCED MATCH

5 FOR PARENTS.—The conditions described in 

6 this clause are the following: 

7 ‘‘(I) The State has a State child 

8 health plan under title XXI which (wheth9 er implemented under such title or under 

10 this title) has an effective income level for 

11 children that is at least 200 percent of the 

12 poverty line. 

13 ‘‘(II) Such State child health plan 

14 does not limit the acceptance of applica15 tions, does not use a waiting list for chil16 dren who meet eligibility standards to 

17 qualify for assistance, and provides bene18 fits to all children in the State who apply 

19 for and meet eligibility standards. 

20 ‘‘(III) Effective for determinations of 

21 eligibility made on or after the date that is 

22 1 year after the date of the enactment of 

23 this clause, the application and renewal 

24 procedures for individuals under 19 years 

25 of age (or such higher age as the State has 
23

•S 1833 IS 

1 elected under section 1902(l)(1)(D)) for 

2 medical assistance under section 

3 1902(a)(10)(A) are not be more restrictive 

4 or burdensome than such procedures used 

5 for children with higher income under the 

6 State child health plan under title XXI. 

7 ‘‘(iv) CONDITIONS RELATING TO MINIMUM

8 COVERAGE FOR PARENTS FOR ENHANCED

9 MATCH FOR PARENTS.—The conditions de10 scribed in this clause are the following: 

11 ‘‘(I) The State does not apply an in12 come level for parents that is lower than 

13 the effective income level (expressed as a 

14 percent of the poverty line) that has been 

15 specified under the State plan under title 

16 XIX (including under a waiver authorized 

17 by the Secretary or under section 

18 1902(r)(2)), as of January 1, 2004, to be 

19 eligible for medical assistance as a parent 

20 under this title. 

21 ‘‘(II) The State plans under this title 

22 and title XXI do not provide coverage for 

23 parents with higher family income without 

24 covering parents with a lower family in25 come. 
24

•S 1833 IS 

1 ‘‘(v) CONDITIONS FOR ENHANCED MATCH

2 FOR CERTAIN PREGNANT WOMEN.—The condi3 tions described in this clause are the following: 

4 ‘‘(I) The State has established an ef5 fective income eligibility level for pregnant 

6 women under subsection (a)(10)(A)(i)(III) 

7 or (l)(2)(A) of section 1902 that is at least 

8 185 percent of the poverty line. 

9 ‘‘(II) The State plans under this title 

10 and title XXI do not provide coverage for 

11 pregnant women described in subpara12 graph (A)(ii) with higher family income 

13 without covering such pregnant women 

14 with a lower family income. 

15 ‘‘(III) The State does not apply an in16 come level for pregnant women that is 

17 lower than the effective income level that 

18 has been specified under the State plan 

19 under subsection (a)(10)(A)(i)(III) or 

20 (l)(2)(A) of section 1902, as of January 1, 

21 2004, to be eligible for medical assistance 

22 as a pregnant woman. 

23 ‘‘(IV) The State satisfies the condi24 tions described in subclauses (I) and (II) 

25 of clause (iii). 
25

•S 1833 IS 

1 ‘‘(vi) DEFINITIONS.—For purposes of this 

2 subsection: 

3 ‘‘(I) The term ‘parent’ has the mean4 ing given such term for purposes of section 

5 1902(k)(1). 

6 ‘‘(II) The term ‘poverty line’ has the 

7 meaning given such term in section 

8 2110(c)(5).’’. 

9 (D) APPROPRIATION FROM TITLE XXI AL10 LOTMENT FOR CERTAIN MEDICAID EXPANSION

11 COSTS.—Section 2105(a) of the Social Security 

12 Act (42 U.S.C. 1397ee(a)) is amended—

13 (i) in paragraph (1), by redesignating 

14 subparagraphs (B) through (D) as sub15 paragraphs (C) through (E), respectively, 

16 and by inserting after subparagraph (A) 

17 the following new subparagraph: 

18 ‘‘(B) for medical assistance that is attrib19 utable to expenditures described in section 

20 1905(u)(4)(A);’’; and 

21 (ii) in paragraph (2), by adding at the 

22 end the following new subparagraph: 

23 ‘‘(E) Fifth, for expenditures for items de24 scribed in paragraph (1)(E).’’. 

25 (2) UNDER TITLE XXI.—
26

•S 1833 IS 

1 (A) FAMILYCARE COVERAGE.—Title XXI 

2 of the Social Security Act (42 U.S.C. 1397aa et 

3 seq.) is amended by adding at the end the fol4 lowing: 

5 ‘‘SEC. 2111. OPTIONAL FAMILYCARE COVERAGE OF PAR6 ENTS OF TARGETED LOW-INCOME CHILDREN. 

7 ‘‘(a) OPTIONAL COVERAGE.—Notwithstanding any 

8 other provision of this title, a State may provide for cov9 erage, through an amendment to its State child health 

10 plan under section 2102, of parent health assistance for 

11 targeted low-income parents, health care assistance for 

12 targeted low-income pregnant women, or both, in accord13 ance with this section, but only if—

14 ‘‘(1) with respect to the provision of parent 

15 health assistance, the State meets the conditions de16 scribed in clause (iii) of section 1905(u)(4)(A); 

17 ‘‘(2) with respect to the provision of health care 

18 assistance for pregnant women, the State meets the 

19 conditions described in clause (iv) of section 

20 1905(u)(4)(A); and 

21 ‘‘(3) in the case of parent health assistance for 

22 targeted low-income parents, the State elects to pro23 vide medical assistance under section 

24 1902(a)(10)(A)(ii)(XIX), under section 1931, or 

25 under a waiver under section 1115 to individuals de-
27

•S 1833 IS 

1 scribed in section 1902(k)(1)(A)(i) and elects an ef2 fective income level that, consistent with paragraphs 

3 (1)(B) and (2) of section 1902(k), ensures to the 

4 maximum extent possible, that such individuals shall 

5 be enrolled in the same program as their children if 

6 their children are eligible for coverage under title 

7 XIX (including under a waiver authorized by the 

8 Secretary or under section 1902(r)(2)). 

9 ‘‘(b) DEFINITIONS.—For purposes of this title: 

10 ‘‘(1) PARENT HEALTH ASSISTANCE.—The term 

11 ‘parent health assistance’ has the meaning given the 

12 term child health assistance in section 2110(a) as if 

13 any reference to targeted low-income children were 

14 a reference to targeted low-income parents. 

15 ‘‘(2) PARENT.—The term ‘parent’ has the 

16 meaning given the term ‘caretaker relative’ for pur17 poses of carrying out section 1931. 

18 ‘‘(3) HEALTH CARE ASSISTANCE FOR PREG19 NANT WOMEN.—The term ‘health care assistance for 

20 pregnant women’ has the meaning given the term 

21 child health assistance in section 2110(a) as if any 

22 reference to targeted low-income children were a ref23 erence to targeted low-income pregnant women. 

24 ‘‘(4) TARGETED LOW-INCOME PARENT.—The 

25 term ‘targeted low-income parent’ has the meaning 
28

•S 1833 IS 

1 given the term targeted low-income child in section 

2 2110(b) as if the reference to a child were deemed 

3 a reference to a parent (as defined in paragraph (3)) 

4 of the child; except that in applying such section—

5 ‘‘(A) there shall be substituted for the in6 come level described in paragraph (1)(B)(ii)(I) 

7 the applicable income level in effect for a tar8 geted low-income child; 

9 ‘‘(B) in paragraph (3), January 1, 2004, 

10 shall be substituted for July 1, 1997; and 

11 ‘‘(C) in paragraph (4), January 1, 2004, 

12 shall be substituted for March 31, 1997. 

13 ‘‘(5) TARGETED LOW-INCOME PREGNANT

14 WOMAN.—The term ‘targeted low-income pregnant 

15 woman’ has the meaning given the term targeted 

16 low-income child in section 2110(b) as if any ref17 erence to a child were a reference to a woman dur18 ing pregnancy and through the end of the month in 

19 which the 60-day period beginning on the last day 

20 of her pregnancy ends; except that in applying such 

21 section—

22 ‘‘(A) there shall be substituted for the in23 come level described in paragraph (1)(B)(ii)(I) 

24 the applicable income level in effect for a tar25 geted low-income child; 
29

•S 1833 IS 

1 ‘‘(B) in paragraph (3), January 1, 2004, 

2 shall be substituted for July 1, 1997; and 

3 ‘‘(C) in paragraph (4), January 1, 2004, 

4 shall be substituted for March 31, 1997. 

5 ‘‘(c) REFERENCES TO TERMS AND SPECIAL

6 RULES.—In the case of, and with respect to, a State pro7 viding for coverage of parent health assistance to targeted 

8 low-income parents or health care assistance to targeted 

9 low-income pregnant women under subsection (a), the fol10 lowing special rules apply: 

11 ‘‘(1) Any reference in this title (other than in 

12 subsection (b)) to a targeted low-income child is 

13 deemed to include a reference to a targeted low-in14 come parent or a targeted low-income pregnant 

15 woman (as applicable). 

16 ‘‘(2) Any such reference to child health assist17 ance—

18 ‘‘(A) with respect to such parents is 

19 deemed a reference to parent health assistance; 

20 and 

21 ‘‘(B) with respect to such pregnant women, 

22 is deemed a reference to health care assistance 

23 for pregnant women.

24 ‘‘(3) In applying section 2103(e)(3)(B) in the 

25 case of a family (consisting of a parent and one or 
30

•S 1833 IS 

1 more children) provided coverage under this section 

2 or a pregnant woman provided coverage under this 

3 section without covering other family members, the 

4 limitation on total annual aggregate cost-sharing 

5 shall be applied to such entire family or such preg6 nant woman, respectively. 

7 ‘‘(4) In applying section 2110(b)(4), any ref8 erence to ‘section 1902(l)(2) or 1905(n)(2) (as se9 lected by a State)’ is deemed a reference to the ef10 fective income level applicable to parents under sec11 tion 1931 or under a waiver approved under section 

12 1115, or, in the case of a pregnant woman, the in13 come level established under section 1902(l)(2)(A). 

14 ‘‘(5) In applying section 2102(b)(3)(B), any 

15 reference to children found through screening to be 

16 eligible for medical assistance under the State med17 icaid plan under title XIX is deemed a reference to 

18 parents and pregnant women.’’. 

19 (B) ADDITIONAL ALLOTMENT FOR STATES

20 PROVIDING FAMILYCARE.—

21 (i) IN GENERAL.—Section 2104 of the 

22 Social Security Act (42 U.S.C. 1397dd) is 

23 amended by inserting after subsection (c) 

24 the following: 
31

•S 1833 IS 

1 ‘‘(d) ADDITIONAL ALLOTMENTS FOR STATE PRO2 VIDING FAMILYCARE.—

3 ‘‘(1) APPROPRIATION; TOTAL ALLOTMENT.—

4 For the purpose of providing additional allotments 

5 to States to provide FamilyCare coverage under sec6 tion 2111, there is appropriated, out of any money 

7 in the Treasury not otherwise appropriated—

8 ‘‘(A) for fiscal year 2004, $2,000,000,000; 

9 ‘‘(B) for fiscal year 2005, $2,000,000,000; 

10 ‘‘(C) for fiscal year 2006, $3,000,000,000; 

11 and 

12 ‘‘(D) for fiscal year 2007, $3,000,000,000. 

13 ‘‘(2) STATE AND TERRITORIAL ALLOTMENTS.—

14 ‘‘(A) IN GENERAL.—In addition to the al15 lotments provided under subsections (b) and 

16 (c), subject to paragraphs (3) and (4), of the 

17 amount available for the additional allotments 

18 under paragraph (1) for a fiscal year, the Sec19 retary shall allot to each State with a State 

20 child health plan approved under this title—

21 ‘‘(i) in the case of such a State other 

22 than a commonwealth or territory de23 scribed in clause (ii), the same proportion 

24 as the proportion of the State’s allotment 

25 under subsection (b) (determined without 
32

•S 1833 IS 

1 regard to subsection (f)) to 98.95 percent 

2 of the total amount of the allotments 

3 under such section for such States eligible 

4 for an allotment under this subparagraph 

5 for such fiscal year; and 

6 ‘‘(ii) in the case of a commonwealth or 

7 territory described in subsection (c)(3), the 

8 same proportion as the proportion of the 

9 commonwealth’s or territory’s allotment 

10 under subsection (c) (determined without 

11 regard to subsection (f)) to 1.05 percent of 

12 the total amount of the allotments under 

13 such section for commonwealths and terri14 tories eligible for an allotment under this 

15 subparagraph for such fiscal year. 

16 ‘‘(B) AVAILABILITY AND REDISTRIBUTION

17 OF UNUSED ALLOTMENTS.—In applying sub18 sections (e) and (f) with respect to additional 

19 allotments made available under this subsection, 

20 the procedures established under such sub21 sections shall ensure such additional allotments 

22 are only made available to States which have 

23 elected to provide coverage under section 2111. 

24 ‘‘(3) USE OF ADDITIONAL ALLOTMENT.—Addi25 tional allotments provided under this subsection are 
33

•S 1833 IS 

1 not available for amounts expended before October 

2 1, 2003. Such amounts are available for amounts ex3 pended on or after such date for child health assist4 ance for targeted low-income children, as well as for 

5 parent health assistance for targeted low-income 

6 parents, and health care assistance for targeted low7 income pregnant women. 

8 ‘‘(4) REQUIRING ELECTION TO PROVIDE COV9 ERAGE.—No payments may be made to a State 

10 under this title from an allotment provided under 

11 this subsection unless the State has made an elec12 tion to provide parent health assistance for targeted 

13 low-income parents, or health care assistance for 

14 targeted low-income pregnant women.’’. 

15 (ii) CONFORMING AMENDMENTS.—

16 Section 2104 of the Social Security Act 

17 (42 U.S.C. 1397dd) is amended—

18 (I) in subsection (a), by inserting 

19 ‘‘subject to subsection (d),’’ after 

20 ‘‘under this section,’’; 

21 (II) in subsection (b)(1), by in22 serting ‘‘and subsection (d)’’ after 

23 ‘‘Subject to paragraph (4)’’; and 
34

•S 1833 IS 

1 (III) in subsection (c)(1), by in2 serting ‘‘subject to subsection (d),’’ 

3 after ‘‘for a fiscal year,’’. 

4 (C) NO COST-SHARING FOR PREGNANCY5 RELATED BENEFITS.—Section 2103(e)(2) of 

6 the Social Security Act (42 U.S.C. 

7 1397cc(e)(2)) is amended—

8 (i) in the heading, by inserting ‘‘AND

9 PREGNANCY-RELATED SERVICES’’ after 

10 ‘‘PREVENTIVE SERVICES’’; and 

11 (ii) by inserting before the period at 

12 the end the following: ‘‘and for pregnancy13 related services’’. 

14 (3) EFFECTIVE DATE.—The amendments made 

15 by this subsection apply to items and services fur16 nished on or after October 1, 2003, whether or not 

17 regulations implementing such amendments have 

18 been issued. 

19 (b) RULES FOR IMPLEMENTATION BEGINNING WITH

20 FISCAL YEAR 2005.—

21 (1) EXPANSION OF AVAILABILITY OF EN22 HANCED MATCH UNDER MEDICAID FOR PRE-CHIP

23 EXPANSIONS.—Paragraph (4) of section 1905(u) of 

24 the Social Security Act (42 U.S.C. 1396d(u)), as in25 serted by subsection (a)(1)(C), is amended—
35

•S 1833 IS 

1 (A) by amending clause (ii) of subpara2 graph (A) to read as follows: 

3 ‘‘(ii) CERTAIN PREGNANT WOMEN.—Ex4 penditures for medical assistance for pregnant 

5 women under section 1902(l)(1)(A) in a family 

6 the income of which exceeds the 133 percent of 

7 the income official poverty line, but only if the 

8 income level established under section 

9 1902(l)(2) (or under a Statewide waiver under 

10 section 1115) for pregnant women is 185 per11 cent of the income official poverty line.’’; and 

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

13 ‘‘(B) CHILDREN IN FAMILIES WITH INCOME

14 ABOVE MEDICAID MANDATORY LEVEL NOT PRE15 VIOUSLY DESCRIBED.—The expenditures described 

16 in this subparagraph are expenditures (other than 

17 expenditures described in paragraph (2) or (3)) for 

18 medical assistance made available to any child who 

19 is eligible for assistance under section 

20 1902(a)(10)(A) (other than under clause (i)) and 

21 the income of whose family exceeds the minimum in22 come level required under subsection 1902(l)(2) (or, 

23 if higher, the minimum level required under section 

24 1931 for that State) for a child of the age involved 
36

•S 1833 IS 

1 (treating any child who is 19 or 20 years of age as 

2 being 18 years of age).’’. 

3 (2) OFFSET OF ADDITIONAL EXPENDITURES

4 FOR ENHANCED MATCH FOR PRE-CHIP EXPAN5 SION.—Section 1905 of the Social Security Act (42 

6 U.S.C. 1396d) is amended—

7 (A) in the fourth sentence of subsection 

8 (b), by inserting ‘‘(except in the case of expend9 itures described in subsection (u)(5))’’ after ‘‘do 

10 not exceed’’; 

11 (B) in subsection (u), by inserting after 

12 paragraph (4) (as inserted by subparagraph 

13 (C)), the following: 

14 ‘‘(5) For purposes of the fourth sentence of sub15 section (b) and section 2105(a), the following payments 

16 under this title do not count against a State’s allotment 

17 under section 2104: 

18 ‘‘(A) REGULAR FMAP FOR EXPENDITURES FOR

19 PREGNANT WOMEN WITH INCOME ABOVE 133 PER20 CENT OF POVERTY.—The portion of the payments 

21 made for expenditures described in paragraph 

22 (4)(A)(ii) that represents the amount that would 

23 have been paid if the enhanced FMAP had not been 

24 substituted for the Federal medical assistance per25 centage. 
37

•S 1833 IS 

1 ‘‘(B) FAMILYCARE PARENTS.—Payments for 

2 expenditures described in paragraph (4)(A)(i). 

3 ‘‘(C) REGULAR FMAP FOR EXPENDITURES FOR

4 CERTAIN CHILDREN IN FAMILIES WITH INCOME

5 ABOVE MEDICAID MANDATORY LEVEL.—The portion 

6 of the payments made for expenditures described in 

7 paragraph (4)(B) that represents the amount that 

8 would have been paid if the enhanced FMAP had 

9 not been substituted for the Federal medical assist10 ance percentage.’’. 

11 (B) CONFORMING AMENDMENTS.—Sub12 paragraph (B) of section 2105(a)(1) of the So13 cial Security Act, as amended by subsection 

14 (a)(1)(D), is amended to read as follows: 

15 ‘‘(B) CERTAIN FAMILYCARE PARENTS AND

16 OTHERS.—Expenditures for medical assistance 

17 that is attributable to expenditures described in 

18 section 1905(u)(4), except as provided in sec19 tion 1905(u)(5).’’.

20 (3) EFFECTIVE DATE.—The amendments made 

21 by this subsection apply as of October 1, 2004, to 

22 fiscal years beginning on or after such date and to 

23 expenditures under the State plan on and after such 

24 date, whether or not regulations implementing such 

25 amendments have been issued. 
38

•S 1833 IS 

1 (c) GAO STUDY.—

2 (1) STUDY.—The Comptroller General of the 

3 United States shall conduct a study regarding fund4 ing under title XXI of the Social Security Act that 

5 examines—

6 (A) the adequacy of overall funding under 

7 such title; 

8 (B) the formula for determining allotments 

9 and for redistribution of unspent funds under 

10 such title; and 

11 (C) the effect of waiting lists and caps on 

12 enrollment under such title.

13 (2) REPORT.—Not later than July 1, 2005, the 

14 Comptroller General shall submit a report on the 

15 study conducted under paragraph (1). Such report 

16 shall include recommendations regarding a better 

17 mechanism for determining State allotments and re18 distribution of unspent funds under such title in 

19 order to ensure all eligible families in need can ac20 cess coverage through such title. 

21 (d) CONFORMING AMENDMENTS.—

22 (1) ELIGIBILITY CATEGORIES.—Section 

23 1905(a) of the Social Security Act (42 U.S.C. 

24 1396d(a)) is amended, in the matter before para25 graph (1)—
39

•S 1833 IS 

1 (A) by striking ‘‘or’’ at the end of clause 

2 (xii); 

3 (B) by inserting ‘‘or’’ at the end of clause 

4 (xiii); and 

5 (C) by inserting after clause (xiii) the fol6 lowing: 

7 ‘‘(xiv) who are parents described (or treated as 

8 if described) in section 1902(k)(1),’’. 

9 (2) INCOME LIMITATIONS.—Section 1903(f)(4) 

10 of the Social Security Act (42 U.S.C. 1396b(f)(4)) 

11 is amended by inserting ‘‘1902(a)(10)(A)(ii)(XIX),’’ 

12 after ‘‘1902(a)(10)(A)(ii)(XVIII),’’.

13 (3) CONFORMING AMENDMENT RELATING TO

14 NO WAITING PERIOD FOR PREGNANT WOMEN.—Sec15 tion 2102(b)(1)(B) of the Social Security Act (42 

16 U.S.C. 1397bb(b)(1)(B)) is amended—

17 (A) by striking ‘‘, and’’ at the end of 

18 clause (i) and inserting a semicolon; 

19 (B) by striking the period at the end of 

20 clause (ii) and inserting ‘‘; and’’; and 

21 (C) by adding at the end the following: 

22 ‘‘(iii) may not apply a waiting period 

23 (including a waiting period to carry out 

24 paragraph (3)(C)) in the case of a targeted 

25 low-income parent who is pregnant.’’. 
40

•S 1833 IS 

1 SEC. 104. AUTOMATIC ENROLLMENT OF CHILDREN BORN 

2 TO TITLE XXI PARENTS. 

3 Section 2102(b)(1) of the Social Security Act (42 

4 U.S.C. 1397bb(b)(1)) is amended by adding at the end 

5 the following: 

6 ‘‘(C) AUTOMATIC ELIGIBILITY OF CHIL7 DREN BORN TO A PARENT BEING PROVIDED

8 FAMILYCARE.—Such eligibility standards shall 

9 provide for automatic coverage of a child born 

10 to an individual who is provided assistance 

11 under this title in the same manner as medical 

12 assistance would be provided under section 

13 1902(e)(4) to a child described in such sec14 tion.’’. 

15 SEC. 105. OPTIONAL COVERAGE OF CHILDREN THROUGH 

16 AGE 20 UNDER THE MEDICAID PROGRAM AND 

17 TITLE XXI. 

18 (a) MEDICAID.—

19 (1) IN GENERAL.—Section 1902(l)(1)(D) of the 

20 Social Security Act (42 U.S.C. 1396a(l)(1)(D)) is 

21 amended by inserting ‘‘(or, at the election of a 

22 State, 20 or 21 years of age)’’ after ‘‘19 years of 

23 age’’. 

24 (2) CONFORMING AMENDMENTS.—

25 (A) Section 1902(e)(3)(A) of the Social Se26 curity Act (42 U.S.C. 1396a(e)(3)(A)) is 
41

•S 1833 IS 

1 amended by inserting ‘‘(or 1 year less than the 

2 age the State has elected under subsection 

3 (l)(1)(D))’’ after ‘‘18 years of age’’. 

4 (B) Section 1902(e)(12) of the Social Se5 curity Act (42 U.S.C. 1396a(e)(12)) is amend6 ed by inserting ‘‘or such higher age as the State 

7 has elected under subsection (l)(1)(D)’’ after 

8 ‘‘19 years of age’’. 

9 (C) Section 1920A(b)(1) of the Social Se10 curity Act (42 U.S.C. 1396r–1a(b)(1)) is 

11 amended by inserting ‘‘or such higher age as 

12 the State has elected under section 

13 1902(l)(1)(D)’’ after ‘‘19 years of age’’. 

14 (D) Section 1928(h)(1) of the Social Secu15 rity Act (42 U.S.C. 1396s(h)(1)) is amended by 

16 inserting ‘‘or 1 year less than the age the State 

17 has elected under section 1902(l)(1)(D)’’ before 

18 the period at the end. 

19 (E) Section 1932(a)(2)(A) of the Social 

20 Security Act (42 U.S.C. 1396u–2(a)(2)(A)) is 

21 amended by inserting ‘‘(or such higher age as 

22 the State has elected under section 

23 1902(l)(1)(D))’’ after ‘‘19 years of age’’. 

24 (b) TITLE XXI.—Section 2110(c)(1) of the Social 

25 Security Act (42 U.S.C. 1397jj(c)(1)) is amended by in-
42

•S 1833 IS 

1 serting ‘‘(or such higher age as the State has elected under 

2 section 1902(l)(1)(D))’’. 

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

4 this section take effect on January 1, 2004, and apply to 

5 medical assistance and child health assistance provided on 

6 or after such date, whether or not regulations imple7 menting such amendments have been issued. 

8 SEC. 106. ALLOWING STATES TO SIMPLIFY RULES FOR FAM9 ILIES. 

10 (a) PRESUMPTIVE ELIGIBILITY.—

11 (1) APPLICATION TO PRESUMPTIVE ELIGIBILITY

12 FOR PREGNANT WOMEN UNDER MEDICAID.—Section 

13 1920(b) of the Social Security Act (42 U.S.C. 

14 1396r–1(b)) is amended by adding at the end after 

15 and below paragraph (2) the following flush sen16 tence: 

17 ‘‘The term ‘qualified provider’ includes a qualified entity 

18 as defined in section 1920A(b)(3).’’. 

19 (2) OPTIONAL APPLICATION OF PRESUMPTIVE

20 ELIGIBILITY PROVISIONS TO PARENTS.—Section 

21 1920A of the Social Security Act (42 U.S.C. 1396r–

22 1a) is amended by adding at the end the following: 

23 ‘‘(e) A State may elect to apply the previous provi24 sions of this section to provide for a period of presumptive 

25 eligibility for medical assistance for a parent of a child 
43

•S 1833 IS 

1 with respect to whom such a period is provided under this 

2 section.’’. 

3 (3) APPLICATION UNDER TITLE XXI.—Section 

4 2107(e)(1)(D) of the Social Security Act (42 U.S.C. 

5 1397gg(e)(1)) is amended to read as follows: 

6 ‘‘(D) Sections 1920 and 1920A (relating to 

7 presumptive eligibility).’’. 

8 (b) 12-MONTHS CONTINUOUS ELIGIBILITY.—

9 (1) MEDICAID.—Section 1902(e)(12) of the So10 cial Security Act (42 U.S.C. 1396a(e)(12)) is 

11 amended—

12 (A) by striking ‘‘At the option of the State, 

13 the plan may’’ and inserting ‘‘The plan shall’’; 

14 (B) by striking ‘‘an age specified by the 

15 State (not to exceed 19 years of age)’’ and in16 serting ‘‘19 years of age (or such higher age as 

17 the State has elected under subsection 

18 (l)(1)(D)) or, at the option of the State, who is 

19 eligible for medical assistance as the parent of 

20 such a child’’; and 

21 (C) in subparagraph (A), by striking ‘‘a 

22 period (not to exceed 12 months) ’’ and insert23 ing ‘‘the 12-month period beginning on the 

24 date’’. 
44

•S 1833 IS 

1 (2) TITLE XXI.—Section 2102(b)(2) of such 

2 Act (42 U.S.C. 1397bb(b)(2)) is amended by adding 

3 at the end the following: ‘‘Such methods shall pro4 vide continuous eligibility for children under this 

5 title in a manner that is no less generous than the 

6 12-months continuous eligibility provided under sec7 tion 1902(e)(12) for children described in such sec8 tion under title XIX. If a State has elected to apply 

9 section 1902(e)(12) to parents, such methods may 

10 provide continuous eligibility for parents under this 

11 title in a manner that is no less generous than the 

12 12-months continuous eligibility provided under such 

13 section for parents described in such section under 

14 title XIX.’’. 

15 (3) EFFECTIVE DATE.—The amendments made 

16 by this subsection shall take effect on July 1, 2004 

17 (or, if later, 60 days after the date of the enactment 

18 of this Act), whether or not regulations imple19 menting such amendments have been issued. 

20 (c) PROVISION OF MEDICAID AND CHIP APPLICA21 TIONS AND INFORMATION UNDER THE SCHOOL LUNCH

22 PROGRAM.—Section 9(b)(2)(B) of the Richard B. Russell 

23 National School Lunch Act (42 U.S.C. 1758(b)(2)(B)) is 

24 amended—
45

•S 1833 IS 

1 (1) by striking ‘‘(B) Applications’’ and inserting 

2 ‘‘(B)(i) Applications’’; and 

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

4 ‘‘(ii)(I) Applications for free and reduced price 

5 lunches that are distributed pursuant to clause (i) to par6 ents or guardians of children in attendance at schools par7 ticipating in the school lunch program under this Act shall 

8 also contain information on the availability of medical as9 sistance under title XIX of the Social Security Act (42 

10 U.S.C. 1396 et seq.) and of child health and FamilyCare 

11 assistance under title XXI of such Act, including informa12 tion on how to obtain an application for assistance under 

13 such programs. 

14 ‘‘(II) Information on the programs referred to in sub15 clause (I) shall be provided on a form separate from the 

16 application form for free and reduced price lunches under 

17 clause (i).’’. 

18 SEC. 107. DEMONSTRATION PROGRAMS TO IMPROVE MED19 ICAID AND CHIP OUTREACH TO HOMELESS 

20 INDIVIDUALS AND FAMILIES. 

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

22 Human Services may award demonstration grants to not 

23 more than 7 States (or other qualified entities) to conduct 

24 innovative programs that are designed to improve out25 reach to homeless individuals and families under the pro-
46

•S 1833 IS 

1 grams described in subsection (b) with respect to enroll2 ment of such individuals and families under such pro3 grams and the provision of services (and coordinating the 

4 provision of such services) under such programs. 

5 (b) PROGRAMS FOR HOMELESS DESCRIBED.—The 

6 programs described in this subsection are as follows: 

7 (1) MEDICAID.—The program under title XIX 

8 of the Social Security Act (42 U.S.C. 1396 et seq.). 

9 (2) CHIP.—The program under title XXI of 

10 the Social Security Act (42 U.S.C. 1397aa et seq.). 

11 (3) TANF.—The program under part of A of 

12 title IV of the Social Security Act (42 U.S.C. 601 

13 et seq.). 

14 (4) SAMHSA BLOCK GRANTS.—The program 

15 of grants under part B of title XIX of the Public 

16 Health Service Act (42 U.S.C. 300x–1 et seq.). 

17 (5) FOOD STAMP PROGRAM.—The program 

18 under the Food Stamp Act of 1977 (7 U.S.C. 2011 

19 et seq.). 

20 (6) WORKFORCE INVESTMENT ACT.—The pro21 gram under the Workforce Investment Act of 1999 

22 (29 U.S.C. 2801 et seq.). 

23 (7) WELFARE-TO-WORK.—The welfare-to-work 

24 program under section 403(a)(5) of the Social Secu25 rity Act (42 U.S.C. 603(a)(5)). 
47

•S 1833 IS 

1 (8) OTHER PROGRAMS.—Other public and pri2 vate benefit programs that serve low-income individ3 uals. 

4 (c) APPROPRIATIONS.—For the purposes of carrying 

5 out this section, there is appropriated for fiscal year 2004, 

6 out of any funds in the Treasury not otherwise appro7 priated, $10,000,000, to remain available until expended. 

8 SEC. 108. ADDITIONAL CHIP REVISIONS.

9 (a) LIMITING COST-SHARING TO 2.5 PERCENT FOR

10 FAMILIES WITH INCOME BELOW 150 PERCENT OF POV11 ERTY.—Section 2103(e)(3)(A) of the Social Security Act 

12 (42 U.S.C. 1397cc(e)(3)(A)) is amended—

13 (1) by striking ‘‘and’’ at the end of clause (i); 

14 (2) by striking the period at the end of clause 

15 (ii) and inserting ‘‘; and’’; and 

16 (3) by adding at the end the following new 

17 clause: 

18 ‘‘(iii) total annual aggregate cost19 sharing described in clauses (i) and (ii) 

20 with respect to all such targeted low-in21 come children in a family under this title 

22 that exceeds 2.5 percent of such family’s 

23 income for the year involved.’’. 
48

•S 1833 IS 

1 (b) EMPLOYER COVERAGE WAIVER CHANGES.—Sec2 tion 2105(c)(3) of such Act (42 U.S.C. 1397ee(c)(3)) is 

3 amended—

4 (1) by redesignating subparagraphs (A) and 

5 (B) as clauses (i) and (ii) and indenting appro6 priately; 

7 (2) by designating the matter beginning with 

8 ‘‘Payment may be made’’ as a subparagraph (A) 

9 with the heading ‘‘IN GENERAL’’ and indenting ap10 propriately; and 

11 (3) by adding at the end the following new sub12 paragraph: 

13 ‘‘(B) APPLICATION OF REQUIREMENTS.—

14 In carrying out subparagraph (A)—

15 ‘‘(i) in determining cost-effectiveness, 

16 the Secretary shall measure against family 

17 coverage costs to the extent that a State 

18 has expanded coverage to parents pursuant 

19 to section 2111; 

20 ‘‘(ii) subject to clause (iii), the State 

21 shall provide satisfactory assurances that 

22 the minimum benefits and cost-sharing 

23 protections established under this title are 

24 provided, either through the coverage 
49

•S 1833 IS 

1 under subparagraph (A) or as a supple2 ment to such coverage; and 

3 ‘‘(iii) coverage under such subpara4 graph shall not be considered to violate 

5 clause (ii) because it does not comply with 

6 requirements relating to reviews of health 

7 service decisions if the enrollee involved is 

8 provided the option of being provided bene9 fits directly under this title.’’. 

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

11 this section apply as of January 1, 2004, whether or not 

12 regulations implementing such amendments have been 

13 issued. 

14 SEC. 109. COORDINATION OF TITLE XXI WITH THE MATER15 NAL AND CHILD HEALTH PROGRAM. 

16 (a) IN GENERAL.—Section 2102(b)(3) of the Social 

17 Security Act (42 U.S.C. 1397bb(b)(3)) is amended—

18 (1) in subparagraph (D), by striking ‘‘and’’ at 

19 the end; 

20 (2) in subparagraph (E), by striking the period 

21 and inserting ‘‘; and’’; and 

22 (3) by adding at the end the following new sub23 paragraph: 

24 ‘‘(F) that operations and activities under 

25 this title are developed and implemented in con-
50

•S 1833 IS 

1 sultation and coordination with the program op2 erated by the State under title V in areas in3 cluding outreach and enrollment, benefits and 

4 services, service delivery standards, public 

5 health and social service agency relationships, 

6 and quality assurance and data reporting.’’. 

7 (b) CONFORMING MEDICAID AMENDMENT.—Section 

8 1902(a)(11) of such Act (42 U.S.C. 1396a(a)(11)) is 

9 amended—

10 (1) by striking ‘‘and’’ before ‘‘(C)’’; and 

11 (2) by inserting before the semicolon at the end 

12 the following: ‘‘, and (D) provide that operations and 

13 activities under this title are developed and imple14 mented in consultation and coordination with the 

15 program operated by the State under title V in areas 

16 including outreach and enrollment, benefits and 

17 services, service delivery standards, public health 

18 and social service agency relationships, and quality 

19 assurance and data reporting’’. 

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

21 this section take effect on January 1, 2004. 
51

•S 1833 IS 

1 Subtitle B—State Option To Pro2 vide Coverage for All Residents 

3 With Income At or Below the 

4 Poverty Line 

5 SEC. 121. STATE OPTION TO PROVIDE COVERAGE FOR ALL 

6 RESIDENTS WITH INCOME AT OR BELOW THE 

7 POVERTY LINE. 

8 (a) IN GENERAL.—Section 1902(a)(10)(A)(ii) of the 

9 Social Security Act (42 U.S.C. 1396a(a)(10)(A)(ii)) is 

10 amended—

11 (1) by striking ‘‘or’’ at the end of subclause 

12 (XVII); 

13 (2) by adding ‘‘or’’ at the end of subclause 

14 (XVIII); and 

15 (3) by adding at the end the following new sub16 clause: 

17 ‘‘(XIX) any individual whose 

18 family income does not exceed 100 

19 percent of the income official poverty 

20 line (as defined by the Office of Man21 agement and Budget, and revised an22 nually in accordance with section 

23 673(2) of the Omnibus Budget Rec24 onciliation Act of 1981) applicable to 

25 a family of the size involved and who 
52

•S 1833 IS 

1 is not otherwise eligible for medical 

2 assistance under this title;’’. 

3 (b) CONFORMING AMENDMENTS.—

4 (1) Section 1905(a) of such Act (42 U.S.C. 

5 1396d(a)) is amended, in the matter before para6 graph (1)—

7 (A) by striking ‘‘or’’ at the end of clause 

8 (xii); 

9 (B) by adding ‘‘or’’ at the end of clause 

10 (xiii); and 

11 (C) by inserting after clause (xiii) the fol12 lowing new clause: 

13 ‘‘(xii) individuals described in section 

14 1902(a)(10)(A)(ii)(XIX),’’. 

15 (2) Section 1903(f)(4) of such Act (42 U.S.C. 

16 1396b(f)(4)) is amended by inserting 

17 ‘‘1902(a)(10)(A)(ii)(XIX),’’ after 

18 ‘‘1902(a)(10)(A)(ii)(XVIII),’’. 

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

20 this section shall take effect on October 1, 2004. 
53

•S 1833 IS 

1 Subtitle C—Optional Coverage of 

2 Legal Immigrants under the 

3 Medicaid Program and Title XXI 

4 SEC. 131. EQUAL ACCESS TO HEALTH COVERAGE FOR 

5 LEGAL IMMIGRANTS. 

6 (a) IN GENERAL.—Section 401(b)(1) of the Personal 

7 Responsibility and Work Opportunity Reconciliation Act 

8 of 1996 (8 U.S.C. 1611(b)(1)) is amended—

9 (1) by striking subparagraph (A) and inserting 

10 the following: 

11 ‘‘(A) Medical assistance under title XIX of 

12 the Social Security Act.’’; and 

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

14 ‘‘(F) Child health assistance under title 

15 XXI of the Social Security Act.’’. 

16 (b) CONFORMING AMENDMENTS.—

17 (1) Section 402(b) of the Personal Responsi18 bility and Work Opportunity Reconciliation Act of 

19 1996 (8 U.S.C. 1612(b)) is amended—

20 (A) in paragraph (2)—

21 (i) in subparagraph (A)—

22 (I) by striking clause (i); 

23 (II) by redesignating clause (ii) 

24 as subparagraph (A) and realigning 

25 the margins accordingly; and 
54

•S 1833 IS 

1 (III) by redesignating subclauses 

2 (I) through (V) of subparagraph (A), 

3 as so redesignated, as clauses (i) 

4 through (v), respectively and realign5 ing the margins accordingly; and 

6 (ii) by striking subparagraphs (E) and 

7 (F); and 

8 (B) in paragraph (3), by striking subpara9 graph (C). 

10 (2) Section 403 of the Personal Responsibility 

11 and Work Opportunity Reconciliation Act of 1996 (8 

12 U.S.C. 1613)) is amended— 

13 (A) in subsection (c), by adding at the end 

14 the following: 

15 ‘‘(M) Child health assistance provided 

16 under title XXI of the Social Security Act.’’; 

17 and 

18 (B) in subsection (d)(1), by striking ‘‘pro19 grams specified in subsections (a)(3) and 

20 (b)(3)(C)’’ and inserting ‘‘program specified in 

21 subsection (a)(3)’’. 

22 (3) Section 421 of the Personal Responsibility 

23 and Work Opportunity Reconciliation Act of 1996 (8 

24 U.S.C. 1631)) is amended by adding at the end the 

25 following: 
55

•S 1833 IS 

1 ‘‘(g) EXCEPTIONS.—This section shall not apply to—

2 ‘‘(1) medical assistance provided under a State 

3 plan approved under title XIX of the Social Security 

4 Act; and 

5 ‘‘(2) child health assistance provided under title 

6 XXI of the Social Security Act.’’. 

7 (4) Section 423(d) of the Personal Responsi8 bility and Work Opportunity Reconciliation Act of 

9 1996 is amended by adding at the end the following: 

10 ‘‘(12) Child health assistance provided under 

11 title XXI of the Social Security Act.’’. 

12 (c) EFFECTIVE DATE.—

13 (1) IN GENERAL.—Except as provided in para14 graph (2), the amendments made by this section 

15 take effect on the date of enactment of this Act and 

16 apply to medical assistance provided under title XIX 

17 of the Social Security Act and child health assist18 ance provided under title XXI of the Social Security 

19 Act on or after that date. 

20 (2) REQUIREMENTS FOR SPONSOR’S AFFIDAVIT

21 OF SUPPORT.—Section 423(d) of the Personal Re22 sponsibility and Work Opportunity Reconciliation 

23 Act of 1996 shall be applied as if the amendments 

24 made by this Act were enacted on December 1, 

25 2002. 
56

•S 1833 IS 

1 Subtitle D—Indian Healthcare 

2 Funding 

3 CHAPTER 1—GUARANTEED FUNDING 

4 SEC. 141. GUARANTEED ADEQUATE FUNDING FOR INDIAN 

5 HEALTHCARE. 

6 Section 825 of the Indian Health Care Improvement 

7 Act (25 U.S.C. 1680o) is amended to read as follows: 

8 ‘‘SEC. 825. FUNDING. 

9 ‘‘(a) IN GENERAL.—Notwithstanding any other pro10 vision of law, not later than 30 days after the date of en11 actment of this section, on October 1, 2003, and on each 

12 October 1 thereafter, out of any funds in the Treasury 

13 not otherwise appropriated, the Secretary of the Treasury 

14 shall transfer to the Secretary to carry out this title the 

15 amount determined under subsection (d). 

16 ‘‘(b) USE AND AVAILABILITY.—

17 ‘‘(1) IN GENERAL.—An amount transferred 

18 under subsection (a)—

19 ‘‘(A) shall remain available until expended; 

20 and

21 ‘‘(B) shall be used to carry out any pro22 grams, functions, and activities relating to clin23 ical services (as defined in paragraph (2)) of 

24 the Service and Service units. 
57

•S 1833 IS 

1 ‘‘(2) CLINICAL SERVICES DEFINED.—For pur2 poses of paragraph (1)(B), the term ‘clinical serv3 ices’ includes all programs of the Indian Health 

4 Service which are funded directly or under the au5 thority of the Indian Self-Determination and Edu6 cation Assistance Act, for the purposes of—

7 ‘‘(A) clinical care, including inpatient care, 

8 outpatient care (including audiology, clinical eye 

9 and vision care), primary care, secondary and 

10 tertiary care, and long term care; 

11 ‘‘(B) preventive health, including mam12 mography and other cancer screening; 

13 ‘‘(C) dental care; 

14 ‘‘(D) mental health, including community 

15 mental health services, inpatient mental health 

16 services, dormitory mental health services, 

17 therapeutic and residential treatment centers; 

18 ‘‘(E) emergency medical services; 

19 ‘‘(F) treatment and control of, and reha20 bilitative care related to, alcoholism and drug 

21 abuse (including fetal alcohol syndrome) among 

22 Indians; 

23 ‘‘(G) accident prevention programs; 

24 ‘‘(H) home healthcare; 

25 ‘‘(I) community health representatives; 
58

•S 1833 IS 

1 ‘‘(J) maintenance and repair; and 

2 ‘‘(K) traditional healthcare practices and 

3 training of traditional healthcare practitioners. 

4 ‘‘(c) RECEIPT AND ACCEPTANCE.—The Secretary 

5 shall be entitled to receive, shall accept, and shall use to 

6 carry out this title the funds transferred under subsection 

7 (a), without further appropriation. 

8 ‘‘(d) AMOUNT.—The amount referred to in sub9 section (a) is—

10 ‘‘(1) for fiscal year 2004, the amount equal to 

11 390 percent of the amount obligated by the Service 

12 during fiscal year 2002 for the purposes described in 

13 subsection (b)(2); and 

14 ‘‘(2) for fiscal year 2005 and each fiscal year 

15 thereafter, the amount equal to the product obtained 

16 by multiplying—

17 ‘‘(A) the number of Indians served by the 

18 Service as of September 30 of the preceding the 

19 fiscal year; and 

20 ‘‘(B) the per capita baseline amount, as 

21 determined under subsection (e). 

22 ‘‘(e) PER CAPITA BASELINE AMOUNT.—

23 ‘‘(1) IN GENERAL.—For the purpose of sub24 section (d)(2)(B), the per capita baseline amount 

25 shall be equal to the sum of—
59

•S 1833 IS 

1 ‘‘(A) the quotient obtained by dividing—

2 ‘‘(i) the amount specified in sub3 section (d)(1); by 

4 ‘‘(ii) the number of Indians served by 

5 the Service as of September 30, 2002; and 

6 ‘‘(B) any applicable increase under para7 graph (2). 

8 ‘‘(2) INCREASE.—For each fiscal year, the Sec9 retary shall provide a percentage increase (rounded 

10 to the nearest dollar) in the per capita baseline 

11 amount equal to the percentage by which—

12 ‘‘(A) the Consumer Price Index for all 

13 Urban Consumers published by the Department 

14 of Labor (relating to the United States city av15 erage for medical care and not seasonally ad16 justed) for the 1-year period ending on the 

17 June 30 of the fiscal year preceding the fiscal 

18 year for which the increase is made; exceeds 

19 ‘‘(B) that Consumer Price Index for the 1-

20 year period preceding the 1-year period de21 scribed in subparagraph (A).’’. 
60

•S 1833 IS 

1 CHAPTER 2—INDIAN HEALTHCARE 

2 PROGRAMS 

3 SEC. 145. PROGRAMS OPERATED BY INDIAN TRIBES AND 

4 TRIBAL ORGANIZATIONS. 

5 The Service shall provide funds for healthcare pro6 grams and facilities operated by Indian tribes and tribal 

7 organizations under funding agreements with the Service 

8 entered into under the Indian Self-Determination and 

9 Education Assistance Act on the same basis as such funds 

10 are provided to programs and facilities operated directly 

11 by the Service. 

12 SEC. 146. LICENSING. 

13 Healthcare professionals employed by Indian tribes 

14 and tribal organizations to carry out agreements under the 

15 Indian Self-Determination and Education Assistance Act, 

16 shall, if licensed in any State, be exempt from the licensing 

17 requirements of the State in which the agreement is per18 formed. 

19 SEC. 147. AUTHORIZATION FOR EMERGENCY CONTRACT 

20 HEALTH SERVICES. 

21 With respect to an elderly Indian or an Indian with 

22 a disability receiving emergency medical care or services 

23 from a non-Service provider or in a non-Service facility 

24 under the authority of the Indian Health Care Improve25 ment Act, the time limitation (as a condition of payment) 
61

•S 1833 IS 

1 for notifying the Service of such treatment or admission 

2 shall be 30 days. 

3 SEC. 148. PROMPT ACTION ON PAYMENT OF CLAIMS. 

4 (a) REQUIREMENT.—The Service shall respond to a 

5 notification of a claim by a provider of a contract care 

6 service with either an individual purchase order or a denial 

7 of the claim within 5 working days after the receipt of 

8 such notification. 

9 (b) FAILURE TO RESPOND.—If the Service fails to 

10 respond to a notification of a claim in accordance with 

11 subsection (a), the Service shall accept as valid the claim 

12 submitted by the provider of a contract care service. 

13 (c) PAYMENT.—The Service shall pay a valid contract 

14 care service claim within 30 days after the completion of 

15 the claim. 

16 SEC. 149. LIABILITY FOR PAYMENT. 

17 (a) NO LIABILITY.—A patient who receives contract 

18 healthcare services that are authorized by the Service shall 

19 not be liable for the payment of any charges or costs asso20 ciated with the provision of such services. 

21 (b) NOTIFICATION.—The Secretary shall notify a 

22 contract care provider and any patient who receives con23 tract healthcare services authorized by the Service that 

24 such patient is not liable for the payment of any charges 

25 or costs associated with the provision of such services. 
62

•S 1833 IS 

1 (c) LIMITATION.—Following receipt of the notice pro2 vided under subsection (b), or, if a claim has been deemed 

3 accepted under section 154(b), the provider shall have no 

4 further recourse against the patient who received the serv5 ices involved. 

6 SEC. 150. HEALTH SERVICES FOR INELIGIBLE PERSONS. 

7 (a) INELIGIBLE PERSONS.—

8 (1) IN GENERAL.—Any individual who—

9 (A) has not attained 19 years of age; 

10 (B) is the natural or adopted child, step11 child, foster-child, legal ward, or orphan of an 

12 eligible Indian; and 

13 (C) is not otherwise eligible for the health 

14 services provided by the Service, 

15 shall be eligible for all health services provided by 

16 the Service on the same basis and subject to the 

17 same rules that apply to eligible Indians until such 

18 individual attains 19 years of age. The existing and 

19 potential health needs of all such individuals shall be 

20 taken into consideration by the Service in deter21 mining the need for, or the allocation of, the health 

22 resources of the Service. If such an individual has 

23 been determined to be legally incompetent prior to 

24 attaining 19 years of age, such individual shall re-
63

•S 1833 IS 

1 main eligible for such services until one year after 

2 the date such disability has been removed. 

3 (2) SPOUSES.—Any spouse of an eligible Indian 

4 who is not an Indian, or who is of Indian descent 

5 but not otherwise eligible for the health services pro6 vided by the Service, shall be eligible for such health 

7 services if all of such spouses or spouses who are 

8 married to members of the Indian tribe being served 

9 are made eligible, as a class, by an appropriate reso10 lution of the governing body of the Indian tribe or 

11 tribal organization providing such services. The 

12 health needs of persons made eligible under this 

13 paragraph shall not be taken into consideration by 

14 the Service in determining the need for, or allocation 

15 of, its health resources. 

16 (b) PROGRAMS AND SERVICES.—

17 (1) PROGRAMS.—

18 (A) IN GENERAL.—The Secretary may 

19 provide health services under this subsection 

20 through health programs operated directly by 

21 the Service to individuals who reside within the 

22 service area of a service unit and who are not 

23 eligible for such health services under any other 

24 subsection of this section or under any other 

25 provision of law if—
64

•S 1833 IS 

1 (i) the Indian tribe (or, in the case of 

2 a multi-tribal service area, all the Indian 

3 tribes) served by such service unit requests 

4 such provision of health services to such 

5 individuals; and 

6 (ii) the Secretary and the Indian tribe 

7 or tribes have jointly determined that—

8 (I) the provision of such health 

9 services will not result in a denial or 

10 diminution of health services to eligi11 ble Indians; and 

12 (II) there is no reasonable alter13 native health program or services, 

14 within or without the service area of 

15 such service unit, available to meet 

16 the health needs of such individuals. 

17 (B) FUNDING AGREEMENTS.—In the case 

18 of health programs operated under a funding 

19 agreement entered into under the Indian Self20 Determination and Educational Assistance Act, 

21 the governing body of the Indian tribe or tribal 

22 organization providing health services under 

23 such funding agreement is authorized to deter24 mine whether health services should be provided 

25 under such funding agreement to individuals 
65

•S 1833 IS 

1 who are not eligible for such health services 

2 under any other subsection of this section or 

3 under any other provision of law. In making 

4 such determinations, the governing body of the 

5 Indian tribe or tribal organization shall take 

6 into account the considerations described in 

7 subparagraph (A)(ii). 

8 (2) LIABILITY FOR PAYMENT.—

9 (A) IN GENERAL.—Persons receiving 

10 health services provided by the Service by rea11 son of this subsection shall be liable for pay12 ment of such health services under a schedule 

13 of charges prescribed by the Secretary which, in 

14 the judgment of the Secretary, results in reim15 bursement in an amount not less than the ac16 tual cost of providing the health services. Not17 withstanding section 1880 of the Social Secu18 rity Act or any other provision of law, amounts 

19 collected under this subsection, including medi20 care or medicaid reimbursements under titles 

21 XVIII and XIX of the Social Security Act, shall 

22 be credited to the account of the program pro23 viding the service and shall be used solely for 

24 the provision of health services within that pro25 gram. Amounts collected under this subsection 
66

•S 1833 IS 

1 shall be available for expenditure within such 

2 program for not to exceed 1 fiscal year after 

3 the fiscal year in which collected. 

4 (B) SERVICES FOR INDIGENT PERSONS.—

5 Health services may be provided by the Sec6 retary through the Service under this sub7 section to an indigent person who would not be 

8 eligible for such health services but for the pro9 visions of paragraph (1) only if an agreement 

10 has been entered into with a State or local gov11 ernment under which the State or local govern12 ment agrees to reimburse the Service for the 

13 expenses incurred by the Service in providing 

14 such health services to such indigent person. 

15 (3) SERVICE AREAS.—

16 (A) SERVICE TO ONLY ONE TRIBE.—In the 

17 case of a service area which serves only one In18 dian tribe, the authority of the Secretary to 

19 provide health services under paragraph (1)(A) 

20 shall terminate at the end of the fiscal year suc21 ceeding the fiscal year in which the governing 

22 body of the Indian tribe revokes its concurrence 

23 to the provision of such health services. 

24 (B) MULTI-TRIBAL AREAS.—In the case of 

25 a multi-tribal service area, the authority of the 
67

•S 1833 IS 

1 Secretary to provide health services under para2 graph (1)(A) shall terminate at the end of the 

3 fiscal year succeeding the fiscal year in which at 

4 least 51 percent of the number of Indian tribes 

5 in the service area revoke their concurrence to 

6 the provision of such health services. 

7 (c) PURPOSE FOR PROVIDING SERVICES.—The Serv8 ice may provide health services under this subsection to 

9 individuals who are not eligible for health services provided 

10 by the Service under any other subsection of this section 

11 or under any other provision of law in order to—

12 (1) achieve stability in a medical emergency; 

13 (2) prevent the spread of a communicable dis14 ease or otherwise deal with a public health hazard; 

15 (3) provide care to non-Indian women pregnant 

16 with an eligible Indian’s child for the duration of the 

17 pregnancy through post partum; or 

18 (4) provide care to immediate family members 

19 of an eligible person if such care is directly related 

20 to the treatment of the eligible person. 

21 (d) HOSPITAL PRIVILEGES.—Hospital privileges in 

22 health facilities operated and maintained by the Service 

23 or operated under a contract entered into under the Indian 

24 Self-Determination Education Assistance Act may be ex25 tended to non-Service healthcare practitioners who provide 
68

•S 1833 IS 

1 services to persons described in subsection (a) or (b). Such 

2 non-Service healthcare practitioners may be regarded as 

3 employees of the Federal Government for purposes of sec4 tion 1346(b) and chapter 171 of title 28, United States 

5 Code (relating to Federal tort claims) only with respect 

6 to acts or omissions which occur in the course of providing 

7 services to eligible persons as a part of the conditions 

8 under which such hospital privileges are extended. 

9 (e) DEFINITION.—In this section, the term ‘‘eligible 

10 Indian’’ means any Indian who is eligible for health serv11 ices provided by the Service without regard to the provi12 sions of this section. 

13 SEC. 151. DEFINITIONS. 

14 For purposes of this chapter, the definitions con15 tained in section 4 of the Indian Health Care Improve16 ment Act shall apply. 

17 SEC. 152. AUTHORIZATION OF APPROPRIATIONS. 

18 There are authorized to be appropriated such sums 

19 as may be necessary for each fiscal year through fiscal 

20 year 2015 to carry out this chapter.

21 Subtitle E—Territories 

22 SEC. 161. FUNDING FOR TERRITORIES. 

23 (a) TEMPORARY ELIMINATION OF SPENDING CAP.—

24 Section 1108 of the Social Security Act (42 U.S.C. 1308) 

25 is amended—
69

•S 1833 IS 

1 (1) in subsection (f), by striking ‘‘subsection 

2 (g)’’ and inserting ‘‘subsections (g) and (h)’’; and 

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

4 ‘‘(h) TEMPORARY ELIMINATION OF CAPS.—With re5 spect to each of fiscal years 2004 through 2007, the Sec6 retary shall make payments under title XIX to Puerto 

7 Rico, the Virgin Islands, Guam, the Northern Mariana Is8 lands, and American Samoa without regard to the limita9 tions on the amount of such payments imposed under sub10 sections (f) and (g).’’. 

11 (b) TEMPORARY INCREASE IN FMAP.—The first 

12 sentence of section 1905(b) of the Social Security Act (42 

13 U.S.C. 1396d(b)) is amended by inserting ‘‘(except that, 

14 only with respect to fiscal years 2004 through 2007 and 

15 only for purposes of expenditures under this title, such 

16 percentage shall be 77 percent)’’ after ‘‘50 per centum’’. 

17 Subtitle F—Migrant Workers and 

18 Farmworkers Health 

19 SEC. 171. DEMONSTRATION PROJECT REGARDING CON20 TINUITY OF COVERAGE OF MIGRANT WORK21 ERS AND FARMWORKERS UNDER MEDICAID 

22 AND CHIP. 

23 (a) AUTHORITY TO CONDUCT DEMONSTRATION

24 PROJECT.—
70

•S 1833 IS 

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

2 Human Services shall conduct a demonstration 

3 project for the purpose of evaluating methods for 

4 strengthening the health coverage of, and continuity 

5 of coverage of, migrant workers and farmworkers 

6 under the medicaid and State children’s health in7 surance programs (42 U.S.C. 1396 et seq., 1397aa 

8 et seq.). 

9 (2) WAIVER AUTHORITY.—The Secretary of 

10 Health and Human Services shall waive compliance 

11 with the requirements of titles XI, XIX, and XXI of 

12 the Social Security Act (42 U.S.C. 1301 et seq, 

13 1396 et seq., 1397aa et seq.) to such extent and for 

14 such period as the Secretary determines is necessary 

15 to conduct the demonstration project under this sec16 tion. 

17 (b) REQUIREMENTS.—The demonstration project 

18 conducted under this section shall provide for—

19 (1) uniform eligibility criteria under the med20 icaid and State children’s health insurance programs 

21 with respect to migrant workers and farmworkers; 

22 and 

23 (2) the portability of coverage of such workers 

24 under those programs between participating States. 
71

•S 1833 IS 

1 (c) REPORT.—Not later than March 31, 2005, the 

2 Secretary of Health and Human Services shall submit a 

3 report to Congress on the demonstration project con4 ducted under this section that contains such recommenda5 tions for legislative action as the Secretary determines is 

6 appropriate. 

7 Subtitle G—Expanded Access to 

8 Health Care 

9 SEC. 181. NATIONAL COMMISSION FOR EXPANDED ACCESS 

10 TO HEALTH CARE. 

11 (a) ESTABLISHMENT.—There is established a com12 mission to be known as the National Commission for Ex13 panded Access to Health Care (referred to in this section 

14 as the ‘‘Commission’’). 

15 (b) APPOINTMENT OF MEMBERS.—

16 (1) IN GENERAL.—Not later than 45 days after 

17 the date of enactment of this Act—

18 (A) the majority and minority leaders of 

19 the Senate and the Speaker and minority leader 

20 of the House of Representatives shall each ap21 point 7 members of the Commission; and 

22 (B) the Secretary of Health and Human 

23 Services (in this section referred to as the ‘‘Sec24 retary’’) shall appoint 1 member of the Com25 mission. 
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•S 1833 IS 

1 (2) CRITERIA.—Members of the Commission 

2 shall include representatives of the following: 

3 (A) Consumers of health insurance. 

4 (B) Health care professionals. 

5 (C) State and territorial officials. 

6 (D) Health economists. 

7 (E) Health care providers. 

8 (F) Experts on health insurance. 

9 (G) Experts on expanding health care to 

10 individuals who are uninsured. 

11 (H) Experts on the elimination of racial 

12 and ethnic health disparities. 

13 (I) Experts on health care in the United 

14 States territories. 

15 (3) CHAIRPERSON.—At the first meeting of the 

16 Commission, the Commission shall select a Chair17 person from among its members. 

18 (c) MEETINGS.—

19 (1) IN GENERAL.—After the initial meeting of 

20 the Commission, which shall be called by the Sec21 retary, the Commission shall meet at the call of the 

22 Chairperson. 

23 (2) QUORUM.—A majority of the members of 

24 the Commission shall constitute a quorum, but a 

25 lesser number of members may hold hearings. 
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•S 1833 IS 

1 (3) SUPERMAJORITY VOTING REQUIREMENT.—

2 To approve a report required under paragraph (1), 

3 (2), or (3) of subsection (e), at least 60 percent of 

4 the membership of the Commission must vote in 

5 favor of such a report. 

6 (d) DUTIES.—The Commission shall—

7 (1) assess the effectiveness of programs de8 signed to expand health care coverage or make 

9 health care coverage affordable to uninsured individ10 uals by identifying the accomplishments and needed 

11 improvements of each program; 

12 (2) make recommendations regarding the bene13 fits and cost-sharing that should be included in 

14 health care coverage for various groups, taking into 

15 account—

16 (A) the special health care needs of chil17 dren and individuals with disabilities; 

18 (B) the different ability of various popu19 lations to pay out-of-pocket costs for services; 

20 (C) incentives for efficiency and cost-con21 tainment; 

22 (D) racial and ethnic disparities in health 

23 status and health care; 

24 (E) incremental changes to the United 

25 States health care delivery system and changes 
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•S 1833 IS 

1 to achieve fundamental restructuring of the sys2 tem; 

3 (F) populations who are traditionally more 

4 difficult to cover, including immigrants and 

5 homeless persons; 

6 (G) preventive care, diagnostic services, 

7 disease management services, and other factors; 

8 (H) quality improvement initiatives among 

9 health institutions serving disadvantaged pa10 tient populations; and 

11 (I) the feasibility of and barriers to the de12 velopment of a comprehensive system of health 

13 care; 

14 (3) recommend mechanisms to expand health 

15 care coverage to uninsured individuals; 

16 (4) recommend automatic enrollment and reten17 tion procedures and other measures to increase 

18 health care coverage among those eligible for assist19 ance; and 

20 (5) analyze the size, effectiveness, and efficiency 

21 of current tax and other subsidies for health care 

22 coverage and recommend improvements. 

23 (e) REPORTS.—

24 (1) ANNUAL REPORTS.—The Commission shall 

25 submit annual reports to the President and the ap-
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•S 1833 IS 

1 propriate committees of Congress addressing the 

2 matters identified in subsection (d). 

3 (2) BIENNIAL REPORT.—The Commission shall 

4 submit biennial reports to the President and the ap5 propriate committees of Congress containing—

6 (A) recommendations concerning essential 

7 benefits and maximum out-of-pocket cost-shar8 ing for—

9 (i) the general population; and 

10 (ii) individuals with limited ability to 

11 pay; and 

12 (B) proposed legislative language to imple13 ment such recommendations. 

14 (3) COMMISSION REPORT.—Not later than Jan15 uary 15, 2007, the Commission shall submit a re16 port to the President and the appropriate commit17 tees of Congress, which shall include—

18 (A) recommendations on policies to provide 

19 health care coverage to uninsured individuals; 

20 (B) recommendations on changes to poli21 cies enacted under this Act; and 

22 (C) proposed legislative language to imple23 ment such recommendations. 

24 (f) ADMINISTRATION.—

25 (1) POWERS.—
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•S 1833 IS 

1 (A) HEARINGS.—The Commission may 

2 hold such hearings, sit and act at such times 

3 and places, take such testimony, and receive 

4 such evidence as the Commission considers ad5 visable to carry out this section. 

6 (B) INFORMATION FROM FEDERAL AGEN7 CIES.—The Commission may secure directly 

8 from any Federal department or agency such 

9 information as the Commission considers nec10 essary to carry out this section. Upon request 

11 of the Chairperson of the Commission, the head 

12 of such department or agency shall furnish such 

13 information to the Commission. 

14 (C) POSTAL SERVICES.—The Commission 

15 may use the United States mails in the same 

16 manner and under the same conditions as other 

17 departments and agencies of the Federal Gov18 ernment. 

19 (D) GIFTS.—The Commission may accept, 

20 use, and dispose of donations of services or 

21 property. 

22 (2) COMPENSATION.—

23 (A) IN GENERAL.—Each member of the 

24 Commission who is not an officer or employee 

25 of the Federal Government shall be com-
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•S 1833 IS 

1 pensated at a rate equal to the daily equivalent 

2 of the annual rate of basic pay prescribed for 

3 level IV of the Executive Schedule under section 

4 5315 of title 5, United States Code, for each 

5 day (including travel time) during which such 

6 member is engaged in the performance of duties 

7 of the Commission. All members of the Com8 mission who are officers or employees of the 

9 United States shall serve without compensation 

10 in addition to that received for their services as 

11 officers or employees of the United States. 

12 (B) TRAVEL EXPENSES.—The members of 

13 the Commission shall be allowed travel ex14 penses, as authorized by the Chairperson of the 

15 Commission, including per diem in lieu of sub16 sistence, at rates authorized for employees of 

17 agencies under subchapter I of chapter 57 of 

18 title 5, United States Code, while away from 

19 their homes or regular places of business in the 

20 performance of services for the Commission. 

21 (3) STAFF.—

22 (A) IN GENERAL.—The Chairperson of the 

23 Commission may appoint an executive director 

24 such other staff as may be necessary to enable 

25 the Commission to perform its duties. The em-
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•S 1833 IS 

1 ployment of an executive director shall be sub2 ject to confirmation by the Commission. 

3 (B) STAFF COMPENSATION.—The Chair4 person of the Commission may fix the com5 pensation of personnel without regard to chap6 ter 51 and subchapter III of chapter 53 of title 

7 5, United States Code, relating to classification 

8 of positions and General Schedule pay rates, ex9 cept that the rate of pay for personnel may not 

10 exceed the rate payable for level V of the Exec11 utive Schedule under section 5316 of such title. 

12 (C) DETAIL OF GOVERNMENT EMPLOY13 EES.—Any Federal Government employee may 

14 be detailed to the Commission without reim15 bursement, and such detail shall be without 

16 interruption or loss of civil service status or 

17 privilege. 

18 (D) PROCUREMENT OF TEMPORARY AND

19 INTERMITTENT SERVICES.—The Chairperson of 

20 the Commission may procure temporary and 

21 intermittent services under section 3109(b) of 

22 title 5, United States Code, at rates for individ23 uals which do not exceed the daily equivalent of 

24 the annual rate of basic pay prescribed for level 
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•S 1833 IS 

1 V of the Executive Schedule under section 5316 

2 of such title. 

3 (g) TERMINATION.—Except with respect to activities 

4 in connection with the ongoing biennial report required 

5 under subsection (e)(2), the Commission shall terminate 

6 90 days after the date on which the Commission submits 

7 the report required under subsection (e)(3). 

8 (h) AUTHORIZATION OF APPROPRIATIONS.—There is 

9 authorized to be appropriated to carry out this section, 

10 such sums as may be necessary for fiscal year 2005 and 

11 each subsequent fiscal year. 

12 TITLE II—CULTURALLY AND LIN13 GUISTICALLY APPROPRIATE 

14 HEALTHCARE 

15 SEC. 201. AMENDMENT TO THE PUBLIC HEALTH SERVICE 

16 ACT. 

17 The Public Health Service Act (42 U.S.C. 201 et 

18 seq.) is amended by adding at the end the following: 

19 ‘‘TITLE XXIX—MINORITY HEALTH 

20 ‘‘SEC. 2900. DEFINITIONS. 

21 ‘‘In this title, the definitions contained in section 801 

22 of the Healthcare Equality and Accountability Act shall 

23 apply. 
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•S 1833 IS 

1 ‘‘Subtitle A—Culturally and Lin2 guistically Appropriate 

3 Healthcare 

4 ‘‘SEC. 2901. IMPROVING ACCESS TO SERVICES FOR INDIVID5 UALS WITH LIMITED ENGLISH PROFICIENCY. 

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

7 13166, it is the purpose of this section—

8 ‘‘(1) to improve access to Federally conducted 

9 and Federally assisted programs and activities for 

10 individuals who are limited in their English pro11 ficiency; 

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

13 the services it provides and develop and implement 

14 a system by which limited English proficient individ15 uals can enjoy meaningful access to those services 

16 consistent with, and without substantially burdening, 

17 the fundamental mission of the agency; 

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

19 that recipients of Federal financial assistance pro20 vide meaningful access to their limited English pro21 ficient applicants and beneficiaries; 

22 ‘‘(4) to ensure that recipients of Federal finan23 cial assistance take reasonable steps, consistent with 

24 the guidelines set forth in the Limited English Pro25 ficient Guidance of the Department of Justice (as 
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•S 1833 IS 

1 issued on June 12, 2002), to ensure meaningful ac2 cess to their programs and activities by limited 

3 English proficient individuals; and 

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

5 Civil Rights Act of 1964 and that healthcare pro6 viders and organizations do not discriminate in the 

7 provision of services. 

8 ‘‘(b) FEDERALLY CONDUCTED PROGRAMS AND AC9 TIVITIES.—

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

11 after the date of enactment of this Act, each Federal 

12 agency that carries out health care-related activities 

13 shall prepare a plan to improve access to the feder14 ally conducted health care-related programs and ac15 tivities of the agency by limited English proficient 

16 individuals. 

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

18 paragraph (1) shall be consistent with the standards 

19 set forth in section 204 of the Healthcare Equality 

20 and Accountability Act, and shall include the steps 

21 the agency will take to ensure that limited English 

22 proficient individuals have access to the agency’s 

23 health care-related programs and activities. Each 

24 agency shall send a copy of such plan to the Depart-
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•S 1833 IS 

1 ment of Justice, which shall serve as the central re2 pository of the agencies’ plans. 

3 ‘‘(c) FEDERALLY ASSISTED PROGRAMS AND ACTIVI4 TIES.—

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

6 after the date of enactment of this Act, each Federal 

7 agency providing health care-related Federal finan8 cial assistance shall ensure that the guidance for re9 cipients of Federal financial assistance developed by 

10 the agency to ensure compliance with title VI of the 

11 Civil Rights Act of 1964 (42 U.S.C. 2000d et seq.) 

12 is specifically tailored to the recipients of such as13 sistance and is consistent with the standards de14 scribed in section 204 of the Healthcare Equality 

15 and Accountability Act. Each agency shall send a 

16 copy of such guidance to the Department of Justice 

17 which shall serve as the central repository of the 

18 agencies’ plans. After approval by the Department of 

19 Justice, each agency shall publish its guidance docu20 ment in the Federal Register for public comment. 

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

22 guidance developed under paragraph (1) shall—

23 ‘‘(A) detail how the general standards es24 tablished under section 204 of the Healthcare 
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•S 1833 IS 

1 Equality and Accountability Act will be applied 

2 to the agency’s recipients; and 

3 ‘‘(B) take into account the types of health 

4 care services provided by the recipients, the in5 dividuals served by the recipients, and other 

6 factors set out in such standards. 

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

8 that has developed a guidance for purposes of title 

9 VI of the Civil Rights Act of 1964 that the Depart10 ment of Justice determines is consistent with the 

11 standards described in section 204 of the Healthcare 

12 Equality and Accountability Act shall examine such 

13 existing guidance, as well as the programs and ac14 tivities to which such guidance applies, to determine 

15 if modification of such guidance is necessary to com16 ply with this subsection. 

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

18 shall consult with the Department of Justice in es19 tablishing the guidances under this subsection. 

20 ‘‘(d) CONSULTATIONS.—

21 ‘‘(1) IN GENERAL.—In carrying out this sec22 tion, each Federal agency that carriers out health 

23 care-related activities shall ensure that stakeholders, 

24 such as limited English proficient individuals and 

25 their representative organizations, recipients of Fed-
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•S 1833 IS 

1 eral assistance, and other appropriate individuals or 

2 entities, have an adequate and comparable oppor3 tunity to provide input with respect to the actions of 

4 the agency. 

5 ‘‘(2) EVALUATION OF NEEDS.—Each Federal 

6 agency described in paragraph (1) shall evaluate the 

7 particular needs of the limited English proficient in8 dividuals served by the agency, and by a recipient of 

9 assistance provided by the agency, and the burdens 

10 of compliance with the agency guidance and its re11 cipients of the requirements of this section.

12 ‘‘SEC. 2902. NATIONAL STANDARDS FOR CULTURALLY AND 

13 LINGUISTICALLY APPROPRIATE SERVICES IN 

14 HEALTHCARE. 

15 ‘‘Recipients of Federal financial assistance from the 

16 Secretary shall, to the extent reasonable and practicable 

17 after applying the 4-factor analysis described in title V 

18 of the Guidance to Federal Financial Assistance Recipi19 ents Regarding Title VI Prohibition Against National Ori20 gin Discrimination Affecting Limited-English Proficient 

21 Persons (June 12, 2002)—

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

23 promote individuals at all levels of the organization 

24 to maintain a diverse staff and leadership that can 

25 provide culturally and linguistically appropriate 
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•S 1833 IS 

1 healthcare to patient populations of the service area 

2 of the organization; 

3 ‘‘(2) ensure that staff at all levels and across all 

4 disciplines of the organization receive ongoing edu5 cation and training in culturally and linguistically 

6 appropriate service delivery; 

7 ‘‘(3) offer and provide language assistance serv8 ices, including bilingual staff and interpreter serv9 ices, at no cost to each patient with limited English 

10 proficiency at all points of contact, in a timely man11 ner during all hours of operation; 

12 ‘‘(4) notify patients of their right to receive lan13 guage assistance services in their primary language; 

14 ‘‘(5) ensure the competence of language assist15 ance provided to limited English proficient patients 

16 by interpreters and bilingual staff, and ensure that 

17 family and friends are not used to provide interpre18 tation services—

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

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

21 has been informed in his or her preferred lan22 guage of the availability of free interpretation 

23 services; 

24 ‘‘(6) make available easily understood patient25 related materials including information or notices 
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•S 1833 IS 

1 about termination of benefits and post signage in 

2 the languages of the commonly encountered groups 

3 or groups represented in the service area of the or4 ganization; 

5 ‘‘(7) develop and implement clear goals, poli6 cies, operational plans, and management account7 ability and oversight mechanisms to provide cul8 turally and linguistically appropriate services; 

9 ‘‘(8) conduct initial and ongoing organizational 

10 self-assessments of culturally and linguistically ap11 propriate services-related activities and integrate cul12 tural and linguistic competence-related measures 

13 into the internal audits, performance improvement 

14 programs, patient satisfaction assessments, and out15 comes-based evaluations of the organization; 

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

17 protections provided for under the regulations pro18 mulgated under section 264(c) of the Health Insur19 ance Portability and Accountability Act of 1996 (42 

20 U.S.C. 1320d–2 note)—

21 ‘‘(A) data on the individual patient’s race, 

22 ethnicity, and primary language are collected in 

23 health records, integrated into the organiza24 tion’s management information systems, and 

25 periodically updated; and 
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•S 1833 IS 

1 ‘‘(B) if the patient is a minor or is inca2 pacitated, the primary language of the parent 

3 or legal guardian is collected; 

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

5 and epidemiological profile of the community as well 

6 as a needs assessment to accurately plan for and im7 plement services that respond to the cultural and 

8 linguistic characteristics of the service area of the 

9 organization; 

10 ‘‘(11) develop participatory, collaborative part11 nerships with communities and utilize a variety of 

12 formal and informal mechanisms to facilitate com13 munity and patient involvement in designing and im14 plementing culturally and linguistically appropriate 

15 services-related activities; 

16 ‘‘(12) ensure that conflict and grievance resolu17 tion processes are culturally and linguistically sen18 sitive and capable of identifying, preventing, and re19 solving cross-cultural conflicts or complaints by pa20 tients; 

21 ‘‘(13) regularly make available to the public in22 formation about their progress and successful inno23 vations in implementing the standards under this 

24 section and provide public notice in their commu25 nities about the availability of this information; and 
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•S 1833 IS 

1 ‘‘(14) regularly make available to the head of 

2 each Federal entity from which Federal funds are 

3 received, information about their progress and suc4 cessful innovations in implementing the standards 

5 under this section as required by the head of such 

6 entity. 

7 ‘‘SEC. 2903. CENTER FOR CULTURAL AND LINGUISTIC COM8 PETENCE IN HEALTHCARE. 

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

10 through the Director of the Office of Minority Health, 

11 shall establish and support a center to be known as the 

12 ‘Center for Cultural and Linguistic Competence in 

13 Healthcare’ (referred to in this section as the ‘Center’) 

14 to carry out the following activities: 

15 ‘‘(1) REMOTE MEDICAL INTERPRETATION.—

16 The Center shall provide remote medical interpreta17 tion, directly or through contract, at no cost to 

18 healthcare providers. Methods of interpretation may 

19 include remote, simultaneous or consecutive inter20 preting through telephonic systems, video confer21 encing, and other methods determined appropriate 

22 by the Secretary for patients with limited English 

23 proficiency. The quality of such interpretation shall 

24 be monitored and reported publicly. Nothing in this 

25 paragraph shall be construed to limit the ability of 
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•S 1833 IS 

1 healthcare providers or organizations to provide 

2 medical interpretation services directly and obtain 

3 reimbursement for such services as provided for 

4 under the medicare, medicaid or SCHIP programs 

5 under titles XVIII, XIX, or XXI of the Social Secu6 rity Act. 

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

8 The Center shall provide, directly or through con9 tract, for the translation of written materials for 

10 healthcare providers and healthcare organizations 

11 (as defined in section 2902(b)) at no cost to such 

12 providers and organizations. Materials may be sub13 mitted for translation into non-English languages. 

14 Translation services shall be provided in a timely 

15 and reasonable manner. The quality of such trans16 lation shall be monitored and reported publicly. 

17 ‘‘(3) MODEL LANGUAGE ASSISTANCE PRO18 GRAMS.—The Center shall provide for the collection 

19 and dissemination of information on current model 

20 language assistance programs and strategies to im21 prove language access to healthcare for individuals 

22 with limited English proficiency, including case stud23 ies using de-identified patient information, program 

24 summaries, and program evaluations. 
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•S 1833 IS 

1 ‘‘(4) MEDICAL INTERPRETATION GUIDE2 LINES.—

3 ‘‘(A) IN GENERAL.—The Center shall con4 vene a working group to develop quality guide5 lines and standards for the training of medical 

6 interpreters and translators. Such group shall 

7 include—

8 ‘‘(i) representatives from the Office of 

9 Minority Health, the National Center on 

10 Minority Health and Health Disparities, 

11 the Agency for Healthcare Research and 

12 Quality, the Centers for Medicare and 

13 Medicaid Services, the Office for Civil 

14 Rights of the Department of Health and 

15 Human Services, and other Federal agen16 cies determined appropriate by the Sec17 retary; and 

18 ‘‘(ii) representatives of communities 

19 with a significant proportion of limited 

20 English proficient individuals, professional 

21 interpreter associations, medical interpre22 tation service providers, and other public 

23 or private organizations determined appro24 priate by the Secretary. 
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•S 1833 IS 

1 ‘‘(B) PUBLICATION.—Not later than 18 

2 months after the date of enactment of this Act, 

3 the Center shall publish guidelines and stand4 ards developed under this paragraph in the 

5 Federal Register. 

6 ‘‘(5) INTERNET HEALTH CLEARINGHOUSE.—

7 The Center shall develop and maintain an Internet 

8 clearinghouse to reduce medical errors and 

9 healthcare costs caused by communication with indi10 viduals with limited English proficiency or low func11 tional health literacy and reduce or eliminate the du12 plication of effort to translate materials by—

13 ‘‘(A) developing and making available tem14 plates for standard documents that are nec15 essary for patients and consumers to access and 

16 make educated decisions about their healthcare, 

17 including—

18 ‘‘(i) administrative and legal docu19 ments such as informed consent, advanced 

20 directives, and waivers of rights; 

21 ‘‘(ii) clinical information such as how 

22 to take medications, how to prevent trans23 mission of a contagious disease, and other 

24 prevention and treatment instructions; and 
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•S 1833 IS 

1 ‘‘(iii) patient education and outreach 

2 materials such as immunization notices, 

3 health warnings, or screening notices; 

4 ‘‘(B) ensuring that the documents are 

5 posted in English and non-English languages 

6 and are culturally appropriate; 

7 ‘‘(C) allowing public review of the docu8 ments before dissemination in order to ensure 

9 that the documents are understandable and cul10 turally appropriate for the target populations; 

11 ‘‘(D) allowing healthcare providers to cus12 tomize the documents for their use; 

13 ‘‘(E) facilitating access to these docu14 ments; 

15 ‘‘(F) providing technical assistance with 

16 respect to the access and use of such informa17 tion; and 

18 ‘‘(G) carrying out any other activities the 

19 Secretary determines to be useful to fulfill the 

20 purposes of the Clearinghouse. 

21 ‘‘(6) PROVISION OF INFORMATION.—The Cen22 ter shall provide information relating to culturally 

23 and linguistically competent healthcare for minority 

24 populations residing in the United States to all 
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•S 1833 IS 

1 healthcare providers and healthcare organizations at 

2 no cost. Such information shall include—

3 ‘‘(A) tenets of culturally and linguistically 

4 competent care; 

5 ‘‘(B) cultural and linguistic competence 

6 self-assessment tools; 

7 ‘‘(C) cultural and linguistic competence 

8 training tools; 

9 ‘‘(D) strategic plans to increase cultural 

10 and linguistic competence in different types of 

11 healthcare organizations; and 

12 ‘‘(E) resources for cultural competence in13 formation for educators, practitioners and re14 searchers. 

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

16 Director to be appointed by the Director of the Office of 

17 Minority Health who shall report to the Director of the 

18 Office of Minority Health. 

19 ‘‘(c) AVAILABILITY OF LANGUAGE ACCESS.—The Di20 rector shall collaborate with the Administrator of the Cen21 ters for Medicare and Medicaid Services and the Adminis22 trator of the Health Resources and Services Administra23 tion, to notify healthcare providers and healthcare organi24 zations about the availability of language access services 

25 by the Center. 
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•S 1833 IS 

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

2 is authorized to be appropriated to carry out this section 

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

4 2005 through 2010. 

5 ‘‘SEC. 2904. INNOVATIONS IN LANGUAGE ACCESS GRANTS. 

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

7 the Administrator of the Centers for Medicare and Med8 icaid Services, the Administrator of the Health Resources 

9 and Services Administration, and the Director of the Of10 fice of Minority Health, shall award grants to eligible enti11 ties to enable such entities to design, implement, and 

12 evaluate innovative, cost-effective programs to improve lin13 guistic access to healthcare for individuals with limited 

14 English proficiency.

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

16 under subsection (a) an entity shall—

17 ‘‘(1) be a city, county, Indian tribe, State, terri18 tory, community-based nonprofit organization, 

19 health center or community clinic, university, col20 lege, or other entity designated by the Secretary; 

21 and 

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

23 application, at such time, in such manner, and ac24 companied by such additional information as the 

25 Secretary may require. 
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•S 1833 IS 

1 ‘‘(c) USE OF FUNDS.—An entity shall use funds re2 ceived under a grant under this section to—

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

4 providing real-time interpretation services through 

5 in-person interpretation, communications, and com6 puter technology, including the Internet, teleconfer7 encing, or video conferencing; 

8 ‘‘(2) develop short-term medical interpretation 

9 training courses and incentives for bilingual 

10 healthcare staff who are asked to interpret in the 

11 workplace; 

12 ‘‘(3) develop formal training programs for indi13 viduals interested in becoming dedicated healthcare 

14 interpreters; 

15 ‘‘(4) provide language training courses for 

16 healthcare staff; 

17 ‘‘(5) provide basic healthcare-related English 

18 language instruction for limited English proficient 

19 individuals; and 

20 ‘‘(6) develop other language assistance services 

21 as determined appropriate by the Secretary. 

22 ‘‘(d) PRIORITY.—In awarding grants under this sec23 tion, the Secretary shall give priority to entities that have 

24 developed partnerships with organizations or agencies with 

25 experience in language access services. 
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•S 1833 IS 

1 ‘‘(e) EVALUATION.—An entity that receives a grant 

2 under this section shall submit to the Secretary an evalua3 tion that describes the activities carried out with funds 

4 received under the grant, and how such activities improved 

5 access to healthcare services and the quality of healthcare 

6 for individuals with limited English proficiency. Such eval7 uation shall be collected and disseminated through the 

8 Center for Linguistic and Cultural Competence in 

9 Healthcare established under section 2903. 

10 ‘‘(f) GRANTEE CONVENTION.—The Secretary, acting 

11 through the Director of the Center for Linguistic and Cul12 tural Competence in Healthcare, shall at the end of the 

13 grant cycle convene grantees under this section to share 

14 findings and develop and disseminate model programs and 

15 practices. 

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

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

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

19 2005 through 2010. 

20 ‘‘SEC. 2905. RESEARCH ON LANGUAGE ACCESS. 

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

22 the Director of the Agency for Healthcare Research and 

23 Quality, shall expand research concerning—

24 ‘‘(1) the barriers to healthcare services that are 

25 faced by limited English proficient individuals; 
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•S 1833 IS 

1 ‘‘(2) the impact of language barriers on the 

2 quality of healthcare and the health status of limited 

3 English proficient individuals and populations; 

4 ‘‘(3) healthcare provider attitudes, knowledge, 

5 and awareness of the barriers described in para6 graphs (1) and (2); and 

7 ‘‘(4) the means by which oral or written lan8 guage interpretation services are provided to limited 

9 English proficient individuals and whether such serv10 ices are effective in improving the quality of care. 

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

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

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

14 2005 through 2010. 

15 ‘‘SEC. 2906. TOLL-FREE TELEPHONE NUMBER. 

16 ‘‘The Secretary shall provide, through a toll-free 

17 number, for a means by which limited English proficient 

18 individuals who are seeking information about, or assist19 ance with, Federal healthcare programs who phone such 

20 toll-free number are transferred (without charge) to ap21 propriate translators for the provision of such information 

22 or assistance.’’. 

23 SEC. 203. STANDARDS FOR LANGUAGE ACCESS SERVICES. 

24 Not later than 120 days after the date of enactment 

25 of this Act, the head of each Federal agency that carries 
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•S 1833 IS 

1 out health care-related activities shall develop and adopt 

2 a guidance on language services for those with limited 

3 English proficiency who attempt to have access to or par4 ticipate in such activities that provides at the minimum 

5 the factors and principles set forth in the Department of 

6 Justice guidance published on June 12, 2002.

7 SEC. 204. FEDERAL REIMBURSEMENT FOR CULTURALLY 

8 AND LINGUISTICALLY APPROPRIATE SERV9 ICES UNDER THE MEDICARE, MEDICAID AND 

10 STATE CHILDREN’S HEALTH INSURANCE 

11 PROGRAM. 

12 (a) DEMONSTRATION PROJECT PROMOTING ACCESS

13 FOR MEDICARE BENEFICIARIES WITH LIMITED ENGLISH

14 PROFICIENCY.—

15 (1) IN GENERAL.—The Secretary shall conduct 

16 a demonstration project (in this section referred to 

17 as the ‘project’) to demonstrate the impact on costs 

18 and health outcomes of providing reimbursement for 

19 interpreter services to certain medicare beneficiaries 

20 who are limited English proficient in urban and 

21 rural areas. 

22 (2) SCOPE.—The Secretary shall carry out the 

23 project in not less than 30 States through contracts 

24 with up to—
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1 (A) ten health plans (under part C of title 

2 XVIII of the Social Security Act); 

3 (B) ten small providers; and 

4 (C) ten hospitals. 

5 (3) DURATION.—Each contract entered into 

6 under the project shall extend over a period of not 

7 longer than 2 years. 

8 (4) REPORT.—Upon completion of the project, 

9 the Secretary shall submit a report to Congress on 

10 the project which shall include recommendations re11 garding the extension of such project to the entire 

12 medicare program. 

13 (5) EVALUATION.—The Director of the Agency 

14 for Healthcare Research and Quality shall award 

15 grants to public and private nonprofit entities for 

16 the evaluation of the project. Such evaluations shall 

17 focus on access, utilization, efficiency, cost-effective18 ness, patient satisfaction, and select health out19 comes. 

20 (b) MEDICAID.—Section 1903(a)(3) of the Social Se21 curity Act (42 U.S.C. 1396b(a)(3)) is amended—

22 (1) in subparagraph (D), by striking ‘‘plus’’ at 

23 the end and inserting ‘‘and’’; and 

24 (2) by adding at the end the following: 
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1 ‘‘(E) 90 percent of the sums expended with 

2 respect to costs incurred during such quarter as 

3 are attributable to the provision of culturally 

4 and linguistically appropriate services, including 

5 oral interpretation, translations of written ma6 terials, and other cultural and linguistic services 

7 for individuals with limited English proficiency 

8 and disabilities who apply for, or receive, med9 ical assistance under the State plan (including 

10 any waiver granted to the State plan); plus’’.

11 (c) SCHIP.—Section 2105(a)(1) of the Social Secu12 rity Act (42 U.S.C.1397ee(a)), as amended by section 

13 515, is amended—

14 (1) in the matter preceding subparagraph (A), 

15 by inserting ‘‘or, in the case of expenditures de16 scribed in subparagraph (D)(iv), 90 percent’’ after 

17 ‘‘enhanced FMAP’’; and 

18 (2) in subparagraph (D)—

19 (A) in clause (iii), by striking ‘‘and’’ at the 

20 end; 

21 (B) by redesignating clause (iv) as clause 

22 (v); and 

23 (C) by inserting after clause (iii) the fol24 lowing: 
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1 ‘‘(iv) for expenditures attributable to 

2 the provision of culturally and linguistically 

3 appropriate services, including oral inter4 pretation, translations of written materials, 

5 and other language services for individuals 

6 with limited English proficiency and dis7 abilities who apply for, or receive, child 

8 health assistance under the plan; and’’. 

9 (d) EFFECTIVE DATE.—The amendments made by 

10 this section take effect on October 1, 2005. 

11 SEC. 205. INCREASING UNDERSTANDING OF HEALTH LIT12 ERACY. 

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

14 Director of the Agency for Healthcare Research and Qual15 ity and the Administrator of the Health Resources and 

16 Services Administration, shall award grants to eligible en17 tities to improve healthcare for patient populations that 

18 have low functional health literacy. 

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

20 under subsection (a), an entity shall—

21 (1) be a hospital, health center or clinic, health 

22 plan, or other health entity; and 

23 (2) prepare and submit to the Secretary an ap24 plication at such time, in such manner, and con-
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1 taining such information as the Secretary may re2 quire. 

3 (c) USE OF FUNDS.—

4 (1) AGENCY FOR HEALTHCARE RESEARCH AND

5 QUALITY.—Grants awarded under subsection (a) 

6 through the Agency for Healthcare Research and 

7 Quality shall be used—

8 (A) to define and increase the under9 standing of health literacy; 

10 (B) to investigate the correlation between 

11 low health literacy and health and healthcare; 

12 (C) to clarify which aspects of health lit13 eracy have an effect on health outcomes; and 

14 (D) for any other activity determined ap15 propriate by the Director of the Agency. 

16 (2) HEALTH RESOURCES AND SERVICES AD17 MINISTRATION.—Grants awarded under subsection 

18 (a) through the Health Resources and Services Ad19 ministration shall be used to conduct demonstration 

20 projects for interventions for patients with low 

21 health literacy that may include—

22 (A) the development of new disease man23 agement programs for patients with low health 

24 literacy; 
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1 (B) the tailoring of existing disease man2 agement programs for patients with low health 

3 literacy; 

4 (C) the translation of written health mate5 rials for patients with low health literacy; 

6 (D) the identification, implementation, and 

7 testing of low health literacy screening tools; 

8 (E) the conduct of educational campaigns 

9 for patients and providers about low health lit10 eracy; and 

11 (F) other activities determined appropriate 

12 by the Administrator of the Health Resources 

13 and Services Administration. 

14 (d) DEFINITIONS.—In this section, the term ‘‘low 

15 health literacy’’ means the inability of an individual to ob16 tain, process, and understand basic health information 

17 and services needed to make appropriate health decisions. 

18 (e) AUTHORIZATION OF APPROPRIATIONS.—There is 

19 authorized to be appropriated to carry out this section, 

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

21 2005 through 2010. 
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1 SEC. 206. REPORT ON FEDERAL EFFORTS TO PROVIDE CUL2 TURALLY AND LINGUISTICALLY APPRO3 PRIATE HEALTHCARE SERVICES. 

4 Not later than 1 year after the date of enactment 

5 of this Act and annually thereafter, the Secretary of 

6 Health and Human Services shall enter into a contract 

7 with the Institute of Medicine for the preparation and 

8 publication of a report that describes federal efforts to en9 sure that all individuals have meaningful access to cul10 turally and linguistically appropriate healthcare services. 

11 Such report shall include—

12 (1) a description and evaluation of the activities 

13 carried out under this title; and

14 (2) a description of best practices, model pro15 grams, guidelines, and other effective strategies for 

16 providing access to culturally and linguistically ap17 propriate healthcare services. 

18 SEC. 207. GENERAL ACCOUNTING OFFICE REPORT ON IM19 PACT OF LANGUAGE ACCESS SERVICES. 

20 Not later than 3 years after the date of enactment 

21 of this Act, the Comptroller General of the United States 

22 shall examine, and prepare and publish a report on, the 

23 impact of language access services on the health and 

24 healthcare of limited English proficient populations. Such 

25 report shall include—
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1 (1) recommendations on the development and 

2 implementation of policies and practices by 

3 healthcare organizations and providers for limited 

4 English proficient patient populations; 

5 (2) a description of the effect of providing lan6 guage access services on quality of healthcare and 

7 access to care; and 

8 (3) a description of the costs associated with or 

9 savings related to provision of language access serv10 ices. 

11 TITLE III—HEALTH WORKFORCE 

12 DIVERSITY 

13 SEC. 301. AMENDMENT TO THE PUBLIC HEALTH SERVICE 

14 ACT. 

15 Title XXIX of the Public Health Service Act, as 

16 added by section 202, is amended by adding at the end 

17 the following: 

18 ‘‘Subtitle B—Workforce Diversity 

19 ‘‘SEC. 2911. REPORT ON WORKFORCE DIVERSITY. 

20 ‘‘(a) IN GENERAL.—Not later than July 1, 2006, and 

21 biannually thereafter, the Secretary, acting through the 

22 director of each entity within the Department of Health 

23 and Human Services, shall prepare and submit to the 

24 Committee on Health, Education, Labor, and Pensions of 

25 the Senate and the Committee on Energy and Commerce 
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1 of the House of Representatives a report on health work2 force diversity. 

3 ‘‘(b) REQUIREMENT.—The report under subsection 

4 (a) shall contain the following information: 

5 ‘‘(1) A description of any grant support that is 

6 provided by each entity for workforce diversity ini7 tiatives with the following information—

8 ‘‘(A) the number of grants made; 

9 ‘‘(B) the purpose of the grants; 

10 ‘‘(C) the populations served through the 

11 grants; 

12 ‘‘(D) the organizations and institutions re13 ceiving the grants; and 

14 ‘‘(E) the tracking efforts that were used to 

15 follow the progress of participants. 

16 ‘‘(2) A description of the entity’s plan to 

17 achieve workforce diversity goals that includes, to 

18 the extent relevant to such entity—

19 ‘‘(A) the number of underrepresented mi20 nority health professionals that will be needed 

21 in various disciplines over the next 10 years to 

22 achieve population parity; 

23 ‘‘(B) the level of funding needed to fully 

24 expand and adequately support health profes25 sions pipeline programs; 
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1 ‘‘(C) the impact such programs have had 

2 on the admissions practices and policies of 

3 health professions schools; 

4 ‘‘(D) the management strategy necessary 

5 to effectively administer and institutionalize 

6 health profession pipeline programs; and 

7 ‘‘(E) the impact that the Government Per8 formance and Results Act (GPRA) has had on 

9 evaluating the performance of grantees and 

10 whether the GPRA is the best assessment tool 

11 for programs under titles VII and VIII. 

12 ‘‘(3) A description of measurable objectives of 

13 each entity relating to workforce diversity initiatives. 

14 ‘‘(c) PUBLIC AVAILABILITY.—The report under sub15 section (a) shall be made available for public review and 

16 comment. 

17 ‘‘SEC. 2912. NATIONAL WORKING GROUP ON WORKFORCE 

18 DIVERSITY. 

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

20 the Bureau of Health Professions within the Health Re21 sources and Services Administration, shall award a grant 

22 to an entity determined appropriate by the Secretary for 

23 the establishment of a national working group on work24 force diversity. 
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1 ‘‘(b) REPRESENTATION.—In establishing the national 

2 working group under subsection (a), the grantee shall en3 sure that the group has representation from the following 

4 entities: 

5 ‘‘(1) The Health Resources and Services Ad6 ministration. 

7 ‘‘(2) The Department of Health and Human 

8 Services Data Council. 

9 ‘‘(3) The Bureau of Labor Statistics of the De10 partment of Labor. 

11 ‘‘(4) The Public Health Practice Program Of12 fice—Office of Workforce Policy and Planning. 

13 ‘‘(5) The National Center on Minority Health 

14 and Health Disparities. 

15 ‘‘(6) The Agency for Healthcare Research and 

16 Quality. 

17 ‘‘(7) The Institute of Medicine Study Com18 mittee for the 2004 workforce diversity report. 

19 ‘‘(8) The Indian Health Service. 

20 ‘‘(9) Academic institutions. 

21 ‘‘(10) Consumer organizations. 

22 ‘‘(11) Health professional associations, includ23 ing those that represent underrepresented minority 

24 populations. 
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1 ‘‘(12) Researchers in the area of health work2 force. 

3 ‘‘(13) Health workforce accreditation entities. 

4 ‘‘(14) Private foundations that have sponsored 

5 workforce diversity initiatives. 

6 ‘‘(15) Not less than 5 health professions stu7 dents representing various health profession fields 

8 and levels of training. 

9 ‘‘(c) ACTIVITIES.—The working group established 

10 under subsection (a) shall convene at least twice each year 

11 to complete the following activities: 

12 ‘‘(1) Review current public and private health 

13 workforce diversity initiatives. 

14 ‘‘(2) Identify successful health workforce diver15 sity programs and practices. 

16 ‘‘(3) Examine challenges relating to the devel17 opment and implementation of health workforce di18 versity initiatives. 

19 ‘‘(4) Draft a national strategic work plan for 

20 health workforce diversity, including recommenda21 tions for public and private sector initiatives. 

22 ‘‘(5) Develop a framework and methods for the 

23 evaluation of current and future health workforce di24 versity initiatives. 
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1 ‘‘(6) Develop recommended standards for work2 force diversity that could be applicable to all health 

3 professions programs and programs funded under 

4 this Act. 

5 ‘‘(7) Develop curriculum guidelines for diversity 

6 training. 

7 ‘‘(8) Develop a strategy for the inclusion of 

8 community members on admissions committees for 

9 health profession schools. 

10 ‘‘(9) Other activities determined appropriate by 

11 the Secretary.

12 ‘‘(d) ANNUAL REPORT.—Not later than 1 year after 

13 the establishment of the working group under subsection 

14 (a), and annually thereafter, the working group shall pre15 pare and make available to the general public for com16 ment, an annual report on the activities of the working 

17 group. Such report shall include the recommendations of 

18 the working group for improving health workforce diver19 sity. 

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

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

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

23 2005 through 2010. 
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1 ‘‘SEC. 2913. TECHNICAL CLEARINGHOUSE FOR HEALTH 

2 WORKFORCE DIVERSITY. 

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

4 the Office of Minority Health, and in collaboration with 

5 the Bureau of Health Professions within the Health Re6 sources and Services Administration, shall establish a 

7 technical clearinghouse on health workforce diversity with8 in the Office of Minority Health and coordinate current 

9 and future clearinghouses. 

10 ‘‘(b) INFORMATION AND SERVICES.—The clearing11 house established under subsection (a) shall offer the fol12 lowing information and services: 

13 ‘‘(1) Information on the importance of health 

14 workforce diversity. 

15 ‘‘(2) Statistical information relating to under16 represented minority representation in health and al17 lied health professions and occupations. 

18 ‘‘(3) Model health workforce diversity practices 

19 and programs. 

20 ‘‘(4) Admissions policies that promote health 

21 workforce diversity and are in compliance with Fed22 eral and State laws. 

23 ‘‘(5) Lists of scholarship, loan repayment, and 

24 loan cancellation grants as well as fellowship infor25 mation for underserved populations for health pro26 fessions schools. 
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1 ‘‘(6) Foundation and other large organizational 

2 initiatives relating to health workforce diversity. 

3 ‘‘(c) CONSULTATION.—In carrying out this section, 

4 the Secretary shall consult with non-Federal entities which 

5 may include minority health professional associations to 

6 ensure the adequacy and accuracy of information. 

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

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

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

10 2005 through 2010. 

11 ‘‘SEC. 2914. EVALUATION OF WORKFORCE DIVERSITY INI12 TIATIVES. 

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

14 the Bureau of Health Professions within the Health Re15 sources and Services Administration, shall award grants 

16 to eligible entities for the conduct of an evaluation of cur17 rent health workforce diversity initiatives funded by the 

18 Department of Health and Human Services. 

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

20 under subsection (a) an entity shall—

21 ‘‘(1) be a city, county, Indian tribe, State, terri22 tory, community-based nonprofit organization, 

23 health center, university, college, or other entity de24 termined appropriate by the Secretary; 
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1 ‘‘(2) with respect to an entity that is not an 

2 academic medical center, university, or private re3 search institution, carry out activities under the 

4 grant in partnership with an academic medical cen5 ter, university, or private research institution; and 

6 ‘‘(3) submit to the Secretary an application at 

7 such time, in such manner, and containing such in8 formation as the Secretary may require. 

9 ‘‘(c) USE OF FUNDS.—Amounts awarded under a 

10 grant under subsection (a) shall be used to support the 

11 following evaluation activities: 

12 ‘‘(1) Determinations of measures of health 

13 workforce diversity success. 

14 ‘‘(2) The short- and long-term tracking of par15 ticipants in health workforce diversity pipeline pro16 grams funded by the Department of Health and 

17 Human Services. 

18 ‘‘(3) Assessments of partnerships formed 

19 through activities to increase health workforce diver20 sity. 

21 ‘‘(4) Assessments of barriers to health work22 force diversity. 

23 ‘‘(5) Assessments of policy changes at the Fed24 eral, State, and local levels. 
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1 ‘‘(6) Assessments of coordination within and be2 tween Federal agencies and other institutions. 

3 ‘‘(7) Other activities determined appropriate by 

4 the Secretary and the Working Group established 

5 under section 2912. 

6 ‘‘(d) REPORT.—Not later than 1 year after the date 

7 of enactment of this title, the Bureau of Health Profes8 sions within the Health Resources and Services Adminis9 tration shall prepare and make available for public com10 ment a report that summarizes the findings made by enti11 ties under grants under this section. 

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

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

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

15 2005 through 2010. 

16 ‘‘SEC. 2915. DATA COLLECTION AND REPORTING BY 

17 HEALTH PROFESSIONAL SCHOOLS. 

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

19 the Bureau of Health Professions of the Health Resources 

20 and Services Administration and the Office of Minority 

21 Health, shall establish an aggregated database on health 

22 professional students. 

23 ‘‘(b) REQUIREMENT TO COLLECT DATA.—Each 

24 health professional school (including medical, dental, and 

25 nursing schools) and allied health profession school and 
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1 program that receives Federal funds shall collect race, eth2 nicity, and language proficiency data concerning those stu3 dents enrolled at such schools or in such programs. In col4 lecting such data, a school or program shall—

5 ‘‘(1) at a minimum, use the categories for race 

6 and ethnicity described in the 1997 Office of Man7 agement and Budget Standards for Maintaining, 

8 Collecting, and Presenting Federal Data on Race 

9 and Ethnicity and available language standards; and 

10 ‘‘(2) if practicable, collect data on additional 

11 population groups if such data can be aggregated 

12 into the minimum race and ethnicity data categories. 

13 ‘‘(c) USE OF DATA.—Data on race, ethnicity, and 

14 primary language collected under this section shall be re15 ported to the database established under subsection (a) 

16 on an annual basis. Such data shall be available for public 

17 use. 

18 ‘‘(d) PRIVACY.—The Secretary shall ensure that all 

19 data collected under this section is protected from inap20 propriate internal and external use by any entity that col21 lects, stores, or receives the data and that such data is 

22 collected without personally identifiable information. 

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

24 is authorized to be appropriated to carry out this section, 
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1 such sums as may be necessary for each of fiscal years 

2 2005 through 2010. 

3 ‘‘SEC. 2916. SUPPORT FOR INSTITUTIONS COMMITTED TO 

4 WORKFORCE DIVERSITY. 

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

6 the Administrator of the Health Resources and Services 

7 Administration, shall award grants to eligible entities that 

8 demonstrate a commitment to health workforce diversity. 

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

10 under subsection (a), an entity shall—

11 ‘‘(1) be an educational institution or entity that 

12 historically produces or trains meaningful numbers 

13 of underrepresented minority health professionals, 

14 including—

15 ‘‘(A) Historically Black Colleges and Uni16 versities; 

17 ‘‘(B) Hispanic-Serving Health Professions 

18 Schools; 

19 ‘‘(C) Hispanic-Serving Institutions; 

20 ‘‘(D) Tribal Colleges and Universities; 

21 ‘‘(E) Asian American and Pacific Islander22 serving institutions; 

23 ‘‘(F) institutions that have programs to re24 cruit and retain underrepresented minority 

25 health professionals, in which a significant 
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1 number of the enrolled participants are under2 represented minorities; 

3 ‘‘(G) health professional associations, 

4 which may include underrepresented minority 

5 health professional associations; and 

6 ‘‘(H) institutions—

7 ‘‘(i) located in communities with pre8 dominantly underrepresented minority pop9 ulations; 

10 ‘‘(ii) with whom partnerships have 

11 been formed for the purpose of increasing 

12 workforce diversity; and 

13 ‘‘(iii) in which at least 20 percent of 

14 the enrolled participants are underrep15 resented minorities; and 

16 ‘‘(2) submit to the Secretary an application at 

17 such time, in such manner, and containing such in18 formation as the Secretary may require. 

19 ‘‘(c) USE OF FUNDS.—Amounts received under a 

20 grant under subsection (a) shall be used to expand existing 

21 workforce diversity programs, implement new workforce 

22 diversity programs, or evaluate existing or new workforce 

23 diversity programs. Such programs shall enhance diversity 

24 by considering minority status as part of an individualized 
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•S 1833 IS 

1 consideration of qualifications. Possible activities may in2 clude—

3 ‘‘(1) educational outreach programs relating to 

4 opportunities in the health professions; 

5 ‘‘(2) scholarship, fellowship, grant, loan repay6 ment, and loan cancellation programs; 

7 ‘‘(3) post-baccalaureate programs; 

8 ‘‘(4) academic enrichment programs, particu9 larly targeting those who would not be competitive 

10 for health professions schools; 

11 ‘‘(5) kindergarten through 12th grade and 

12 other health pipeline programs; 

13 ‘‘(6) mentoring programs; 

14 ‘‘(7) internship or rotation programs involving 

15 hospitals, health systems, health plans and other 

16 health entities; 

17 ‘‘(8) community partnership development for 

18 purposes relating to workforce diversity; or 

19 ‘‘(9) leadership training. 

20 ‘‘(d) REPORTS.—Not later than 1 year after receiving 

21 a grant under this section, and annually for the term of 

22 the grant, a grantee shall submit to the Secretary a report 

23 that summarizes and evaluates all activities conducted 

24 under the grant. 
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1 ‘‘(e) DEFINITION.—In this section, the term ‘Asian 

2 American and Pacific Islander-serving institutions’ means 

3 institutions—

4 ‘‘(1) that are eligible institutions under section 

5 312(b) of the Higher Education Act of 1965; and 

6 ‘‘(2) that, at the time of their application, have 

7 an enrollment of undergraduate students that is 

8 made up of at least 10 percent Asian American and 

9 Pacific Islander students. 

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

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

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

13 2005 through 2010. 

14 ‘‘SEC. 2917. CAREER DEVELOPMENT FOR SCIENTISTS AND 

15 RESEARCHERS. 

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

17 the Director of the National Institutes of Health, the Di18 rector of the Centers for Disease Control and Prevention, 

19 the Commissioner of the Food and Drug Administration, 

20 and the Director of the Agency for Healthcare Research 

21 and Quality, shall award grants that expand existing op22 portunities for scientists and researchers and promote the 

23 inclusion of underrepresented minorities in the health pro24 fessions. 
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1 ‘‘(b) RESEARCH FUNDING.—The head of each entity 

2 within the Department of Health and Human Services 

3 shall establish or expand existing programs to provide re4 search funding to scientists and researchers in-training. 

5 Under such programs, the head of each such entity shall 

6 give priority in allocating research funding to support 

7 health research in traditionally underserved communities, 

8 including underrepresented minority communities, and re9 search classified as community or participatory. 

10 ‘‘(c) DATA COLLECTION.—The head of each entity 

11 within the Department of Health and Human Services 

12 shall collect data on the number (expressed as an absolute 

13 number and a percentage) of underrepresented minority 

14 and nonminority applicants who receive and are denied 

15 agency funding at every stage of review. Such data shall 

16 be reported annually to the Secretary and the appropriate 

17 committees of Congress. 

18 ‘‘(d) STUDENT LOAN REIMBURSEMENT.—The Sec19 retary shall establish a student loan reimbursement pro20 gram to provide student loan reimbursement assistance to 

21 researchers who focus on minority health issues or minor22 ity racial and ethnic disparities in health. The Secretary 

23 shall promulgate regulations to define the scope and pro24 cedures for the program under this subsection. 
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1 ‘‘(e) STUDENT LOAN CANCELLATION.—The Sec2 retary shall establish a student loan cancellation program 

3 to provide student loan cancellation assistance to research4 ers who focus on minority health issues or minority racial 

5 and ethnic disparities in health. Students participating in 

6 the program shall make a minimum 5-year commitment 

7 to work at an accredited health profession school. The Sec8 retary shall promulgate additional regulations to define 

9 the scope and procedures for the program under this sub10 section. 

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

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

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

14 2005 through 2010. 

15 ‘‘SEC. 2918. CAREER SUPPORT FOR NON-RESEARCH 

16 HEALTH PROFESSIONALS. 

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

18 the Director of the Centers for Disease Control and Pre19 vention, the Administrator of the Substance Abuse and 

20 Mental Health Services Administration, the Administrator 

21 of the Health Resources and Services Administration, and 

22 the Administrator of the Centers for Medicare and Med23 icaid Services shall establish a program to award grants 

24 to eligible individuals for career support in non-research25 related healthcare. 
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1 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 

2 under subsection (a) an individual shall—

3 ‘‘(1) be a student in a health professions school, 

4 a graduate of such a school who is working in a 

5 health profession, or a faculty member of such a 

6 school; and 

7 ‘‘(2) submit to the Secretary an application at 

8 such time, in such manner, and containing such in9 formation as the Secretary may require. 

10 ‘‘(c) USE OF FUNDS.—An individual shall use 

11 amounts received under a grant under this section to—

12 ‘‘(1) support the individual’s health activities or 

13 projects that involve underserved communities, in14 cluding racial and ethnic minority communities; 

15 ‘‘(2) support health-related career advancement 

16 activities; and 

17 ‘‘(3) to pay, or as reimbursement for payments 

18 of, student loans for individuals who are health pro19 fessionals and are focused on health issues affecting 

20 underserved communities, including racial and eth21 nic minority communities. 

22 ‘‘(d) DEFINITION.—In this section, the term ‘career 

23 in non-research-related healthcare’ means employment or 

24 intended employment in the field of public health, health 

25 policy, health management, health administration, medi-
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1 cine, nursing, pharmacy, allied health, community health, 

2 or other fields determined appropriate by the Secretary, 

3 other than in a position that involves research. 

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

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

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

7 2005 through 2010. 

8 ‘‘SEC. 2919. RESEARCH ON THE EFFECT OF WORKFORCE DI9 VERSITY ON QUALITY. 

10 ‘‘(a) IN GENERAL.—The Director of the Agency for 

11 Healthcare Research and Quality, in collaboration with 

12 the Director of the Office of Minority Health and the Di13 rector of the National Center on Minority Health and 

14 Health Disparities, shall award grants to eligible entities 

15 to expand research on the link between health workforce 

16 diversity and quality healthcare. 

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

18 under subsection (a) an entity shall—

19 ‘‘(1) be a clinical, public health, or health serv20 ices research entity or other entity determined ap21 propriate by the Director; and 

22 ‘‘(2) submit to the Secretary an application at 

23 such time, in such manner, and containing such in24 formation as the Secretary may require. 
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1 ‘‘(c) USE OF FUNDS.—Amounts received under a 

2 grant awarded under subsection (a) shall be used to sup3 port research that investigates the effect of health work4 force diversity on—

5 ‘‘(1) language access; 

6 ‘‘(2) cultural competence; 

7 ‘‘(3) patient satisfaction; 

8 ‘‘(4) timeliness of care; 

9 ‘‘(5) safety of care; 

10 ‘‘(6) effectiveness of care; 

11 ‘‘(7) efficiency of care; 

12 ‘‘(8) patient outcomes; 

13 ‘‘(9) community engagement; 

14 ‘‘(10) resource allocation; 

15 ‘‘(11) organizational structure; or 

16 ‘‘(12) other topics determined appropriate by 

17 the Director. 

18 ‘‘(d) PRIORITY.—In awarding grants under sub19 section (a), the Director shall give individualized consider20 ation to all relevant aspects of the applicant’s background. 

21 Consideration of prior research experience involving the 

22 health of underserved communities shall be such a factor. 

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

24 is authorized to be appropriated to carry out this section, 
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1 such sums as may be necessary for each of fiscal years 

2 2005 through 2010. 

3 ‘‘SEC. 2920. HEALTH DISPARITIES EDUCATION PROGRAM. 

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

5 through the National Center on Minority Health and 

6 Health Disparities and in collaboration with the Office of 

7 Minority Health, the Office for Civil Rights, the Centers 

8 for Disease Control and Prevention, the Centers for Medi9 care and Medicaid Services, the Health Resources and 

10 Services Administration, and other appropriate public and 

11 private entities, shall establish and coordinate a health and 

12 healthcare disparities education program to support, de13 velop, and implement educational initiatives and outreach 

14 strategies that inform healthcare professionals and the 

15 public about the existence of and methods to reduce racial 

16 and ethnic disparities in health and healthcare. 

17 ‘‘(b) ACTIVITIES.—The Secretary, through the edu18 cation program established under subsection (a) shall, 

19 through the use of public awareness and outreach cam20 paigns targeting the general public and the medical com21 munity at large—

22 ‘‘(1) disseminate scientific evidence for the ex23 istence and extent of racial and ethnic disparities in 

24 healthcare, including disparities that are not other25 wise attributable to known factors such as access to 
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•S 1833 IS 

1 care, patient preferences, or appropriateness of 

2 intervention, as described in the 2002 Institute of 

3 Medicine Report, Unequal Treatment; 

4 ‘‘(2) disseminate new research findings to 

5 healthcare providers and patients to assist them in 

6 understanding, reducing, and eliminating health and 

7 healthcare disparities; 

8 ‘‘(3) disseminate information about the impact 

9 of linguistic and cultural barriers on healthcare qual10 ity and the obligation of health providers who receive 

11 Federal financial assistance to ensure that people 

12 with limited English proficiency have access to lan13 guage access services; 

14 ‘‘(4) disseminate information about the impor15 tance and legality of racial, ethnic, and primary lan16 guage data collection, analysis, and reporting; 

17 ‘‘(5) design and implement specific educational 

18 initiatives to health care providers relating to health 

19 and health care disparities; 

20 ‘‘(6) assess the impact of the programs estab21 lished under this section in raising awareness of 

22 health and healthcare disparities and providing in23 formation on available resources. 

24 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 

25 is authorized to be appropriated to carry out this section, 
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•S 1833 IS 

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

2 2005 through 2010. 

3 ‘‘SEC. 2920A. CULTURAL COMPETENCE TRAINING FOR 

4 HEALTHCARE PROFESSIONALS. 

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

6 the Administrator of the Health Resources and Services 

7 Administration, the Director of the Office of Minority 

8 Health, and the Director of the National Center for Mi9 nority Health and Health Disparities, shall award grants 

10 to eligible entities to test, implement, and evaluate models 

11 of cultural competence training for healthcare providers 

12 in coordination with the initiative under section 2920A(a). 

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

14 under subsection (a), an entity shall—

15 ‘‘(1) be an academic medical center, a health 

16 center or clinic, a hospital, a health plan, or a health 

17 system; 

18 ‘‘(2) partner with a minority serving institution, 

19 minority professional association, or community20 based organization representing minority popu21 lations, in addition to a research institution to carry 

22 out activities under this grant; and 

23 ‘‘(3) prepare and submit to the Secretary an 

24 application at such time, in such manner, and con-
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•S 1833 IS 

1 taining such information as the Secretary may re2 quire. 

3 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 

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

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

6 2005 through 2010.’’. 

7 SEC. 302. HEALTH CAREERS OPPORTUNITY PROGRAM. 

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

9 diversify the healthcare workforce by increasing the num10 ber of individuals from disadvantaged backgrounds in the 

11 health and allied health professions by enhancing the aca12 demic skills of students from disadvantaged backgrounds 

13 and supporting them in successfully competing, entering, 

14 and graduating from health professions training pro15 grams. 

16 (b) AUTHORIZATION OF APPROPRIATIONS.—Section 

17 740(c) of the Public Health Service Act (42 U.S.C. 

18 293d(c)) is amended by striking ‘‘$29,400,000’’ and all 

19 that follows through ‘‘2002’’ and inserting ‘‘$50,000,000 

20 for fiscal year 2005, and such sums as may be necessary 

21 for each of fiscal years 2006 through 2010’’. 
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•S 1833 IS 

1 SEC. 303. PROGRAM OF EXCELLENCE IN HEALTH PROFES2 SIONS EDUCATION FOR UNDERREP3 RESENTED MINORITIES. 

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

5 diversify the healthcare workforce by supporting programs 

6 of excellence in designated health professions schools that 

7 demonstrate a commitment to underrepresented minority 

8 populations with a focus on minority health issues, cul9 tural and linguistic competence, and eliminating health 

10 disparities. 

11 (b) AUTHORIZATION OF APPROPRIATION.—Section 

12 737(h)(1) of the Public Health Service Act (42 U.S.C. 

13 293(h)(1)) is amended to read as follows: 

14 ‘‘(1) AUTHORIZATION OF APPROPRIATIONS.—

15 For the purpose of making grants under subsection 

16 (a), there are authorized to be appropriated 

17 $50,000,000 for fiscal year 2005, and such sums as 

18 may be necessary for each of the fiscal years 2006 

19 through 2010.’’. 

20 SEC. 304. HISPANIC-SERVING HEALTH PROFESSIONS 

21 SCHOOLS. 

22 Part B of title VII of the Public Health Service Act 

23 (42 U.S.C. 293 et seq.) is amended by adding at the end 

24 the following: 
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•S 1833 IS 

1 ‘‘SEC. 742. HISPANIC-SERVING HEALTH PROFESSIONS 

2 SCHOOLS. 

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

4 the Administrator of the Health Resources and Services 

5 Administration, shall award grants to Hispanic-serving 

6 health professions schools for the purpose of carrying out 

7 programs to recruit Hispanic individuals to enroll in and 

8 graduate from such schools, which may include providing 

9 scholarships and other financial assistance as appropriate. 

10 ‘‘(b) ELIGIBILITY.—In subsection (a), the term ‘His11 panic-serving health professions school’ means an entity 

12 that—

13 ‘‘(1) is a school or program under section 

14 799B; 

15 ‘‘(2) has an enrollment of full-time equivalent 

16 students that is made up of at least 9 percent His17 panic students; 

18 ‘‘(3) has been effective in carrying out pro19 grams to recruit Hispanic individuals to enroll in 

20 and graduate from the school; 

21 ‘‘(4) has been effective in recruiting and retain22 ing Hispanic faculty members; and 

23 ‘‘(5) has a significant number of graduates who 

24 are providing health services to medically under25 served populations or to individuals in health profes26 sional shortage areas.’’. 
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•S 1833 IS 

1 SEC. 305. HEALTH PROFESSIONS STUDENT LOAN FUND; AU2 THORIZATIONS OF APPROPRIATIONS RE3 GARDING STUDENTS FROM DISADVANTAGED 

4 BACKGROUNDS. 

5 Section 724(f)(1) of the Public Health Service Act 

6 (42 U.S.C. 292t(f)(1)) is amended by striking 

7 ‘‘$8,000,000’’ and all that follows and inserting 

8 ‘‘$35,000,000 for fiscal year 2005, and such sums as may 

9 be necessary for each of the fiscal years 2006 through 

10 2010.’’. 

11 SEC. 306. NATIONAL HEALTH SERVICE CORPS; RECRUIT12 MENT AND FELLOWSHIPS FOR INDIVIDUALS 

13 FROM DISADVANTAGED BACKGROUNDS. 

14 (a) IN GENERAL.—Section 331(b) of the Public 

15 Health Service Act (42 U.S.C. 254d(b)) is amended by 

16 adding at the end the following: 

17 ‘‘(3) The Secretary shall ensure that the individuals 

18 with respect to whom activities under paragraphs (1) and 

19 (2) are carried out include individuals from disadvantaged 

20 backgrounds, including activities carried out to provide 

21 health professions students with information on the Schol22 arship and Repayment Programs.’’. 

23 (b) ASSIGNMENT OF CORPS PERSONNEL.—Section 

24 333(a) of the Public Health Service Act (42 U.S.C. 

25 254f(a)) is amended by adding at the end the following: 
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•S 1833 IS 

1 ‘‘(4) In assigning Corps personnel under this section, 

2 the Secretary shall give preference to applicants who re3 quest assignment to a federally qualified health center (as 

4 defined in section 1905(l)(2)(B) of the Social Security 

5 Act) or to a provider organization that has a majority of 

6 patients who are minorities or individuals from low-income 

7 families (families with a family income that is less than 

8 200 percent of the Official Poverty Line).’’. 

9 SEC. 307. LOAN REPAYMENT PROGRAM OF CENTERS FOR 

10 DISEASE CONTROL AND PREVENTION. 

11 Section 317F(c) of the Public Health Service Act (42 

12 U.S.C. 247b–7(c)) is amended—

13 (1) by striking ‘‘and’’ after ‘‘1994,’’; and 

14 (2) by inserting before the period the following: 

15 ‘‘$750,000 for fiscal year 2005, and such sums as 

16 may be necessary for each of the fiscal years 2006 

17 through 2010.’’. 

18 SEC. 308. COOPERATIVE AGREEMENTS FOR ONLINE DE19 GREE PROGRAMS AT SCHOOLS OF PUBLIC 

20 HEALTH AND SCHOOLS OF ALLIED HEALTH. 

21 Part B of title VII of the Public Health Service Act 

22 (42 U.S.C. 293 et seq.), as amended by section 304, is 

23 further amended by adding at the end the following: 
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•S 1833 IS 

1 ‘‘SEC. 743. COOPERATIVE AGREEMENTS FOR ONLINE DE2 GREE PROGRAMS. 

3 ‘‘(a) COOPERATIVE AGREEMENTS.—The Secretary, 

4 acting through the Administrator of the Health Resources 

5 and Services Administration, in consultation with the Di6 rector of the Centers for Disease Control and Prevention, 

7 the Director of the Agency for Healthcare Research and 

8 Quality, and the Director of the Office of Minority Health, 

9 shall award cooperative agreements to schools of public 

10 health and schools of allied health to design and imple11 ment online degree programs. 

12 ‘‘(b) PRIORITY.—In awarding cooperative agreements 

13 under this section, the Secretary shall give priority to any 

14 school of public health or school of allied health that is 

15 located in a medically underserved community. 

16 ‘‘(c) REQUIREMENTS.—Awardees must design and 

17 implement an online degree program, that meet the fol18 lowing restrictions: 

19 ‘‘(1) Enrollment of individuals who have ob20 tained a secondary school diploma or its recognized 

21 equivalent. 

22 ‘‘(2) Maintaining a significant enrollment of 

23 underrepresented minority or disadvantaged stu24 dents. 

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

26 are authorized to be appropriated to carry out this section, 
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•S 1833 IS 

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

2 2005 through 2010.’’. 

3 SEC. 309. MID-CAREER HEALTH PROFESSIONS SCHOLAR4 SHIP PROGRAM. 

5 Part B of title VII of the Public Health Service Act 

6 (as amended by section 308) is further amended by adding 

7 at the end the following: 

8 ‘‘SEC. 744. MID-CAREER HEALTH PROFESSIONS SCHOLAR9 SHIP PROGRAM. 

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

11 to eligible schools for awarding scholarships to eligible in12 dividuals to attend the school involved, for the purpose of 

13 enabling the individuals to make a career change from a 

14 non-health profession to a health profession.

15 ‘‘(b) EXPENSES.—Amounts awarded as a scholarship 

16 under this section may be expended only for tuition ex17 penses, other reasonable educational expenses, and reason18 able living expenses incurred in the attendance of the 

19 school involved. 

20 ‘‘(c) DEFINITIONS.—In this section: 

21 ‘‘(1) ELIGIBLE SCHOOL.—The term ‘eligible 

22 school’ means a school of medicine, osteopathic med23 icine, dentistry, nursing (as defined in section 801), 

24 pharmacy, podiatric medicine, optometry, veterinary 

25 medicine, public health, chiropractic, or allied health, 
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•S 1833 IS 

1 a school offering a graduate program in behavioral 

2 and mental health practice, or an entity providing 

3 programs for the training of physician assistants. 

4 ‘‘(2) ELIGIBLE INDIVIDUAL.—The term ‘eligible 

5 individual’ means an individual who has obtained a 

6 secondary school diploma or its recognized equiva7 lent. 

8 ‘‘(d) PRIORITY.—In providing scholarships to eligible 

9 individuals, eligible schools shall give to individuals from 

10 disadvantaged backgrounds. 

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

12 are authorized to be appropriated to carry out this section, 

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

14 2005 through 2010.’’. 

15 SEC. 310. NATIONAL REPORT ON THE PREPAREDNESS OF 

16 HEALTH PROFESSIONALS TO CARE FOR DI17 VERSE POPULATIONS. 

18 The Secretary of Health and Human Services shall 

19 include in the report prepared under section 1707(c) of 

20 the Public Health Service Act (as added by section 603 

21 of this Act), information relating to the preparedness of 

22 health professionals to care for racially and ethnically di23 verse populations. Such information, which shall be col24 lected by the Bureau of Health Professions, shall in25 clude—
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•S 1833 IS 

1 (1) with respect to health professions education, 

2 the number and percentage of hours of classroom 

3 discussion relating to minority health issues, includ4 ing cultural competence; 

5 (2) a description of the coursework involved in 

6 such education; 

7 (3) a description of the results of an evaluation 

8 of the preparedness of students in such education; 

9 (4) a description of the types of exposure that 

10 students have during their education to minority pa11 tient populations; and 

12 (5) a description of model programs and prac13 tices. 

14 SEC. 311. SCHOLARSHIP AND FELLOWSHIP PROGRAMS. 

15 Subtitle B of title XXIX of the Public Health Service 

16 Act, as amended by section 301, is further amended by 

17 adding at the end the following: 

18 ‘‘SEC. 2920B. DAVID SATCHER PUBLIC HEALTH AND 

19 HEALTH SERVICES CORPS. 

20 ‘‘(a) IN GENERAL.—The Administrator of the Health 

21 Resources and Services Administration and Director of 

22 the Centers for Disease Control and Prevention, in col23 laboration with the Director of the Office of Minority 

24 Health, shall award grants to eligible entities to increase 
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•S 1833 IS 

1 awareness among post-primary and post-secondary stu2 dents of career opportunities in the health professions. 

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

4 under subsection (a) an entity shall—

5 ‘‘(1) be a clinical, public health or health serv6 ices organization, community-based or non-profit en7 tity, or other entity determined appropriate by the 

8 Director of the Centers for Disease Control and Pre9 vention; 

10 ‘‘(2) serve a health professional shortage area, 

11 as determined by the Secretary; 

12 ‘‘(3) work with students, including those from 

13 racial and ethnic minority backgrounds, that have 

14 expressed an interest in the health professions; and 

15 ‘‘(4) submit to the Secretary an application at 

16 such time, in such manner, and containing such in17 formation as the Secretary may require. 

18 ‘‘(c) USE OF FUNDS.—Grant awards under sub19 section (a) shall be used to support internships that will 

20 increase awareness among students of non-research based 

21 and career opportunities in the following health profes22 sions: 

23 ‘‘(1) Medicine. 

24 ‘‘(2) Nursing. 

25 ‘‘(3) Public Health. 
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•S 1833 IS 

1 ‘‘(4) Pharmacy. 

2 ‘‘(5) Health Administration and Management. 

3 ‘‘(6) Health Policy. 

4 ‘‘(7) Psychology. 

5 ‘‘(8) Dentistry. 

6 ‘‘(9) International Health. 

7 ‘‘(10) Social Work. 

8 ‘‘(11) Allied Health. 

9 ‘‘(12) Other professions deemed appropriate by 

10 the Director of the Centers for Disease Control and 

11 Prevention. 

12 ‘‘(d) PRIORITY.—In awarding grants under sub13 section (a), the Director of the Centers for Disease Con14 trol and Prevention shall give priority to those entities 

15 that—

16 ‘‘(1) serve a high proportion of individuals from 

17 disadvantaged backgrounds; 

18 ‘‘(2) have experience in health disparity elimi19 nation programs; 

20 ‘‘(3) facilitate the entry of disadvantaged indi21 viduals into institutions of higher education; and 

22 ‘‘(4) provide counseling or other services de23 signed to assist disadvantaged individuals in success24 fully completing their education at the post-sec25 ondary level. 
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•S 1833 IS 

1 ‘‘(f) STIPENDS.—The Secretary may approve sti2 pends under this section for individuals for any period of 

3 education in student-enhancement programs (other than 

4 regular courses) at health professions schools, programs, 

5 or entities, except that such a stipend may not be provided 

6 to an individual for more than 6 months, and such a sti7 pend may not exceed $20 per day (notwithstanding any 

8 other provision of law regarding the amount of stipends). 

9 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There 

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

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

12 2005 through 2010. 

13 ‘‘SEC. 2920C. LOUIS STOKES PUBLIC HEALTH SCHOLARS 

14 PROGRAM. 

15 ‘‘(a) IN GENERAL.—The Director of the Centers for 

16 Disease Control and Prevention, in collaboration with the 

17 Director of the Office of Minority Health, shall award 

18 scholarships to postsecondary students who seek a career 

19 in public health. 

20 ‘‘(b) ELIGIBILITY.—To be eligible to receive a schol21 arship under subsection (a) an individual shall—

22 ‘‘(1) have experience in public health research 

23 or public health practice, or other health professions 

24 as determined appropriate by the Director of the 

25 Centers for Disease Control and Prevention; 
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•S 1833 IS 

1 ‘‘(2) reside in a health professional shortage 

2 area as determined by the Secretary; 

3 ‘‘(3) have expressed an interest in public health; 

4 ‘‘(4) demonstrate promise for becoming a leader 

5 in public health; 

6 ‘‘(5) secure admission to a 4-year institution of 

7 higher education; 

8 ‘‘(6) comply with subsection (f); and 

9 ‘‘(7) submit to the Secretary an application at 

10 such time, in such manner, and containing such in11 formation as the Secretary may require.

12 ‘‘(c) USE OF FUNDS.—Amounts received under an 

13 award under subsection (a) shall be used to support oppor14 tunities for students to become public health professionals. 

15 ‘‘(d) PRIORITY.—In awarding grants under sub16 section (a), the Director shall give priority to those stu17 dents that—

18 ‘‘(1) are from disadvantaged backgrounds; 

19 ‘‘(2) have secured admissions to a minority 

20 serving institution; and 

21 ‘‘(3) have identified a health professional as a 

22 mentor at their school or institution and an aca23 demic advisor to assist in the completion of their 

24 baccalaureate degree. 
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•S 1833 IS 

1 ‘‘(e) SCHOLARSHIPS.—The Secretary may approve 

2 payment of scholarships under this section for such indi3 viduals for any period of education in student under4 graduate tenure, except that such a scholarship may not 

5 be provided to an individual for more than 4 years, and 

6 such scholarships may not exceed $10,000 per academic 

7 year (notwithstanding any other provision of law regard8 ing the amount of scholarship). 

9 ‘‘(f) REQUIREMENTS.—To be eligible to receive as10 sistance under this section an individual shall—

11 ‘‘(1) have at minimum a grade point average of 

12 2.75 at the time of entry to an entity described in 

13 subsection (d)(2) and maintain such 2.75 average or 

14 above throughout their tenure at such institutions; 

15 ‘‘(2) receive academic instruction that prepares 

16 the individual to enter the field of public health; 

17 ‘‘(3) gain experience in public health through 

18 working at non-profit, community-based health fa19 cilities or at Federal, State, or local governmental 

20 healthcare institutions; and 

21 ‘‘(4) meet at minimum twice a month with the 

22 identified health professions mentor. 

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

24 is authorized to be appropriated to carry out this section, 
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•S 1833 IS 

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

2 2005 through 2010. 

3 ‘‘SEC. 2920D. PATSY MINK HEALTH AND GENDER RESEARCH 

4 FELLOWSHIP PROGRAM. 

5 ‘‘(a) IN GENERAL.—The Director of the Centers for 

6 Disease Control and Prevention, in collaboration with the 

7 Director of the Office of Minority Health, the Adminis8 trator of the Substance Abuse and Mental Health Services 

9 Administration, and the Director of the Indian Health 

10 Services, shall award research fellowships to post-bacca11 laureate students to conduct research that will examine 

12 gender and health disparities and to pursue a career in 

13 the health professions. 

14 ‘‘(b) ELIGIBILITY.—To be eligible to receive a fellow15 ship under subsection (a) an individual shall—

16 ‘‘(1) have experience in health research or pub17 lic health practice; 

18 ‘‘(2) reside in a health professional shortage 

19 area as determined by the Secretary; 

20 ‘‘(3) have expressed an interest in the health 

21 professions; 

22 ‘‘(4) demonstrate promise for becoming a leader 

23 in the field of women’s health; 
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•S 1833 IS 

1 ‘‘(5) secure admission to a health professions 

2 school or graduate program with an emphasis in 

3 gender studies; 

4 ‘‘(6) comply with subsection (f); and 

5 ‘‘(7) submit to the Secretary an application at 

6 such time, in such manner, and containing such in7 formation as the Secretary may require. 

8 ‘‘(c) USE OF FUNDS.—Amounts received under an 

9 award under subsection (a) shall be used to support oppor10 tunities for students to become researchers and advance 

11 the research base on the intersection between gender and 

12 health. 

13 ‘‘(d) PRIORITY.—In awarding grants under sub14 section (a), the Director of the Centers for Disease Con15 trol and Prevention shall give priority to those applicants 

16 that—

17 ‘‘(1) are from disadvantaged backgrounds; and 

18 ‘‘(2) have identified a mentor and academic ad19 visor who will assist in the completion of their grad20 uate or professional degree and have secured a re21 search assistant position with a researcher working 

22 in the area of gender and health. 

23 ‘‘(e) FELLOWSHIPS.—The Director of the Centers for 

24 Disease Control and Prevention may approve fellowships 

25 for individuals under this section for any period of edu-
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•S 1833 IS 

1 cation in the student’s graduate or health profession ten2 ure, except that such a fellowship may not be provided 

3 to an individual for more than 3 years, and such a fellow4 ship may not exceed $18,000 per academic year (notwith5 standing any other provision of law regarding the amount 

6 of fellowship). 

7 ‘‘(f) REQUIREMENTS.—To be eligible to receive as8 sistance under this section, an individual shall—

9 ‘‘(1) maintain a minimum a grade point aver10 age of 2.75 at the time of entry to an entity de11 scribed in subsection (b)(5) and maintain a grade 

12 point average of 3.25 or above throughout their ten13 ure at such institution; 

14 ‘‘(2) undergo academic instruction to assist in 

15 completion of the health professions or graduate de16 gree; and 

17 ‘‘(3) attend twice-monthly meetings with an 

18 academic advisor throughout the tenure of the fel19 lowship. 

20 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There 

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

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

23 2005 through 2010. 
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•S 1833 IS 

1 ‘‘SEC. 2920E. PAUL DAVID WELLSTONE INTERNATIONAL 

2 HEALTH FELLOWSHIP PROGRAM. 

3 ‘‘(a) IN GENERAL.—The Director of the Agency for 

4 Healthcare Research and Quality, in collaboration with 

5 the Director of the Office of Minority Health, shall award 

6 research fellowships to college students or recent grad7 uates to advance their understanding of international 

8 health. 

9 ‘‘(b) ELIGIBILITY.—To be eligible to receive a fellow10 ship under subsection (a) an individual shall—

11 ‘‘(1) have educational experience in the field of 

12 international health; 

13 ‘‘(2) reside in a health professional shortage 

14 area as determined by the Secretary; 

15 ‘‘(3) demonstrate promise for becoming a leader 

16 in the field of international health; 

17 ‘‘(4) be a college senior or recent graduate of 

18 a four year higher education institution; 

19 ‘‘(5) comply with subsection (f); and 

20 ‘‘(6) submit to the Secretary an application at 

21 such time, in such manner, and containing such in22 formation as the Secretary may require. 

23 ‘‘(c) USE OF FUNDS.—Amounts received under an 

24 award under subsection (a) shall be used to support oppor25 tunities for students to become health professionals and 
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•S 1833 IS 

1 to advance their knowledge about international issues re2 lating to healthcare access and quality. 

3 ‘‘(d) PRIORITY.—In awarding grants under sub4 section (a), the Director shall give priority to those appli5 cants that—

6 ‘‘(1) are from a disadvantaged background; and 

7 ‘‘(2) have identified a mentor at a health pro8 fessions school or institution, an academic advisor to 

9 assist in the completion of their graduate or profes10 sional degree, and an advisor from an international 

11 health Non-Governmental Organization, Private Vol12 unteer Organization, or other international institu13 tion or program that focuses on increasing 

14 healthcare access and quality for residents in devel15 oping countries. 

16 ‘‘(e) FELLOWSHIPS.—The Secretary shall approve 

17 fellowships for college seniors or recent graduates, except 

18 that such a fellowship may not be provided to an indi19 vidual for more than 6 months, may not be awarded to 

20 a graduate that has not been enrolled in school for more 

21 than 1 year, and may not exceed $4,000 per academic year 

22 (notwithstanding any other provision of law regarding the 

23 amount of fellowship). 

24 ‘‘(f) REQUIREMENTS.—To be eligible to receive as25 sistance under this section, an individual shall—
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•S 1833 IS 

1 ‘‘(1) maintain a minimum grade point average 

2 of 2.75 at the time of application; and 

3 ‘‘(2) undergo academic instruction in global 

4 health, and issues relating to access and quality of 

5 healthcare; 

6 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There 

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

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

9 2005 through 2010. 

10 ‘‘SEC. 2920F. EDWARD R. ROYBAL HEALTHCARE SCHOLAR 

11 PROGRAM. 

12 ‘‘(a) IN GENERAL.—The Director of the Agency for 

13 Healthcare Research and Quality, the Director of the Cen14 ters for Medicaid and Medicare, and the Administrator for 

15 Health Resources and Services Administration, in collabo16 ration with the Director of the Office of Minority Health, 

17 shall award grants to eligible entities to expose entering 

18 graduate students to the health professions. 

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

20 under subsection (a) an entity shall—

21 ‘‘(1) be a clinical, public health or health serv22 ices organization, community-based or non-profit en23 tity, or other entity determined appropriate by the 

24 Director of the Agency for Healthcare Research and 

25 Quality; 
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•S 1833 IS 

1 ‘‘(2) serve in a health professional shortage 

2 area as determined by the Secretary; 

3 ‘‘(3) work with students obtaining a degree in 

4 the health professions; and 

5 ‘‘(4) submit to the Secretary an application at 

6 such time, in such manner, and containing such in7 formation as the Secretary may require. 

8 ‘‘(c) USE OF FUNDS.—Amounts received under a 

9 grant awarded under subsection (a) shall be used to sup10 port opportunities that expose students to non-research 

11 based health professions, including—

12 ‘‘(1) public health policy; 

13 ‘‘(2) healthcare and pharmaceutical policy; 

14 ‘‘(3) healthcare administration and manage15 ment; 

16 ‘‘(4) health economics; and 

17 ‘‘(5) other professions determined appropriate 

18 by the Director of the Agency for Healthcare Re19 search and Quality. 

20 ‘‘(d) PRIORITY.—In awarding grants under sub21 section (a), the Director of the Agency for Healthcare Re22 search and Quality shall give priority to those entities 

23 that—

24 ‘‘(1) have experience with health disparity elimi25 nation programs; 
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•S 1833 IS 

1 ‘‘(2) facilitate training in the fields described in 

2 subsection (c); and 

3 ‘‘(3) provide counseling or other services de4 signed to assist such individuals in successfully com5 pleting their education at the post-secondary level. 

6 ‘‘(e) STIPENDS.—The Secretary may approve the 

7 payment of stipends for individuals under this section for 

8 any period of education in student-enhancement programs 

9 (other than regular courses) at health professions schools 

10 or entities, except that such a stipend may not be provided 

11 to an individual for more than 2 months, and such a sti12 pend may not exceed $100 per day (notwithstanding any 

13 other provision of law regarding the amount of stipends). 

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

15 is authorized to be appropriated to carry out this section 

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

17 2005 through 2010.’’. 
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•S 1833 IS 

1 TITLE IV—REDUCING DISEASE 

2 AND DISEASE-RELATED COM3 PLICATIONS 

4 Subtitle A—Eliminating Disparities 

5 in Prevention, Detection, and 

6 Treatment of Disease 

7 CHAPTER 1—GENERAL PROVISIONS 

8 SEC. 401. GUIDELINES FOR DISEASE SCREENING FOR MI9 NORITY PATIENTS. 

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

11 Director of the Agency for Healthcare Research and Qual12 ity, shall convene a series of meetings to develop guidelines 

13 for disease screening for minority patient populations 

14 which have a higher than average risk for many chronic 

15 diseases and cancers. 

16 (b) PARTICIPANTS.—In convening meetings under 

17 subsection (a), the Secretary shall ensure that meeting 

18 participants include representatives of—

19 (1) professional societies and associations; 

20 (2) minority health organizations; 

21 (3) healthcare researchers and providers, in22 cluding those with expertise in minority health; 

23 (4) Federal health agencies, including the Of24 fice of Minority Health and the National Institutes 

25 of Health; and 
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•S 1833 IS 

1 (5) other experts determined appropriate by the 

2 Secretary. 

3 (c) DISEASES.—Screening guidelines for minority 

4 populations shall be developed under subsection (a) for—

5 (1) hypertension; 

6 (2) hypercholesterolemia; 

7 (3) diabetes; 

8 (4) cardiovascular disease; 

9 (5) prostate cancer; 

10 (6) breast cancer; 

11 (7) colon cancer; 

12 (8) kidney disease; 

13 (9) glaucoma; and 

14 (10) other diseases determined appropriate by 

15 the Secretary. 

16 (d) DISSEMINATION.—Not later than 24 months 

17 after the date of enactment of this title, the Secretary 

18 shall publish and disseminate to healthcare provider orga19 nizations the guidelines developed under subsection (a). 

20 (e) AUTHORIZATION OF APPROPRIATIONS.—There is 

21 authorized to be appropriated to carry out this section, 

22 sums as may be necessary for each of fiscal years 2005 

23 through 2010. 
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1 SEC. 402. PREVENTIVE HEALTH SERVICES BLOCK GRANTS, 

2 USE OF ALLOTMENTS. 

3 Section 1904(a)(1) of the Public Health Service Act 

4 (42 U.S.C. 300w–3(a)(1)) is amended—

5 (1) in subparagraph (G)—

6 (A) by striking ‘‘through (F)’’ and insert7 ing ‘‘through (G)’’; and 

8 (B) by redesignating such subparagraph as 

9 subparagraph (H); and 

10 (2) by inserting after subparagraph (F), the fol11 lowing: 

12 ‘‘(G) Community outreach and education pro13 grams and other activities designed to address and 

14 prevent minority health conditions (as defined in 

15 section 485E(c)(2)).’’. 

16 SEC. 403. PROGRAM FOR INCREASING IMMUNIZATION 

17 RATES FOR ADULTS AND ADOLESCENTS; COL18 LECTION OF ADDITIONAL IMMUNIZATION 

19 DATA. 

20 (a) ACTIVITIES OF CENTERS FOR DISEASE CONTROL

21 AND PREVENTION.—Section 317(j) of the Public Health 

22 Service Act (42 U.S.C. 247b(j)) is amended by adding at 

23 the end the following paragraphs: 

24 ‘‘(3)(A) For the purpose of carrying out activities to25 ward increasing immunization rates for adults and adoles26 cents through the immunization program under this sub-
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1 section, and for the purpose of carrying out subsection 

2 (k)(2), there are authorized to be appropriated such sums 

3 as may be necessary for each of the fiscal years 2004 

4 through 2010. Such authorization is in addition to 

5 amounts available under paragraphs (1) and (2) for such 

6 purposes. 

7 ‘‘(B) In expending amounts appropriated under sub8 paragraph (A), the Secretary shall give priority to adults 

9 and adolescents who are medically underserved and are 

10 at risk for vaccine-preventable diseases, including as ap11 propriate populations identified through projects under 

12 subsection (k)(2)(E). 

13 ‘‘(C) The purposes for which amounts appropriated 

14 under subparagraph (A) are available include (with re15 spect to immunizations for adults and adolescents) pay16 ment of the costs of storing vaccines, outreach activities 

17 to inform individuals of the availability of the immuniza18 tions, and other program expenses necessary for the estab19 lishment or operation of immunization programs carried 

20 out or supported by States or other public entities pursu21 ant to this subsection. 

22 ‘‘(4) The Secretary shall annually submit to the Con23 gress a report that—

24 ‘‘(A) evaluates the extent to which the immuni25 zation system in the United States has been effective 
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1 in providing for adequate immunization rates for 

2 adults and adolescents, taking into account the ap3 plicable year 2010 health objectives established by 

4 the Secretary regarding the health status of the peo5 ple of the United States; and 

6 ‘‘(B) describes any issues identified by the Sec7 retary that may affect such rates. 

8 ‘‘(5) In carrying out this subsection and paragraphs 

9 (1) and (2) of subsection (k), the Secretary shall consider 

10 recommendations regarding immunizations that are made 

11 in reports issued by the Institute of Medicine.’’. 

12 (b) RESEARCH, DEMONSTRATIONS, AND EDU13 CATION.—Section 317(k) of the Public Health Service Act 

14 (42 U.S.C. 247b(k)) is amended—

15 (1) by redesignating paragraphs (2) through 

16 (4) as paragraphs (3) through (5), respectively; and 

17 (2) by inserting after paragraph (1) the fol18 lowing paragraph: 

19 ‘‘(2) The Secretary, directly and through grants 

20 under paragraph (1), shall provide for a program of 

21 research, demonstration projects, and education in 

22 accordance with the following: 

23 ‘‘(A) The Secretary shall coordinate with 

24 public and private entities (including nonprofit 

25 private entities), and develop and disseminate 
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1 guidelines, toward the goal of ensuring that im2 munizations are routinely offered to adults and 

3 adolescents by public and private health care 

4 providers. 

5 ‘‘(B) The Secretary shall cooperate with 

6 public and private entities to obtain information 

7 for the annual evaluations required in sub8 section (j)(4)(A). 

9 ‘‘(C) The Secretary shall (relative to fiscal 

10 year 2001) increase the extent to which the 

11 Secretary collects data on the incidence, preva12 lence, and circumstances of diseases and ad13 verse events that are experienced by adults and 

14 adolescents and may be associated with immu15 nizations, including collecting data in coopera16 tion with commercial laboratories. 

17 ‘‘(D) The Secretary shall ensure that the 

18 entities with which the Secretary cooperates for 

19 purposes of subparagraphs (A) through (C) in20 clude managed care organizations, community 

21 based organizations that provide health serv22 ices, and other health care providers. 

23 ‘‘(E) The Secretary shall provide for 

24 projects to identify racial and ethnic minority 

25 groups and other health disparity populations 
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1 for which immunization rates for adults and 

2 adolescents are below such rates for the general 

3 population, and to determine the factors under4 lying such disparities.’’. 

5 SEC. 404. INNOVATIVE CHRONIC DISEASE MANAGEMENT 

6 PROGRAMS. 

7 (a) IN GENERAL.—The Secretary, acting in coordina8 tion with the Administrator of the Centers for Medicare 

9 and Medicaid Services, the Administrator of the Health 

10 Resources and Services Administration, the Director of 

11 the National Institutes of Health, the Director of the Cen12 ters for Disease Control and Prevention, and the Director 

13 of the Office of Minority Health, shall award grants to 

14 eligible entities for the identification, implementation, and 

15 evaluation of programs for patients with chronic disease. 

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

17 under subsection (a), an entity shall—

18 (1) be a health center or clinic, public health 

19 department, health plan, hospital, health system, 

20 community-based or non-profit organization, or 

21 other health entity determined appropriate by the 

22 Secretary; and 

23 (2) prepare and submit to the Secretary an ap24 plication at such time, in such manner, and con-
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1 taining such information as the Secretary may re2 quire. 

3 (c) USE OF FUNDS.—An entity shall use amounts re4 ceived under a grant under subsection (a) to identify, im5 plement, and evaluate chronic disease management pro6 grams that are tailored for racially and ethnically diverse 

7 populations. In carrying out such activities, an entity shall 

8 focus on—

9 (1) self-management training; 

10 (2) patient empowerment; 

11 (3) group visits; 

12 (4) community health workers; 

13 (5) case management; 

14 (6) work- and school-based interventions; 

15 (7) home visitation; or 

16 (8) other activities determined appropriate by 

17 the Secretary. 

18 (d) AUTHORIZATION OF APPROPRIATIONS.—There is 

19 authorized to be appropriated to carry out this section, 

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

21 2004 through 2010. 

22 SEC. 405. GRANTS FOR RACIAL AND ETHNIC APPROACHES 

23 TO COMMUNITY HEALTH. 

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

25 provide for the awarding of grants to assist communities 
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1 in mobilizing and organizing resources in support of effec2 tive and sustainable programs that will reduce or eliminate 

3 disparities in health and healthcare experienced by racial 

4 and ethnic minority individuals. 

5 (b) AUTHORITY TO AWARD GRANTS.—The Sec6 retary, acting through the Centers for Disease Control and 

7 Prevention and the Office of Minority Health, shall award 

8 planning, implementation, and evaluation grants to eligi9 ble entities to assist in designing, implementing, and eval10 uating culturally and linguistically appropriate, science11 based, and community-driven strategies to eliminate racial 

12 and ethnic health and healthcare disparities. 

13 (c) ELIGIBLE ENTITIES.—To be eligible to receive a 

14 grant under this section, an entity shall—

15 (1) represent a coalition—

16 (A) whose principal purpose is to develop 

17 and implement interventions to reduce or elimi18 nate a health or healthcare disparity in a tar19 geted racial or ethnic minority group in the 

20 community served by the coalition; and 

21 (B) that includes—

22 (i) at least 3 members selected from 

23 among—

24 (I) public health departments; 
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1 (II) community-based organiza2 tions; 

3 (III) university and/or research 

4 organizations; 

5 (IV) Indian tribal organizations 

6 or national Indian organizations; 

7 (V) Papa Ola Lokahi; and 

8 (VI) interested public or private 

9 sector healthcare providers or organi10 zations; 

11 (ii) at least 1 member that is from a 

12 community-based organization that rep13 resents the targeted racial or ethnic minor14 ity group; and 

15 (iii) at least 1 member that is a Na16 tional Center for Minority Health and 

17 Health Disparities Center of Excellence 

18 (unless such a Center does not exist within 

19 the community involved, declines or refuses 

20 to participate, or the coalition dem21 onstrates to the Secretary that such par22 ticipation would not further the goals of 

23 the program or would be unduly burden24 some); and 
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1 (2) submit to the Secretary an application, at 

2 such time, in such manner, and containing such in3 formation as the Secretary may require, including—

4 (A) a description of the targeted racial or 

5 ethnic population in the community to be served 

6 under the grant; 

7 (B) a description of at least 1 health dis8 parity that exists in the racial or ethnic tar9 geted population; and 

10 (C) a demonstration of the proven record 

11 of accomplishment of the coalition members in 

12 serving and working with the targeted commu13 nity. 

14 (d) PLANNING GRANTS.—

15 (1) IN GENERAL.—The Secretary shall award 

16 grants to eligible entities described in subsection (c) 

17 to support the planning and development of cul18 turally and linguistically appropriate programs that 

19 utilize science-based and community-driven strate20 gies to reduce or eliminate a health or healthcare 

21 disparity in the targeted population. Such grants 

22 may be used to—

23 (A) expand the coalition that is rep24 resented by the entity through the identification 

25 of additional partners, particularly among the 
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1 targeted community, and establish linkages with 

2 national and State public and private partners; 

3 (B) establish community working groups; 

4 (C) conduct a needs assessment for the 

5 targeted population in the area of the health 

6 disparity using input from the targeted commu7 nity; 

8 (D) participate in workshops sponsored by 

9 the Office of Minority Health or the Centers for 

10 Disease Control and Prevention for technical 

11 assistance, planning, evaluation, and other pro12 grammatic issues; 

13 (E) identify promising intervention strate14 gies; and 

15 (F) develop a plan with the input of the 

16 targeted community that includes strategies 

17 for—

18 (i) implementing intervention strate19 gies that have the most promising potential 

20 for reducing the health disparity in the 

21 target population; 

22 (ii) identifying other sources of rev23 enue and integrating current and proposed 

24 funding sources to ensure long-term sus25 tainability of the program; and 
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1 (iii) evaluating the program, including 

2 collecting data and measuring progress to3 ward reducing or eliminating the health 

4 disparity in the targeted population that 

5 takes into account the evaluation model de6 veloped by the Centers for Disease Control 

7 and Prevention in collaboration with the 

8 Office of Minority Health. 

9 (2) DURATION.—The period during which pay10 ments may be made under a grant under paragraph 

11 (1) shall not exceed 1 year, except where the Sec12 retary determines that extraordinary circumstances 

13 exist as described in section 340(c)(3) of the Public 

14 Health Service Act. 

15 (e) IMPLEMENTATION GRANTS.—

16 (1) IN GENERAL.—The Secretary shall award 

17 grants to eligible entities that have received a plan18 ning grant under subsection (d) to enable such enti19 ty to—

20 (A) implement a plan to address the se21 lected health disparity for the target population, 

22 in an effective and timely manner; 

23 (B) collect data appropriate for monitoring 

24 and evaluating the program carried out under 

25 the grant; 
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1 (C) analyze and interpret data, or collabo2 rate with academic or other appropriate institu3 tions, for such analysis and collection; 

4 (D) participate in conferences and work5 shops for the purpose of informing and edu6 cating others regarding the experiences and les7 sons learned from the project; 

8 (E) collaborate with appropriate partners 

9 to publish the results of the project for the ben10 efit of the public health community; 

11 (F) establish mechanisms with other public 

12 or private groups to maintain financial support 

13 for the program after the grant terminates; and 

14 (G) maintain relationships with local part15 ners and continue to develop new relationships 

16 with State and national partners. 

17 (2) DURATION.—The period during which pay18 ments may be made under a grant under paragraph 

19 (1) shall not exceed 4 years. Such payments shall be 

20 subject to annual approval by the Secretary and to 

21 the availability of appropriations for the fiscal year 

22 involved. 

23 (f) EVALUATION GRANTS.—

24 (1) IN GENERAL.—The Secretary shall award 

25 grants to eligible entities that have received an im-
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1 plementation grant under subsection (e) that require 

2 additional assistance for the purpose of rigorous 

3 data analysis, program evaluation (including process 

4 and outcome measures), or dissemination of find5 ings. 

6 (2) PRIORITY.—In awarding grants under this 

7 subsection, the Secretary shall give priority to—

8 (A) entities that in previous funding cy9 cles—

10 (i) have received a planning grant 

11 under subsection (d); and 

12 (ii) implemented activities of the type 

13 described in subsection (e)(1); 

14 (B) entities that fulfilled the goals of their 

15 planning grant under subsection (d) in an espe16 cially timely manner; 

17 (C) entities that incorporate best practices 

18 or build on successful models in their action 

19 plan, including the use of community health 

20 workers; and 

21 (D) entities that would enable the Sec22 retary to provide for an equitable distribution of 

23 such grants among the 5 categories for race 

24 and ethnicity described in the 1997 Office of 

25 Management and Budget Standards for Main-
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1 taining, Collecting, and Presenting Federal 

2 Data on Race and Ethnicity. 

3 (g) MAINTENANCE OF EFFORT.—The Secretary may 

4 not award a grant to an eligible entity under this section 

5 unless the entity agrees that, with respect to the costs to 

6 be incurred by the entity in carrying out the activities for 

7 which the grant was awarded, the entity (and each of the 

8 participating partners in the coalition represented by the 

9 entity) will maintain its expenditures of non-Federal funds 

10 for such activities at a level that is not less than the level 

11 of such expenditures during the fiscal year immediately 

12 preceding the first fiscal year for which the grant is 

13 awarded. 

14 (h) TECHNICAL ASSISTANCE.—The Secretary may, 

15 either directly or by grant or contract, provide any entity 

16 that receives a grant under this section with technical and 

17 other nonfinancial assistance necessary to meet the re18 quirements of this section. 

19 (i) ADMINISTRATIVE BURDENS.—The Secretary shall 

20 make every effort to minimize duplicative or unnecessary 

21 administrative burdens on grantees in the process of ap22 plying for grants under subsection (d), (e), or (f). 

23 (j) REPORT.—Not later than September 30, 2007, 

24 the Secretary shall publish a report that describes the ex25 tent to which the activities funded under this section have 
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1 been successful in reducing and eliminating disparities in 

2 health and healthcare in targeted populations, and pro3 vides examples of best practices or model programs funded 

4 under this section. 

5 (k) AUTHORIZATION OF APPROPRIATIONS.—There is 

6 authorized to be appropriated such sums as may be nec7 essary to carry out this section for each of fiscal years 

8 2005 through 2010. 

9 SEC. 406. IOM STUDY REQUEST. 

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

11 Human Services shall request that the Institute of Medi12 cine conduct, or contract with another entity to conduct, 

13 a study to investigate promising strategies for improving 

14 minority health and reducing and eliminating racial and 

15 ethnic disparities in health and healthcare. 

16 (b) CONTENT.—The study under subsection (a) 

17 shall—

18 (1) identify key stakeholders for intervention in 

19 the public and private sector; 

20 (2) identify the barriers to eliminating racial 

21 and ethnic disparities in health and healthcare; 

22 (3) explore approaches for addressing dispari23 ties in health and healthcare using a quality im24 provement framework; 
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1 (4) suggest an evaluation and research agenda 

2 that will advance effective strategies for reducing 

3 and eliminating racial and ethnic disparities in 

4 health and healthcare; and 

5 (5) assess the capacity of the Department of 

6 Health and Human Services, as currently struc7 tured, to implement and evaluate promising strate8 gies to improve minority health and reduce and 

9 eliminate racial and ethnic disparities in health and 

10 healthcare. 

11 (c) AGENDA.—The agenda described in subsection 

12 (b)(4) shall include a focus on the following: 

13 (1) Observational studies of race-discordant and 

14 race-concordant physician-patient clinical encoun15 ters. 

16 (2) Studies of the behaviors and expressed atti17 tudes toward race and ethnicity during education 

18 and training of health professionals. 

19 (3) Expansion of prospective studies of dispari20 ties in care, combining clinical data with qualitative 

21 interviews with patients and providers. 

22 (4) Studies of the natural history of social cat23 egorization in medical education and practice. 
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1 (5) Studies of the effectiveness of standard clin2 ical guidelines in reducing disparities across disease 

3 categories. 

4 (6) Exploration of health system characteristics 

5 that may contribute to or mitigate disparities in 

6 health care. 

7 (7) Evaluation of cultural competency programs 

8 and their impact on the attitudes, knowledge, skills, 

9 and behaviors of healthcare providers. 

10 (8) Expansion of community-participatory re11 search with a focus on such topics as increasing 

12 trust and patient empowerment. 

13 (9) Studies on appropriate indicators of socio14 economic status, and methods for incorporating such 

15 indicators in patient records. 

16 (10) Interventional studies designed to elimi17 nate disparities. 

18 (d) REPORT.—Not later than 24 months after the 

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

20 Human Services shall submit to the appropriate commit21 tees of Congress a report containing the results of the 

22 study conducted under subsection (a). 

23 (e) AUTHORIZATION OF APPROPRIATIONS.—There is 

24 authorized to be appropriated to carry out this section, 
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1 such sums as may be necessary for each of fiscal years 

2 2005 and 2006. 

3 SEC. 407. STRATEGIC PLAN. 

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

5 Administrator of the Substance Abuse and Mental Health 

6 Services Administration, shall formulate a strategic plan 

7 for implementing the 2001 report by the Surgeon General 

8 of the Public Health Service entitled ‘Mental Health: Cul9 ture, Race, and Ethnicity—A Supplement to Mental 

10 Health: A Report of the Surgeon General’ and the 2003 

11 report by the President’s New Freedom Commission on 

12 Mental Health entitled ‘Achieving the Promise: Trans13 forming Mental Health Care in America’. 

14 (b) SUBMISSION.—Not later than 6 months after the 

15 date of the enactment of this title, the Secretary shall sub16 mit to the Congress the strategic plan formulated under 

17 this section. 

18 CHAPTER 2—ENVIRONMENTAL JUSTICE 

19 SEC. 410. SHORT TITLE; PURPOSES. 

20 (a) SHORT TITLE.—This chapter may be cited as the 

21 ‘‘Environmental Justice Act of 2003’’. 

22 (b) PURPOSES.—The purposes of this chapter are—

23 (1) to ensure that all Federal health agencies 

24 develop practices that promote environmental jus25 tice; 
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1 (2) to provide minority, low-income, and Native 

2 American communities greater access to public in3 formation and opportunity for participation in deci4 sionmaking affecting human health and the environ5 ment; and 

6 (3) to mitigate the inequitable distribution of 

7 the burdens and benefits of Federal programs hav8 ing significant impact on human health and the en9 vironment. 

10 SEC. 411. DEFINITIONS. 

11 For purposes of this chapter: 

12 (1) ENVIRONMENTAL JUSTICE.—

13 (A) IN GENERAL.—The term ‘‘environ14 mental justice’’ means the fair treatment of 

15 people of all races, cultures, and socioeconomic 

16 groups with respect to the development, adop17 tion, implementation, and enforcement of laws, 

18 regulations, and policies affecting the environ19 ment. 

20 (B) FAIR TREATMENT.—The term ‘‘fair 

21 treatment’’ means policies and practices that 

22 will minimize the likelihood that a minority, 

23 low-income, or Native American community will 

24 bear a disproportionate share of the adverse en25 vironmental consequences, or be denied reason-
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1 able access to the environmental benefits, re2 sulting from implementation of a Federal pro3 gram or policy. 

4 (2) FEDERAL AGENCY.—The term ‘‘Federal 

5 agency’’ means—

6 (A) each Federal entity represented on the 

7 Working Group; 

8 (B) any other entity that conducts any 

9 Federal program or activity that substantially 

10 affects human health or the environment; and 

11 (C) each Federal agency that implements 

12 any program, policy, or activity applicable to 

13 Native Americans. 

14 (3) WORKING GROUP.—The term ‘‘Working 

15 Group’’ means the interagency working group estab16 lished by section 413. 

17 (4) ADVISORY COMMITTEE.—The term ‘‘the Ad18 visory Committee’’ means the advisory committee es19 tablished by section 415. 

20 SEC. 412. ENVIRONMENTAL JUSTICE RESPONSIBILITIES OF 

21 FEDERAL AGENCIES. 

22 (a) ENVIRONMENTAL JUSTICE MISSION.—To the 

23 greatest extent practicable, the head of each Federal agen24 cy shall make achieving environmental justice part of its 

25 mission by identifying and addressing, as appropriate, dis-
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1 proportionately high and adverse human health or envi2 ronmental effects of its programs, policies, and activities 

3 on minority and low-income populations in the United 

4 States and its territories and possessions, including the 

5 District of Columbia, the Commonwealth of Puerto Rico, 

6 Virgin Islands, Guam, and the Commonwealth of the Mar7 iana Islands. 

8 (b) NONDISCRIMINATION.—Each Federal agency 

9 shall conduct its programs, policies, and activities in a 

10 manner that ensures that such programs, policies, and ac11 tivities do not have the effect of excluding any person or 

12 group from participation in, denying any person or group 

13 the benefits of, or subjecting any person or group to dis14 crimination under, such programs, policies, and activities, 

15 because of race, color, national origin, or income. 

16 SEC. 413. INTERAGENCY ENVIRONMENTAL JUSTICE WORK17 ING GROUP. 

18 (a) CREATION AND COMPOSITION.—There is hereby 

19 established the Interagency Working Group on Environ20 mental Justice, comprising the heads of the following exec21 utive agencies and offices, or their designees: 

22 (1) The Department of Defense. 

23 (2) The Department of Health and Human 

24 Services. 
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1 (3) The Department of Housing and Urban De2 velopment. 

3 (4) The Department of Homeland Security. 

4 (5) The Department of Labor. 

5 (6) The Department of Agriculture. 

6 (7) The Department of Transportation. 

7 (8) The Department of Justice; 

8 (9) The Department of the Interior. 

9 (10) The Department of Commerce. 

10 (11) The Department of Energy. 

11 (12) The Environmental Protection Agency. 

12 (13) The Office of Management and Budget. 

13 (14) Any other official of the United States 

14 that the President may designate. 

15 (b) FUNCTIONS.—The Working Group shall—

16 (1) provide guidance to Federal agencies on cri17 teria for identifying disproportionately high and ad18 verse human health or environmental effects on mi19 nority, low-income, and Native American popu20 lations; 

21 (2) coordinate with, provide guidance to, and 

22 serve as a clearinghouse for, each Federal agency as 

23 it develops or revises an environmental justice strat24 egy as required by this chapter, in order to ensure 

25 that the administration, interpretation and enforce-
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1 ment of programs, activities, and policies are under2 taken in a consistent manner; 

3 (3) assist in coordinating research by, and stim4 ulating cooperation among, the Environmental Pro5 tection Agency, the Department of Health and 

6 Human Services, the Department of Housing and 

7 Urban Development, and other Federal agencies 

8 conducting research or other activities in accordance 

9 with section 7; 

10 (4) assist in coordinating data collection, main11 tenance, and analysis required by this chapter; 

12 (5) examine existing data and studies on envi13 ronmental justice; 

14 (6) hold public meetings and otherwise solicit 

15 public participation and consider complaints as re16 quired under subsection (c); 

17 (7) develop interagency model projects on envi18 ronmental justice that evidence cooperation among 

19 Federal agencies; and 

20 (8) in coordination with the Department of the 

21 Interior and after consultation with tribal leaders, 

22 coordinate steps to be taken pursuant to this chap23 ter that affect or involve federally-recognized Indian 

24 Tribes. 
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1 (c) PUBLIC PARTICIPATION.—The Working Group 

2 shall—

3 (1) hold public meetings and otherwise solicit 

4 public participation, as appropriate, for the purpose 

5 of fact-finding with regard to implementation of this 

6 chapter, and prepare for public review a summary of 

7 the comments and recommendations provided; and 

8 (2) receive, consider, and in appropriate in9 stances conduct inquiries concerning complaints re10 garding environmental justice and the implementa11 tion of this chapter by Federal agencies. 

12 (d) ANNUAL REPORTS.—

13 (1) IN GENERAL.—Each fiscal year following 

14 enactment of this Act, the Working Group shall sub15 mit to the President, through the Office of the Dep16 uty Assistant to the President for Environmental 

17 Policy and the Office of the Assistant to the Presi18 dent for Domestic Policy, a report that describes the 

19 implementation of this chapter, including, but not 

20 limited to, a report of the final environmental justice 

21 strategies described in section 6 of this chapter and 

22 annual progress made in implementing those strate23 gies. 

24 (2) COPY OF REPORT.—The President shall 

25 transmit to the Speaker of the House of Representa-
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1 tives and the President of the Senate a copy of each 

2 report submitted to the President pursuant to para3 graph (1). 

4 (e) CONFORMING CHANGE.—The Interagency Work5 ing Group on Environmental Justice established under 

6 Executive Order No. 12898, dated February 11, 1994, is 

7 abolished. 

8 SEC. 414. FEDERAL AGENCY STRATEGIES. 

9 (a) AGENCY-WIDE STRATEGIES.—Each Federal 

10 agency shall develop an agency-wide environmental justice 

11 strategy that identifies and addresses disproportionally 

12 high and adverse human health or environmental effects 

13 or disproportionally low benefits of its programs, policies, 

14 and activities with respect to minority, low-income, and 

15 Native American populations. 

16 (b) REVISIONS.—Each strategy developed pursuant 

17 to subsection (a) shall identify programs, policies, plan18 ning, and public participation processes, rulemaking, and 

19 enforcement activities related to human health or the envi20 ronment that should be revised to—

21 (1) promote enforcement of all health and envi22 ronmental statutes in areas with minority, low-in23 come, or Native American populations; 

24 (2) ensure greater public participation; 
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1 (3) improve research and data collection relat2 ing to the health of and environment of minority, 

3 low-income, and Native American populations; and 

4 (4) identify differential patterns of use of nat5 ural resources among minority, low-income, and Na6 tive American populations. 

7 (c) TIMETABLES.—Each strategy developed pursuant 

8 to subsection (a) shall include, where appropriate, a time9 table for undertaking revisions identified pursuant to sub10 section (b). 

11 SEC. 415. FEDERAL ENVIRONMENTAL JUSTICE ADVISORY 

12 COMMITTEE. 

13 (a) ESTABLISHMENT.—There is established a com14 mittee to be known as the ‘‘Federal Environmental Justice 

15 Advisory Committee’’. 

16 (b) DUTIES.—The Advisory Committee shall provide 

17 independent advice and recommendations to the Environ18 mental Protection Agency and the Working Group on 

19 areas relating to environmental justice, which may include 

20 any of the following: 

21 (1) Advice on Federal agencies’ framework de22 velopment for integrating socioeconomic programs 

23 into strategic planning, annual planning, and man24 agement accountability for achieving environmental 

25 justice results agency-wide. 
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1 (2) Advice on measuring and evaluating agen2 cies’ progress, quality, and adequacy in planning, de3 veloping, and implementing environmental justice 

4 strategies, projects, and programs. 

5 (3) Advice on agencies’ existing and future in6 formation management systems, technologies, and 

7 data collection, and the conduct of analyses that 

8 support and strengthen environmental justice pro9 grams in administrative and scientific areas. 

10 (4) Advice to help develop, facilitate, and con11 duct reviews of the direction, criteria, scope, and 

12 adequacy of the Federal agencies’ scientific research 

13 and demonstration projects relating to environ14 mental justice. 

15 (5) Advice for improving how the Environ16 mental Protection Agency and others participate, co17 operate, and communicate within that agency and 

18 between other Federal agencies, State or local gov19 ernments, federally recognized Tribes, environmental 

20 justice leaders, interest groups, and the public. 

21 (6) Advice regarding the Environmental Protec22 tion Agency’s administration of grant programs re23 lating to environmental justice assistance (not to in24 clude the review or recommendations of individual 

25 grant proposals or awards). 
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1 (7) Advice regarding agencies’ awareness, edu2 cation, training, and other outreach activities involv3 ing environmental justice. 

4 (c) ADVISORY COMMITTEE.—The Advisory Com5 mittee shall be considered an advisory committee within 

6 the meaning of the Federal Advisory Committee Act (5 

7 U.S.C. App.). 

8 (d) MEMBERSHIP.—

9 (1) IN GENERAL.—The Advisory Committee 

10 shall be composed of 21 members to be appointed in 

11 accordance with paragraph (2). Members shall in12 clude representatives of—

13 (A) community-based groups; 

14 (B) industry and business; 

15 (C) academic and educational institutions; 

16 (D) minority health organizations; 

17 (E) State and local governments, federally 

18 recognized tribes, and indigenous groups; and 

19 (F) nongovernmental and environmental 

20 groups. 

21 (2) APPOINTMENTS.—Of the members of the 

22 Advisory Committee—

23 (A) five members shall be appointed by the 

24 majority leader of the Senate; 
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1 (B) five members shall be appointed by the 

2 minority leader of the Senate; 

3 (C) five members shall be appointed by the 

4 Speaker of the House of Representatives; 

5 (D) five members shall be appointed by the 

6 minority leader of the House of Representa7 tives; and 

8 (E) one member to be appointed by the 

9 President. 

10 (e) MEETINGS.—The Advisory Committee shall meet 

11 at least twice annually. Meetings shall occur as needed and 

12 approved by the Director of the Office of Environmental 

13 Justice of the Environmental Protection Agency, who shall 

14 serve as the officer required to be appointed under section 

15 10(e) of the Federal Advisory Committee Act (5 U.S.C. 

16 App.) with respect to the Committee (in this subsection 

17 referred to as the ‘‘Designated Federal Officer’’). The Ad18 ministrator of the Environmental Protection Agency may 

19 pay travel and per diem expenses of members of the Advi20 sory Committee when determined necessary and appro21 priate. The Designated Federal Officer or a designee of 

22 such Officer shall be present at all meetings, and each 

23 meeting will be conducted in accordance with an agenda 

24 approved in advance by such Officer. The Designated Fed25 eral Officer may adjourn any meeting when the Des-
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1 ignated Federal Officer determines it is in the public inter2 est to do so. As required by the Federal Advisory Com3 mittee Act, meetings of the Advisory Committee shall be 

4 open to the public unless the President determines that 

5 a meeting or a portion of a meeting may be closed to the 

6 public in accordance with subsection (c) of section 552b 

7 of title 5, United States Code. Unless a meeting or portion 

8 thereof is closed to the public, the Designated Federal Of9 ficer shall provide an opportunity for interested persons 

10 to file comments before or after such meeting or to make 

11 statements to the extent that time permits. 

12 (f) DURATION.—The Advisory Committee shall re13 main in existence until otherwise provided by law. 

14 SEC. 416. HUMAN HEALTH AND ENVIRONMENTAL RE15 SEARCH, DATA COLLECTION AND ANALYSIS. 

16 (a) DISPROPORTIONATE IMPACT.—To the extent per17 mitted by other applicable law, including section 552a of 

18 title 5, United States Code, popularly known as the Pri19 vacy Act of 1974, the Administrator of the Environmental 

20 Protection Agency, or the head of such other Federal 

21 agency as the President may direct, shall collect, maintain, 

22 and analyze information assessing and comparing environ23 mental and human health risks borne by populations iden24 tified by race, national origin, or income. To the extent 

25 practical and appropriate, Federal agencies shall use this 
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1 information to determine whether their programs, policies, 

2 and activities have disproportionally high and adverse 

3 human health or environmental effects on, or 

4 disproportionally low benefits for, minority, low-income, 

5 and Native American populations. 

6 (b) INFORMATION RELATED TO NON-FEDERAL FA7 CILITIES.—In connection with the development and imple8 mentation of agency strategies in section 4, the Adminis9 trator of the Environmental Protection Agency, or the 

10 head of such other Federal agency as the President may 

11 direct, shall collect, maintain, and analyze information on 

12 the race, national origin, and income level, and other read13 ily accessible and appropriate information, for areas sur14 rounding facilities or sites expected to have a substantial 

15 environmental, human health, or economic effect on the 

16 surrounding populations, if such facilities or sites become 

17 the subject of a substantial Federal environmental admin18 istrative or judicial action. 

19 (c) IMPACT FROM FEDERAL FACILITIES.—The Ad20 ministrator of the Environmental Protection Agency, or 

21 the head of such other Federal agency as the President 

22 may direct, shall collect, maintain, and analyze informa23 tion on the race, national origin, and income level, and 

24 other readily accessible and appropriate information, for 

25 areas surrounding Federal facilities that are—
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1 (1) subject to the reporting requirements under 

2 the Emergency Planning and Community Right-to3 Know Act (42 U.S.C. 11001 et seq.) as mandated 

4 in Executive Order No. 12856; and 

5 (2) expected to have a substantial environ6 mental, human health, or economic effect on sur7 rounding populations. 

8 (d) INFORMATION SHARING.—

9 (1) IN GENERAL.—In carrying out the respon10 sibilities in this section, each Federal agency, to the 

11 extent practicable and appropriate, shall share infor12 mation and eliminate unnecessary duplication of ef13 forts through the use of existing data systems and 

14 cooperative agreements among Federal agencies and 

15 with State, local, and tribal governments. 

16 (2) PUBLIC AVAILABILITY.—Except as prohib17 ited by other applicable law, information collected or 

18 maintained pursuant to this section shall be made 

19 available to the public. 

20 (e) PUBLIC COMMENT.—Federal agencies shall pro21 vide minority, low-income, and Native American popu22 lations the opportunity to participate in the development, 

23 design, and conduct of activities undertaken pursuant to 

24 this section. 
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1 CHAPTER 3—BORDER HEALTH 

2 SEC. 421. SHORT TITLE. 

3 This chapter may be cited as the ‘‘Border Health Se4 curity Act of 2003’’. 

5 SEC. 422. DEFINITIONS. 

6 In this chapter: 

7 (1) BORDER AREA.—The term ‘‘border area’’ 

8 has the meaning given the term ‘‘United States9 Mexico Border Area’’ in section 8 of the United 

10 States-Mexico Border Health Commission Act (22 

11 U.S.C. 290n–6). 

12 (2) SECRETARY.—The term ‘‘Secretary’’ means 

13 the Secretary of Health and Human Services. 

14 SEC. 423. BORDER HEALTH GRANTS. 

15 (a) ELIGIBLE ENTITY DEFINED.—In this section, 

16 the term ‘‘eligible entity’’ means a State, public institution 

17 of higher education, local government, tribal government, 

18 nonprofit health organization, community health center, or 

19 community clinic receiving assistance under section 330 

20 of the Public Health Service Act (42 U.S.C. 254b), that 

21 is located in the border area. 

22 (b) AUTHORIZATION.—From funds appropriated 

23 under subsection (f), the Secretary, acting through the 

24 United States members of the United States-Mexico Bor25 der Health Commission, shall award grants to eligible en-
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•S 1833 IS 

1 tities to address priorities and recommendations to im2 prove the health of border area residents that are estab3 lished by—

4 (1) the United States members of the United 

5 States-Mexico Border Health Commission; 

6 (2) the State border health offices; and 

7 (3) the Secretary. 

8 (c) APPLICATION.—An eligible entity that desires a 

9 grant under subsection (b) shall submit an application to 

10 the Secretary at such time, in such manner, and con11 taining such information as the Secretary may require. 

12 (d) USE OF FUNDS.—An eligible entity that receives 

13 a grant under subsection (b) shall use the grant funds 

14 for—

15 (1) programs relating to—

16 (A) maternal and child health; 

17 (B) primary care and preventative health; 

18 (C) public health and public health infra19 structure; 

20 (D) health education and promotion; 

21 (E) oral health; 

22 (F) behavioral and mental health; 

23 (G) substance abuse; 

24 (H) health conditions that have a high 

25 prevalence in the border area; 
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1 (I) medical and health services research; 

2 (J) workforce training and development; 

3 (K) community health workers or 

4 promotoras; 

5 (L) health care infrastructure problems in 

6 the border area (including planning and con7 struction grants); 

8 (M) health disparities in the border area; 

9 (N) environmental health; and 

10 (O) outreach and enrollment services with 

11 respect to Federal programs (including pro12 grams authorized under titles XIX and XXI of 

13 the Social Security Act (42 U.S.C. 1396 and 

14 1397aa)); and 

15 (2) other programs determined appropriate by 

16 the Secretary. 

17 (e) SUPPLEMENT, NOT SUPPLANT.—Amounts pro18 vided to an eligible entity awarded a grant under sub19 section (b) shall be used to supplement and not supplant 

20 other funds available to the eligible entity to carry out the 

21 activities described in subsection (d). 

22 (f) AUTHORIZATION OF APPROPRIATIONS.—There is 

23 authorized to be appropriated to carry out this section, 

24 $200,000,000 for fiscal year 2005, and such sums as may 

25 be necessary for each succeeding fiscal year. 
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•S 1833 IS 

1 SEC. 424. UNITED STATES-MEXICO BORDER HEALTH COM2 MISSION ACT AMENDMENTS. 

3 The United States-Mexico Border Health Commis4 sion Act (22 U.S.C. 290n et seq.) is amended by adding 

5 at the end the following: 

6 ‘‘SEC. 9. AUTHORIZATION OF APPROPRIATIONS. 

7 ‘‘There is authorized to be appropriated to carry out 

8 this Act $10,000,000 for fiscal year 2005 and such sums 

9 as may be necessary for each succeeding fiscal year.’’. 

10 CHAPTER 4—PATIENT NAVIGATOR, OUT11 REACH, AND CHRONIC DISEASE PRE12 VENTION 

13 SEC. 425. SHORT TITLE. 

14 This chapter may be cited as the ‘‘Patient Navigator, 

15 Outreach, and Chronic Disease Prevention Act of 2003’’. 

16 SEC. 426. HRSA GRANTS FOR MODEL COMMUNITY CANCER 

17 AND CHRONIC DISEASE CARE AND PREVEN18 TION; HRSA GRANTS FOR PATIENT NAVIGA19 TORS. 

20 Subpart I of part D of title III of the Public Health 

21 Service Act (42 U.S.C. 254b et seq.) is amended by adding 

22 at the end the following: 
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1 ‘‘SEC. 330I. MODEL COMMUNITY CANCER AND CHRONIC 

2 DISEASE CARE AND PREVENTION; PATIENT 

3 NAVIGATORS. 

4 ‘‘(a) MODEL COMMUNITY CANCER AND CHRONIC

5 DISEASE CARE AND PREVENTION.—

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

7 through the Administrator of the Health Resources 

8 and Services Administration, may make grants to 

9 public and nonprofit private health centers (includ10 ing health centers under section 330, Indian Health 

11 Service Centers, tribal governments, urban Indian 

12 organizations, tribal organizations, clinics serving 

13 Asian Americans and Pacific Islanders and Alaska 

14 Natives, and rural health clinics and qualified non15 profit entities that partner with one or more centers 

16 providing healthcare to provide navigation services, 

17 which demonstrate the ability to perform all of the 

18 functions outlined in this subsection and subsections 

19 (b) and (c)) for the development and operation of 

20 model programs that—

21 ‘‘(A) provide to individuals of health dis22 parity populations prevention, early detection, 

23 treatment, and appropriate follow-up care serv24 ices for cancer and chronic diseases; 
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1 ‘‘(B) ensure that the health services are 

2 provided to such individuals in a culturally com3 petent manner; 

4 ‘‘(C) assign patient navigators, in accord5 ance with applicable criteria of the Secretary, 

6 for managing the care of individuals of health 

7 disparity populations to—

8 ‘‘(i) accomplish, to the extent possible, 

9 the follow-up and diagnosis of an abnormal 

10 finding and the treatment and appropriate 

11 follow-up care of cancer or other chronic 

12 disease; and 

13 ‘‘(ii) facilitate access to appropriate 

14 healthcare services within the healthcare 

15 system to ensure optimal patient utiliza16 tion of such services, including aid in co17 ordinating and scheduling appointments 

18 and referrals, community outreach, assist19 ance with transportation arrangements, 

20 and assistance with insurance issues and 

21 other barriers to care and providing infor22 mation about clinical trials; 

23 ‘‘(D) require training for patient naviga24 tors employed through such model programs to 

25 ensure the ability of navigators to perform all 
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•S 1833 IS 

1 of the duties required in this subsection and in 

2 subsection (b), including training to ensure that 

3 navigators are informed about health insurance 

4 systems and are able to aid patients in resolv5 ing access issues; and 

6 ‘‘(E) ensure that consumers have direct ac7 cess to patient navigators during regularly 

8 scheduled hours of business operation. 

9 ‘‘(2) OUTREACH SERVICES.—A condition for 

10 the receipt of a grant under paragraph (1) is that 

11 the applicant involved agree to provide ongoing out12 reach activities while receiving the grant, in a man13 ner that is culturally competent for the health dis14 parity population served by the program, to inform 

15 the public and the specific community that the pro16 gram is serving, about the services of the model pro17 gram under the grant. Such activities shall include 

18 facilitating access to appropriate healthcare services 

19 and patient navigators within the healthcare system 

20 to ensure optimal patient utilization of these serv21 ices. 

22 ‘‘(3) DATA COLLECTION AND REPORT.—In 

23 order to allow for effective program evaluation, the 

24 grantee shall collect specific patient data recording 

25 services provided to each patient served by the pro-
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•S 1833 IS 

1 gram and shall establish and implement procedures 

2 and protocols, consistent with applicable Federal and 

3 State laws (including 45 C.F.R. 160 and 164) to en4 sure the confidentiality of all information shared by 

5 a participant in the program, or their personal rep6 resentative and their healthcare providers, group 

7 health plans, or health insurance insurers with the 

8 program. The program may, consistent with applica9 ble Federal and State confidentiality laws, collect, 

10 use or disclose aggregate information that is not in11 dividually identifiable (as defined in 45 C.F.R. 160 

12 and 164). With this data, the grantee shall submit 

13 an annual report to the Secretary that summarizes 

14 and analyzes these data, provides information on 

15 needs for navigation services, types of access difficul16 ties resolved, sources of repeated resolution and 

17 flaws in the system of access, including insurance 

18 barriers. 

19 ‘‘(4) APPLICATION FOR GRANT.—A grant may 

20 be made under paragraph (1) only if an application 

21 for the grant is submitted to the Secretary and the 

22 application is in such form, is made in such manner, 

23 and contains such agreements, assurances, and in24 formation as the Secretary determines to be nec25 essary to carry out this section. 
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1 ‘‘(5) EVALUATIONS.—

2 ‘‘(A) IN GENERAL.—The Secretary, acting 

3 through the Administrator of the Health Re4 sources and Services Administration, shall, di5 rectly or through grants or contracts, provide 

6 for evaluations to determine which outreach ac7 tivities under paragraph (2) were most effective 

8 in informing the public and the specific commu9 nity that the program is serving, about the 

10 model program services and to determine the 

11 extent to which such programs were effective in 

12 providing culturally competent services to the 

13 health disparity population served by the pro14 grams. 

15 ‘‘(B) DISSEMINATION OF FINDINGS.—The 

16 Secretary shall as appropriate disseminate to 

17 public and private entities the findings made in 

18 evaluations under subparagraph (A). 

19 ‘‘(6) COORDINATION WITH OTHER PRO20 GRAMS.—The Secretary shall coordinate the pro21 gram under this subsection with the program under 

22 subsection (b), with the program under section 

23 417D, and to the extent practicable, with programs 

24 for prevention centers that are carried out by the 
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1 Director of the Centers for Disease Control and Pre2 vention. 

3 ‘‘(b) PROGRAM FOR PATIENT NAVIGATORS.—

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

5 through the Administrator of the Health Resources 

6 and Services Administration, may make grants to 

7 public and nonprofit private health centers (includ8 ing health centers under section 330, Indian Health 

9 Service Centers, tribal governments, urban Indian 

10 organizations, tribal organizations, clinics serving 

11 Asian Americans and Pacific Islanders and Alaska 

12 Natives, and rural health clinics and qualified non13 profit entities that partner with one or more centers 

14 providing healthcare to provide navigation services, 

15 which demonstrate the ability to perform all of the 

16 functions outlined in this subsection and subsections 

17 (a) and (c)) for the development and operation of 

18 programs to pay the costs of such health centers 

19 in—

20 ‘‘(A) assigning patient navigators, in ac21 cordance with applicable criteria of the Sec22 retary, for managing the care of individuals of 

23 health disparity populations for the duration of 

24 receiving health services from the health cen25 ters, including aid in coordinating and sched-
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1 uling appointments and referrals, community 

2 outreach, assistance with transportation ar3 rangements, and assistance with insurance 

4 issues and other barriers to care and providing 

5 information about clinical trials; 

6 ‘‘(B) ensuring that the services provided by 

7 the patient navigators to such individuals in8 clude case management and psychosocial as9 sessment and care or information and referral 

10 to such services; 

11 ‘‘(C) ensuring that patient navigators with 

12 direct knowledge of the communities they serve 

13 provide services to such individuals in a cul14 turally competent manner; 

15 ‘‘(D) developing model practices for patient 

16 navigators, including with respect to—

17 ‘‘(i) coordination of health services, 

18 including psychosocial assessment and 

19 care;

20 ‘‘(ii) appropriate follow-up care, in21 cluding psychosocial assessment and care; 

22 ‘‘(iii) determining coverage under 

23 health insurance and health plans for all 

24 services; 
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1 ‘‘(iv) ensuring the initiation, continu2 ation and/or sustained access to care pre3 scribed by the patients’ healthcare pro4 viders; and 

5 ‘‘(v) aiding patients with health insur6 ance coverage issues; 

7 ‘‘(E) requiring training for patient naviga8 tors to ensure the ability of navigators to per9 form all of the duties required in this sub10 section and in subsection (a), including training 

11 to ensure that navigators are informed about 

12 health insurance systems and are able to aid 

13 patients in resolving access issues; and 

14 ‘‘(F) ensuring that consumers have direct 

15 access to patient navigators during regularly 

16 scheduled hours of business operation. 

17 ‘‘(2) OUTREACH SERVICES.—A condition for 

18 the receipt of a grant under paragraph (1) is that 

19 the applicant involved agree to provide ongoing out20 reach activities while receiving the grant, in a man21 ner that is culturally competent for the health dis22 parity population served by the program, to inform 

23 the public and the specific community that the pa24 tient navigator is serving of the services of the model 

25 program under the grant. 
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•S 1833 IS 

1 ‘‘(3) DATA COLLECTION AND REPORT.—In 

2 order to allow for effective patient navigator pro3 gram evaluation, the grantee shall collect specific pa4 tient data recording navigation services provided to 

5 each patient served by the program and shall estab6 lish and implement procedures and protocols, con7 sistent with applicable Federal and State laws (in8 cluding 45 C.F.R. 160 and 164) to ensure the con9 fidentiality of all information shared by a participant 

10 in the program, or their personal representative and 

11 their healthcare providers, group health plans, or 

12 health insurance insurers with the program. The pa13 tient navigator program may, consistent with appli14 cable Federal and State confidentiality laws, collect, 

15 use or disclose aggregate information that is not in16 dividually identifiable (as defined in 45 C.F.R. 160 

17 and 164). With this data, the grantee shall submit 

18 an annual report to the Secretary that summarizes 

19 and analyzes these data, provides information on 

20 needs for navigation services, types of access difficul21 ties resolved, sources of repeated resolution and 

22 flaws in the system of access, including insurance 

23 barriers. 

24 ‘‘(4) APPLICATION FOR GRANT.—A grant may 

25 be made under paragraph (1) only if an application 
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•S 1833 IS 

1 for the grant is submitted to the Secretary and the 

2 application is in such form, is made in such manner, 

3 and contains such agreements, assurances, and in4 formation as the Secretary determines to be nec5 essary to carry out this section. 

6 ‘‘(5) EVALUATIONS.—

7 ‘‘(A) IN GENERAL.—The Secretary, acting 

8 through the Administrator of the Health Re9 sources and Services Administration, shall, di10 rectly or through grants or contracts, provide 

11 for evaluations to determine the effects of the 

12 services of patient navigators on the individuals 

13 of health disparity populations for whom the 

14 services were provided, taking into account the 

15 matters referred to in paragraph (1)(C). 

16 ‘‘(B) DISSEMINATION OF FINDINGS.—The 

17 Secretary shall as appropriate disseminate to 

18 public and private entities the findings made in 

19 evaluations under subparagraph (A).

20 ‘‘(6) COORDINATION WITH OTHER PRO21 GRAMS.—The Secretary shall coordinate the pro22 gram under this subsection with the program under 

23 subsection (a) and with the program under section 

24 417D. 

25 ‘‘(c) REQUIREMENTS REGARDING FEES.—
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1 ‘‘(1) IN GENERAL.—A condition for the receipt 

2 of a grant under subsection (a)(1) or (b)(1) is that 

3 the program for which the grant is made have in ef4 fect—

5 ‘‘(A) a schedule of fees or payments for 

6 the provision of its healthcare services related 

7 to the prevention and treatment of disease that 

8 is consistent with locally prevailing rates or 

9 charges and is designed to cover its reasonable 

10 costs of operation; and 

11 ‘‘(B) a corresponding schedule of discounts 

12 to be applied to the payment of such fees or 

13 payments, which discounts are adjusted on the 

14 basis of the ability of the patient to pay. 

15 ‘‘(2) RULE OF CONSTRUCTION.—Nothing in 

16 this section shall be construed to require payment 

17 for navigation services or to require payment for 

18 healthcare services in cases where care is provided 

19 free of charge, including the case of services pro20 vided through programs of the Indian Health Serv21 ice. 

22 ‘‘(d) MODEL.—Not later than five years after the 

23 date of the enactment of this section, the Secretary shall 

24 develop a peer-reviewed model of systems for the services 

25 provided by this section. The Secretary shall update such 
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•S 1833 IS 

1 model as may be necessary to ensure that the best prac2 tices are being utilized. 

3 ‘‘(e) DURATION OF GRANT.—The period during 

4 which payments are made to an entity from a grant under 

5 subsection (a)(1) or (b)(1) may not exceed five years. The 

6 provision of such payments are subject to annual approval 

7 by the Secretary of the payments and subject to the avail8 ability of appropriations for the fiscal year involved to 

9 make the payments. This subsection may not be construed 

10 as establishing a limitation on the number of grants under 

11 such subsection that may be made to an entity. 

12 ‘‘(f) DEFINITIONS.—For purposes of this section: 

13 ‘‘(1) The term ‘culturally competent’, with re14 spect to providing health-related services, means 

15 services that, in accordance with standards and 

16 measures of the Secretary, are designed to effec17 tively and efficiently respond to the cultural and lin18 guistic needs of patients. 

19 ‘‘(2) The term ‘appropriate follow-up care’ in20 cludes palliative and end-of-life care. 

21 ‘‘(3) The term ‘health disparity population’ 

22 means a population in which there exists a signifi23 cant disparity in the overall rate of disease inci24 dence, morbidity, mortality, or survival rates in the 
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1 population as compared to the health status of the 

2 general population. Such term includes—

3 ‘‘(A) racial and ethnic minority groups as 

4 defined in section 1707; and 

5 ‘‘(B) medically underserved groups, such 

6 as rural and low-income individuals and individ7 uals with low levels of literacy. 

8 ‘‘(4)(A) The term ‘patient navigator’ means an 

9 individual whose functions include—

10 ‘‘(i) assisting and guiding patients with a 

11 symptom or an abnormal finding or diagnosis of 

12 cancer or other chronic disease within the 

13 healthcare system to accomplish the follow-up 

14 and diagnosis of an abnormal finding as well as 

15 the treatment and appropriate follow-up care of 

16 cancer or other chronic disease including pro17 viding information about clinical trials; and 

18 ‘‘(ii) identifying, anticipating, and helping 

19 patients overcome barriers within the healthcare 

20 system to ensure prompt diagnostic and treat21 ment resolution of an abnormal finding of can22 cer or other chronic disease. 

23 ‘‘(B) Such term includes representatives of the 

24 target health disparity population, such as nurses, 
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•S 1833 IS 

1 social workers, cancer survivors, and patient advo2 cates. 

3 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—

4 ‘‘(1) IN GENERAL.—

5 ‘‘(A) MODEL PROGRAMS.—For the purpose 

6 of carrying out subsection (a) (other than the 

7 purpose described in paragraph (2)(A)), there 

8 are authorized to be appropriated such sums as 

9 may be necessary for each of the fiscal years 

10 2005 through 2010. 

11 ‘‘(B) PATIENT NAVIGATORS.—For the pur12 pose of carrying out subsection (b) (other than 

13 the purpose described in paragraph (2)(B)), 

14 there are authorized to be appropriated such 

15 sums as may be necessary for each of the fiscal 

16 years 2005 through 2010. 

17 ‘‘(C) BUREAU OF PRIMARY

18 HEALTHCARE.—Amounts appropriated under 

19 subparagraph (A) or (B) shall be administered 

20 through the Bureau of Primary Health Care. 

21 ‘‘(2) PROGRAMS IN RURAL AREAS.—

22 ‘‘(A) MODEL PROGRAMS.—For the purpose 

23 of carrying out subsection (a) by making grants 

24 under such subsection for model programs in 

25 rural areas, there are authorized to be appro-
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•S 1833 IS 

1 priated such sums as may be necessary for each 

2 of the fiscal years 2005 through 2010. 

3 ‘‘(B) PATIENT NAVIGATORS.—For the pur4 pose of carrying out subsection (b) by making 

5 grants under such subsection for programs in 

6 rural areas, there are authorized to be appro7 priated such sums as may be necessary for each 

8 of the fiscal years 2005 through 2010. 

9 ‘‘(C) OFFICE OF RURAL HEALTH POL10 ICY.—Amounts appropriated under subpara11 graph (A) or (B) shall be administered through 

12 the Office of Rural Health Policy. 

13 ‘‘(3) RELATION TO OTHER AUTHORIZATIONS.—

14 Authorizations of appropriations under paragraphs 

15 (1) and (2) are in addition to other authorizations 

16 of appropriations that are available for the purposes 

17 described in such paragraphs.’’. 

18 SEC. 427. NCI GRANTS FOR MODEL COMMUNITY CANCER 

19 AND CHRONIC DISEASE CARE AND PREVEN20 TION; NCI GRANTS FOR PATIENT NAVIGA21 TORS. 

22 Subpart 1 of part C of title IV of the Public Health 

23 Service Act (42 U.S.C. 285 et seq.) is amended by adding 

24 at the end the following section: 
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•S 1833 IS 

1 ‘‘SEC. 417D. MODEL COMMUNITY CANCER AND CHRONIC 

2 DISEASE CARE AND PREVENTION; PATIENT 

3 NAVIGATORS. 

4 ‘‘(a) MODEL COMMUNITY CANCER AND CHRONIC

5 DISEASE CARE AND PREVENTION.—

6 ‘‘(1) IN GENERAL.—The Director of the Insti7 tute may make grants to eligible entities for the de8 velopment and operation of model programs that—

9 ‘‘(A) provide to individuals of health dis10 parity populations prevention, early detection, 

11 treatment, and appropriate follow-up care serv12 ices for cancer and chronic diseases; 

13 ‘‘(B) ensure that the health services are 

14 provided to such individuals in a culturally com15 petent manner; 

16 ‘‘(C) assign patient navigators, in accord17 ance with applicable criteria of the Secretary, 

18 for managing the care of individuals of health 

19 disparity populations to—

20 ‘‘(i) accomplish, to the extent possible, 

21 the follow-up and diagnosis of an abnormal 

22 finding and the treatment and appropriate 

23 follow-up care of cancer or other chronic 

24 disease; and 

25 ‘‘(ii) facilitate access to appropriate 

26 healthcare services within the healthcare 
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•S 1833 IS 

1 system to ensure optimal patient utiliza2 tion of such services, including aid in co3 ordinating and scheduling appointments 

4 and referrals, community outreach, assist5 ance with transportation arrangements, 

6 and assistance with insurance issues and 

7 other barriers to care and providing infor8 mation about clinical trials; 

9 ‘‘(D) require training for patient naviga10 tors employed through such model programs to 

11 ensure the ability of navigators to perform all 

12 of the duties required in this subsection and in 

13 subsection (b), including training to ensure that 

14 navigators are informed about health insurance 

15 systems and are able to aid patients in resolv16 ing access issues; and 

17 ‘‘(E) ensure that consumers have direct ac18 cess to patient navigators during regularly 

19 scheduled hours of business operation. 

20 ‘‘(2) ELIGIBLE ENTITIES.—For purposes of this 

21 section, an eligible entity is a designated cancer cen22 ter of the Institute, an academic institution, Indian 

23 Health Service Clinics, tribal governments, urban In24 dian organizations, tribal organizations, a hospital, a 

25 qualified nonprofit entity that partners with one or 
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•S 1833 IS 

1 more centers providing healthcare to provide naviga2 tion services, which demonstrates the ability to per3 form all of the functions outlined in this subsection 

4 and subsections (b) and (c), or any other public or 

5 private entity determined to be appropriate by the 

6 Director of the Institute, that provides services de7 scribed in paragraph (1)(A) for cancer and chronic 

8 diseases. 

9 ‘‘(3) DATA COLLECTION AND REPORT.—In 

10 order to allow for effective program evaluation, the 

11 grantee shall collect specific patient data recording 

12 services provided to each patient served by the pro13 gram and shall establish and implement procedures 

14 and protocols, consistent with applicable Federal and 

15 State laws (including 45 C.F.R. 160 and 164) to en16 sure the confidentiality of all information shared by 

17 a participant in the program, or their personal rep18 resentative and their healthcare providers, group 

19 health plans, or health insurance insurers with the 

20 program. The program may, consistent with applica21 ble Federal and State confidentiality laws, collect, 

22 use or disclose aggregate information that is not in23 dividually identifiable (as defined in 45 C.F.R. 160 

24 and 164). With this data, the grantee shall submit 

25 an annual report to the Secretary that summarizes 
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•S 1833 IS 

1 and analyzes these data, provides information on 

2 needs for navigation services, types of access difficul3 ties resolved, sources of repeated resolution and 

4 flaws in the system of access, including insurance 

5 barriers. 

6 ‘‘(4) OUTREACH SERVICES.—A condition for 

7 the receipt of a grant under paragraph (1) is that 

8 the applicant involved agree to provide ongoing out9 reach activities while receiving the grant, in a man10 ner that is culturally competent for the health dis11 parity population served by the program, to inform 

12 the public and the specific community that the pro13 gram is serving of the services of the model program 

14 under the grant. Such activities shall include facili15 tating access to appropriate healthcare services and 

16 patient navigators within the healthcare system to 

17 ensure optimal patient utilization of these services. 

18 ‘‘(5) APPLICATION FOR GRANT.—A grant may 

19 be made under paragraph (1) only if an application 

20 for the grant is submitted to the Director of the In21 stitute and the application is in such form, is made 

22 in such manner, and contains such agreements, as23 surances, and information as the Director deter24 mines to be necessary to carry out this section. 

25 ‘‘(6) EVALUATIONS.—
207

•S 1833 IS 

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

2 Institute, directly or through grants or con3 tracts, shall provide for evaluations to deter4 mine which outreach activities under paragraph 

5 (3) were most effective in informing the public 

6 and the specific community that the program is 

7 serving of the model program services and to 

8 determine the extent to which such programs 

9 were effective in providing culturally competent 

10 services to the health disparity population 

11 served by the programs. 

12 ‘‘(B) DISSEMINATION OF FINDINGS.—The 

13 Director of the Institute shall as appropriate 

14 disseminate to public and private entities the 

15 findings made in evaluations under subpara16 graph (A). 

17 ‘‘(7) COORDINATION WITH OTHER PRO18 GRAMS.—The Secretary shall coordinate the pro19 gram under this subsection with the program under 

20 subsection (b), with the program under section 330I, 

21 and to the extent practicable, with programs for pre22 vention centers that are carried out by the Director 

23 of the Centers for Disease Control and Prevention. 

24 ‘‘(b) PROGRAM FOR PATIENT NAVIGATORS.—
208

•S 1833 IS 

1 ‘‘(1) IN GENERAL.—The Director of the Insti2 tute may make grants to eligible entities for the de3 velopment and operation of programs to pay the 

4 costs of such entities in—

5 ‘‘(A) assigning patient navigators, in ac6 cordance with applicable criteria of the Sec7 retary, for managing the care of individuals of 

8 health disparity populations for the duration of 

9 receiving health services from the health cen10 ters, including aid in coordinating and sched11 uling appointments and referrals, community 

12 outreach, assistance with transportation ar13 rangements, and assistance with insurance 

14 issues and other barriers to care and providing 

15 information about clinical trials; 

16 ‘‘(B) ensuring that the services provided by 

17 the patient navigators to such individuals in18 clude case management and psychosocial as19 sessment and care or information and referral 

20 to such services; 

21 ‘‘(C) ensuring that the patient navigators 

22 with direct knowledge of the communities they 

23 serve provide services to such individuals in a 

24 culturally competent manner; 
209

•S 1833 IS 

1 ‘‘(D) developing model practices for patient 

2 navigators, including with respect to—

3 ‘‘(i) coordination of health services, 

4 including psychosocial assessment and 

5 care; 

6 ‘‘(ii) follow-up services, including psy7 chosocial assessment and care; 

8 ‘‘(iii) determining coverage under 

9 health insurance and health plans for all 

10 services; 

11 ‘‘(iv) ensuring the initiation, continu12 ation and/or sustained access to care pre13 scribed by the patients’ healthcare pro14 viders; and 

15 ‘‘(v) aiding patients with health insur16 ance coverage issues; 

17 ‘‘(E) requiring training for patient naviga18 tors to ensure the ability of navigators to per19 form all of the duties required in this sub20 section and in subsection (a), including training 

21 to ensure that navigators are informed about 

22 health insurance systems and are able to aid 

23 patients in resolving access issues; and 
210

•S 1833 IS 

1 ‘‘(F) ensuring that consumers have direct 

2 access to patient navigators during regularly 

3 scheduled hours of business operation. 

4 ‘‘(2) OUTREACH SERVICES.—A condition for 

5 the receipt of a grant under paragraph (1) is that 

6 the applicant involved agree to provide ongoing out7 reach activities while receiving the grant, in a man8 ner that is culturally competent for the health dis9 parity population served by the program, to inform 

10 the public and the specific community that the pa11 tient navigator is serving of the services of the model 

12 program under the grant. 

13 ‘‘(3) DATA COLLECTION AND REPORT.—In 

14 order to allow for effective patient navigator pro15 gram evaluation, the grantee shall collect specific pa16 tient data recording navigation services provided to 

17 each patient served by the program and shall estab18 lish and implement procedures and protocols, con19 sistent with applicable Federal and State laws (in20 cluding 45 C.F.R. 160 and 164) to ensure the con21 fidentiality of all information shared by a participant 

22 in the program, or their personal representative and 

23 their healthcare providers, group health plans, or 

24 health insurance insurers with the program. The pa25 tient navigator program may, consistent with appli-
211

•S 1833 IS 

1 cable Federal and State confidentiality laws, collect, 

2 use or disclose aggregate information that is not in3 dividually identifiable (as defined in 45 C.F.R. 160 

4 and 164). With this data, the grantee shall submit 

5 an annual report to the Secretary that summarizes 

6 and analyzes these data, provides information on 

7 needs for navigation services, types of access difficul8 ties resolved, sources of repeated resolution and 

9 flaws in the system of access, including insurance 

10 barriers. 

11 ‘‘(4) APPLICATION FOR GRANT.—A grant may 

12 be made under paragraph (1) only if an application 

13 for the grant is submitted to the Director of the In14 stitute and the application is in such form, is made 

15 in such manner, and contains such agreements, as16 surances, and information as the Director deter17 mines to be necessary to carry out this section. 

18 ‘‘(5) EVALUATIONS.—

19 ‘‘(A) IN GENERAL.—The Director of the 

20 Institute, directly or through grants or con21 tracts, shall provide for evaluations to deter22 mine the effects of the services of patient navi23 gators on the health disparity population for 

24 whom the services were provided, taking into 
212

•S 1833 IS 

1 account the matters referred to in paragraph 

2 (1)(C).

3 ‘‘(B) DISSEMINATION OF FINDINGS.—The 

4 Director of the Institute shall as appropriate 

5 disseminate to public and private entities the 

6 findings made in evaluations under subpara7 graph (A). 

8 ‘‘(6) COORDINATION WITH OTHER PRO9 GRAMS.—The Secretary shall coordinate the pro10 gram under this subsection with the program under 

11 subsection (a) and with the program under section 

12 330I. 

13 ‘‘(c) REQUIREMENTS REGARDING FEES.—

14 ‘‘(1) IN GENERAL.—A condition for the receipt 

15 of a grant under subsection (a)(1) or (b)(1) is that 

16 the program for which the grant is made have in ef17 fect—

18 ‘‘(A) a schedule of fees or payments for 

19 the provision of its healthcare services related 

20 to the prevention and treatment of disease that 

21 is consistent with locally prevailing rates or 

22 charges and is designed to cover its reasonable 

23 costs of operation; and

24 ‘‘(B) a corresponding schedule of discounts 

25 to be applied to the payment of such fees or 
213

•S 1833 IS 

1 payments, which discounts are adjusted on the 

2 basis of the ability of the patient to pay. 

3 ‘‘(2) RULE OF CONSTRUCTION.—Nothing in 

4 this section shall be construed to require payment 

5 for navigation services or to require payment for 

6 healthcare services in cases where care is provided 

7 free of charge, including the case of services pro8 vided through programs of the Indian Health Serv9 ice. 

10 ‘‘(d) MODEL.—Not later than five years after the 

11 date of the enactment of this section, the Director of the 

12 Institute shall develop a peer-reviewed model of systems 

13 for the services provided by this section. The Director shall 

14 update such model as may be necessary to ensure that 

15 the best practices are being utilized. 

16 ‘‘(e) DURATION OF GRANT.—The period during 

17 which payments are made to an entity from a grant under 

18 subsection (a)(1) or (b)(1) may not exceed five years. The 

19 provision of such payments are subject to annual approval 

20 by the Director of the Institute of the payments and sub21 ject to the availability of appropriations for the fiscal year 

22 involved to make the payments. This subsection may not 

23 be construed as establishing a limitation on the number 

24 of grants under such subsection that may be made to an 

25 entity. 
214

•S 1833 IS 

1 ‘‘(f) DEFINITIONS.—For purposes of this section: 

2 ‘‘(1) The term ‘culturally competent’, with re3 spect to providing health-related services, means 

4 services that, in accordance with standards and 

5 measures of the Secretary, are designed to effec6 tively and efficiently respond to the cultural and lin7 guistic needs of patients. 

8 ‘‘(2) the term ‘appropriate follow-up care’ in9 cludes palliative and end-of-life care. 

10 ‘‘(3) the term ‘health disparity population’ 

11 means a population where there exists a significant 

12 disparity in the overall rate of disease incidence, 

13 morbidity, mortality, or survival rates in the popu14 lation as compared to the health status of the gen15 eral population. Such term includes—

16 ‘‘(A) racial and ethnic minority groups as 

17 defined in section 1707; and 

18 ‘‘(B) medically underserved groups, such 

19 as rural and low-income individuals and individ20 uals with low levels of literacy. 

21 ‘‘(4)(A) the term ‘patient navigator’ means an 

22 individual whose functions include—

23 ‘‘(i) assisting and guiding patients with a 

24 symptom or an abnormal finding or diagnosis of 

25 cancer or other chronic disease within the 
215

•S 1833 IS 

1 healthcare system to accomplish the follow-up 

2 and diagnosis of an abnormal finding as well as 

3 the treatment and appropriate follow-up care of 

4 cancer or other chronic disease, including pro5 viding information about clinical trials; and 

6 ‘‘(ii) identifying, anticipating, and helping 

7 patients overcome barriers within the healthcare 

8 system to ensure prompt diagnostic and treat9 ment resolution of an abnormal finding of can10 cer or other chronic disease. 

11 ‘‘(B) Such term includes representatives of the 

12 target health disparity population, such as nurses, 

13 social workers, cancer survivors, and patient advo14 cates. 

15 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—

16 ‘‘(1) MODEL PROGRAMS.—For the purpose of 

17 carrying out subsection (a), there are authorized to 

18 be appropriated such sums as may be necessary for 

19 each of the fiscal years 2005 through 2010. 

20 ‘‘(2) PATIENT NAVIGATORS.—For the purpose 

21 of carrying out subsection (b), there are authorized 

22 to be appropriated such sums as may be necessary 

23 for each of the fiscal years 2005 through 2010. 

24 ‘‘(3) RELATION TO OTHER AUTHORIZATIONS.—

25 Authorizations of appropriations under paragraphs 
216

•S 1833 IS 

1 (1) and (2) are in addition to other authorizations 

2 of appropriations that are available for the purposes 

3 described in such paragraphs.’’. 

4 SEC. 428. IHS GRANTS FOR MODEL COMMUNITY CANCER 

5 AND CHRONIC DISEASE CARE AND PREVEN6 TION; IHS GRANTS FOR PATIENT NAVIGA7 TORS. 

8 (a) MODEL COMMUNITY CANCER AND CHRONIC DIS9 EASE CARE AND PREVENTION.—

10 (1) IN GENERAL.—The Director of the Indian 

11 Health Service may make grants to Indian Health 

12 Service Centers, tribal governments, urban Indian 

13 organizations, tribal organizations, and qualified 

14 nonprofit entities demonstrating the ability to per15 form all of the functions outlined in this subsection 

16 and subsections (b) and (c) that partner with pro17 viders or centers providing healthcare serving Native 

18 American populations to provide navigation services, 

19 for the development and operation of model pro20 grams that—

21 (A) provide to individuals of health dis22 parity populations prevention, early detection, 

23 treatment, and appropriate follow-up care serv24 ices for cancer and chronic diseases; 
217

•S 1833 IS 

1 (B) ensure that the health services are pro2 vided to such individuals in a culturally com3 petent manner; 

4 (C) assign patient navigators, in accord5 ance with applicable criteria of the Secretary, 

6 for managing the care of individuals of health 

7 disparity populations to—

8 (i) accomplish, to the extent possible, 

9 the follow-up and diagnosis of an abnormal 

10 finding and the treatment and appropriate 

11 follow-up care of cancer or other chronic 

12 disease; and 

13 (ii) facilitate access to appropriate 

14 healthcare services within the healthcare 

15 system to ensure optimal patient utiliza16 tion of such services, including aid in co17 ordinating and scheduling appointments 

18 and referrals, community outreach, assist19 ance with transportation arrangements, 

20 and assistance with insurance issues and 

21 other barriers to care and providing infor22 mation about clinical trials; 

23 (D) require training for patient navigators 

24 employed through such model programs to en25 sure the ability of navigators to perform all of 
218

•S 1833 IS 

1 the duties required in this subsection and in 

2 subsection (b), including training to ensure that 

3 navigators are informed about health insurance 

4 systems and are able to aid patients in resolv5 ing access issues; and 

6 (E) ensure that consumers have direct ac7 cess to patient navigators during regularly 

8 scheduled hours of business operation. 

9 (2) OUTREACH SERVICES.—A condition for the 

10 receipt of a grant under paragraph (1) is that the 

11 applicant involved agree to provide ongoing outreach 

12 activities while receiving the grant, in a manner that 

13 is culturally competent for the health disparity popu14 lation served by the program, to inform the public 

15 and the specific community that the program is 

16 serving of the services of the model program under 

17 the grant. Such activities shall include facilitating 

18 access to appropriate healthcare services and patient 

19 navigators within the healthcare system to ensure 

20 optimal patient utilization of these services. 

21 (3) DATA COLLECTION AND REPORT.—In order 

22 to allow for effective program evaluation, the grantee 

23 shall collect specific patient data recording services 

24 provided to each patient served by the program and 

25 shall establish and implement procedures and proto-
219

•S 1833 IS 

1 cols, consistent with applicable Federal and State 

2 laws (including 45 C.F.R. 160 and 164) to ensure 

3 the confidentiality of all information shared by a 

4 participant in the program, or their personal rep5 resentative and their healthcare providers, group 

6 health plans, or health insurance insurers with the 

7 program. The program may, consistent with applica8 ble Federal and State confidentiality laws, collect, 

9 use or disclose aggregate information that is not in10 dividually identifiable (as defined in 45 C.F.R. 160 

11 and 164). With this data, the grantee shall submit 

12 an annual report to the Secretary that summarizes 

13 and analyzes these data, provides information on 

14 needs for navigation services, types of access difficul15 ties resolved, sources of repeated resolution and 

16 flaws in the system of access, including insurance 

17 barriers. 

18 (4) APPLICATION FOR GRANT.—A grant may be 

19 made under paragraph (1) only if an application for 

20 the grant is submitted to the Secretary and the ap21 plication is in such form, is made in such manner, 

22 and contains such agreements, assurances, and in23 formation as the Secretary determines to be nec24 essary to carry out this section. 

25 (5) EVALUATIONS.—
220

•S 1833 IS 

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

2 through the Director of the Indian Health Serv3 ice, shall, directly or through grants or con4 tracts, provide for evaluations to determine 

5 which outreach activities under paragraph (2) 

6 were most effective in informing the public and 

7 the specific community that the program is 

8 serving of the model program services and to 

9 determine the extent to which such programs 

10 were effective in providing culturally competent 

11 services to the health disparity population 

12 served by the programs. 

13 (B) DISSEMINATION OF FINDINGS.—The 

14 Secretary shall as appropriate disseminate to 

15 public and private entities the findings made in 

16 evaluations under subparagraph (A). 

17 (6) COORDINATION WITH OTHER PROGRAMS.—

18 The Secretary shall coordinate the program under 

19 this subsection with the program under subsection 

20 (b), with the program under section 417D, and to 

21 the extent practicable, with programs for prevention 

22 centers that are carried out by the Director of the 

23 Centers for Disease Control and Prevention. 

24 (b) PROGRAM FOR PATIENT NAVIGATORS.—
221

•S 1833 IS 

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

2 through the Director of the Indian Health Service, 

3 may make grants to Indian Health Service Centers, 

4 tribal governments, urban Indian organizations, trib5 al organizations, and qualified nonprofit entities 

6 demonstrating the ability to perform all of the func7 tions outlined in this subsection and subsections (a) 

8 and (c) that partner with providers or centers pro9 viding healthcare serving Native American popu10 lations to provide navigation services, for the devel11 opment and operation of model programs to pay the 

12 costs of such organizations in—

13 (A) assigning patient navigators, in accord14 ance with applicable criteria of the Secretary, 

15 for individuals of health disparity populations 

16 for the duration of receiving health services 

17 from the health centers, including aid in coordi18 nating and scheduling appointments and refer19 rals, community outreach, assistance with 

20 transportation arrangements, and assistance 

21 with insurance issues and other barriers to care 

22 and providing information about clinical trials; 

23 (B) ensuring that the services provided by 

24 the patient navigators to such individuals in25 clude case management and psychosocial as-
222

•S 1833 IS 

1 sessment and care or information and referral 

2 to such services; 

3 (C) ensuring that patient navigators with 

4 direct knowledge of the communities they serve 

5 provide services to such individuals in a cul6 turally competent manner; 

7 (D) developing model practices for patient 

8 navigators, including with respect to—

9 (i) coordination of health services, in10 cluding psychosocial assessment and care; 

11 (ii) appropriate follow-up care, includ12 ing psychosocial assessment and care; 

13 (iii) determining coverage under 

14 health insurance and health plans for all 

15 services; 

16 (iv) ensuring the initiation, continu17 ation and/or sustained access to care pre18 scribed by the patients’ healthcare pro19 viders; and 

20 (v) aiding patients with health insur21 ance coverage issues; 

22 (E) requiring training for patient naviga23 tors to ensure the ability of navigators to per24 form all of the duties required in this sub25 section and in subsection (a), including training 
223

•S 1833 IS 

1 to ensure that navigators are informed about 

2 health insurance systems and are able to aid 

3 patients in resolving access issues; and 

4 (F) ensuring that consumers have direct 

5 access to patient navigators during regularly 

6 scheduled hours of business operation. 

7 (2) OUTREACH SERVICES.—A condition for the 

8 receipt of a grant under paragraph (1) is that the 

9 applicant involved agree to provide ongoing outreach 

10 activities while receiving the grant, in a manner that 

11 is culturally competent for the health disparity popu12 lation served by the program, to inform the public 

13 and the specific community that the patient navi14 gator is serving of the services of the model program 

15 under the grant. 

16 (3) DATA COLLECTION AND REPORT.—In order 

17 to allow for effective patient navigator program eval18 uation, the grantee shall collect specific patient data 

19 recording navigation services provided to each pa20 tient served by the program and shall establish and 

21 implement procedures and protocols, consistent with 

22 applicable Federal and State laws (including 45 

23 C.F.R. 160 and 164) to ensure the confidentiality of 

24 all information shared by a participant in the pro25 gram, or their personal representative and their 
224

•S 1833 IS 

1 healthcare providers, group health plans, or health 

2 insurance insurers with the program. The patient 

3 navigator program may, consistent with applicable 

4 Federal and State confidentiality laws, collect, use or 

5 disclose aggregate information that is not individ6 ually identifiable (as defined in 45 C.F.R. 160 and 

7 164). With this data, the grantee shall submit an 

8 annual report to the Secretary that summarizes and 

9 analyzes these data, provides information on needs 

10 for navigation services, types of access difficulties re11 solved, sources of repeated resolution and flaws in 

12 the system of access, including insurance barriers. 

13 (4) APPLICATION FOR GRANT.—A grant may be 

14 made under paragraph (1) only if an application for 

15 the grant is submitted to the Secretary and the ap16 plication is in such form, is made in such manner, 

17 and contains such agreements, assurances, and in18 formation as the Secretary determines to be nec19 essary to carry out this section. 

20 (5) EVALUATIONS.—

21 (A) IN GENERAL.—The Secretary, acting 

22 through the Director of the Indian Health Serv23 ice, shall, directly or through grants or con24 tracts, provide for evaluations to determine the 

25 effects of the services of patient navigators on 
225

•S 1833 IS 

1 the individuals of health disparity populations 

2 for whom the services were provided, taking 

3 into account the matters referred to in para4 graph (1)(C). 

5 (B) DISSEMINATION OF FINDINGS.—The 

6 Secretary shall as appropriate disseminate to 

7 public and private entities the findings made in 

8 evaluations under subparagraph (A). 

9 (6) COORDINATION WITH OTHER PROGRAMS.—

10 The Secretary shall coordinate the program under 

11 this subsection with the program under subsection 

12 (a) and with the program under section 417D. 

13 (c) REQUIREMENTS REGARDING FEES.—

14 (1) IN GENERAL.—A condition for the receipt 

15 of a grant under subsection (a)(1) or (b)(1) is that 

16 the program for which the grant is made have in ef17 fect—

18 (A) a schedule of fees or payments for the 

19 provision of its healthcare services related to 

20 the prevention and treatment of disease that is 

21 consistent with locally prevailing rates or 

22 charges and is designed to cover its reasonable 

23 costs of operation; and 

24 (B) a corresponding schedule of discounts 

25 to be applied to the payment of such fees or 
226

•S 1833 IS 

1 payments, which discounts are adjusted on the 

2 basis of the ability of the patient to pay. 

3 (2) RULE OF CONSTRUCTION.—Nothing in this 

4 section shall be construed to require payment for 

5 navigation services or to require payment for 

6 healthcare services in cases, such as with the Indian 

7 Health Service, where care is provided free of 

8 charge. 

9 (d) MODEL.—Not later than five years after the date 

10 of the enactment of this section, the Secretary shall de11 velop a peer-reviewed model of systems for the services 

12 provided by this section. The Secretary shall update such 

13 model as may be necessary to ensure that the best prac14 tices are being utilized. 

15 (e) DURATION OF GRANT.—The period during which 

16 payments are made to an entity from a grant under sub17 section (a)(1) or (b)(1) may not exceed five years. The 

18 provision of such payments are subject to annual approval 

19 by the Secretary of the payments and subject to the avail20 ability of appropriations for the fiscal year involved to 

21 make the payments. This subsection may not be construed 

22 as establishing a limitation on the number of grants under 

23 such subsection that may be made to an entity. 

24 (f) DEFINITIONS.—For purposes of this section: 
227

•S 1833 IS 

1 (1) The term ‘‘culturally competent’’, with re2 spect to providing health-related services, means 

3 services that, in accordance with standards and 

4 measures of the Secretary, are designed to effec5 tively and efficiently respond to the cultural and lin6 guistic needs of patients. 

7 (2) The term ‘‘appropriate follow-up care’’ in8 cludes palliative and end-of-life care. 

9 (3) The term ‘‘health disparity population’’ 

10 means a population where there exists a significant 

11 disparity in the overall rate of disease incidence, 

12 morbidity, mortality, or survival rates in the popu13 lation as compared to the health status of the gen14 eral population. Such term includes—

15 (A) racial and ethnic minority groups as 

16 defined in section 1707; and 

17 (B) medically underserved groups, such as 

18 rural and low-income individuals and individ19 uals with low levels of literacy. 

20 (4)(A) The term ‘‘patient navigator’’ means an 

21 individual whose functions include—

22 (i) assisting and guiding patients with a 

23 symptom or an abnormal finding or diagnosis of 

24 cancer or other chronic disease within the 

25 healthcare system to accomplish the follow-up 
228

•S 1833 IS 

1 and diagnosis of an abnormal finding as well as 

2 the treatment and appropriate follow-up care of 

3 cancer or other chronic disease, including pro4 viding information about clinical trials; and 

5 (ii) identifying, anticipating, and helping 

6 patients overcome barriers within the healthcare 

7 system to ensure prompt diagnostic and treat8 ment resolution of an abnormal finding of can9 cer or other chronic disease. 

10 (B) Such term includes representatives of the 

11 target health disparity population, such as nurses, 

12 social workers, cancer survivors, and patient advo13 cates. 

14 (g) AUTHORIZATION OF APPROPRIATIONS.—

15 (1) IN GENERAL.—

16 (A) MODEL PROGRAMS.—For the purpose 

17 of carrying out subsection (a) (other than the 

18 purpose described in paragraph (2)(A)), there 

19 are authorized to be appropriated such sums as 

20 may be necessary for each of the fiscal years 

21 2005 through 2010. 

22 (B) PATIENT NAVIGATORS.—For the pur23 pose of carrying out subsection (b) (other than 

24 the purpose described in paragraph (2)(B)), 

25 there are authorized to be appropriated such 
229

•S 1833 IS 

1 sums as may be necessary for each of the fiscal 

2 years 2005 through 2010. 

3 (C) BUREAU OF PRIMARY HEALTH 13

4 CARE.—Amounts appropriated under subpara5 graph (A) or (B) shall be administered through 

6 the Bureau of Primary Health Care. 

7 (2) PROGRAMS IN RURAL AREAS.—

8 (A) MODEL PROGRAMS.—For the purpose 

9 of carrying out subsection (a) by making grants 

10 under such subsection for model programs in 

11 rural areas, there are authorized to be appro12 priated such sums as may be necessary for each 

13 of the fiscal years 2005 through 2010. 

14 (B) PATIENT NAVIGATORS.—For the pur15 pose of carrying out subsection (b) by making 

16 grants under such subsection for programs in 

17 rural areas, there are authorized to be appro18 priated such sums as may be necessary for each 

19 of the fiscal years 2005 through 2010. 

20 (C) OFFICE OF RURAL HEALTH POLICY.—

21 Amounts appropriated under subparagraph (A) 

22 or (B) shall be administered through the Office 

23 of Rural Health Policy. 

24 (3) RELATION TO OTHER AUTHORIZATIONS.—

25 Authorizations of appropriations under paragraphs 
230

•S 1833 IS 

1 (1) and (2) are in addition to other authorizations 

2 of appropriations that are available for the purposes 

3 described in such paragraphs. 

4 CHAPTER 5—COMMUNITY HEALTH 

5 WORKERS

6 SEC. 431. SHORT TITLE. 

7 This chapter may be cited as the ‘‘Community Health 

8 Workers Act of 2003’’. 

9 SEC. 432. GRANTS TO PROMOTE POSITIVE HEALTH BEHAV10 IORS IN WOMEN. 

11 Part P of title III of the Public Health Service Act 

12 (42 U.S.C. 280g et seq.) is amended by adding at the end 

13 the following:

14 ‘‘SEC. 399O. GRANTS TO PROMOTE POSITIVE HEALTH BE15 HAVIORS IN WOMEN. 

16 ‘‘(a) GRANTS AUTHORIZED.—The Secretary, in col17 laboration with the Director of the Centers for Disease 

18 Control and Prevention and other Federal officials deter19 mined appropriate by the Secretary, is authorized to 

20 award grants to States or local or tribal units, to promote 

21 positive health behaviors for women in target populations, 

22 especially racial and ethnic minority women in medically 

23 underserved communities.
231

•S 1833 IS 

1 ‘‘(b) USE OF FUNDS.—Grants awarded pursuant to 

2 subsection (a) may be used to support community health 

3 workers—

4 ‘‘(1) to educate, guide, and provide outreach in 

5 a community setting regarding health problems prev6 alent among women and especially among racial and 

7 ethnic minority women; 

8 ‘‘(2) to educate, guide, and provide experiential 

9 learning opportunities that target behavioral risk 

10 factors; 

11 ‘‘(3) to educate and guide regarding effective 

12 strategies to promote positive health behaviors with13 in the family; 

14 ‘‘(4) to educate and provide outreach regarding 

15 enrollment in health insurance including the State 

16 Children’s Health Insurance Program under title 

17 XXI of the Social Security Act, medicare under title 

18 XVIII of such Act and medicaid under title XIX of 

19 such Act; 

20 ‘‘(5) to promote community wellness and aware21 ness; and 

22 ‘‘(6) to educate and refer target populations to 

23 appropriate health care agencies and community24 based programs and organizations in order to in-
232

•S 1833 IS 

1 crease access to quality health care services, includ2 ing preventive health services. 

3 ‘‘(c) APPLICATION.—

4 ‘‘(1) IN GENERAL.—Each State or local or trib5 al unit (including federally recognized tribes and 

6 Alaska native villages) that desires to receive a grant 

7 under subsection (a) shall submit an application to 

8 the Secretary, at such time, in such manner, and ac9 companied by such additional information as the 

10 Secretary may require. 

11 ‘‘(2) CONTENTS.—Each application submitted 

12 pursuant to paragraph (1) shall—

13 ‘‘(A) describe the activities for which as14 sistance under this section is sought; 

15 ‘‘(B) contain an assurance that with re16 spect to each community health worker pro17 gram receiving funds under the grant awarded, 

18 such program provides training and supervision 

19 to community health workers to enable such 

20 workers to provide authorized program services; 

21 ‘‘(C) contain an assurance that the appli22 cant will evaluate the effectiveness of commu23 nity health worker programs receiving funds 

24 under the grant; 
233

•S 1833 IS 

1 ‘‘(D) contain an assurance that each com2 munity health worker program receiving funds 

3 under the grant will provide services in the cul4 tural context most appropriate for the individ5 uals served by the program; 

6 ‘‘(E) contain a plan to document and dis7 seminate project description and results to 

8 other States and organizations as identified by 

9 the Secretary; and 

10 ‘‘(F) describe plans to enhance the capac11 ity of individuals to utilize health services and 

12 health-related social services under Federal, 

13 State, and local programs by—

14 ‘‘(i) assisting individuals in estab15 lishing eligibility under the programs and 

16 in receiving the services or other benefits 

17 of the programs; and 

18 ‘‘(ii) providing other services as the 

19 Secretary determines to be appropriate, 

20 that may include transportation and trans21 lation services. 

22 ‘‘(d) PRIORITY.—In awarding grants under sub23 section (a), the Secretary shall give priority to those appli24 cants—

25 ‘‘(1) who propose to target geographic areas—
234

•S 1833 IS 

1 ‘‘(A) with a high percentage of residents 

2 who are eligible for health insurance but are 

3 uninsured or underinsured; 

4 ‘‘(B) with a high percentage of families for 

5 whom English is not their primary language; 

6 and 

7 ‘‘(C) that encompass the United States8 Mexico border region; 

9 ‘‘(2) with experience in providing health or 

10 health-related social services to individuals who are 

11 underserved with respect to such services; and 

12 ‘‘(3) with documented community activity and 

13 experience with community health workers. 

14 ‘‘(e) COLLABORATION WITH ACADEMIC INSTITU15 TIONS.—The Secretary shall encourage community health 

16 worker programs receiving funds under this section to col17 laborate with academic institutions. Nothing in this sec18 tion shall be construed to require such collaboration.

19 ‘‘(f) QUALITY ASSURANCE AND COST-EFFECTIVE20 NESS.—The Secretary shall establish guidelines for assur21 ing the quality of the training and supervision of commu22 nity health workers under the programs funded under this 

23 section and for assuring the cost-effectiveness of such pro24 grams. 
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•S 1833 IS 

1 ‘‘(g) MONITORING.—The Secretary shall monitor 

2 community health worker programs identified in approved 

3 applications and shall determine whether such programs 

4 are in compliance with the guidelines established under 

5 subsection (e). 

6 ‘‘(h) TECHNICAL ASSISTANCE.—The Secretary may 

7 provide technical assistance to community health worker 

8 programs identified in approved applications with respect 

9 to planning, developing, and operating programs under the 

10 grant. 

11 ‘‘(i) REPORT TO CONGRESS.— 

12 ‘‘(1) IN GENERAL.—Not later than 4 years 

13 after the date on which the Secretary first awards 

14 grants under subsection (a), the Secretary shall sub15 mit to Congress a report regarding the grant 

16 project. 

17 ‘‘(2) CONTENTS.—The report required under 

18 paragraph (1) shall include the following: 

19 ‘‘(A) A description of the programs for 

20 which grant funds were used. 

21 ‘‘(B) The number of individuals served. 

22 ‘‘(C) An evaluation of—

23 ‘‘(i) the effectiveness of these pro24 grams; 

25 ‘‘(ii) the cost of these programs; and 
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•S 1833 IS 

1 ‘‘(iii) the impact of the project on the 

2 health outcomes of the community resi3 dents. 

4 ‘‘(D) Recommendations for sustaining the 

5 community health worker programs developed 

6 or assisted under this section. 

7 ‘‘(E) Recommendations regarding training 

8 to enhance career opportunities for community 

9 health workers. 

10 ‘‘(j) DEFINITIONS.—In this section: 

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

12 ‘community health worker’ means an individual who 

13 promotes health or nutrition within the community 

14 in which the individual resides—

15 ‘‘(A) by serving as a liaison between com16 munities and health care agencies;

17 ‘‘(B) by providing guidance and social as18 sistance to community residents; 

19 ‘‘(C) by enhancing community residents’ 

20 ability to effectively communicate with health 

21 care providers; 

22 ‘‘(D) by providing culturally and linguis23 tically appropriate health or nutrition edu24 cation; 
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•S 1833 IS 

1 ‘‘(E) by advocating for individual and com2 munity health or nutrition needs; and 

3 ‘‘(F) by providing referral and followup 

4 services. 

5 ‘‘(2) COMMUNITY SETTING.—The term ‘commu6 nity setting’ means a home or a community organi7 zation located in the neighborhood in which a partic8 ipant resides. 

9 ‘‘(3) MEDICALLY UNDERSERVED COMMUNITY.—

10 The term ‘medically underserved community’ means 

11 a community identified by a State—

12 ‘‘(A) that has a substantial number of in13 dividuals who are members of a medically un14 derserved population, as defined by section 

15 330(b)(3); and 

16 ‘‘(B) a significant portion of which is a 

17 health professional shortage area as designated 

18 under section 332. 

19 ‘‘(4) SUPPORT.—The term ‘support’ means the 

20 provision of training, supervision, and materials 

21 needed to effectively deliver the services described in 

22 subsection (b), reimbursement for services, and 

23 other benefits. 
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•S 1833 IS 

1 ‘‘(5) TARGET POPULATION.—The term ‘target 

2 population’ means women of reproductive age, re3 gardless of their current childbearing status. 

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

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

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

7 2005 through 2010.’’. 

8 CHAPTER 6—HEALTH EMPOWERMENT 

9 ZONES 

10 SEC. 440. HEALTH EMPOWERMENT ZONES. 

11 (a) HEALTH EMPOWERMENT ZONE PROGRAMS.—

12 (1) GRANTS.—The Secretary, acting through 

13 the Administrator of the Health Resources and Serv14 ices Administration and the Director of the Office of 

15 Minority Health, and in cooperation with the Direc16 tor of the Office of Community Services and the Di17 rector of the National Center for Minority Health 

18 and Health Disparities, shall make grants to part19 nerships of private and public entities to establish 

20 health empowerment zone programs in communities 

21 that disproportionately experience disparities in 

22 health status and healthcare for the purpose de23 scribed in paragraph (2). 

24 (2) USE OF FUNDS.—
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•S 1833 IS 

1 (A) IN GENERAL.—Subject to subpara2 graph (B), the purpose of a health empower3 ment zone program under this section shall be 

4 to assist individuals, businesses, schools, minor5 ity health associations, non-profit organizations, 

6 community-based organizations, hospitals, 

7 healthcare clinics, foundations, and other enti8 ties in communities that disproportionately ex9 perience disparities in health status and 

10 healthcare which are seeking—

11 (i) to improve the health or environ12 ment of minority individuals in the com13 munity and to reduce disparities in health 

14 status and healthcare by assisting individ15 uals in accessing Federal programs; and 

16 (ii) to coordinate the efforts of gov17 ernmental and private entities regarding 

18 the elimination of racial and ethnic dispari19 ties in health status and healthcare. 

20 (B) MEDICARE AND MEDICAID.—A health 

21 empowerment zone program under this section 

22 shall not provide any assistance (other than re23 ferral and follow-up services) that is duplicative 

24 of programs under title XVIII or XIX of the 
240

•S 1833 IS 

1 Social Security Act (42 U.S.C. 1395 and 1396 

2 et seq.). 

3 (3) DISTRIBUTION.—The Secretary shall make 

4 at least 1 grant under this section to a partnership 

5 for a health empowerment zone program in commu6 nities that disproportionately experience disparities 

7 in health status and healthcare that is located in a 

8 territory or possession of the United States. 

9 (4) APPLICATION.—To obtain a grant under 

10 this section, a partnership shall submit to the Sec11 retary an application in such form and in such man12 ner as the Secretary may require. An application 

13 under this paragraph shall—

14 (A) demonstrate that the communities to 

15 be served by the health empowerment zone pro16 gram are those that disproportionately experi17 ence disparities in health status and healthcare;

18 (B) set forth a strategic plan for accom19 plishing the purpose described in paragraph (2), 

20 by—

21 (i) describing the coordinated health, 

22 economic, human, community, and physical 

23 development plan and related activities 

24 proposed for the community; 
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•S 1833 IS 

1 (ii) describing the extent to which 

2 local institutions and organizations have 

3 contributed and will contribute to the plan4 ning process and implementation; 

5 (iii) identifying the projected amount 

6 of Federal, State, local, and private re7 sources that will be available in the area 

8 and the private and public partnerships to 

9 be used (including any participation by or 

10 cooperation with universities, colleges, 

11 foundations, non-profit organizations, med12 ical centers, hospitals, health clinics, school 

13 districts, or other private and public enti14 ties); 

15 (iv) identifying the funding requested 

16 under any Federal program in support of 

17 the proposed activities; 

18 (v) identifying benchmarks for meas19 uring the success of carrying out the stra20 tegic plan; 

21 (vi) demonstrating the ability to reach 

22 and service the targeted underserved mi23 nority community populations in a cul24 turally appropriate and linguistically re25 sponsive manner; and 
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•S 1833 IS 

1 (vii) demonstrating a capacity and in2 frastructure to provide long-term commu3 nity response that is culturally appropriate 

4 and linguistically responsive to commu5 nities that disproportionately experience 

6 disparities in health and healthcare; and 

7 (C) include such other information as the 

8 Secretary may require. 

9 (5) PREFERENCE.—In awarding grants under 

10 this subsection, the Secretary shall give preference 

11 to proposals from indigenous community entities 

12 that have an expertise in providing culturally appro13 priate and linguistically responsive services to com14 munities that disproportionately experience dispari15 ties in health and health care. 

16 (b) FEDERAL ASSISTANCE FOR HEALTH EMPOWER17 MENT ZONE GRANT PROGRAMS.—The Secretary, the Ad18 ministrator of the Small Business Administration, the 

19 Secretary of Agriculture, the Secretary of Education, the 

20 Secretary of Labor, and the Secretary of Housing and 

21 Urban Development shall each—

22 (1) where appropriate, provide entity-specific 

23 technical assistance and evidence-based strategies to 

24 communities that disproportionately experience dis25 parities in health status and healthcare to further 
243

•S 1833 IS 

1 the purposes served by a health empowerment zone 

2 program established with a grant under subsection 

3 (a); 

4 (2) identify all programs administered by the 

5 Department of Health and Human Services, Small 

6 Business Administration, Department of Agri7 culture, Department of Education, Department of 

8 Labor, and the Department of Housing and Urban 

9 Development, respectively, that may be used to fur10 ther the purpose of a health empowerment zone pro11 gram established with a grant under subsection (a); 

12 and 

13 (3) in administering any program identified 

14 under paragraph (2), consider the appropriateness of 

15 giving priority to any individual or entity located in 

16 communities that disproportionately experience dis17 parities in health status and healthcare served by a 

18 health empowerment zone program established with 

19 a grant under subsection (a), if such priority would 

20 further the purpose of the health empowerment zone 

21 program. 

22 (c) HEALTH EMPOWERMENT ZONE COORDINATING

23 COMMITTEE.—

24 (1) ESTABLISHMENT.—For each health em25 powerment zone program established with a grant 
244

•S 1833 IS 

1 under subsection (a), the Secretary acting through 

2 the Director of Office of Minority Health and the 

3 Administrator of the Health Resources and Services 

4 Administration shall establish a health empowerment 

5 zone coordinating committee. 

6 (2) DUTIES.—Each coordinating committee es7 tablished, in coordination with the Director of the 

8 Office of Minority Health and the Administrator of 

9 the Health Resources and Services Administration, 

10 shall provide technical assistance and evidence-based 

11 strategies to the grant recipient involved, including 

12 providing guidance on research, strategies, health 

13 outcomes, program goals, management, implementa14 tion, monitoring, assessment, and evaluation proc15 esses. 

16 (3) MEMBERSHIP.—

17 (A) APPOINTMENT.—The Director of the 

18 Office of Minority Health and the Adminis19 trator of the Health Resources and Services Ad20 ministration, in consultation with the respective 

21 grant recipient shall appoint the members of 

22 each coordinating committee. 

23 (B) COMPOSITION.—The Director of the 

24 Office of Minority Health, and the Adminis25 trator of the Health Resources and Services Ad-
245

•S 1833 IS 

1 ministration shall ensure that each coordinating 

2 committee established—

3 (i) has not more than 20 members; 

4 (ii) includes individuals from commu5 nities that disproportionately experience 

6 disparities in health status and healthcare; 

7 (iii) includes community leaders and 

8 leaders of community-based organizations; 

9 (iv) includes representatives of aca10 demia and lay and professional organiza11 tions and associations including those hav12 ing expertise in medicine, technical, social 

13 and behavioral science, health policy, advo14 cacy, cultural and linguistic competency, 

15 research management, and organization; 

16 and 

17 (v) represents a reasonable cross-sec18 tion of knowledge, views, and application 

19 of expertise on societal, ethical, behavioral, 

20 educational, policy, legal, cultural, lin21 guistic, and workforce issues related to 

22 eliminating disparities in health and 

23 healthcare. 

24 (C) INDIVIDUAL QUALIFICATIONS.—The 

25 Director of the Office of Minority Health and 
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•S 1833 IS 

1 the Administrator of the Health Resources and 

2 Services Administration may not appoint an in3 dividual to serve on a coordinating committee 

4 unless the individual meets the following quali5 fications: 

6 (i) The individual is not employed by 

7 the Federal Government. 

8 (ii) The individual has appropriate ex9 perience, including experience in the areas 

10 of community development, cultural and 

11 linguistic competency, reducing and elimi12 nating racial and ethnic disparities in 

13 health and health care, or minority health. 

14 (D) SELECTION.—In selecting individuals 

15 to serve on a coordinating committee, the Di16 rector of Office of Minority Health and the Ad17 ministrator Health Resources and Services Ad18 ministration shall give due consideration to the 

19 recommendations of the Congress, industry 

20 leaders, the scientific community (including the 

21 Institute of Medicine), academia, community 

22 based non-profit organizations, minority health 

23 and related organizations, the education com24 munity, State and local governments, and other 

25 appropriate organizations. 
247

•S 1833 IS 

1 (E) CHAIRPERSON.—The Director of the 

2 Office of Minority Health and the Adminis3 trator of the Health Resources and Services Ad4 ministration, in consultation with the members 

5 of the coordinating committee involved, shall 

6 designate a chairperson of the coordinating 

7 committee, who shall serve for a term of 3 

8 years and who may be reappointed at the expi9 ration of each such term. 

10 (F) TERMS.—Each member of a coordi11 nating committee shall be appointed for a term 

12 of 1 to 3 years in overlapping staggered terms, 

13 as determined by the Director of the Office of 

14 Minority Health and the Administrator of the 

15 Health Resources and Services Administration 

16 at the time of appointment, and may be re17 appointed at the expiration of each such term. 

18 (G) VACANCIES.—A vacancy on a coordi19 nating committee shall be filled in the same 

20 manner in which the original appointment was 

21 made. 

22 (H) COMPENSATION.—Each member of a 

23 coordinating committee shall be compensated at 

24 a rate equal to the daily equivalent of the an25 nual rate of basic pay for level IV of the Execu-
248

•S 1833 IS 

1 tive Schedule for each day (including travel 

2 time) during which such member is engaged in 

3 the performance of the duties of the coordi4 nating committee. 

5 (I) TRAVEL EXPENSES.—Each member of 

6 a coordinating committee shall receive travel ex7 penses, including per diem in lieu of subsist8 ence, in accordance with applicable provisions 

9 under subchapter I of chapter 57 of title 5, 

10 United States Code. 

11 (4) MEETINGS.—A coordinating committee 

12 shall meet 3 to 5 times each year, at the call of the 

13 coordinating committee’s chairperson and in con14 sultation with the Director of Office of Minority 

15 Health and the Administrator Health Resources and 

16 Services Administration. 

17 (5) REPORT.—Each coordinating committee 

18 shall transmit to the Congress an annual report 

19 that, with respect to the health empowerment zone 

20 program involved, includes the following: 

21 (A) A review of the program’s effectiveness 

22 in achieving stated goals and outcomes. 

23 (B) A review of the program’s manage24 ment and the coordination of the entities in25 volved. 
249

•S 1833 IS 

1 (C) A review of the activities in the pro2 gram’s portfolio and components. 

3 (D) An identification of policy issues raised 

4 by the program. 

5 (E) An assessment of the program’s capac6 ity, infrastructure, and number of underserved 

7 minority communities reached. 

8 (F) Recommendations for new program 

9 goals, research areas, enhanced approaches, 

10 partnerships, coordination and management 

11 mechanisms, and projects to be established to 

12 achieve the program’s stated goals, to improve 

13 outcomes, monitoring, and evaluation. 

14 (G) A review of the degree of minority en15 tity participation in the program, and an identi16 fication of a strategy to increase such participa17 tion. 

18 (H) Any other reviews or recommendations 

19 determined to be appropriate by the coordi20 nating committee. 

21 (d) REPORT.—The Director of the Office of Minority 

22 Health and the Administrator of the Health Resources 

23 and Services Administration shall submit a joint annual 

24 report to the appropriate committees of Congress on the 
250

•S 1833 IS 

1 results of the implementation of programs under this sec2 tion. 

3 (e) 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 2010. 

7 Subtitle B—Targeting Diseases and 

8 Conditions with Particularly 

9 Disparate Impact 

10 CHAPTER 1—CANCER REDUCTION 

11 SEC. 441. CANCER REDUCTION. 

12 (a) PREVENTIVE HEALTH MEASURES WITH RE13 SPECT TO BREAST AND CERVICAL CANCER.—

14 (1) IN GENERAL.—Section 1510(a) of the Pub15 lic Health Service Act (42 U.S.C. 300n–5(a)) is 

16 amended by striking ‘‘2003’’ and inserting ‘‘2008’’. 

17 (2) SUPPLEMENTAL GRANTS FOR ADDITIONAL

18 PREVENTIVE HEALTH SERVICES.—Section 

19 1509(d)(1) of the Public Health Service Act (42 

20 U.S.C. 300n–4a(d)(1)) is amended by striking 

21 ‘‘2003’’ and inserting ‘‘2008’’. 

22 (b) TREATMENT AND PREVENTION.—Title XXIX of 

23 the Public Health Service Act, as amended by section 302, 

24 is further amended by adding at the end the following: 
251

•S 1833 IS 

1 ‘‘Subtitle C—Reducing Disease and 

2 Disease-Related Complications 

3 ‘‘CHAPTER 1—CANCER REDUCTION 

4 ‘‘SEC. 2921. CANCER PREVENTION AND TREATMENT FOR 

5 UNDERSERVED MINORITY OR OTHER POPU6 LATIONS. 

7 ‘‘(a) GRANTS.—The Secretary may make grants to 

8 qualifying health centers, non-profit organizations, and 

9 public institutions for the development, expansion, or oper10 ation of programs that, for individuals otherwise served 

11 by such centers, provide—

12 ‘‘(1) information and education on cancer pre13 vention; 

14 ‘‘(2) screenings for cancer; 

15 ‘‘(3) counseling on cancer, including counseling 

16 upon a diagnosis of cancer; and 

17 ‘‘(4) treatment for cancer. 

18 ‘‘(b) QUALIFYING HEALTH CENTERS AND PUBLIC

19 INSTITUTIONS.—For purposes of this section: 

20 ‘‘(1) QUALIFYING HEALTH CENTERS.—The 

21 term ‘qualifying health center’ includes community 

22 health centers, migrant health centers, health cen23 ters for the homeless, health centers for residents of 

24 public housing, and community clinics. 
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•S 1833 IS 

1 ‘‘(2) QUALIFYING PUBLIC INSTITUTIONS.—The 

2 term ‘qualifying public institutions’ means an entity 

3 that meets the requirements of section 2971(b)(1). 

4 ‘‘(c) PREFERENCE IN MAKING GRANTS.—In making 

5 grants under subsection (a), the Secretary shall give pref6 erence to applicants that—

7 ‘‘(1) have service populations that include a sig8 nificant number of low-income minority individuals 

9 who are at-risk for cancer; 

10 ‘‘(2) will, through programs under subsection 

11 (b)—

12 ‘‘(A) emphasize early detection of and com13 prehensive treatment for cancer; 

14 ‘‘(B) provide comprehensive treatment 

15 services for cancer in its earliest stages; and 

16 ‘‘(C) carry out subparagraphs (A) and (B) 

17 for two or more types of cancer; and 

18 ‘‘(3) in order to provide treatment for cancer, 

19 have established or will establish referral arrange20 ments with entities that provide screenings for low21 income individuals. 

22 ‘‘(d) APPROPRIATE CULTURAL CONTEXT.—As a con23 dition for the receipt of a grant under subsection (a), the 

24 applicant shall agree that, in the program carried out with 

25 the grant, services will be provided in the languages most 
253

•S 1833 IS 

1 appropriate for, and with consideration for the cultural 

2 background of, the individuals for whom the services are 

3 provided. 

4 ‘‘(e) OUTREACH SERVICES.—As a condition for the 

5 receipt of a grant under subsection (a), the applicant shall 

6 agree to provide outreach activities to inform the public 

7 of the services of the program, and to provide information 

8 on cancer; and 

9 ‘‘(f) APPLICATION FOR GRANT.—A grant may be 

10 made under subsection (a) only if an application for the 

11 grant is submitted to the Secretary and the application 

12 is in such form, is made in such manner, and contains 

13 such agreements, assurances, and information as the Sec14 retary determines to be necessary to carry out this section. 

15 ‘‘(g) DESIGNATION OF TYPE OF CANCER.—In mak16 ing a grant under subsection (a), the Secretary shall des17 ignate the type or types of cancer with respect to which 

18 the grant is being made. 

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

20 purpose of carrying out this section, there are authorized 

21 to be appropriated such sums as may be necessary for 

22 each of the fiscal years 2005 through 2010.’’. 
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•S 1833 IS 

1 CHAPTER 2—HIV/AIDS REDUCTION 

2 SEC. 442. HIV/AIDS REDUCTION. 

3 Subtitle C of title XXIX of the Public Health Service 

4 Act, as added by section 441, is amended by adding at 

5 the end the following: 

6 ‘‘CHAPTER 2—HIV/AIDS REDUCTION 

7 ‘‘SEC. 2922. HIV/AIDS REDUCTION IN THE MINORITY COM8 MUNITY. 

9 ‘‘(a) EXPANDED FUNDING.—The Secretary, in col10 laboration with the Director of the Office of Minority 

11 Health, the Director of the Centers for Disease Control 

12 and Prevention, the Administrator of the Health Re13 sources and Services Administration, and the Adminis14 trator of the Substance Abuse and Mental Health Admin15 istration, shall provide funds and carry out activities to 

16 expand the Minority HIV/AIDS Initiative.

17 ‘‘(b) USE OF FUNDS.—The additional funds made 

18 available under this section may be used, through the Mi19 nority HIV/AIDS Initiative, to support the following ac20 tivities: 

21 ‘‘(1) The provision of technical assistance and 

22 infrastructure support to reduce HIV/AIDS in mi23 nority populations. 

24 ‘‘(2) To increase minority populations’ access to 

25 HIV/AIDS prevention and care services. 
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•S 1833 IS 

1 ‘‘(3) To build stronger community programs 

2 and partnerships to address HIV prevention and the 

3 healthcare needs of specific minority racial and eth4 nic populations. 

5 ‘‘(c) PRIORITY INTERVENTIONS.—Within the minor6 ity populations referred to in subsection (b), priority in 

7 conducting intervention services shall be given to—

8 ‘‘(1) women; 

9 ‘‘(2) youth; 

10 ‘‘(3) men who engage in homosexual activity; 

11 ‘‘(4) persons who engage in intravenous drug 

12 abuse; 

13 ‘‘(5) homeless individuals; and 

14 ‘‘(6) individuals incarcerated or in the penal 

15 system. 

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

17 purpose of carrying out this section, there are authorized 

18 to be appropriated $610,000,000 for fiscal year 2005, and 

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

20 2006 through 2010.’’. 
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•S 1833 IS 

1 CHAPTER 3—INFANT MORTALITY 

2 REDUCTION 

3 SEC. 443. INFANT MORTALITY REDUCTION. 

4 Subtitle C of title XXIX of the Public Health Service 

5 Act, as amended by section 442, is further amended by 

6 adding at the end the following: 

7 ‘‘CHAPTER 3—INFANT MORTALITY 

8 REDUCTION 

9 ‘‘SEC. 2923. INFANT MORTALITY REDUCTION. 

10 ‘‘(a) BACK TO SLEEP CAMPAIGN.—

11 ‘‘(1) IN GENERAL.—The Secretary shall sup12 port collaborations through the National Institute of 

13 Child Health and Human Development. 

14 ‘‘(2) USE OF FUNDS.—Collaborations funded 

15 under paragraph (1) shall be directed towards the 

16 goal of reducing the incidence of Sudden Infant 

17 Death Syndrome in minority communities, particu18 larly the African American and American Indian and 

19 Native Alaskan communities, through increased edu20 cation on the importance of back sleeping for in21 fants. Such increased education shall include child 

22 care centers and other secondary child caregivers. 

23 ‘‘(b) GUIDELINES FOR CHILD CARE LICENSURE.—

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

25 through the Director of the National Institute of 
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•S 1833 IS 

1 Child Health and Human Development, shall con2 vene a working group to develop health guidelines 

3 relating to infant mortality reduction for use by 

4 child care licensing entities, including State, terri5 torial, tribal, and local governments. 

6 ‘‘(2) FOCUS.—The guidelines developed under 

7 paragraph (1) shall focus specifically on appropriate 

8 actions to reduce the incidence of Sudden Infant 

9 Death Syndrome in child care settings. 

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

11 date of enactment of this title, the Secretary shall 

12 submit to the appropriate committees of Congress 

13 and the States a report that describes the guidelines 

14 developed under this subsection. 

15 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 

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

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

18 2005 through 2010.’’. 

19 CHAPTER 4—FETAL ALCOHOL SYNDROME 

20 TREATMENT AND DIAGNOSIS 

21 SEC. 444. FETAL ALCOHOL SYNDROME. 

22 Subtitle C of title XXIX of the Public Health Service 

23 Act, as amended added by section 443, is further amended 

24 by adding at the end the following: 
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•S 1833 IS 

1 ‘‘CHAPTER 4—FETAL ALCOHOL 

2 SYNDROME TREATMENT AND DIAGNOSIS 

3 ‘‘SEC. 2924. FETAL ALCOHOL SYNDROME. 

4 ‘‘(a) SURVEILLANCE AND IDENTIFICATION RE5 SEARCH.—The Secretary shall direct the National Center 

6 for Birth Defects and Developmental Disabilities (referred 

7 to in this section as the ‘Center’) to—

8 ‘‘(1) develop a uniform surveillance case defini9 tion for Fetal Alcohol Syndrome (referred to in this 

10 section as ‘FAS’) and a uniform surveillance defini11 tion for Alcohol Related Neurodevelopmental Dis12 order (referred to in this section as ‘ARND’); 

13 ‘‘(2) develop a comprehensive screening process 

14 for FAS and ARND to include all age groups; and 

15 ‘‘(3) disseminate the screening process devel16 oped under paragraph (2) to—

17 ‘‘(A) hospitals, outpatient programs, and 

18 other healthcare providers; 

19 ‘‘(B) incarceration and detainment facili20 ties; 

21 ‘‘(C) primary and secondary schools; 

22 ‘‘(D) social work and child welfare offices; 

23 ‘‘(E) State offices and others providing 

24 services to individuals with disabilities; and 
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•S 1833 IS 

1 ‘‘(F) others determined appropriate by the 

2 Secretary. 

3 ‘‘(b) CLINICAL CHARACTERIZATION OF FAS AND RE4 LATED DISEASES.—The Secretary shall direct the Na5 tional Institute of Alcohol Abuse and Alcoholism to—

6 ‘‘(1) research methods to quantify the central 

7 nervous system impairments associated with fetal al8 cohol exposure and to develop clinical diagnostic 

9 tools for the intellectual and behavioral problems as10 sociated with FAS and related diseases; 

11 ‘‘(2) develop a neurocognitive phenotype for 

12 FAS and ARND; and 

13 ‘‘(3) include all relevant scientific and clinical 

14 characterizations of FAS and related diseases in rel15 evant diagnostic codes. 

16 ‘‘(c) COMMUNITY-BASED AND SUPPORT SERVICES

17 COORDINATION GRANTS.—The Secretary shall award 

18 grants to States, Indian tribes and tribal organizations, 

19 and nongovernmental organizations for the establishment 

20 of—

21 ‘‘(1) pilot projects to identify and implement 

22 best practices for—

23 ‘‘(A) educating children with fetal alcohol 

24 spectrum disorders, including—
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•S 1833 IS 

1 ‘‘(i) activities and programs designed 

2 specifically for the identification, treat3 ment, and education of such children; and 

4 ‘‘(ii) curricula development and 

5 credentialing of teachers, administrators, 

6 and social workers who implement such 

7 programs; 

8 ‘‘(B) educating judges, attorneys, child ad9 vocates, law enforcement officers, prison war10 dens, alternative incarceration administrators, 

11 and incarceration officials on how to treat and 

12 support individuals suffering from a fetal alco13 hol spectrum disorder within the criminal jus14 tice system, including—

15 ‘‘(i) programs designed specifically for 

16 the identification, treatment, and education 

17 of those with a fetal alcohol spectrum dis18 order; and

19 ‘‘(ii) curricula development and 

20 credentialing within justice system for indi21 viduals who implement such programs; and 

22 ‘‘(C) educating adoption or foster care 

23 agency officials about available and necessary 

24 services for children with fetal alcohol spectrum 

25 disorders, including—
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•S 1833 IS 

1 ‘‘(i) programs designed specifically for 

2 the identification, treatment, and education 

3 of those with a fetal alcohol spectrum dis4 order; and 

5 ‘‘(ii) education and training for poten6 tial parents of an adopted child with a 

7 fetal alcohol spectrum disorder; 

8 ‘‘(2) nationally coordinated systems that inte9 grate transitional services for those affected by pre10 natal alcohol exposure such as housing assistance, 

11 vocational training and placement, and medication 

12 monitoring by—

13 ‘‘(A) providing training and support to 

14 family services programs, children’s mental 

15 health programs, and other local efforts; 

16 ‘‘(B) recruiting and training mentors for 

17 teenagers with a fetal alcohol spectrum dis18 order; and 

19 ‘‘(C) maintaining a clearinghouse including 

20 all relevant neurobehavioral information needed 

21 for supporting individuals with a fetal alcohol 

22 spectrum disorder; and 

23 ‘‘(3) programs to disseminate and coordinate 

24 fetal alcohol spectrum disorder awareness and iden-
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•S 1833 IS 

1 tification efforts by community health centers, in2 cluding—

3 ‘‘(A) education of health professionals re4 garding available support services; and 

5 ‘‘(B) implementation of a tracking system 

6 targeting the rates of fetal alcohol spectrum 

7 disorders among individuals from certain racial, 

8 ethnic, and economic backgrounds. 

9 ‘‘(d) APPLICATION.—To be eligible to receive a grant 

10 under subsection (d), an entity shall submit to the Sec11 retary an application in such form, in such manner, and 

12 containing such agreements, assurances, and information 

13 as the Secretary determines to be necessary to carry out 

14 this section. 

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

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

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

18 2005 through 2010.’’. 

19 CHAPTER 5—DIABETES PREVENTION AND 

20 TREATMENT 

21 SEC 445. MONITORING THE QUALITY OF AND DISPARITIES 

22 IN DIABETES CARE. 

23 Part A of title IX of the Public Health Service Act 

24 (42 U.S.C. 299 et seq.) is amended by adding at the end 

25 the following: 
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1 ‘‘SEC. 904. AREAS OF SPECIAL EMPHASIS. 

2 ‘‘The Secretary, acting through the Director, shall in3 corporate within the annual quality report required under 

4 section 913(b)(2) and the annual disparities report re5 quired under section 903(a)(6), scientific evidence and in6 formation appropriate for monitoring the quality and safe7 ty of diabetes care and identifying, understanding, and re8 ducing disparities in care.’’. 

9 SEC. 446. DIABETES PREVENTION, TREATMENT, AND CON10 TROL. 

11 (a) DETERMINATION.—The Secretary, in consulta12 tion with Indian tribes and tribal organizations, shall de13 termine—

14 (1) by tribe, tribal organization, and service 

15 unit of the Service, the prevalence of, and the types 

16 of complications resulting from, diabetes among In17 dians; and 

18 (2) based on paragraph (1), the measures (in19 cluding patient education) each service unit should 

20 take to reduce the prevalence of, and prevent, treat, 

21 and control the complications resulting from, diabe22 tes among Indian tribes within that service unit. 

23 (b) SCREENING.—The Secretary shall screen each In24 dian who receives services from the Service for diabetes 

25 and for conditions which indicate a high risk that the indi26 vidual will become diabetic. Such screening may be done 
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1 by an Indian tribe or tribal organization operating 

2 healthcare programs or facilities with funds from the Serv3 ice under the Indian Self-Determination and Education 

4 Assistance Act. 

5 (c) CONTINUED FUNDING.—The Secretary shall con6 tinue to fund, through fiscal year 2015, each effective 

7 model diabetes project in existence on the date of the en8 actment of this Act and such other diabetes programs op9 erated by the Secretary or by Indian tribes and tribal or10 ganizations and any additional programs added to meet 

11 existing diabetes needs. Indian tribes and tribal organiza12 tions shall receive recurring funding for the diabetes pro13 grams which they operate pursuant to this section. Model 

14 diabetes projects shall consult, on a regular basis, with 

15 tribes and tribal organizations in their regions regarding 

16 diabetes needs and provide technical expertise as needed.

17 (d) DIALYSIS PROGRAMS.—The Secretary shall pro18 vide funding through the Service, Indian tribes and tribal 

19 organizations to establish dialysis programs, including 

20 funds to purchase dialysis equipment and provide nec21 essary staffing. 

22 (e) OTHER ACTIVITIES.—The Secretary shall, to the 

23 extent funding is available—

24 (1) in each area office of the Service, consult 

25 with Indian tribes and tribal organizations regarding 
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1 programs for the prevention, treatment, and control 

2 of diabetes; 

3 (2) establish in each area office of the Service 

4 a registry of patients with diabetes to track the 

5 prevalence of diabetes and the complications from 

6 diabetes in that area; and 

7 (3) ensure that data collected in each area of8 fice regarding diabetes and related complications 

9 among Indians is disseminated to tribes, tribal orga10 nizations, and all other area offices. 

11 (f) DEFINITIONS.—For purposes of this section, the 

12 definitions contained in section 4 of the Indian Health 

13 Care Improvement Act shall apply. 

14 SEC. 447. GENETICS OF DIABETES. 

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

16 281 et seq.) is amended by inserting after section 430 the 

17 following: 

18 ‘‘SEC. 430A. GENETICS OF DIABETES. 

19 ‘‘The Diabetes Mellitus Interagency Coordinating 

20 Committee, in collaboration with the Directors of the Na21 tional Human Genome Research Institute, the National 

22 Institute of Diabetes and Digestive and Kidney Diseases, 

23 and the National Institute of Environmental Health 

24 Sciences, and other voluntary organizations and interested 

25 parties, shall—
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1 ‘‘(1) coordinate and assist efforts of the Type 

2 1 Diabetes Genetics Consortium, which will collect 

3 and share valuable DNA information from type 1 di4 abetes patients from studies around the world; and 

5 ‘‘(2) provide continued coordination and sup6 port for the consortia of laboratories investigating 

7 the genomics of diabetes.’’. 

8 SEC. 448. RESEARCH AND TRAINING ON DIABETES IN UN9 DERSERVED AND MINORITY POPULATIONS. 

10 (a) RESEARCH.—Subpart 3 of part C of title IV of 

11 the Public Health Service Act (42 U.S.C. 285c et seq.) 

12 is amended by adding at the end the following:

13 ‘‘SEC. 434B. RESEARCH ON DIABETES IN UNDERSERVED 

14 AND MINORITY POPULATIONS. 

15 ‘‘(a) IN GENERAL.—The Director of the Institute, in 

16 coordination with the Director of the National Center on 

17 Minority Health and Health Disparities, the Director of 

18 the Office of Minority Health, and other appropriate insti19 tutes and centers, shall expand, intensify, and coordinate 

20 research programs on pre-diabetes, type 1 diabetes and 

21 type 2 diabetes in underserved populations and minority 

22 groups. 

23 ‘‘(b) RESEARCH.—The research described in sub24 section (a) shall include research on—
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1 ‘‘(1) behavior, including diet and physical activ2 ity and other aspects of behavior; 

3 ‘‘(2) environmental factors related to type 2 di4 abetes that are unique to, more serious, or more 

5 prevalent, among underserved or high-risk popu6 lations; 

7 ‘‘(3) research on the prevention of complica8 tions, which are unique to, more serious, or more 

9 prevalent among minorities, as well as research on 

10 how to effectively translate the findings of clinical 

11 trials and research to improve methods for self-man12 agement and health-care delivery; and 

13 ‘‘(4) genetic studies of diabetes, consistent with 

14 research conducted under section 430A. 

15 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 

16 are authorized to be appropriated for purposes of carrying 

17 out this section, such sums as may be necessary for each 

18 of fiscal years 2005 through 2010.’’. 

19 (b) DIVISION DIRECTORS.—Section 428(b)(1) of the 

20 Public Health Service Act (42 U.S.C. 285c–2(b)(1)) is 

21 amended by inserting ‘‘(including research training of 

22 members of minority populations in order to facilitate 

23 their conduct of diabetes-related research in underserved 

24 populations and minority groups)’’ after ‘‘research pro25 grams’’. 
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1 SEC. 449. AUTHORIZATION OF APPROPRIATIONS. 

2 Subpart 3 of part C of title IV of the Public Health 

3 Service Act (42 U.S.C. 285c et seq.) (as amended by sec4 tion 448(a)) is amended by adding at the end the fol5 lowing: 

6 ‘‘SEC. 434C. AUTHORIZATION OF APPROPRIATIONS. 

7 ‘‘For the purpose of carrying out this subpart with 

8 respect to the programs of the National Institute of Diabe9 tes and Digestive and Kidney Diseases, other than section 

10 434B, there are authorized to be appropriated such sums 

11 as may be necessary for each of fiscal years 2005 through 

12 2010.’’. 

13 SEC. 450. MODEL COMMUNITY DIABETES AND CHRONIC 

14 DISEASE CARE AND PREVENTION AMONG PA15 CIFIC ISLANDERS AND NATIVE HAWAIIANS. 

16 Part P of title III of the Public Health Service Act 

17 (42 U.S.C. 280g et seq.), as amended by section 432, is 

18 further amended by adding at the end the following: 

19 ‘‘SEC. 399P. MODEL COMMUNITY DIABETES AND CHRONIC 

20 DISEASE CARE AND PREVENTION AMONG PA21 CIFIC ISLANDERS AND NATIVE HAWAIIANS. 

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

23 the Director of the Centers for Disease Control and Pre24 vention, may award grants and enter into cooperative 

25 agreements and contracts with eligible entities to establish 

26 a model community demonstration project to provide 
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1 training and support for community-based prevention and 

2 control programs targeting diabetes, hypertension, cardio3 vascular disease, and other related health problems in 

4 American Samoa, the Commonwealth of the Northern 

5 Mariana Islands, Guam, the Federated States of Micro6 nesia, Hawaii, the Republic of the Marshall Islands, and 

7 the Republic of Palau. 

8 ‘‘(b) ELIGIBLE ENTITY DEFINED.—In this section 

9 the term ‘eligible entity’ means any organization described 

10 in section 501(c)(3) of the Internal Revenue Code of 1986 

11 and exempt from tax under section 501(a) of such Code. 

12 ‘‘(c) PRIORITY.—The Secretary shall give priority for 

13 grants, agreements, and contracts under this section to 

14 eligible entities that have previously administered cul15 turally appropriate Centers for Disease Control and Pre16 vention programs intended to prevent and control diabetes 

17 in the areas described in subsection (a). 

18 ‘‘(d) REGULATIONS.—The Secretary is authorized to 

19 promulgate such regulations as may be necessary to carry 

20 out this section. 

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

22 are authorized to be appropriated to carry out this section, 

23 such sums as may be necessary for fiscal years 2005 

24 through 2010.’’. 
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1 SEC. 451. PROGRAMS OF CENTERS FOR DISEASE CONTROL 

2 AND PREVENTION. 

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

4 (42 U.S.C. 243 et seq.) is amended by striking section 

5 317H and inserting the following: 

6 ‘‘SEC. 317H. DIABETES IN CHILDREN AND YOUTH. 

7 ‘‘(a) SURVEILLANCE ON TYPE 1 DIABETES.—The 

8 Secretary, acting through the Director of the Centers for 

9 Disease Control and Prevention and in consultation with 

10 the Director of the National Institutes of Health, shall de11 velop a sentinel system to collect data on type 1 diabetes, 

12 including the incidence and prevalence of type 1 diabetes 

13 and shall establish a national database for such data. 

14 ‘‘(b) TYPE 2 DIABETES IN YOUTH.—The Secretary 

15 shall implement a national public health effort to address 

16 type 2 diabetes in youth, including—

17 ‘‘(1) enhancing surveillance systems and ex18 panding research to better assess the prevalence and 

19 incidence of type 2 diabetes in youth and determine 

20 the extent to which type 2 diabetes is incorrectly di21 agnosed as type 1 diabetes among children; 

22 ‘‘(2) standardizing and improving methods to 

23 assist in diagnosis, treatment, and prevention of dia24 betes including developing less invasive ways to mon25 itor blood glucose to prevent hypoglycemia such as 
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1 nonmydriatic retinal imaging and improving existing 

2 glucometers that measure blood glucose; and 

3 ‘‘(3) developing methods to identify obstacles 

4 facing children in traditionally underserved popu5 lations to obtain care to prevent or treat type 2 dia6 betes. 

7 ‘‘(c) LONG-TERM EPIDEMIOLOGICAL STUDIES ON DI8 ABETES IN CHILDREN.—The Secretary, acting through 

9 the Director of the Centers for Disease Control and Pre10 vention and the Director of the National Institute of Dia11 betes and Digestive and Kidney Diseases, shall conduct 

12 or support long-term epidemiology studies in children with 

13 diabetes or at risk for diabetes. Such studies shall inves14 tigate the causes and characteristics of the disease and 

15 its complications. 

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

17 are authorized to be appropriated to carry out this section, 

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

19 2005 through 2010.’’. 

20 CHAPTER 6—HEART DISEASE AND 

21 STROKE PREVENTION AND TREATMENT 

22 SEC. 455. SYSTEMS FOR HEART DISEASE AND STROKE. 

23 Title XXIX of the Public Health Service Act, as 

24 amended by section 443, is further amended by adding 

25 at the end the following: 
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1 ‘‘Subtitle D—Systems for Heart 

2 Disease and Stroke 

3 ‘‘CHAPTER 1—HEART DISEASE 

4 ‘‘SEC. 2941. HEART DISEASE. 

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

6 the National Heart, Lung and Blood Institute and the 

7 Centers for Disease Control, shall award competitive 

8 grants to eligible entities to provide for community-based 

9 interventions to encourage healthy lifestyles to reduce 

10 morbidity and mortality from heart disease.

11 ‘‘(b) ELIGIBLE ENTITIES.—To be eligible to receive 

12 a grant under subsection (a), an entity shall—

13 ‘‘(1) be a community-based or non-profit orga14 nization, academic medical institution, hospital, 

15 health center, health plan, health department, or 

16 other health-related entity determined appropriate 

17 by the Secretary; and 

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

19 application at such time, in such manner, and con20 taining such information as the Secretary may re21 quire. 

22 ‘‘(c) USE OF FUNDS.—An entity shall use amounts 

23 received under a grant under this section to—

24 ‘‘(1) carry out interventions that address pri25 mary prevention of heart disease in the minority 
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1 community, including educational outreach efforts 

2 concerning risk factors for, and the prevention of, 

3 heart disease; 

4 ‘‘(2) carry out activities to facilitate healthy 

5 lifestyles in minority populations through—

6 ‘‘(A) behavioral change interventions to in7 crease physical activity and improve nutrition; 

8 ‘‘(B) the increased use of community facili9 ties and public spaces for exercise; 

10 ‘‘(C) school, after-school, or intramural 

11 physical activity or sports programs for children 

12 and youth; 

13 ‘‘(D) employment-based interventions to 

14 increase physical activity or nutrition; or 

15 ‘‘(3) expand or evaluate existing programs of 

16 the type described in paragraphs (1) and (2). 

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

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

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

20 2005 through 2010. 

21 ‘‘CHAPTER 2—STROKE EDUCATION 

22 CAMPAIGN 

23 ‘‘SEC. 2945. STROKE EDUCATION CAMPAIGN. 

24 ‘‘(a) IN GENERAL.—The Secretary shall carry out a 

25 national education and information campaign to promote 
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1 stroke prevention and increase the number of stroke pa2 tients who seek immediate treatment. In implementing 

3 such education and information campaign, the Secretary 

4 shall avoid duplicating existing stroke education efforts by 

5 other Federal Government agencies and may consult with 

6 national and local associations that are dedicated to in7 creasing the public awareness of stroke, consumers of 

8 stroke awareness products, and providers of stroke care. 

9 ‘‘(b) USE OF FUNDS.—The Secretary may use 

10 amounts appropriated to carry out the campaign described 

11 in subsection (a)—

12 ‘‘(1) to make public service announcements 

13 about the warning signs of stroke and the impor14 tance of treating stroke as a medical emergency; 

15 ‘‘(2) to provide education regarding ways to 

16 prevent stroke and the effectiveness of stroke treat17 ment; 

18 ‘‘(3) to purchase media time and space; 

19 ‘‘(4) to pay for advertising production costs; 

20 ‘‘(5) to test and evaluate advertising and edu21 cational materials for effectiveness, especially among 

22 groups at high risk for stroke, including women, 

23 older adults, and African-Americans; 

24 ‘‘(6) to develop alternative campaigns that are 

25 targeted to unique communities, including rural and 
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1 urban communities, and States with a particularly 

2 high incidence of stroke; 

3 ‘‘(7) to measure public awareness prior to the 

4 start of the campaign on a national level and in tar5 geted communities to provide baseline data that will 

6 be used to evaluate the effectiveness of the public 

7 awareness efforts; and 

8 ‘‘(8) to carry out other activities that the Sec9 retary determines will promote prevention practices 

10 among the general public and increase the number 

11 of stroke patients who seek immediate care. 

12 ‘‘(c) CONSULTATIONS.—In carrying out this section, 

13 the Secretary shall consult with medical, surgical, rehabili14 tation, and nursing specialty groups, hospital associations, 

15 voluntary health organizations, emergency medical serv16 ices, State directors, and associations, experts in the use 

17 of telecommunication technology to provide stroke care, 

18 national disability, minority health professional organiza19 tions and consumer organizations representing individuals 

20 with disabilities and chronic illnesses, concerned advo21 cates, and other interested parties. 

22 ‘‘(d) STROKE.—In this section, the term ‘stroke’ 

23 means a ‘brain attack’ in which blood flow to the brain 

24 is interrupted or in which a blood vessel or aneurysm in 

25 the brain breaks or ruptures. 
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1 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 

2 is authorized to be appropriated to carry out subsection 

3 (b), such sums as may be necessary for each of fiscal years 

4 2005 through 2010.’’. 

5 CHAPTER 7—OBESITY AND OVERWEIGHT 

6 REDUCTION 

7 SEC. 461. OVERWEIGHT AND OBESITY PREVENTION AND 

8 TREATMENT. 

9 (a) IN GENERAL.—The Secretary, in collaboration 

10 with the Director of the Centers for Disease Control and 

11 Prevention, the Administrator of the National Center for 

12 Minority Health and Health Disparities, and the Adminis13 trator of the Health Resources and Services Administra14 tion, shall establish grant programs for the purpose of pre15 venting and treating overweight and obesity in under16 served minority populations. 

17 (b) DEFINITIONS.—In this section, with respect to an 

18 individual: 

19 (1) OBESITY.—The term ‘‘obesity’’ means a 

20 Body Mass Index greater than or equal to 30.0 kg/

m2 21 . 

22 (2) OVERWEIGHT.—The term ‘‘overweight’’ 

means a Body Mass Index of 25 to 29.9 kg/m2 23 . 

24 (c) CENTERS FOR DISEASE CONTROL AND PREVEN25 TION.—The Director of the Centers for Disease Control 
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1 and Prevention shall expand overweight and obesity reduc2 tion activities that include the following: 

3 (1) Surveillance in minority racial and ethnic 

4 populations. 

5 (2) Communication strategies, including the use 

6 of social marketing for minority populations, about 

7 the dangers of obesity. 

8 (3) Creation of partnerships with State health 

9 departments in developing obesity prevention and 

10 treatment interventions. 

11 (4) Development of work-based wellness pro12 grams to encourage adoption of healthy lifestyles by 

13 employees. 

14 (d) NATIONAL CENTER FOR MINORITY HEALTH AND

15 HEALTH DISPARITIES.—The Director of the Centers for 

16 Disease Control and Prevention shall establish and imple17 ment a grant program to support research in the following 

18 areas: 

19 (1) Behavioral and environmental causes of 

20 overweight and obesity in minority populations. 

21 (2) Prevention and treatment interventions for 

22 overweight and obesity, tailored for minority popu23 lations. 
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1 (3) Disparities in the prevalence of overweight 

2 and obesity among racial and ethnic minority 

3 groups. 

4 (4) Development and dissemination of best 

5 practice guidelines for treatment of overweight and 

6 obesity, tailored for gender and age groups within 

7 minority populations. 

8 (5) Data collection and reporting relating to 

9 overweight and obesity in minority populations. 

10 (e) HEALTH RESOURCES AND SERVICES ADMINIS11 TRATION.—The Administrator of the Health Resources 

12 and Services Administration, in collaboration with the Di13 rector of the Office of Minority Health, the Secretary of 

14 Education, and the Secretary of Agriculture, shall estab15 lish and implement a school-based obesity prevention and 

16 treatment program that may include the following activi17 ties: 

18 (1) Projects to change the perception of over19 weight and obesity of children from racially and eth20 nically diverse backgrounds at all ages. 

21 (2) Culturally appropriate student education 

22 about healthy eating habits, based on the Dietary 

23 Guidelines for Americans. 
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•S 1833 IS 

1 (3) Student programs to increase knowledge, 

2 attitudes, skills, behaviors, and confidence needed to 

3 be physically active for life. 

4 (4) Student peer advisor programs to increase 

5 awareness and model healthy lifestyles among fellow 

6 students. 

7 (5) Teacher education using scientifically evalu8 ated physical education and nutrition curricula tai9 lored to minority populations. 

10 (6) Family-focused initiatives to encourage the 

11 adoption of strategies relating to healthy lifestyles 

12 for parents (or guardians) and children. 

13 (7) The creation of partnerships with commu14 nity, fitness, or health organizations that will pro15 mote healthy eating and physical activity among 

16 children. 

17 (8) Incentive programs to ensure the provision 

18 of healthful foods and beverages on school campuses 

19 and at school events. 

20 (f) EVALUATION.—A grantee under this section shall 

21 submit to the Secretary an evaluation, in collaboration 

22 with an academic health center or other qualified entity, 

23 that describes activities carried out with funds received 

24 under the grant and the effectiveness of such activities in 

25 preventing or treating overweight and obesity. 
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1 (g) AUTHORIZATION OF APPROPRIATIONS.—There is 

2 authorized to be appropriated to carry out this section, 

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

4 2005 through 2010. 

5 CHAPTER 8—TUBERCULOSIS CONTROL, 

6 PREVENTION, AND TREATMENT 

7 SEC. 465. ADVISORY COUNCIL FOR THE ELIMINATION OF 

8 TUBERCULOSIS. 

9 Section 317E(f) of the Public Health Service Act (42 

10 U.S.C. 247b–6(f)) is amended—

11 (1) by redesignating paragraph (5) as para12 graph (6); and 

13 (2) by striking paragraphs (2) through (4), and 

14 inserting the following: 

15 ‘‘(2) DUTIES.—For the purpose of making 

16 progress toward the goal of eliminating tuberculosis 

17 from the United States, the Council shall provide to 

18 the Secretary and other appropriate Federal officials 

19 advice on coordinating the activities of the Public 

20 Health Service and other Federal agencies that re21 late to such disease and on efficiently utilizing the 

22 Federal resources involved. 

23 ‘‘(3) NATIONAL PLAN.—In carrying out para24 graph (2), the Council, in consultation with appro25 priate public and private entities, shall make rec-
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1 ommendations on the development, revision, and im2 plementation of a national plan to eliminate tuber3 culosis in the United States. In carrying out this 

4 paragraph, the Council shall—

5 ‘‘(A) consider the recommendations of the 

6 Institute of Medicine regarding the elimination 

7 of tuberculosis; 

8 ‘‘(B) address the development and applica9 tion of new technologies; and 

10 ‘‘(C) review the extent to which progress 

11 has been made toward eliminating tuberculosis. 

12 ‘‘(4) GLOBAL ACTIVITIES.—In carrying out 

13 paragraph (2), the Council, in consultation with ap14 propriate public and private entities, shall make rec15 ommendations for the development and implementa16 tion of a plan to guide the involvement of the United 

17 States in global and cross border tuberculosis-control 

18 activities, including recommendations regarding poli19 cies, strategies, objectives, and priorities. Such rec20 ommendations for the plan shall have a focus on 

21 countries where a high incidence of tuberculosis di22 rectly affects the United States, such as Mexico, and 

23 on access to a comprehensive package of tuberculosis 

24 control measures, as defined by the World Health 
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1 Organization directly observed treatment, short 

2 course strategy (commonly known as DOTS). 

3 ‘‘(5) COMPOSITION.—The Council shall be com4 posed of—

5 ‘‘(A) representatives from the Centers for 

6 Disease Control and Prevention, the National 

7 Institutes of Health, the Agency for Healthcare 

8 Research and Quality, the Health Resources 

9 and Services Administration, the U.S.-Mexico 

10 Border Health Commission, and other Federal 

11 departments and agencies that carry out signifi12 cant activities relating to tuberculosis; and 

13 ‘‘(B) members appointed from among indi14 viduals who are not officers or employees of the 

15 Federal Government.’’. 

16 SEC. 466. NATIONAL PROGRAM FOR TUBERCULOSIS ELIMI17 NATION. 

18 Section 317E of the Public Health Service Act (42 

19 U.S.C. 247b–6) is amended—

20 (1) by striking the heading for the section and 

21 inserting the following: 

22 ‘‘NATIONAL PROGRAM FOR TUBERCULOSIS

23 ELIMINATION’’; 

24 (2) by amending subsection (b) to read as fol25 lows: 
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•S 1833 IS 

1 ‘‘(b) RESEARCH, DEMONSTRATION PROJECTS, EDU2 CATION, AND TRAINING.—With respect to the prevention, 

3 control, and elimination of tuberculosis, the Secretary 

4 may, directly or through grants to public or nonprofit pri5 vate entities, carry out the following: 

6 ‘‘(1) Research, with priority given to research 

7 concerning—

8 ‘‘(A) diagnosis and treatment of latent in9 fection of tuberculosis; 

10 ‘‘(B) strains of tuberculosis resistant to 

11 drugs; 

12 ‘‘(C) cases of tuberculosis that affect cer13 tain high-risk populations; and 

14 ‘‘(D) clinical trials, including those con15 ducted through the Tuberculosis Trials Consor16 tium. 

17 ‘‘(2) Demonstration projects, including for—

18 ‘‘(A) the development of regional capabili19 ties for the prevention, control, and elimination 

20 of tuberculosis particularly in low-incidence re21 gions; and 

22 ‘‘(B) collaboration with the Immigration 

23 and Naturalization Service to identify and treat 

24 immigrants with active or latent tuberculosis in25 fection. 
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1 ‘‘(3) Public information and education pro2 grams. 

3 ‘‘(4) Education, training and clinical skills im4 provement activities for health professionals, includ5 ing allied health personnel.

6 ‘‘(5) Support of model centers to carry out ac7 tivities under paragraphs (2) through (4). 

8 ‘‘(6) Collaboration with international organiza9 tions and foreign countries, including Mexico, in co10 ordination with the United States Agency for Inter11 national Development, in carrying out such activi12 ties, including coordinating activities through the 

13 Advisory Council for the Elimination of Tuber14 culosis. 

15 ‘‘(7) Capacity support to States and large cities 

16 for strengthening tuberculosis programs.’’; and 

17 (3) by striking subsection (g) and inserting the 

18 following: 

19 ‘‘(g) REPORTS.—The Secretary, acting through the 

20 Director of the Centers for Disease Control and Preven21 tion and in consultation with the Advisory Council for the 

22 Elimination of Tuberculosis, shall biennially prepare and 

23 submit to the Committee on Health, Education, Labor, 

24 and Pensions of the Senate and the Committee on Energy 

25 and Commerce of the House of Representatives, a report 
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•S 1833 IS 

1 on the activities carried out under this section. Each re2 port shall include the opinion of the Council on the extent 

3 to which its recommendations under section 317E(f)(3) 

4 regarding tuberculosis have been implemented. 

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

6 purpose of carrying out this section, there are authorized 

7 to be appropriated such sums as may be necessary for 

8 each of the fiscal years 2005 through 2010.’’. 

9 SEC. 467. INCLUSION OF INPATIENT HOSPITAL SERVICES 

10 FOR THE TREATMENT OF TB-INFECTED INDI11 VIDUALS. 

12 (a) IN GENERAL.—Section 1902(z)(2) of the Social 

13 Security Act (42 U.S.C. 1396a(z)(2)) is amended by add14 ing at the end the following: 

15 ‘‘(G) Inpatient hospital services.’’. 

16 (b) EFFECTIVE DATE.—The amendment made by 

17 subsection (a) takes effect on October 1, 2004. 

18 CHAPTER 9—ASTHMA 

19 SEC. 471. PROVISIONS REGARDING NATIONAL ASTHMA 

20 EDUCATION AND PREVENTION PROGRAM OF 

21 NATIONAL HEART, LUNG, AND BLOOD INSTI22 TUTE. 

23 In addition to any other authorization of appropria24 tions that is available to the National Heart, Lung, and 

25 Blood Institute for the purpose of carrying out the Na-
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•S 1833 IS 

1 tional Asthma Education and Prevention Program, there 

2 is authorized to be appropriated to such Institute for such 

3 purpose such sums as may be necessary for each of fiscal 

4 years 2005 through 2010. Amounts appropriated under 

5 the preceding sentence shall be expended to expand such 

6 Program. 

7 SEC. 472. ASTHMA-RELATED ACTIVITIES OF CENTERS FOR 

8 DISEASE CONTROL AND PREVENTION. 

9 (a) EXPANSION OF PUBLIC HEALTH SURVEILLANCE

10 ACTIVITIES; PROGRAM FOR PROVIDING INFORMATION

11 AND EDUCATION TO PUBLIC.—The Secretary of Health 

12 and Human Services, acting through the Director of the 

13 Centers for Disease Control and Prevention, shall collabo14 rate with the States to expand the scope of—

15 (1) activities that are carried out to determine 

16 the incidence and prevalence of asthma; and 

17 (2) activities that are carried out to prevent the 

18 health consequences of asthma, including through 

19 the provision of information and education to the 

20 public regarding asthma, which may include the use 

21 of public service announcements through the media 

22 and such other means as such Director determines 

23 to be appropriate. 

24 (b) COMPILATION OF DATA.—The Secretary of 

25 Health and Human Services, acting through the Director 
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•S 1833 IS 

1 of the Centers for Disease Control and Prevention and in 

2 consultation with the National Asthma Education Preven3 tion Program Coordinating Committee, shall—

4 (1) conduct local asthma surveillance activities 

5 to collect data on the prevalence and severity of 

6 asthma and the quality of asthma management, in7 cluding—

8 (A) telephone surveys to collect sample 

9 household data on the local burden of asthma; 

10 and 

11 (B) health care facility specific surveillance 

12 to collect asthma data on the prevalence and se13 verity of asthma, and on the quality of asthma 

14 care; and 

15 (2) compile and annually publish data on—

16 (A) the prevalence of children suffering 

17 from asthma in each State; and 

18 (B) the childhood mortality rate associated 

19 with asthma nationally and in each State. 

20 (c) ADDITIONAL FUNDING.—In addition to any other 

21 authorization of appropriations that is available to the 

22 Centers for Disease Control and Prevention for the pur23 pose of carrying out this section, there is authorized to 

24 be appropriated to such Centers for such purpose such 
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1 sums as may be necessary for each of fiscal years 2005 

2 through 2010. 

3 SEC. 473. GRANTS FOR COMMUNITY OUTREACH REGARD4 ING ASTHMA INFORMATION, EDUCATION, 

5 AND SERVICES. 

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

7 to nonprofit private entities for projects to carry out, in 

8 communities identified by entities applying for the grants, 

9 outreach activities to provide for residents of the commu10 nities the following: 

11 (1) Information and education on asthma. 

12 (2) Referrals to health programs of public and 

13 nonprofit private entities that provide asthma-re14 lated services, including such services for low-income 

15 individuals. The grant may be expended to make ar16 rangements to coordinate the activities of such enti17 ties in order to establish and operate networks or 

18 consortia regarding such referrals. 

19 (b) PREFERENCES IN MAKING GRANTS.—In making 

20 grants under subsection (a), the Secretary shall give pref21 erence to applicants that will carry out projects under such 

22 subsection in communities that are disproportionately af23 fected by asthma or underserved with respect to the activi24 ties described in such subsection and in which a significant 

25 number of low-income individuals reside. 
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1 (c) EVALUATIONS.—A condition for a grant under 

2 subsection (a) is that the applicant for the grant agree 

3 to provide for the evaluation of the projects carried out 

4 under such subsection by the applicant to determine the 

5 extent to which the projects have been effective in carrying 

6 out the activities referred to in such subsection. 

7 (d) FUNDING.—For the purpose of carrying out this 

8 section, there is authorized to be appropriated such sums 

9 as may be necessary for each of fiscal years 2005 through 

10 2010. 

11 SEC. 474. ACTION PLANS OF LOCAL EDUCATIONAL AGEN12 CIES REGARDING ASTHMA. 

13 (a) IN GENERAL.—

14 (1) SCHOOL-BASED ASTHMA ACTIVITIES.—The 

15 Secretary of Education (in this section referred to as 

16 the ‘‘Secretary’’), in consultation with the Director 

17 of the Centers for Disease Control and Prevention 

18 and the Director of the National Institutes of 

19 Health, may make grants to local educational agen20 cies for programs to carry out at elementary and 

21 secondary schools specified in paragraph (2) asthma22 related activities for children who attend such 

23 schools. 

24 (2) ELIGIBLE SCHOOLS.—The elementary and 

25 secondary schools referred to in paragraph (1) are 
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•S 1833 IS 

1 such schools that are located in communities with a 

2 significant number of low-income or underserved in3 dividuals (as defined by the Secretary).

4 (b) DEVELOPMENT OF PROGRAMS.—Programs under 

5 subsection (a) shall include grants under which local edu6 cation agencies and State public health officials collabo7 rate to develop programs to improve the management of 

8 asthma in school settings. 

9 (c) CERTAIN GUIDELINES.—Programs under sub10 section (a) shall be carried out in accordance with applica11 ble guidelines or other recommendations of the National 

12 Institutes of Health (including the National Heart, Lung, 

13 and Blood Institute) and the Environmental Protection 

14 Agency. 

15 (d) CERTAIN ACTIVITIES.—Activities that may be 

16 carried out in programs under subsection (a) include the 

17 following: 

18 (1) Identifying and working directly with local 

19 hospitals, community clinics, advocacy organizations, 

20 parent-teacher associations, minority health organi21 zations, and asthma coalitions. 

22 (2) Identifying asthmatic children and training 

23 them and their families in asthma self-management. 

24 (3) Purchasing asthma equipment. 

25 (4) Hiring school nurses. 
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•S 1833 IS 

1 (5) Training teachers, nurses, coaches, and 

2 other school personnel in asthma-symptom recogni3 tion and emergency responses. 

4 (6) Simplifying procedures to improve students’ 

5 safe access to their asthma medications. 

6 (7) Such other asthma-related activities as the 

7 Secretary determines to be appropriate. 

8 (e) DEFINITIONS.—For purposes of this section, the 

9 terms ‘‘elementary school’’, ‘‘local educational agency’’, 

10 and ‘‘secondary school’’ have the meanings given such 

11 terms in the Elementary and Secondary Education Act of 

12 1965. 

13 (f) FUNDING.—For the purpose of carrying out this 

14 section, there is authorized to be appropriated such sums 

15 as may be necessary for each of fiscal years 2005 through 

16 2010. 

17 CHAPTER 10—SICKLE CELL DISEASE 

18 SEC. 481. DEMONSTRATION PROGRAM FOR THE DEVELOP19 MENT AND ESTABLISHMENT OF SYSTEMIC 

20 MECHANISMS FOR THE PREVENTION AND 

21 TREATMENT OF SICKLE CELL DISEASE. 

22 (a) AUTHORITY TO CONDUCT DEMONSTRATION PRO23 GRAM.—

24 (1) IN GENERAL.—The Administrator, through 

25 the Bureau of Primary Health Care and the Mater-
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•S 1833 IS 

1 nal and Child Health Bureau, shall conduct a dem2 onstration program by making grants to up to 40 el3 igible entities for each fiscal year in which the pro4 gram is conducted under this section for the purpose 

5 of developing and establishing systemic mechanisms 

6 to improve the prevention and treatment of Sickle 

7 Cell Disease, including through—

8 (A) the coordination of service delivery for 

9 individuals with Sickle Cell Disease; 

10 (B) genetic counseling and testing; 

11 (C) bundling of technical services related 

12 to the prevention and treatment of Sickle Cell 

13 Disease; 

14 (D) training of health professionals; and 

15 (E) identifying and establishing other ef16 forts related to the expansion and coordination 

17 of education, treatment, pain management, and 

18 continuity of care programs for individuals with 

19 Sickle Cell Disease. 

20 (2) GRANT AWARD REQUIREMENTS.—

21 (A) GEOGRAPHIC DIVERSITY.—The Ad22 ministrator shall, to the extent practicable, 

23 award grants under this section to eligible enti24 ties located in different regions of the United 

25 States. 
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•S 1833 IS 

1 (B) PRIORITY.—In awarding grants under 

2 this section, the Administrator shall give pri3 ority to awarding grants to eligible entities that 

4 are—

5 (i) Federally-qualified health centers 

6 that have a partnership or other arrange7 ment with a comprehensive Sickle Cell Dis8 ease treatment center that does not receive 

9 funds from the National Institutes of 

10 Health; or 

11 (ii) Federally-qualified health centers 

12 that intend to develop a partnership or 

13 other arrangement with a comprehensive 

14 Sickle Cell Disease treatment center that 

15 does not receive funds from the National 

16 Institutes of Health. 

17 (b) ADDITIONAL REQUIREMENTS.—An eligible entity 

18 awarded a grant under this section shall use funds made 

19 available under the grant to carry out, in addition to the 

20 activities described in subsection (a)(1), the following ac21 tivities: 

22 (1) To facilitate and coordinate the delivery of 

23 education, treatment, and continuity of care for indi24 viduals with Sickle Cell Disease under—
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•S 1833 IS 

1 (A) the entity’s collaborative agreement 

2 with a community-based Sickle Cell Disease or3 ganization or a nonprofit entity that works with 

4 individuals who have Sickle Cell Disease; 

5 (B) the Sickle Cell Disease newborn 

6 screening program for the State in which the 

7 entity is located; and 

8 (C) the maternal and child health program 

9 under title V of the Social Security Act (42 

10 U.S.C. 701 et seq.) for the State in which the 

11 entity is located. 

12 (2) To train nursing and other health staff who 

13 specialize in pediatrics, obstetrics, internal medicine, 

14 or family practice to provide healthcare and genetic 

15 counseling for individuals with the sickle cell trait. 

16 (3) To enter into a partnership with adult or 

17 pediatric hematologists in the region and other re18 gional experts in Sickle Cell Disease at tertiary and 

19 academic health centers and State and county health 

20 offices. 

21 (c) NATIONAL COORDINATING CENTER.—

22 (1) ESTABLISHMENT.—The Administrator shall 

23 enter into a contract with an entity to serve as the 

24 National Coordinating Center for the demonstration 

25 program conducted under this section. 
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1 (2) ACTIVITIES DESCRIBED.—The National Co2 ordinating Center shall—

3 (A) collect, coordinate, monitor, and dis4 tribute data, best practices, and findings re5 garding the activities funded under grants made 

6 to eligible entities under the demonstration pro7 gram; 

8 (B) develop a model protocol for eligible 

9 entities with respect to the prevention and 

10 treatment of Sickle Cell Disease; 

11 (C) develop educational materials regard12 ing the prevention and treatment of Sickle Cell 

13 Disease; and 

14 (D) prepare and submit to Congress a 

15 final report that includes recommendations re16 garding the effectiveness of the demonstration 

17 program conducted under this section and such 

18 direct outcome measures as—

19 (i) the number and type of healthcare 

20 resources utilized (such as emergency room 

21 visits, hospital visits, length of stay, and 

22 physician visits for individuals with Sickle 

23 Cell Disease); and 
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•S 1833 IS 

1 (ii) the number of individuals that 

2 were tested and subsequently received ge3 netic counseling for the sickle cell trait.

4 (d) APPLICATION.—An eligible entity desiring a 

5 grant under this section shall submit an application to the 

6 Administrator at such time, in such manner, and con7 taining such information as the Administrator may re8 quire. 

9 (e) DEFINITIONS.—In this section: 

10 (1) ADMINISTRATOR.—The term ‘‘Adminis11 trator’’ means the Administrator of the Health Re12 sources and Services Administration. 

13 (2) ELIGIBLE ENTITY.—The term ‘‘eligible enti14 ty’’ means a Federally-qualified health center, a non15 profit hospital or clinic, or a university health center 

16 that provides primary healthcare, that—

17 (A) has a collaborative agreement with a 

18 community-based Sickle Cell Disease organiza19 tion or a nonprofit entity with experience in 

20 working with individuals who have Sickle Cell 

21 Disease; and 

22 (B) demonstrates to the Administrator 

23 that either the Federally-qualified health center, 

24 the nonprofit hospital or clinic, the university 

25 health center, the organization or entity de-
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•S 1833 IS 

1 scribed in subparagraph (A), or the experts de2 scribed in subsection (b)(3), has at least 5 

3 years of experience in working with individuals 

4 who have Sickle Cell Disease. 

5 (3) FEDERALLY-QUALIFIED HEALTH CEN6 TER.—The term ‘‘Federally-qualified health center’’ 

7 has the meaning given that term in section 

8 1905(l)(2)(B) of the Social Security Act (42 U.S.C. 

9 1396d(l)(2)(B)). 

10 (f) AUTHORIZATION OF APPROPRIATIONS.—There is 

11 authorized to be appropriated to carry out this section, 

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

13 2005 through 2010. 

14 CHAPTER 11—AUTOIMMUNE DISEASE IN 

15 MINORITY POPULATIONS 

16 SEC. 482. RESEARCH FUNDING FOR AUTOIMMUNE DISEASE 

17 IN MINORITY POPULATIONS. 

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

19 is amended by inserting after section 409E (42 U.S.C. 

20 284i) the following: 

21 ‘‘SEC. 490E–1. RESEARCH FUNDING FOR AUTOIMMUNE DIS22 EASE IN MINORITY POPULATIONS. 

23 ‘‘(a) EXPANSION AND INTENSIFICATION OF ACTIVI24 TIES REGARDING AUTOIMMUNE DISEASES ON MINORI25 TIES.—With respect to the plan under section 409E(c)(1), 
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•S 1833 IS 

1 the Coordinating Committee shall ensure that provisions 

2 of the plan developed under paragraph (2) of such sub3 section include provisions for the following: 

4 ‘‘(1)(A) Basic research, epidemiological re5 search, and other appropriate research concerning 

6 the etiology and causes of autoimmune diseases in 

7 all minorities, including genetic, hormonal, and envi8 ronmental factors. 

9 ‘‘(B)(i) Giving priority under subparagraph (A) 

10 to research regarding environmental factors. 

11 ‘‘(ii) The coordination of (to the extent prac12 ticable and appropriate), and providing additional 

13 support for, research described in clause (i) that is 

14 conducted by public or nonprofit private entities. 

15 ‘‘(2)(A) The development of information and 

16 education programs for patients, healthcare pro17 viders, and others as appropriate on genetic, hor18 monal, and environmental risk factors associated 

19 with autoimmune diseases in minorities, and on the 

20 importance of the prevention or control of such risk 

21 factors and timely referral with appropriate diag22 nosis and treatment. 

23 ‘‘(B) The inclusion in programs under subpara24 graph (A) of information and education on the prev25 alence and nature of autoimmune diseases, on risk 
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•S 1833 IS 

1 factors, and on health-related behaviors that can im2 prove health status in minority populations. 

3 ‘‘(3) Outreach programs for purposes of para4 graphs (1) and (2) that—

5 ‘‘(A) are directed toward minority individ6 uals, particularly those who are at-risk for auto7 immune diseases; and 

8 ‘‘(B) are carried out through community 

9 health centers, community clinics, or other 

10 health centers under section 330, through 

11 State, territory, or local health departments, In12 dian tribes, or through primary care physicians. 

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

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

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

16 2005 through 2010.’’. 

17 CHAPTER 12—PREVENTION AND CON18 TROL OF SEXUALLY TRANSMITTED 

19 DISEASES 

20 SEC. 485. PREVENTION AND CONTROL OF SEXUALLY 

21 TRANSMITTED DISEASES. 

22 (a) IN GENERAL.—Section 318(e)(1) of the Public 

23 Health Service Act (42 U.S.C. 247c(e)(1)) is amended by 

24 striking ‘‘1998’’ and inserting ‘‘2008’’.
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•S 1833 IS 

1 (b) PREVENTABLE CASES OF INFERTILITY.—Section 

2 318A of the Public Health Service Act (42 U.S.C. 247c–

3 1) is amended—

4 (1) in subsection (q), by striking ‘‘1998’’ and 

5 inserting ‘‘2010’’; and 

6 (2) in subsection (r)(2), by striking ‘‘1998’’ and 

7 inserting ‘‘2010’’. 

8 CHAPTER 13—DENTAL DISEASE 

9 SEC. 486. GRANTS TO IMPROVE THE PROVISION OF DENTAL 

10 SERVICES UNDER MEDICAID AND SCHIP. 

11 Title V of the Social Security Act (42 U.S.C. 701 

12 et seq.) is amended by adding at the end the following: 

13 ‘‘SEC. 511. GRANTS TO IMPROVE THE PROVISION OF DEN14 TAL SERVICES UNDER MEDICAID AND SCHIP. 

15 ‘‘(a) AUTHORITY TO MAKE GRANTS.—In addition to 

16 any other payments made under this title to a State, the 

17 Secretary shall award grants to States that satisfy the re18 quirements of subsection (b) to improve the provision of 

19 dental services to children who are enrolled in a State plan 

20 under title XIX or a State child health plan under title 

21 XXI (in this section, collectively referred to as the ‘State 

22 plans’). 

23 ‘‘(b) REQUIREMENTS.—In order to be eligible for a 

24 grant under this section, a State shall provide the Sec25 retary with the following assurances: 
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•S 1833 IS 

1 ‘‘(1) IMPROVED SERVICE DELIVERY.—The 

2 State shall have a plan to improve the delivery of 

3 dental services to children, including children with 

4 special health care needs, who are enrolled in the 

5 State plans, including providing outreach and ad6 ministrative case management, improving collection 

7 and reporting of claims data, and providing incen8 tives, in addition to raising reimbursement rates, to 

9 increase provider participation. 

10 ‘‘(2) ADEQUATE PAYMENT RATES.—The State 

11 has provided for payment under the State plans for 

12 dental services for children at levels consistent with 

13 the market-based rates and sufficient enough to en14 list providers to treat children in need of dental serv15 ices. 

16 ‘‘(3) ENSURED ACCESS.—The State shall en17 sure it will make dental services available to children 

18 enrolled in the State plans to the same extent as 

19 such services are available to the general population 

20 of the State. 

21 ‘‘(c) USE OF FUNDS.—

22 ‘‘(1) IN GENERAL.—Funds provided under this 

23 section may be used to provide administrative re24 sources (such as program development, provider 

25 training, data collection and analysis, and research-
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•S 1833 IS 

1 related tasks) to assist States in providing and as2 sessing services that include preventive and thera3 peutic dental care regimens. 

4 ‘‘(2) LIMITATION.—Funds provided under this 

5 section may not be used for payment of direct den6 tal, medical, or other services or to obtain Federal 

7 matching funds under any Federal program. 

8 ‘‘(d) APPLICATION.—A State shall submit an applica9 tion to the Secretary for a grant under this section in such 

10 form and manner and containing such information as the 

11 Secretary may require. 

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

13 are authorized to be appropriated to make grants under 

14 this section, such sums as may be necessary for fiscal year 

15 2005 and each fiscal year thereafter. 

16 ‘‘(f) APPLICATION OF OTHER PROVISIONS OF

17 TITLE.—

18 ‘‘(1) IN GENERAL.—Except as provided in para19 graph (2), the other provisions of this title shall not 

20 apply to a grant made under this section. 

21 ‘‘(2) EXCEPTIONS.—The following provisions of 

22 this title shall apply to a grant made under sub23 section (a) to the same extent and in the same man24 ner as such provisions apply to allotments made 

25 under section 502(c): 
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•S 1833 IS 

1 ‘‘(A) Section 504(b)(6) (relating to prohi2 bition on payments to excluded individuals and 

3 entities). 

4 ‘‘(B) Section 504(c) (relating to the use of 

5 funds for the purchase of technical assistance).

6 ‘‘(C) Section 504(d) (relating to a limita7 tion on administrative expenditures). 

8 ‘‘(D) Section 506 (relating to reports and 

9 audits), but only to the extent determined by 

10 the Secretary to be appropriate for grants made 

11 under this section. 

12 ‘‘(E) Section 507 (relating to penalties for 

13 false statements).

14 ‘‘(F) Section 508 (relating to non15 discrimination). 

16 ‘‘(G) Section 509 (relating to the adminis17 tration of the grant program).’’. 

18 SEC. 487. STATE OPTION TO PROVIDE WRAP-AROUND 

19 SCHIP COVERAGE TO CHILDREN WHO HAVE 

20 OTHER HEALTH COVERAGE. 

21 (a) IN GENERAL.—

22 (1) SCHIP.—

23 (A) STATE OPTION TO PROVIDE WRAP24 AROUND COVERAGE.—Section 2110(b) of the 
304

•S 1833 IS 

1 Social Security Act (42 U.S.C. 1397jj(b)) is 

2 amended—

3 (i) in paragraph (1)(C), by inserting 

4 ‘‘, subject to paragraph (5),’’ after ‘‘under 

5 title XIX or’’; and 

6 (ii) by adding at the end the fol7 lowing: 

8 ‘‘(5) STATE OPTION TO PROVIDE WRAP-AROUND

9 COVERAGE.—A State may waive the requirement of 

10 paragraph (1)(C) that a targeted low-income child 

11 may not be covered under a group health plan or 

12 under health insurance coverage, if the State satis13 fies the conditions described in subsection (c)(8). 

14 The State may waive such requirement in order to 

15 provide—

16 ‘‘(A) dental services; 

17 ‘‘(B) cost-sharing protection; or 

18 ‘‘(C) all services. 

19 In waiving such requirement, a State may limit the 

20 application of the waiver to children whose family in21 come does not exceed a level specified by the State, 

22 so long as the level so specified does not exceed the 

23 maximum income level otherwise established for 

24 other children under the State child health plan.’’. 
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•S 1833 IS 

1 (B) CONDITIONS DESCRIBED.—Section 

2 2105(c) of the Social Security Act (42 U.S.C. 

3 1397ee(c)) is amended by adding at the end the 

4 following: 

5 ‘‘(8) CONDITIONS FOR PROVISION OF WRAP6 AROUND COVERAGE.—For purposes of section 

7 2110(b)(5), the conditions described in this para8 graph are the following: 

9 ‘‘(A) INCOME ELIGIBILITY.—The State 

10 child health plan (whether implemented under 

11 title XIX or this XXI)—

12 ‘‘(i) has the highest income eligibility 

13 standard permitted under this title as of 

14 January 1, 2002; 

15 ‘‘(ii) subject to subparagraph (B), 

16 does not limit the acceptance of applica17 tions for children; and 

18 ‘‘(iii) provides benefits to all children 

19 in the State who apply for and meet eligi20 bility standards. 

21 ‘‘(B) NO WAITING LIST IMPOSED.—With 

22 respect to children whose family income is at or 

23 below 200 percent of the poverty line, the State 

24 does not impose any numerical limitation, wait25 ing list, or similar limitation on the eligibility of 
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•S 1833 IS 

1 such children for child health assistance under 

2 such State plan. 

3 ‘‘(C) NO MORE FAVORABLE TREATMENT.—

4 The State child health plan may not provide 

5 more favorable coverage of dental services to 

6 the children covered under section 2110(b)(5) 

7 than to children otherwise covered under this 

8 title.’’. 

9 (C) STATE OPTION TO WAIVE WAITING PE10 RIOD.—Section 2102(b)(1)(B) of the Social Se11 curity Act (42 U.S.C. 1397bb(b)(1)(B)) is 

12 amended—

13 (i) in clause (i), by striking ‘‘and’’ at 

14 the end; 

15 (ii) in clause (ii), by striking the pe16 riod and inserting ‘‘; and’’; and 

17 (iii) by adding at the end the fol18 lowing: 

19 ‘‘(iii) at State option, may not apply 

20 a waiting period in the case of a child de21 scribed in section 2110(b)(5), if the State 

22 satisfies the requirements of section 

23 2105(c)(8).’’. 
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•S 1833 IS 

1 (2) APPLICATION OF ENHANCED MATCH UNDER

2 MEDICAID.—Section 1905 of the Social Security Act 

3 (42 U.S.C. 1396d) is amended—

4 (A) in subsection (b), in the fourth sen5 tence, by striking ‘‘or subsection (u)(3)’’ and 

6 inserting ‘‘(u)(3), or (u)(4)’’; and 

7 (B) in subsection (u)—

8 (i) by redesignating paragraph (4) as 

9 paragraph (5); and 

10 (ii) by inserting after paragraph (3) 

11 the following: 

12 ‘‘(4) For purposes of subsection (b), the ex13 penditures described in this paragraph are expendi14 tures for items and services for children described in 

15 section 2110(b)(5), but only in the case of a State 

16 that satisfies the requirements of section 

17 2105(c)(8).’’. 

18 (3) APPLICATION OF SECONDARY PAYOR PROVI19 SIONS.—Section 2107(e)(1) of the Social Security 

20 Act (42 U.S.C. 1397gg(e)(1)) is amended—

21 (A) by redesignating subparagraphs (B) 

22 through (D) as subparagraphs (C) through (E), 

23 respectively; and 

24 (B) by inserting after subparagraph (A) 

25 the following: 
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•S 1833 IS 

1 ‘‘(B) Section 1902(a)(25) (relating to co2 ordination of benefits and secondary payor pro3 visions) with respect to children covered under 

4 a waiver described in section 2110(b)(5).’’. 

5 (b) EFFECTIVE DATE.—The amendments made by 

6 subsection (a) shall take effect on January 1, 2004, and 

7 shall apply to child health assistance and medical assist8 ance provided on or after that date. 

9 SEC. 488. GRANTS TO IMPROVE THE PROVISION OF DENTAL 

10 HEALTH SERVICES THROUGH COMMUNITY 

11 HEALTH CENTERS AND PUBLIC HEALTH DE12 PARTMENTS. 

13 Part D of title III of the Public Health Service Act 

14 (42 U.S.C. 254b et seq.) is amended by insert before sec15 tion 330, the following: 

16 ‘‘SEC. 329. GRANT PROGRAM TO EXPAND THE AVAIL17 ABILITY OF SERVICES. 

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

19 the Health Resources and Services Administration, shall 

20 establish a program under which the Secretary may award 

21 grants to eligible entities and eligible individuals to expand 

22 the availability of primary dental care services in dental 

23 health professional shortage areas or medically under24 served areas. 

25 ‘‘(b) ELIGIBILITY.—
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•S 1833 IS 

1 ‘‘(1) ENTITIES.—To be eligible to receive a 

2 grant under this section an entity—

3 ‘‘(A) shall be—

4 ‘‘(i) a health center receiving funds 

5 under section 330 or designated as a Fed6 erally qualified health center; 

7 ‘‘(ii) a county or local public health 

8 department, if located in a federally-des9 ignated dental health professional shortage 

10 area; 

11 ‘‘(iii) an Indian tribe or tribal organi12 zation (as defined in section 4 of the In13 dian Self-Determination and Education 

14 Assistance Act (25 U.S.C. 450b)); 

15 ‘‘(iv) a dental education program ac16 credited by the Commission on Dental Ac17 creditation; or 

18 ‘‘(v) a community-based program 

19 whose child service population is made up 

20 of at least 33 percent of children who are 

21 eligible children, including at least 25 per22 cent of such children being children with 

23 mental retardation or related develop24 mental disabilities, unless specific docu-
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•S 1833 IS 

1 mentation of a lack of need for access by 

2 this sub-population is established; and 

3 ‘‘(B) shall prepare and submit to the Sec4 retary an application at such time, in such 

5 manner, and containing such information as the 

6 Secretary may require, including information 

7 concerning dental provider capacity to serve in8 dividuals with developmental disabilities. 

9 ‘‘(2) INDIVIDUALS.—To be eligible to receive a 

10 grant under this section an individual shall—

11 ‘‘(A) be a dental health professional li12 censed or certified in accordance with the laws 

13 of State in which such individual provides den14 tal services;

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

16 an application at such time, in such manner, 

17 and containing such information as the Sec18 retary may require; and 

19 ‘‘(C) provide assurances that—

20 ‘‘(i) the individual will practice in a 

21 federally-designated dental health profes22 sional shortage area; or 

23 ‘‘(ii) not less than 25 percent of the 

24 patients of such individual are—
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•S 1833 IS 

1 ‘‘(I) receiving assistance under a 

2 State plan under title XIX of the So3 cial Security Act (42 U.S.C. 1396 et 

4 seq.); 

5 ‘‘(II) receiving assistance under a 

6 State plan under title XXI of the So7 cial Security Act (42 U.S.C. 1397aa 

8 et seq.); or 

9 ‘‘(III) uninsured. 

10 ‘‘(c) USE OF FUNDS.—

11 ‘‘(1) ENTITIES.—An entity shall use amounts 

12 received under a grant under this section to provide 

13 for the increased availability of primary dental serv14 ices in the areas described in subsection (a). Such 

15 amounts may be used to supplement the salaries of16 fered for individuals accepting employment as den17 tists in such areas. 

18 ‘‘(2) INDIVIDUALS.—A grant to an individual 

19 under subsection (a) shall be in the form of a 

20 $1,000 bonus payment for each month in which such 

21 individual is in compliance with the eligibility re22 quirements of subsection (b)(2)(C). 

23 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—

24 ‘‘(1) IN GENERAL.—Notwithstanding any other 

25 amounts appropriated under section 330 for health 
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•S 1833 IS 

1 centers, there is authorized to be appropriated such 

2 sums as may be necessary for each of fiscal years 

3 2005 through 2010 to hire and retain dental 

4 healthcare providers under this section. 

5 ‘‘(2) USE OF FUNDS.—Of the amount appro6 priated for a fiscal year under paragraph (1), the 

7 Secretary shall use—

8 ‘‘(A) not less than 65 percent of such 

9 amount to make grants to eligible entities; and 

10 ‘‘(B) not more than 35 percent of such 

11 amount to make grants to eligible individuals.’’. 

12 CHAPTER 14—PREVENTION AND 

13 CONTROL OF INJURIES 

14 SEC. 491. PREVENTION AND CONTROL OF INJURIES. 

15 (a) IN GENERAL.—Section 394A of the Public 

16 Health Service Act (42 U.S.C. 280b–3) is amended—

17 (1) by striking ‘‘and’’ after ‘‘1994,’’; 

18 (2) by striking ‘‘and’’ after ‘‘1998,’’; and 

19 (3) by striking ‘‘through 2005’’ and all that fol20 lows and inserting the following: ‘‘through 2004, 

21 $300,000,000 for fiscal year 2005, and such sums 

22 as may be necessary for each of the fiscal years 

23 2006 through 2010.’’. 

24 (b) DEMONSTRATION PROJECTS IN URBAN AREAS.—

25 Section 394A of the Public Health Service Act (42 U.S.C. 
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•S 1833 IS 

1 280b–3) is amended by adding at the end the following 

2 sentence: ‘‘For the purpose of carrying out section 

3 393(a)(6) in urban areas, there are authorized to be ap4 propriated such sums as may be necessary for each of the 

5 fiscal years 2005 through 2010, in addition to amounts 

6 available for such purpose pursuant to the preceding sen7 tence.’’. 

8 (c) DEMONSTRATION PROJECTS REGARDING VIO9 LENCE.—Section 393 of the Public Health Service Act (42 

10 U.S.C. 280b–1a) is amended—

11 (1) by redesignating subsection (b) as sub12 section (c); and 

13 (2) by inserting after subsection (a) the fol14 lowing subsection: 

15 ‘‘(b) Grants under subsection (a)(6) shall include 

16 grants to public or nonprofit private trauma centers for 

17 demonstration projects to reduce violence.’’. 

18 CHAPTER 15—UTERINE FIBROID 

19 RESEARCH AND EDUCATION 

20 SEC. 495. RESEARCH WITH RESPECT TO UTERINE 

21 FIBROIDS. 

22 (a) IN GENERAL.—The Director of the National In23 stitutes of Health (in this section referred to as the ‘‘Di24 rector of NIH’’) shall expand, intensify, and coordinate 
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•S 1833 IS 

1 programs for the conduct and support of research with 

2 respect to uterine fibroids. 

3 (b) ADMINISTRATION.—

4 (1) IN GENERAL.—The Director of NIH shall 

5 carry out this section through the appropriate insti6 tutes, offices, and centers, including the National In7 stitute of Child Health and Human Development, 

8 the National Institute of Environmental Health 

9 Sciences, the Office of Research on Women’s Health, 

10 the National Center on Minority Health and Health 

11 Disparities, and any other agencies that the Director 

12 of NIH determines to be appropriate. 

13 (2) COORDINATION OF ACTIVITIES.—The Office 

14 of Research on Women’s Health shall coordinate ac15 tivities under paragraph (1) among the institutes, 

16 offices, and centers of the National Institutes of 

17 Health. 

18 (c) AUTHORIZATION OF APPROPRIATIONS.—For the 

19 purpose of carrying out this section, there are authorized 

20 to be appropriated such sums as may be necessary for 

21 each of the fiscal years 2005 through 2010. 

22 SEC. 496. INFORMATION AND EDUCATION WITH RESPECT 

23 TO UTERINE FIBROIDS. 

24 (a) UTERINE FIBROIDS PUBLIC EDUCATION PRO25 GRAM.—
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1 (1) IN GENERAL.—The Secretary of Health and 

2 Human Services (referred to in this section as the 

3 ‘‘Secretary’’), acting through the Director of the 

4 Centers for Disease Control and Prevention, shall 

5 develop and disseminate to the public information 

6 regarding uterine fibroids, including information 

7 on—

8 (A) the incidence and prevalence of uterine 

9 fibroids; 

10 (B) the elevated risk for minority women; 

11 and 

12 (C) the availability, as medically appro13 priate, of a range of treatment options for 

14 symptomatic uterine fibroids. 

15 (2) DISSEMINATION.—The Secretary may dis16 seminate information under paragraph (1) directly, 

17 or through arrangements with nonprofit organiza18 tions, consumer groups, institutions of higher edu19 cation (as defined in section 101 of the Higher Edu20 cation Act of 1965 (20 U.S.C. 1001)), Federal, 

21 State, or local agencies, or the media. 

22 (3) AUTHORIZATION OF APPROPRIATIONS.—For 

23 the purpose of carrying out this subsection, there 

24 are authorized to be appropriated such sums as may 
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•S 1833 IS 

1 be necessary for each of the fiscal years 2005 

2 through 2010. 

3 (b) UTERINE FIBROIDS INFORMATION PROGRAM FOR

4 HEALTH CARE PROVIDERS.—

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

6 through the Administrator of the Health Resources 

7 and Services Administration, shall develop and dis8 seminate to health care providers information on 

9 uterine fibroids, including information on the ele10 vated risk for minority women and the range of 

11 available options for the treatment of symptomatic 

12 uterine fibroids. 

13 (2) AUTHORIZATION OF APPROPRIATIONS.—For 

14 the purpose of carrying out this subsection, there 

15 are authorized to be appropriated such sums as may 

16 be necessary for each of the fiscal years 2005 

17 through 2010. 

18 (c) DEFINITION.—For purposes of this section, the 

19 term ‘‘minority’’, with respect to women, means women 

20 who are members of racial or ethnic minority groups with21 in the meaning of section 1707 of the Public Health Serv22 ice Act (42 U.S.C. 300u–6). 
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1 TITLE V—DATA COLLECTION 

2 AND REPORTING. 

3 Subtitle A—General Provisions 

4 SEC. 501. AMENDMENT TO THE PUBLIC HEALTH SERVICE 

5 ACT. 

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

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

8 ethnicity, and primary language among federally sup9 ported health programs. 

10 (b) AMENDMENT.—Title XXIX of the Public Health 

11 Service Act, as amended by section 463, is further amend12 ed by adding at the end the following: 

13 ‘‘Subtitle E—Data Collection and 

14 Reporting 

15 ‘‘SEC. 2951. DATA ON RACE, ETHNICITY AND PRIMARY LAN16 GUAGE. 

17 ‘‘(a) REQUIREMENTS.—

18 ‘‘(1) IN GENERAL.—Each health-related pro19 gram operated by or that receives funding or reim20 bursement, in whole or in part, either directly or in21 directly from the Department of Health and Human 

22 Services shall—

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

24 or program involved, of data on the race, eth25 nicity, and primary language of each applicant 
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1 for and recipient of health-related assistance 

2 under such program—

3 ‘‘(i) using, at a minimum, the cat4 egories for race and ethnicity described in 

5 the 1997 Office of Management and Budg6 et Standards for Maintaining, Collecting, 

7 and Presenting Federal Data on Race and 

8 Ethnicity; 

9 ‘‘(ii) using the standards developed 

10 under subsection (e) for the collection of 

11 language data; 

12 ‘‘(iii) where practicable, collecting 

13 data for additional population groups if 

14 such groups can be aggregated into the 

15 minimum race and ethnicity categories; 

16 and 

17 ‘‘(iv) where practicable, through self18 report; 

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

20 data described in subparagraph (A) for appli21 cants and recipients who are minors or other22 wise legally incapacitated, require that—

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

24 parent or legal guardian of such an appli25 cant or recipient; and 
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•S 1833 IS 

1 ‘‘(ii) the preferred language of the 

2 parent or legal guardian of such an appli3 cant or recipient be collected; 

4 ‘‘(C) systematically analyze such data 

5 using the smallest appropriate units of analysis 

6 feasible to detect racial and ethnic disparities in 

7 health and healthcare and when appropriate, 

8 for men and women separately, and report the 

9 results of such analysis to the Secretary, the 

10 Director of the Office for Civil Rights, the Com11 mittee on Health, Education, Labor, and Pen12 sions and the Committee on Finance of the 

13 Senate, and the Committee on Energy and 

14 Commerce and the Committee on Ways and 

15 Means of the House of Representatives; 

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

17 at least an annual basis; and 

18 ‘‘(E) ensure that the provision of assist19 ance to an applicant or recipient of assistance 

20 is not denied or otherwise adversely affected be21 cause of the failure of the applicant or recipient 

22 to provide race, ethnicity, and primary language 

23 data. 

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

25 this subsection shall be construed to—
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•S 1833 IS 

1 ‘‘(A) permit the use of information col2 lected under this subsection in a manner that 

3 would adversely affect any individual providing 

4 any such information; and 

5 ‘‘(B) require health care providers to col6 lect data. 

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

8 ensure (through the promulgation of regulations or other9 wise) that all data collected pursuant to subsection (a) is 

10 protected—

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

12 Secretary applies to other health data under the reg13 ulations promulgated under section 264(c) of the 

14 Health Insurance Portability and Accountability Act 

15 of 1996 (Public Law 104–191; 110 Stat. 2033) re16 lating to the privacy of individually identifiable 

17 health information and other protections; and 

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

19 entity that collects, stores, or receives the data, in20 cluding use of such data in determinations of eligi21 bility (or continued eligibility) in health plans, and 

22 from other inappropriate uses, as defined by the 

23 Secretary. 

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

25 Secretary shall develop and implement a national plan to 
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1 improve the collection, analysis, and reporting of racial, 

2 ethnic, and primary language data at the Federal, State, 

3 territorial, Tribal, and local levels, including data to be 

4 collected under subsection (a). The Data Council of the 

5 Department of Health and Human Services, in consulta6 tion with the National Committee on Vital Health Statis7 tics, the Office of Minority Health, and other appropriate 

8 public and private entities, shall make recommendations 

9 to the Secretary concerning the development, implementa10 tion, and revision of the national plan. Such plan shall 

11 include recommendations on how to—

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

13 the cost and administrative burdens of data collec14 tion and reporting; 

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

16 States, territories, Indian tribes, health providers, 

17 health plans, health insurance issuers, and the gen18 eral public that data collection, analysis, and report19 ing by race, ethnicity, and primary language is legal 

20 and necessary to assure equity and non-discrimina21 tion in the quality of healthcare services; 

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

23 have data code sets for racial, ethnic, and primary 

24 language identifiers and that such identifiers can be 
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1 retrieved from clinical records, including records 

2 transmitted electronically; 

3 ‘‘(4) improve health and healthcare data collec4 tion and analysis for more population groups if such 

5 groups can be aggregated into the minimum race 

6 and ethnicity categories, including exploring the fea7 sibility of enhancing collection efforts in States for 

8 racial and ethnic groups that comprise a significant 

9 proportion of the population of the State; 

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

11 racial, ethnic, and primary language data, subject to 

12 privacy and confidentiality regulations; and 

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

14 collected under subsection (a). 

15 ‘‘(d) COMPLIANCE WITH STANDARDS.—Data col16 lected under subsection (a) shall be obtained, maintained, 

17 and presented (including for reporting purposes) in ac18 cordance with the 1997 Office of Management and Budget 

19 Standards for Maintaining, Collecting, and Presenting 

20 Federal Data on Race and Ethnicity (at a minimum). 

21 ‘‘(e) LANGUAGE COLLECTION STANDARDS.—Not 

22 later than 1 year after the date of enactment of this title, 

23 the Director of the Office of Minority Health, in consulta24 tion with the Office for Civil Rights of the Department 

25 of Health and Human Services, shall develop and dissemi-
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•S 1833 IS 

1 nate Standards for the Classification of Federal Data on 

2 Preferred Written and Spoken Language. 

3 ‘‘(f) TECHNICAL ASSISTANCE FOR THE COLLECTION

4 AND REPORTING OF DATA.—

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

6 directly or through grant or contract, provide tech7 nical assistance to enable a healthcare program or 

8 an entity operating under such program to comply 

9 with the requirements of this section. 

10 ‘‘(2) TYPES OF ASSISTANCE.—Assistance pro11 vided under this subsection may include assistance 

12 to—

13 ‘‘(A) enhance or upgrade computer tech14 nology that will facilitate racial, ethnic, and pri15 mary language data collection and analysis; 

16 ‘‘(B) improve methods for health data col17 lection and analysis including additional popu18 lation groups beyond the Office of Management 

19 and Budget categories if such groups can be 

20 aggregated into the minimum race and ethnicity 

21 categories; 

22 ‘‘(C) develop mechanisms for submitting 

23 collected data subject to existing privacy and 

24 confidentiality regulations; and
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•S 1833 IS 

1 ‘‘(D) develop educational programs to in2 form health insurance issuers, health plans, 

3 health providers, health-related agencies, and 

4 the general public that data collection and re5 porting by race, ethnicity, and preferred lan6 guage are legal and essential for eliminating 

7 health and healthcare disparities. 

8 ‘‘(g) ANALYSIS OF RACIAL AND ETHNIC DATA.—The 

9 Secretary, acting through the Director of the Agency for 

10 Healthcare Research and Quality and in coordination with 

11 the Administrator of the Centers for Medicare and Med12 icaid Services, shall provide technical assistance to agen13 cies of the Department of Health and Human Services in 

14 meeting Federal standards for race, ethnicity, and pri15 mary language data collection and analysis of racial and 

16 ethnic disparities in health and healthcare in public pro17 grams by—

18 ‘‘(1) identifying appropriate quality assurance 

19 mechanisms to monitor for health disparities; 

20 ‘‘(2) specifying the clinical, diagnostic, or thera21 peutic measures which should be monitored; 

22 ‘‘(3) developing new quality measures relating 

23 to racial and ethnic disparities in health and 

24 healthcare; 
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•S 1833 IS 

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

2 should be conducted; and 

3 ‘‘(5) sharing data with external organizations 

4 for research and quality improvement purposes. 

5 ‘‘(h) NATIONAL CONFERENCE.—

6 ‘‘(1) IN GENERAL.—The Secretary shall spon7 sor a biennial national conference on racial, ethnic, 

8 and primary language data collection to enhance co9 ordination, build partnerships, and share best prac10 tices in racial, ethnic, and primary language data 

11 collection, analysis, and reporting. 

12 ‘‘(2) REPORTS.—Not later than 6 months after 

13 the date on which a national conference has con14 vened under paragraph (1), the Secretary shall pub15 lish in the Federal Register and submit to the Com16 mittee on Health, Education, Labor, and Pensions 

17 and the Committee on Finance of the Senate and 

18 the Committee on Energy and Commerce and the 

19 Committee on Ways and Means of the House of 

20 Representatives a report concerning the proceedings 

21 and findings of the conference. 

22 ‘‘(i) REPORT.—Not later than 2 years after the date 

23 of enactment of this title, and biennially thereafter, the 

24 Secretary shall submit to the appropriate committees of 

25 Congress a report on the effectiveness of data collection, 
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•S 1833 IS 

1 analysis, and reporting on race, ethnicity, and primary 

2 language under the programs and activities of the Depart3 ment of Health and Human Services and under other Fed4 eral data collection systems with which the Department 

5 interacts to collect relevant data on race and ethnicity. 

6 The report shall evaluate the progress made in the De7 partment with respect to the national plan under sub8 section (c) or subsequent revisions thereto. 

9 ‘‘(j) GRANTS FOR DATA COLLECTION BY HEALTH

10 PLANS, HEALTH CENTERS, AND HOSPITALS.—

11 ‘‘(1) IN GENERAL.—The Secretary, in consulta12 tion with the Administrator of the Centers for Medi13 care and Medicaid Services, is authorized to award 

14 grants for the conduct of 20 demonstration pro15 grams by health plans, health centers, or hospitals 

16 to enhance their ability to collect, analyze, and re17 port the data required under subsection (a). 

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

19 grant under paragraph (1), a health plan or hospital 

20 shall—

21 ‘‘(A) prepare and submit to the Secretary 

22 an application at such time, in such manner, 

23 and containing such information as the Sec24 retary may require, including a plan to elimi25 nate racial, ethnic, and primary language dis-
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•S 1833 IS 

1 parities in health and healthcare through one or 

2 more of the activities described in paragraph 

3 (3); and 

4 ‘‘(B) provide assurances that the health 

5 plan or hospital will use, at a minimum, the ra6 cial and ethnic categories and the standards for 

7 collection described in the 1997 Office of Man8 agement and Budget Standards for Maintain9 ing, Collecting, and Presenting Federal Data on 

10 Race and Ethnicity and available standards for 

11 language. 

12 ‘‘(3) ACTIVITIES.—A grantee shall use amounts 

13 received under a grant under paragraph (1) to—

14 ‘‘(A) collect, analyze, and report data by 

15 race, ethnicity, and primary language for pa16 tients served by the hospital (including emer17 gency room patients and patients served on an 

18 outpatient basis) or health center, or, in the 

19 case of a private health plan, such data for en20 rollees; 

21 ‘‘(B) enhance or upgrade computer tech22 nology that will facilitate racial, ethnic, and pri23 mary language data collection and analysis; 

24 ‘‘(C) provide analyses of racial and ethnic 

25 disparities in health and healthcare, including 
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•S 1833 IS 

1 specific disease conditions, diagnostic and 

2 therapeutic procedures, or outcomes; 

3 ‘‘(D) 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 ‘‘(E) develop mechanisms for sharing col9 lected data subject to privacy and confiden10 tiality regulations; 

11 ‘‘(F) 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 healthcare; and 

19 ‘‘(G) develop quality assurance systems de20 signed to track disparities and quality improve21 ment systems designed to eliminate disparities. 

22 ‘‘(l) DEFINITION.—In this section, the term ‘health23 related program’ mean a program—
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•S 1833 IS 

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

2 301 et seq.) that pay for healthcare and services; 

3 and 

4 ‘‘(2) under this Act that provide Federal finan5 cial assistance for healthcare, biomedical research, 

6 health services research, and programs designed to 

7 improve the public’s health. 

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

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

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

11 2005 through 2010. 

12 ‘‘SEC. 2952. PROVISIONS RELATING TO NATIVE AMERICANS. 

13 ‘‘(a) EPIDEMIOLOGY CENTERS.—

14 ‘‘(1) ESTABLISHMENT.—

15 ‘‘(A) IN GENERAL.—In addition to those 

16 centers operating 1 day prior to the date of en17 actment of this title, (including those centers 

18 for which funding is currently being provided 

19 through funding agreements under the Indian 

20 Self-Determination and Education Assistance 

21 Act), the Secretary shall, not later than 180 

22 days after such date of enactment, establish 

23 and fund an epidemiology center in each service 

24 area which does not have such a center to carry 

25 out the functions described in subparagraph 
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•S 1833 IS 

1 (B). Any centers established under the pre2 ceding sentence may be operated by Indian 

3 tribes or tribal organizations pursuant to fund4 ing agreements under the Indian Self-Deter5 mination and Education Assistance Act, but 

6 funding under such agreements may not be di7 visible. 

8 ‘‘(B) FUNCTIONS.—In consultation with 

9 and upon the request of Indian tribes, tribal or10 ganizations and urban Indian organizations, 

11 each area epidemiology center established under 

12 this subsection shall, with respect to such area 

13 shall—

14 ‘‘(i) collect data related to the health 

15 status objective described in section 3(b) of 

16 the Indian Health Care Improvement Act, 

17 and monitor the progress that the Service, 

18 Indian tribes, tribal organizations, and 

19 urban Indian organizations have made in 

20 meeting such health status objective; 

21 ‘‘(ii) evaluate existing delivery sys22 tems, data systems, and other systems that 

23 impact the improvement of Indian health; 

24 ‘‘(iii) assist Indian tribes, tribal orga25 nizations, and urban Indian organizations 
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•S 1833 IS 

1 in identifying their highest priority health 

2 status objectives and the services needed to 

3 achieve such objectives, based on epidemio4 logical data; 

5 ‘‘(iv) make recommendations for the 

6 targeting of services needed by tribal, 

7 urban, and other Indian communities; 

8 ‘‘(v) make recommendations to im9 prove healthcare delivery systems for Indi10 ans and urban Indians; 

11 ‘‘(vi) provide requested technical as12 sistance to Indian tribes and urban Indian 

13 organizations in the development of local 

14 health service priorities and incidence and 

15 prevalence rates of disease and other ill16 ness in the community; and 

17 ‘‘(vii) provide disease surveillance and 

18 assist Indian tribes, tribal organizations, 

19 and urban Indian organizations to promote 

20 public health. 

21 ‘‘(C) TECHNICAL ASSISTANCE.—The direc22 tor of the Centers for Disease Control and Pre23 vention shall provide technical assistance to the 

24 centers in carrying out the requirements of this 

25 subsection. 
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•S 1833 IS 

1 ‘‘(2) FUNDING.—The Secretary may make 

2 funding available to Indian tribes, tribal organiza3 tions, and eligible intertribal consortia or urban In4 dian organizations to conduct epidemiological studies 

5 of Indian communities. 

6 ‘‘(b) DEFINITIONS.—For purposes of this section, the 

7 definitions contained in section 4 of the Indian Health 

8 Care Improvement Act shall apply.’’. 

9 SEC. 502. COLLECTION OF RACE AND ETHNICITY DATA BY 

10 THE SOCIAL SECURITY ADMINISTRATION. 

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

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

13 the following: 

14 ‘‘SEC. 1150A. COLLECTION OF RACE AND ETHNICITY DATA 

15 BY THE SOCIAL SECURITY ADMINISTRATION. 

16 ‘‘(a) REQUIREMENT.—The Commissioner of the So17 cial Security Administration in consultation with the Ad18 ministrator of the Centers for Medicare and Medicaid 

19 Services shall—

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

21 ethnicity, and primary language of all applicants for 

22 social security numbers, social security income, so23 cial security disability, and medicare—

24 ‘‘(A) using, at a minimum, the categories 

25 for race and ethnicity described in the 1997 Of-
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•S 1833 IS 

1 fice of Management and Budget Standards for 

2 Maintaining, Collecting, and Presenting Federal 

3 Data on Race and Ethnicity and available lan4 guage standards; and 

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

6 additional population groups if such groups can 

7 be aggregated into the minimum race and eth8 nicity categories; 

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

10 described in paragraph (1) for applicants who are 

11 under 18 years of age or otherwise legally incapaci12 tated, require that—

13 ‘‘(A) such data be collected from the par14 ent or legal guardian of such an applicant; and 

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

16 or legal guardian of such an applicant or recipi17 ent be used; 

18 ‘‘(3) require that such data be uniformly ana19 lyzed and reported at least annually to the Commis20 sioner of Social Security; 

21 ‘‘(4) be responsible for storing the data re22 ported under paragraph (3); 

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

24 Medicare and Medicaid Services and other Federal 

25 health agencies; 
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•S 1833 IS 

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

2 least an annual basis; and 

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

4 an applicant is not denied or otherwise adversely af5 fected because of the failure of the applicant to pro6 vide race, ethnicity, and primary language data. 

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

8 Social Security shall ensure (through the promulgation of 

9 regulations or otherwise) that all data collected pursuant 

10 subsection (a) is protected—

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

12 Secretary applies to other health data under the reg13 ulations promulgated under section 264(c) of the 

14 Health Insurance Portability and Accountability Act 

15 of 1996 (Public Law 104–191; 110 Stat. 2033) re16 lating to the privacy of individually identifiable 

17 health information and other protections; and 

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

19 entity that collects, stores, or receives the data, in20 cluding use of such data in determinations of eligi21 bility (or continued eligibility) in health plans, and 

22 from other inappropriate uses, as defined by the 

23 Secretary. 

24 ‘‘(c) NATIONAL EDUCATION PROGRAM.—Not later 

25 than 18 months after the date of enactment of this sec-
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•S 1833 IS 

1 tion, the Secretary, acting through the Director of the Of2 fice of Minority Health and in collaboration with the Com3 missioner of the Social Security Administration, shall de4 velop and implement a program to educate all populations 

5 about the purpose and uses of racial, ethnic, and primary 

6 language health data collection. 

7 ‘‘(d) RULE OF CONSTRUCTION.—Nothing in this sec8 tion shall be construed to permit the use of information 

9 collected under this section in a manner that would ad10 versely affect any individual providing any such informa11 tion. 

12 ‘‘(e) TECHNICAL ASSISTANCE.—The Secretary may, 

13 either directly or by grant or contract, provide technical 

14 assistance to enable any health entity to comply with the 

15 requirements of this section. 

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

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

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

19 2005 through 2010.’’. 

20 SEC. 503. REVISION OF HIPAA CLAIMS STANDARDS. 

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

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

23 Human Services shall revise the regulations promulgated 

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

25 U.S.C. 1320d et seq.), as added by the Health Insurance 
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•S 1833 IS 

1 Portability and Accountability Act of 1996 (Public Law 

2 104–191), relating to the collection of data on race, eth3 nicity, and primary language in a health-related trans4 action to require—

5 (1) the use, at a minimum, of the categories for 

6 race and ethnicity described in the 1997 Office of 

7 Management and Budget Standards for Maintain8 ing, Collecting, and Presenting Federal Data on 

9 Race and Ethnicity; 

10 (2) the establishment of a new data code set for 

11 primary language; and 

12 (3) the designation of the racial, ethnic, and 

13 primary language code sets as ‘‘required’’ for claims 

14 and enrollment data. 

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

16 Human Services shall disseminate the new standards de17 veloped under subsection (a) to all health entities that are 

18 subject to the regulations described in such subsection and 

19 provide technical assistance with respect to the collection 

20 of the data involved. 

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

22 Human Services shall require that health entities comply 

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

24 later than 2 years after the final promulgation of such 

25 standards. 
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•S 1833 IS 

1 SEC. 504. NATIONAL CENTER FOR HEALTH STATISTICS. 

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

3 U.S.C. 242k(n)) is amended—

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

5 inserting ‘‘2010’’; 

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

7 striking ‘‘2003’’ and inserting ‘‘2010’’; and 

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

9 inserting ‘‘2010’’. 

10 Subtitle B—Minority Health and 

11 Genomics Commission 

12 SEC. 511. SHORT TITLE. 

13 This subtitle may be cited as the ‘‘Minority Health 

14 and Genomics Act of 2003’’. 

15 SEC. 512. MINORITY HEALTH AND GENOMICS COMMISSION. 

16 (a) ESTABLISHMENT.—There is established a com17 mission to be known as the Minority Health and Genomics 

18 Commission (in this subtitle referred to as the ‘‘Commis19 sion’’). 

20 (b) DUTIES.—

21 (1) STUDY.—The Commission shall conduct a 

22 thorough study of, and develop recommendations on, 

23 issues relating to genomic research as applied to mi24 nority groups and, under section 516, submit a re25 port to the appropriate committees of Congress that 

26 recommends policies that the Commission finds will 
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•S 1833 IS 

1 ultimately improve healthcare and promote the elimi2 nation of health disparities. 

3 (2) ISSUES.—The study under paragraph (1) 

4 shall address specific issues and the needs of each 

5 minority group described in subparagraph (A) in ad6 dition to issues involving genomic research that af7 fect the groups as a whole. In conducting such study 

8 the Commission shall carry out the following: 

9 (A) Establish standards in genomic re10 search and services that will promote the im11 provement of health and health-related services 

12 for the following groups: American Indians and 

13 Alaska Natives, African Americans, Asian 

14 Americans, Hispanics, and Native Hawaiians 

15 and other Pacific Islanders. 

16 (B) Recommend minimum requirements 

17 and standards for the equitable use of genetics 

18 research in patient care and public health serv19 ices for racial and ethnic minority patients. 

20 (C) Examine the accessibility, effective21 ness, availability, and cost efficiency of genomic 

22 research, genetic testing, genetic counseling, 

23 and genetic screening to minority populations. 

24 (D) Determine and recommend procedures 

25 and policies to address the need for cultural, 
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•S 1833 IS 

1 linguistic, and religious sensitivity training for 

2 genetic counselors and researchers who work 

3 with minority groups. 

4 (E) Evaluate whether minority persons are 

5 provided with informed consent that is cul6 turally and linguistically appropriate to allow a 

7 fully informed decision about their healthcare, 

8 availability of treatments or options, or partici9 pation in any clinical trial involving the collec10 tion of genetic material. 

11 (F) Recommend how population sampling 

12 studies of genetic information can be improved 

13 to aid in the elimination of health disparities 

14 and improve healthcare for minority commu15 nities. 

16 (G) Examine how genetic material or in17 formation derived from individual minorities is 

18 used the help minority groups with the use of 

19 highly specific drug therapies. 

20 (H) Identify the accessibility, effectiveness, 

21 availability, privacy, and benefit of genetic data22 bases and depositories to minority communities. 

23 (I) Identify the accessibility, effectiveness, 

24 and affordability of reproductive technologies to 

25 minority groups. 
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•S 1833 IS 

1 (J) Recommend an incentives program for 

2 genomic researchers that will encourage the 

3 study of disease and genetic ailments that dis4 proportionately affect minority communities. 

5 SEC. 513. REPORT. 

6 Not later than 2 years after the date of the enact7 ment of this Act, the Commission shall prepare and sub8 mit to the appropriate committees of Congress, the Presi9 dent, and the general public a report containing a detailed 

10 statement of the findings and conclusions of the Commis11 sion with respect to matters described in section 

12 512(b)(2), together with such recommendations as the 

13 Commission considers appropriate that may be specific to 

14 each minority group. 

15 SEC. 514. MEMBERSHIP. 

16 (a) NUMBER AND APPOINTMENT.—The Commission 

17 shall be composed of 17 members to be appointed as fol18 lows: 

19 (1) Four members shall be appointed by the 

20 Speaker of the House of Representatives. 

21 (2) Four members shall be appointed by the mi22 nority leader of the House of Representatives. 

23 (3) Four members shall be appointed by the 

24 majority leader of the Senate. 
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•S 1833 IS 

1 (4) Four members shall be appointed by the mi2 nority leader of the Senate. 

3 (5) One member shall be appointed by the 

4 President. 

5 (b) PERSONS ELIGIBLE.—

6 (1) IN GENERAL.—The members of the Com7 mission shall be individuals who have knowledge or 

8 expertise, whether by experience or training, in mat9 ters to be studied by the Commission. The members 

10 may be from the public or private sector, and may 

11 include employees of the Federal Government or of 

12 State, territory, tribal, or local governments, mem13 bers of academia, legal scholars and practitioners, 

14 tribal leaders, representatives of nonprofit organiza15 tions, or other interested individuals who dem16 onstrate a dedication to the use of genomics to im17 prove minority healthcare and the elimination of 

18 health disparities among minorities. 

19 (2) DIVERSITY.—It is the intent of Congress 

20 that individuals appointed to the Commission rep21 resent diverse interests, ethnicities, various profes22 sional backgrounds, and are from different regions 

23 of the United States. 

24 (c) CONSULTATION AND APPOINTMENT.—
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•S 1833 IS 

1 (1) IN GENERAL.—The President, Speaker of 

2 the House of Representatives, minority leader of the 

3 House of Representatives, majority leader of the 

4 Senate, and minority leader of the Senate shall con5 sult among themselves before appointing the mem6 bers of the Commission in order to achieve, to the 

7 maximum extent practicable, fair and equitable rep8 resentation of various points of view with respect to 

9 matters studied by the Commission. 

10 (2) DATE OF APPOINTMENT.—The appoint11 ments of the members of the Commission shall be 

12 made not later than 90 days after the date of enact13 ment of this Act. 

14 (d) TERMS.—

15 (1) IN GENERAL.—Each member of the Com16 mission shall be appointed for the life of the Com17 mission. 

18 (2) VACANCIES.—A vacancy in the Commission 

19 shall be filled in the manner in which the original 

20 appointment was made. 

21 (e) BASIC PAY.—Members of the Commission shall 

22 serve without pay. 

23 (f) TRAVEL EXPENSES.—Each member of the Com24 mission shall receive travel expenses, including per diem 

25 in lieu of subsistence, in accordance with applicable provi-
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•S 1833 IS 

1 sions under subchapter I of chapter 57 of title 5, United 

2 States Code. 

3 (g) CHAIRPERSON AND VICE CHAIRPERSON.—The 

4 members of the Commission shall elect a Chairperson and 

5 Vice Chairperson of the Commission from among the 

6 members. 

7 (h) MEETINGS.—

8 (1) IN GENERAL.—The Commission shall meet 

9 at the call of the Chairperson or a majority of its 

10 members. 

11 (2) INITIAL MEETING.—Not later than 30 days 

12 after the date on which all members of the Commis13 sion have been appointed, the Commission shall hold 

14 its first meeting. 

15 SEC. 515. POWERS OF COMMISSION. 

16 (a) HEARINGS AND SESSIONS.—The Commission 

17 may, for the purpose of carrying out this subtitle, hold 

18 hearings, sit and act at times and places, take testimony, 

19 and receive evidence as the Commission considers appro20 priate to carry out this subtitle. 

21 (b) POWERS OF MEMBERS AND AGENTS.—Any mem22 ber or agent of the Commission may, if authorized by the 

23 Commission, take any action that the Commission is au24 thorized to take by this section. 
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•S 1833 IS 

1 (c) OBTAINING OFFICIAL DATA.—Notwithstanding 

2 sections 552 and 552a of title 5, United States Code, the 

3 Commission may secure directly from any department or 

4 agency of the United States information necessary to en5 able it to carry out this subtitle. Upon request of the Com6 mission, the head of that department or agency shall fur7 nish that information to the Commission. 

8 (d) POSTAL SERVICES.—The Commission may use 

9 the United States mails in the same manner and under 

10 the same conditions as other departments and agencies of 

11 the United States. 

12 (e) WEBSITE.—For purposes of conducting the study 

13 under section 512(b)(1), the Commission shall establish 

14 and maintain a website to facilitate public comment and 

15 participation. 

16 (f) STAFF OF FEDERAL AGENCIES.—Upon request 

17 of the Commission, the head of any Federal department 

18 or agency may detail, on a nonreimbursable basis, any of 

19 the personnel of that department or agency to the Com20 mission to assist it in carrying out its duties under this 

21 subtitle. 

22 (g) ADMINISTRATIVE SUPPORT SERVICES.—Upon 

23 the request of the Commission, the Administrator of Gen24 eral Services may provide to the Commission, on a non25 reimbursable basis, the administrative support services 
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•S 1833 IS 

1 necessary for the Commission to carry out its responsibil2 ities under this subtitle. 

3 SEC. 516. TERMINATION. 

4 The Commission shall terminate 1 year after submit5 ting its final report pursuant to section 513. 

6 TITLE VI—ACCOUNTABILITY 

7 SEC. 601. REPORT ON WORKFORCE DIVERSITY. 

8 (a) IN GENERAL.—Not later than July 1, 2005, and 

9 annually thereafter, the Secretary, acting through the di10 rector of each entity within the Department of Health and 

11 Human Services, shall prepare and submit to the Com12 mittee on Health, Education, Labor, and Pensions of the 

13 Senate and the Committee on Energy and Commerce of 

14 the House of Representatives a report on healthcare work15 force diversity. 

16 (b) REQUIREMENT.—The report under subsection (a) 

17 shall contain the following information: 

18 (1) The response of the entity involved to the 

19 upcoming 2004 Institute of Medicine report on 

20 workforce diversity, the 2002 Institute of Medicine 

21 report entitled The Future of the Public Health in 

22 the 21st Century, and the Healthy People 2010 ini23 tiative. 
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•S 1833 IS 

1 (2) A description of the personnel in each such 

2 entity who are responsible for overseeing workforce 

3 diversity initiatives. 

4 (3) The level of workforce diversity achieved 

5 within each such entity, including absolute numbers 

6 and percentages of minority employees as well as the 

7 rank of such employees. 

8 (4) A description of any grant support that is 

9 provided by each entity for workforce diversity ini10 tiatives, including the amount of the grants and the 

11 percentage of grant funds as compared to overall en12 tity funding; 

13 (c) PUBLIC AVAILABILITY.—The report under sub14 section (a) shall be made available for public review and 

15 comment. 

16 SEC. 602. FEDERAL AGENCY PLAN TO ELIMINATE DISPARI17 TIES AND IMPROVE THE HEALTH OF MINOR18 ITY POPULATIONS. 

19 (a) IN GENERAL.—Not later than September 1, 

20 2005, each Federal health agency shall develop and imple21 ment a national strategic action plan to eliminate dispari22 ties on the basis of race, ethnicity, and primary language 

23 and improve the health and healthcare of minority popu24 lations, through programs relevant to the mission of the 

25 agency. 
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•S 1833 IS 

1 (b) PUBLICATION.—Each action plan described in 

2 paragraph (1) shall—

3 (1) be publicly reported in draft form for public 

4 review and comment; 

5 (2) include a response to the review and com6 ment described in paragraph (1) in the final plan; 

7 (3) include the agency response to the 2002 In8 stitute of Medicine report, Unequal Treatment—

9 Confronting Racial and Ethnic Disparities in 

10 Healthcare; 

11 (4) demonstrate progress in meeting the 

12 Healthy People 2010 objectives; and 

13 (5) be updated, including progress reports, for 

14 inclusion in an annual report to Congress. 

15 SEC. 603. ACCOUNTABILITY WITHIN THE DEPARTMENT OF 

16 HEALTH AND HUMAN SERVICES. 

17 Title XXIX of the Public Health Service Act, as 

18 amended by section 502(b), is further amended by adding 

19 at the end the following: 

20 ‘‘Subtitle F—Accountability 

21 ‘‘SEC. 2961. ELEVATION OF THE OFFICE OF CIVIL RIGHTS. 

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

23 within the Office for Civil Rights an Office of Health Dis24 parities, which shall be headed by a director to be ap25 pointed by the Secretary.
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•S 1833 IS 

1 ‘‘(b) PURPOSE.—The Office of Health Disparities 

2 shall ensure that the health programs, activities, and oper3 ations of health entities which receive Federal financial as4 sistance are in compliance with title VI of the Civil Rights 

5 Act, which prohibits discrimination on the basis of race, 

6 color, or national origin. The activities of the Office shall 

7 include the following: 

8 ‘‘(1) The development and implementation of 

9 an action plan to address racial and ethnic 

10 healthcare disparities, which shall address concerns 

11 relating to the Office for Civil Rights as released by 

12 the United States Commission on Civil Rights in the 

13 report entitled ‘Health Care Challenge: Acknowl14 edging Disparity, Confronting Discrimination, and 

15 Ensuring Equity’ (September, 1999). This plan shall 

16 be publicly disclosed for review and comment and 

17 the final plan shall address any comments or con18 cerns that are received by the Office. 

19 ‘‘(2) Investigative and enforcement actions 

20 against intentional discrimination and policies and 

21 practices that have a disparate impact on minorities. 

22 ‘‘(3) The review of racial, ethnic, and primary 

23 language health data collected by Federal health 

24 agencies to assess healthcare disparities related to 
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•S 1833 IS 

1 intentional discrimination and policies and practices 

2 that have a disparate impact on minorities. 

3 ‘‘(4) Outreach and education activities relating 

4 to compliance with title VI of the Civil Rights Act. 

5 ‘‘(5) The provision of technical assistance for 

6 health entities to facilitate compliance with title VI 

7 of the Civil Rights Act. 

8 ‘‘(6) Coordination and oversight of activities of 

9 the civil rights compliance offices established under 

10 section 2962. 

11 ‘‘(7) Ensuring compliance with the 1997 Office 

12 of Management and Budget Standards for Maintain13 ing, Collecting, and Presenting Federal Data on 

14 Race, Ethnicity and the available language stand15 ards. 

16 ‘‘(c) FUNDING AND STAFF.—The Secretary shall en17 sure the effectiveness of the Office of Health Disparities 

18 by ensuring that the Office is provided with—

19 ‘‘(1) adequate funding to enable the Office to 

20 carry out its duties under this section; and 

21 ‘‘(2) staff with expertise in—

22 ‘‘(A) epidemiology; 

23 ‘‘(B) statistics; 

24 ‘‘(C) health quality assurance; 
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•S 1833 IS 

1 ‘‘(D) minority health and health dispari2 ties; and 

3 ‘‘(E) civil rights. 

4 ‘‘(d) REPORT.—Not later than December 31, 2005, 

5 and annually thereafter, the Secretary, in collaboration 

6 with the Director of the Office for Civil Rights, shall sub7 mit a report to the Committee on Health, Education, 

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

9 Energy and Commerce of the House of Representatives 

10 that includes—

11 ‘‘(1) the number of cases filed, broken down by 

12 category; 

13 ‘‘(2) the number of cases investigated and 

14 closed by the office; 

15 ‘‘(3) the outcomes of cases investigated; and 

16 ‘‘(4) the staffing levels of the office including 

17 staff credentials. 

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

19 are authorized to be appropriated to carry out this section, 

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

21 2005 through 2010. 
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•S 1833 IS 

1 ‘‘SEC. 2962. ESTABLISHMENT OF HEALTH PROGRAM OF2 FICES FOR CIVIL RIGHTS WITHIN FEDERAL 

3 HEALTH AND HUMAN SERVICES AGENCIES. 

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

5 civil rights compliance offices in each agency within the 

6 Department of Health and Human Services that admin7 isters health programs. 

8 ‘‘(b) PURPOSE OF OFFICES.—Each office established 

9 under subsection (a) shall ensure that recipients of Fed10 eral financial assistance under Federal health programs 

11 administer their programs, services, and activities in a 

12 manner that— 

13 ‘‘(1) does not discriminate, either intentionally 

14 or in effect, on the basis of race, national origin, lan15 guage, ethnicity, sex, age, or disability; and 

16 ‘‘(2) promotes the reduction and elimination of 

17 disparities in health and healthcare based on race, 

18 national origin, language, ethnicity, sex, age, and 

19 disability. 

20 ‘‘(c) POWERS AND DUTIES.—The offices established 

21 in subsection (a) shall have the following powers and du22 ties: 

23 ‘‘(1) The establishment of compliance and pro24 gram participation standards for recipients of Fed25 eral financial assistance under each program admin26 istered by an agency within the Department of 
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•S 1833 IS 

1 Health and Human Services including the establish2 ment of disparity reduction standards to encompass 

3 disparities in health and healthcare related to race, 

4 national origin, language, ethnicity, sex, age, and 

5 disability. 

6 ‘‘(2) The development and implementation of 

7 program-specific guidelines that interpret and apply 

8 Department of Health and Human Services guid9 ance under title VI of the Civil Rights Act of 1964 

10 to each Federal health program administered by the 

11 agency. 

12 ‘‘(3) The development of a disparity-reduction 

13 impact analysis methodology that shall be applied to 

14 every rule issued by the agency and published as 

15 part of the formal rulemaking process under sections 

16 555, 556, and 557 of title 5, United States Code. 

17 ‘‘(4) Oversight of data collection, analysis, and 

18 publication requirements for all recipients of Federal 

19 financial assistance under each Federal health pro20 gram administered by the agency, and compliance 

21 with the 1997 Office of Management and Budget 

22 Standards for Maintaining, Collecting, and Pre23 senting Federal Data on Race and Ethnicity and the 

24 available language standards. 
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•S 1833 IS 

1 ‘‘(5) The conduct of publicly available studies 

2 regarding discrimination within Federal health pro3 grams administered by the agency as well as dis4 parity reduction initiatives by recipients of Federal 

5 financial assistance under Federal health programs. 

6 ‘‘(6) Annual reports to the Committee on 

7 Health, Education, Labor, and Pensions and the 

8 Committee on Finance of the Senate and the Com9 mittee on Energy and Commerce and the Committee 

10 on Ways and Means of the House of Representatives 

11 on the progress in reducing disparities in health and 

12 healthcare through the Federal programs adminis13 tered by the agency. 

14 ‘‘(d) RELATIONSHIP TO OFFICE FOR CIVIL RIGHTS

15 IN THE DEPARTMENT OF JUSTICE.—

16 ‘‘(1) DEPARTMENT OF HEALTH AND HUMAN

17 SERVICES.—The Office for Civil Rights in the De18 partment of Health and Human Services shall pro19 vide standard-setting and compliance review inves20 tigation support services to the Civil Rights Compli21 ance Office for each agency. 

22 ‘‘(2) DEPARTMENT OF JUSTICE.—The Office 

23 for Civil Rights in the Department of Justice shall 

24 continue to maintain the power to institute formal 

25 proceedings when an agency Office for Civil Rights 
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•S 1833 IS 

1 determines that a recipient of Federal financial as2 sistance is not in compliance with the disparity re3 duction standards of the agency. 

4 ‘‘(e) DEFINITION.—In this section, the term ‘Federal 

5 health programs’ mean programs—

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

7 301 et seq.) that pay for healthcare and services; 

8 and 

9 ‘‘(2) under this Act that provide Federal finan10 cial assistance for healthcare, biomedical research, 

11 health services research, and programs designed to 

12 improve the public’s health.’’. 

13 SEC. 604. OFFICE OF MINORITY HEALTH. 

14 Section 1707 of the Public Health Service Act (42 

15 U.S.C. 300u–6) is amended—

16 (1) by striking the section heading and insert17 ing the following: 

18 ‘‘OFFICE OF MINORITY HEALTH AND RACIAL, ETHNIC, 

19 AND PRIMARY LANGUAGE HEALTH DISPARITY ELIMI20 NATION’’; 

21 (2) by striking ‘‘Office of Minority Health’’ 

22 each place that such appears and inserting ‘‘Office 

23 of Minority Health and Racial, Ethnic, and Primary 

24 Language Health Disparities Elimination’’; 

25 (3) by striking subsection (b) and inserting the 

26 following: 
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•S 1833 IS 

1 ‘‘(b) DUTIES.—With respect to improving the health 

2 of racial and ethnic minority groups, the Secretary, acting 

3 through the Deputy Assistant Secretary for Minority 

4 Health and Racial, Ethnic, and Primary Language Health 

5 Disparities Elimination (in this section referred to as the 

6 ‘Deputy Assistant Secretary’), shall carry out the fol7 lowing: 

8 ‘‘(1) Establish, implement, monitor, and evalu9 ate short-range and long-range goals and objectives 

10 and oversee all other activities within the Public 

11 Health Service that relate to disease prevention, 

12 health promotion, service delivery, and research con13 cerning minority groups. The heads of each of the 

14 agencies of the Service shall consult with the Deputy 

15 Assistant Secretary to ensure the coordination of 

16 such activities. 

17 ‘‘(2) Oversee all activities within the Depart18 ment of Health and Human Services that relate to 

19 reducing or eliminating disparities in health and 

20 healthcare in racial and ethnic minority populations, 

21 including coordinating—

22 ‘‘(A) the design of programs, support for 

23 programs, and the evaluation of programs; 

24 ‘‘(B) the monitoring of trends in health 

25 and healthcare; 
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•S 1833 IS 

1 ‘‘(C) research efforts; 

2 ‘‘(D) the training of health providers; and 

3 ‘‘(E) information and education programs 

4 and campaigns. 

5 ‘‘(3) Enter into interagency and intra-agency 

6 agreements with other agencies of the Public Health 

7 Service. 

8 ‘‘(4) Ensure that the Federal health agencies 

9 and the National Center for Health Statistics collect 

10 data on the health status and healthcare of each mi11 nority group, using at a minimum the categories 

12 specified in the 1997 OMB Standards for Maintain13 ing, Collecting, and Presenting Federal Data on 

14 Race and Ethnicity as required under subtitle B and 

15 available language standards. 

16 ‘‘(5) Provide technical assistance to States, 

17 local agencies, territories, Indian tribes, and entities 

18 for activities relating to the elimination of racial and 

19 ethnic disparities in health and healthcare. 

20 ‘‘(6) Support a national minority health re21 source center to carry out the following: 

22 ‘‘(A) Facilitate the exchange of informa23 tion regarding matters relating to health infor24 mation, health promotion and wellness, preven-
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•S 1833 IS 

1 tive health services, and education in the appro2 priate use of health services. 

3 ‘‘(B) Facilitate timely access to culturally 

4 and linguistically appropriate information. 

5 ‘‘(C) Assist in the analysis of such infor6 mation. 

7 ‘‘(D) Provide technical assistance with re8 spect to the exchange of such information (in9 cluding facilitating the development of materials 

10 for such technical assistance). 

11 ‘‘(7) Carry out programs to improve access to 

12 healthcare services for individuals with limited 

13 English proficiency, including developing and car14 rying out programs to provide bilingual or interpre15 tive services through the development and support of 

16 a National Center for Cultural and Linguistic Com17 petence in Healthcare as provided for in section 

18 2903. 

19 ‘‘(8) Carry out programs to improve access to 

20 healthcare services and to improve the quality of 

21 healthcare services for individuals with low func22 tional health literacy. As used in the preceding sen23 tence, the term ‘functional health literacy’ means the 

24 ability to obtain, process, and understand basic 
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•S 1833 IS 

1 health information and services needed to make ap2 propriate health decisions. 

3 ‘‘(9) Advise in matters related to the develop4 ment, implementation, and evaluation of health pro5 fessions education on decreasing disparities in 

6 healthcare outcomes, with focus on cultural com7 petency as a method of eliminating disparities in 

8 health and healthcare in racial and ethnic minority 

9 populations. 

10 ‘‘(10) Assist healthcare professionals, commu11 nity and advocacy organizations, academic centers 

12 and public health departments in the design and im13 plementation of programs that will improve the qual14 ity of health outcomes by strengthening the pro15 vider-patient relationship.’’. 

16 (2) by redesignating subsections (c) through (f) 

17 and subsections (g) and (h) as subsections (d) 

18 through (g) and subsections (j) and (k), respectively; 

19 (3) by inserting after subsection (b), the fol20 lowing: 

21 ‘‘(c) NATIONAL PLAN TO ELIMINATE RACIAL AND

22 ETHNIC HEALTH AND HEALTHCARE DISPARITIES.—

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

24 through the Deputy Assistant Secretary, shall—
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•S 1833 IS 

1 ‘‘(A) not later than 1 year after the date 

2 of enactment of the Healthcare Equality and 

3 Accountability Act, establish and implement a 

4 comprehensive plan to achieve the goal of 

5 Healthy People 2010 to eliminate health dis6 parities in the United States; 

7 ‘‘(B) establish the plan referred to in sub8 paragraph (A) in consultation with—

9 ‘‘(i) the Director of the Centers for 

10 Disease Control and Prevention; 

11 ‘‘(ii) the Director of the National In12 stitutes of Health; 

13 ‘‘(iii) the Director of the National 

14 Center on Minority Health and Health 

15 Disparities; 

16 ‘‘(iv) the Director of the Agency for 

17 Healthcare Research and Quality; 

18 ‘‘(v) the Administrator of the Health 

19 Resources and Services Administration; 

20 ‘‘(vi) the Administrator of the Centers 

21 for Medicare and Medicaid Services; 

22 ‘‘(vii) the Director of the Office for 

23 Civil Rights;
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•S 1833 IS 

1 ‘‘(viii) the Administrator of the Sub2 stance Abuse and Mental Health Services 

3 Administration; 

4 ‘‘(ix) the Commissioner of the Food 

5 and Drug Administration; and 

6 ‘‘(x) the heads of other appropriate 

7 public and private entities; 

8 ‘‘(C) ensure that the plan includes measur9 able objectives, describes the means for achiev10 ing such objectives, and designates a date by 

11 which such objectives are expected to be 

12 achieved; 

13 ‘‘(D) ensure that all amounts appropriated 

14 for such activities are expended in accordance 

15 with the plan; 

16 ‘‘(E) review the plan on at least an annual 

17 basis and revise the plan as appropriate; 

18 ‘‘(F) ensure that the plan will serve as a 

19 binding statement of policy with respect to the 

20 agencies’ activities related to disparities in 

21 health and healthcare; and 

22 ‘‘(G) not later than March 1 of each year, 

23 submit the plan (or any revisions to the plan), 

24 to the Committee on Health, Education, Labor, 

25 and Pensions of the Senate and the Committee 
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•S 1833 IS 

1 on Energy and Commerce of the House of Rep2 resentatives. 

3 ‘‘(2) COMPONENTS OF THE PLAN.—The Deputy 

4 Assistant Secretary shall ensure that the comprehen5 sive plan established under paragraph (1) address6 es—

7 ‘‘(A) the recommendations of the 2002 In8 stitute of Medicine report (Unequal Treatment) 

9 with respect to racial and ethnic disparities in 

10 healthcare; 

11 ‘‘(B) health and disease prevention edu12 cation for racial, ethnic, and primary language 

13 health disparity populations; 

14 ‘‘(C) research to identify sources of health 

15 and healthcare disparities in minority groups; 

16 ‘‘(D) the implementation and assessment 

17 of promising intervention strategies; 

18 ‘‘(E) data collection and the monitoring of 

19 the healthcare and health status of health dis20 parity populations; 

21 ‘‘(F) care of individuals who lack pro22 ficiency with the English language; 

23 ‘‘(G) care of individuals with low func24 tional health literacy; 
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•S 1833 IS 

1 ‘‘(H) the training, recruitment, and reten2 tion of minority health professionals; 

3 ‘‘(I) programs to expand and facilitate ac4 cess to healthcare services, including the use of 

5 telemedicine, National Health Service Scholars, 

6 community health workers, and case managers; 

7 ‘‘(J) public and health provider awareness 

8 of racial and ethnic disparities in healthcare; 

9 ‘‘(K) methods to evaluate and measure 

10 progress toward the goal of eliminating dispari11 ties in health and healthcare in racial and eth12 nic minority populations; 

13 ‘‘(L) the promotion of interagency and 

14 intra-agency coordination and collaboration and 

15 public-private and community partnerships; and 

16 ‘‘(M) the preparedness of health profes17 sionals to care for racially, ethnically, and lin18 guistically diverse populations and low func19 tional health literacy populations including eval20 uations as required under section 606 of the 

21 Healthcare Equality and Accountability Act.’’; 

22 (4) in subsection (d) (as so redesignated)—

23 (A) in paragraph (1), by inserting ‘‘and 

24 Racial, Ethnic, and Primary Language Health 
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•S 1833 IS 

1 Disparities Elimination’’ after ‘‘Minority 

2 Health’’; and 

3 (B) in paragraph (2)—

4 (i) by striking ‘‘Deputy Assistant’’; 

5 and 

6 (ii) by striking ‘‘(10) of subsection 

7 (b)’’ and inserting ‘‘(9) of subsection (c)’’; 

8 (5) in subsection (e)(1) (as so redesignated)—

9 (A) in subparagraph (A), by striking ‘‘sub10 section (b)(9)’’ and inserting ‘‘subsection 

11 (b)(7)’’; and 

12 (B) in subparagraph (B), by striking ‘‘sub13 section (b)(10)’’ and inserting ‘‘subsection 

14 (b)(8)’’; 

15 (6) in subsection (f)(3) (as so redesignated), by 

16 striking ‘‘subsection (f)’’ and inserting ‘‘subsection 

17 (g)’’; 

18 (7) in subsection (g)(1) (as so redesignated)—

19 (A) by striking ‘‘1999 and each second’’ 

20 and inserting ‘‘2004 and each’’; 

21 (B) by striking ‘‘Labor and Human Re22 sources’’ and inserting ‘‘Health, Education, 

23 Labor, and Pensions’’; 

24 (C) by striking ‘‘2 fiscal years’’ and insert25 ing ‘‘fiscal year’’; and
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•S 1833 IS 

1 (D) by inserting after ‘‘improving the 

2 health of racial and ethnic minority groups’’ the 

3 following: ‘‘reducing and eliminating disparities 

4 in health and healthcare in racial and ethnic 

5 minority populations, in accordance with the 

6 national plan specified under subsection (c) and 

7 the goals of Healthy People 2010’’; 

8 (8) by inserting after subsection (g) (as so re9 designated) the following: 

10 ‘‘(h) FEDERAL PARTNERSHIP WITH ACCREDITATION

11 ENTITIES.— 

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

13 the date of enactment of the Healthcare Equality 

14 and Accountability Act, the Secretary, in collabora15 tion with the Director of the Agency for Healthcare 

16 Research and Quality, the Administrator of the Cen17 ters for Medicare and Medicaid Services, the Direc18 tor of the Office for Minority Health, and the heads 

19 of appropriate State agencies, shall convene a work20 ing group with members of accreditation organiza21 tions and other quality standard setting organiza22 tions to develop guidelines to evaluate and report on 

23 the health and healthcare of minority populations 

24 served by health centers, health plans, hospitals, and 

25 other federally funded health entities. 
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•S 1833 IS 

1 ‘‘(2) REPORT.—Not later than 6 months after 

2 the convening of the working group under paragraph 

3 (1), the working group shall submit a report to the 

4 Secretary at such time, in such manner, and con5 taining such information as the Secretary may re6 quire, including guidelines and recommendations on 

7 how each accreditation body will work with con8 stituent members to ensure the adoption of such 

9 guidelines. 

10 ‘‘(3) DEMONSTRATION PROJECTS.—The Sec11 retary, acting through the Administrator of the Cen12 ters for Medicare and Medicaid Services, shall award 

13 grants for the establishment of demonstration 

14 projects to assess the impact of providing financial 

15 incentives for the reporting and analysis of the qual16 ity of minority healthcare by hospitals, health plans, 

17 health centers, and other healthcare entities. 

18 ‘‘(4) AUTHORIZATION OF APPROPRIATIONS.—

19 There are authorized to be appropriated to carry out 

20 this subsection, such sums as may be necessary for 

21 each of fiscal years 2005 through 2010. 

22 ‘‘(i) PREPARATION OF HEALTH PROFESSIONALS TO

23 PROVIDE HEALTHCARE TO MINORITY POPULATIONS.—

24 The Secretary, in collaboration with the Director of the 

25 Bureau of Health Professions and the Director of the Of-
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•S 1833 IS 

1 fice of Minority Health, shall require that health profes2 sional schools that receive Federal funds train future 

3 health professionals to provide culturally and linguistically 

4 appropriate healthcare to diverse populations.’’; and 

5 (9) by striking subsection (k) (as so redesig6 nated) and inserting the following: 

7 ‘‘(k) AUTHORIZATION OF APPROPRIATIONS.—For the 

8 purpose of carrying out this section (other than subsection 

9 (h)), there is authorized to be appropriated $100,000,000 

10 for fiscal year 2004, and such sums as may be necessary 

11 for each of fiscal years 2005 through 2010.’’. 

12 SEC. 605. ESTABLISHMENT OF THE INDIAN HEALTH SERV13 ICE AS AN AGENCY OF THE PUBLIC HEALTH 

14 SERVICE. 

15 (a) ESTABLISHMENT.—

16 (1) IN GENERAL.—In order to more effectively 

17 and efficiently carry out the responsibilities, authori18 ties, and functions of the United States to provide 

19 healthcare services to Indians and Indian tribes, as 

20 are or may be hereafter provided by Federal statute 

21 or treaties, there is established within the Public 

22 Health Service of the Department of Health and 

23 Human Services the Indian Health Service. 

24 (2) ASSISTANT SECRETARY OF INDIAN

25 HEALTH.—The Service shall be administered by an 
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•S 1833 IS 

1 Assistant Secretary of Indian Health, who shall be 

2 appointed by the President, by and with the advice 

3 and consent of the Senate. The Assistant Secretary 

4 shall report to the Secretary. Effective with respect 

5 to an individual appointed by the President, by and 

6 with the advice and consent of the Senate the term 

7 of service of the Assistant Secretary shall be 4 years. 

8 An Assistant Secretary may serve more than 1 term. 

9 (b) AGENCY.—The Service shall be an agency within 

10 the Public Health Service of the Department, and shall 

11 not be an office, component, or unit of any other agency 

12 of the Department. 

13 (c) FUNCTIONS AND DUTIES.—The Secretary shall 

14 carry out through the Assistant Secretary of the Service—

15 (1) all functions which were, on the day before 

16 the date of enactment of the Indian Health Care 

17 Amendments of 1988, carried out by or under the 

18 direction of the individual serving as Director of the 

19 Service on such day; 

20 (2) all functions of the Secretary relating to the 

21 maintenance and operation of hospital and health fa22 cilities for Indians and the planning for, and provi23 sion and utilization of, health services for Indians; 

24 (3) all health programs under which healthcare 

25 is provided to Indians based upon their status as In-
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1 dians which are administered by the Secretary, in2 cluding programs under—

3 (A) the Indian Health Care Improvement 

4 Act; 

5 (B) the Act of November 2, 1921 (25 

6 U.S.C. 13); 

7 (C) the Act of August 5, 1954 (42 U.S.C. 

8 2001, et seq.); 

9 (D) the Act of August 16, 1957 (42 

10 U.S.C. 2005 et seq.); 

11 (E) the Indian Self-Determination Act (25 

12 U.S.C. 450f, et seq.); and 

13 (F) title XXIX of the Public Health Serv14 ice Act; and 

15 (4) all scholarship and loan functions carried 

16 out under title I of the Indian Health Care Improve17 ment Act. 

18 (d) AUTHORITY.—

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

20 through the Assistant Secretary, shall have the au21 thority—

22 (A) except to the extent provided for in 

23 paragraph (2), to appoint and compensate em24 ployees for the Service in accordance with title 

25 5, United States Code; 
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•S 1833 IS 

1 (B) to enter into contracts for the procure2 ment of goods and services to carry out the 

3 functions of the Service; and 

4 (C) to manage, expend, and obligate all 

5 funds appropriated for the Service. 

6 (2) PERSONNEL ACTIONS.—Notwithstanding 

7 any other provision of law, the provisions of section 

8 12 of the Act of June 18, 1934 (48 Stat. 986; 25 

9 U.S.C. 472), shall apply to all personnel actions 

10 taken with respect to new positions created within 

11 the Service as a result of its establishment under 

12 subsection (a). 

13 (e) RATE OF PAY.—

14 (1) POSITIONS AT LEVEL IV.—Section 5315 of 

15 title 5, United States Code, is amended by striking 

16 the following: ‘‘Assistant Secretaries of Health and 

17 Human Services (6).’’ and inserting ‘‘Assistant Sec18 retaries of Health and Human Services (7).’’. 

19 (2) POSITIONS AT LEVEL V.—Section 5316 of 

20 such title is amended by striking the following: ‘‘Di21 rector, Indian Health Service, Department of Health 

22 and Human Services.’’. 

23 (f) DUTIES OF ASSISTANT SECRETARY FOR INDIAN

24 HEALTH.—Section 601 of the Indian Health Care Im-
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•S 1833 IS 

1 provement Act (25 U.S.C. 1661) is amended in subsection 

2 (a)—

3 (1) by inserting ‘‘(1)’’ after ‘‘(a)’’; 

4 (2) in the second sentence of paragraph (1), as 

5 so designated, by striking ‘‘a Director,’’ and insert6 ing ‘‘the Assistant Secretary for Indian Health,’’; 

7 (3) by striking the third sentence of paragraph 

8 (1), as so designated, and all that follows through 

9 the end of the subsection (a) of such section and in10 serting the following: ‘‘The Assistant Secretary for 

11 Indian Health shall carry out the duties specified in 

12 paragraph (2).’’; and 

13 (4) by adding after paragraph (1) the following: 

14 ‘‘(2) The Assistant Secretary for Indian Health 

15 shall—

16 ‘‘(A) report directly to the secretary con17 cerning all policy and budget-related matters 

18 affecting Indian health; 

19 ‘‘(B) collaborate with the Assistant Sec20 retary for Health concerning appropriate mat21 ters of Indian health that affect the agencies of 

22 the Public Health Service; 

23 ‘‘(C) advise each Assistant Secretary of the 

24 Department of Health and Human Services 

25 concerning matters of Indian health with re-
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•S 1833 IS 

1 spect to which that Assistant Secretary has au2 thority and responsibility; 

3 ‘‘(D) advise the heads of other agencies 

4 and programs of the Department of Health and 

5 Human Services concerning matters of Indian 

6 health with respect to which those heads have 

7 authority and responsibility; and 

8 ‘‘(E) coordinate the activities of the De9 partment of Health and Human Services con10 cerning matters of Indian health.’’. 

11 (g) CONTINUED SERVICE BY INCUMBENT.—The indi12 vidual serving in the position of Director of the Indian 

13 Health Service on the date preceding the date of enact14 ment of this Act may serve as Assistant Secretary for In15 dian Health, at the pleasure of the President after the 

16 date of enactment of this Act. 

17 (h) CONFORMING AMENDMENTS.—

18 (1) AMENDMENTS TO INDIAN HEALTH CARE IM19 PROVEMENT ACT.—The Indian Health Care Im20 provement Act (25 U.S.C. 1601 et seq.) is amend21 ed—

22 (A) in section 601—

23 (i) in subsection (c), by striking ‘‘Di24 rector of the Indian Health Service’’ both 
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•S 1833 IS 

1 places it appears and inserting ‘‘Assistant 

2 Secretary for Indian Health’’; and 

3 (ii) in subsection (d), by striking ‘‘Di4 rector of the Indian Health Service’’ and 

5 inserting ‘‘Assistant Secretary for Indian 

6 Health’’; and 

7 (B) in section 816(c)(1), by striking ‘‘Di8 rector of the Indian Health Service’’ and insert9 ing ‘‘Assistant Secretary for Indian Health’’. 

10 (2) AMENDMENTS TO OTHER PROVISIONS OF

11 LAW.—The following provisions are each amended 

12 by striking ‘‘Director of the Indian Health Service’’ 

13 each place it appears and inserting ‘‘Assistant Sec14 retary for Indian Health’’: 

15 (A) Section 203(a)(1) of the Rehabilitation 

16 Act of 1973 (29 U.S.C. 761b(a)(1)). 

17 (B) Subsections (b) and (e) of section 518 

18 of the Federal Water Pollution Control Act (33 

19 U.S.C. 1377 (b) and (e)). 

20 (C) Section 803B(d)(1) of the Native 

21 American Programs Act of 1974 (42 U.S.C. 

22 2991b–2(d)(1)). 

23 (i) REFERENCES.—Reference in any other Federal 

24 law, Executive order, rule, regulation, or delegation of au25 thority, or any document of or relating to the Director 
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•S 1833 IS 

1 of the Indian Health Service shall be deemed to refer to 

2 the Assistant Secretary for Indian Health. 

3 (j) DEFINITIONS.—For purposes of this section, the 

4 definitions contained in section 4 of the Indian Health 

5 Care Improvement Act shall apply. 

6 SEC. 606. OFFICE OF MINORITY HEALTH AT THE CENTERS 

7 FOR MEDICARE AND MEDICAID SERVICES. 

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

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

10 Human Services shall establish within the Centers for 

11 Medicare and Medicaid Services an Office of Minority 

12 Health (referred to in this section as the ‘‘Office’’). 

13 (b) DUTIES.—The Office shall be responsible for the 

14 coordination and facilitation of activities of the Centers 

15 for Medicare and Medicaid Services to improve minority 

16 health and healthcare and to reduce racial and ethnic dis17 parities in health and healthcare, which shall include—

18 (1) creating a strategic plan, which shall be 

19 made available for public review, to improve the 

20 health and healthcare of Medicare, Medicaid, and 

21 SCHIP beneficiaries; 

22 (2) promoting agency-wide policies relating to 

23 healthcare delivery and financing that could have a 

24 beneficial impact on the health and healthcare of mi25 nority populations; 
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•S 1833 IS 

1 (3) assisting health plans, hospitals, and other 

2 health entities in providing culturally and linguis3 tically appropriate healthcare services; 

4 (4) increasing awareness and outreach activities 

5 for minority healthcare consumers and providers 

6 about the causes and remedies for health and 

7 healthcare disparities; 

8 (5) developing grant programs and demonstra9 tion projects to identify, implement and evaluate in10 novative approaches to improving the health and 

11 healthcare of minority beneficiaries in the Medicare, 

12 Medicaid, and SCHIP programs; 

13 (6) considering incentive programs relating to 

14 reimbursement that would reward health entities for 

15 providing quality healthcare for minority populations 

16 using established benchmarks for quality of care; 

17 (7) collaborating with the compliance office to 

18 ensure compliance with the anti-discrimination provi19 sions under title VI of the Civil Rights Act of 1964; 

20 (8) identifying barriers to enrollment in public 

21 programs under the jurisdiction of the Centers for 

22 Medicare and Medicaid Services; 

23 (9) monitoring and evaluating on a regular 

24 basis the success of minority health programs and 

25 initiatives; 
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1 (10) publishing an annual report about the ac2 tivities of the Centers for Medicare and Medicaid 

3 Services relating to minority health improvement; 

4 and 

5 (11) other activities determined appropriate by 

6 the Secretary of Health and Human Services. 

7 (c) STAFF.—The staff at the Office shall include—

8 (1) one or more individuals with expertise in 

9 minority health and racial and ethnic health dispari10 ties; and 

11 (2) one or more individuals with expertise in 

12 healthcare financing and delivery in underserved 

13 communities. 

14 (d) COORDINATION.—In carrying out its duties under 

15 this section, the Office shall coordinate with—

16 (1) the Office of Minority Health in the Office 

17 of the Secretary of Health and Human Services; 

18 (2) the National Centers for Minority Health 

19 and Health Disparities in the National Institutes of 

20 Health; and 

21 (3) the Office of Minority Health in the Centers 

22 for Disease Control and Prevention. 

23 (e) AUTHORIZATION OF APPROPRIATIONS.—For the 

24 purpose of carrying out this section, there are authorized 

25 to be appropriated $10,000,000 for fiscal year 2004, and 
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•S 1833 IS 

1 such sums may be necessary for each of fiscal years 2005 

2 through 2010. 

3 SEC. 607. OFFICE OF MINORITY AFFAIRS AT THE FOOD AND 

4 DRUG ADMINISTRATION. 

5 Chapter IX of the Federal Food, Drug, and Cosmetic 

6 Act (21 U.S.C. 391 et seq.) is amended by adding at the 

7 end the following: 

8 ‘‘SEC. 908. OFFICE OF MINORITY AFFAIRS. 

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

10 date of enactment of this section, the Secretary shall es11 tablish within the Office of the Commissioner of the Food 

12 and Drug Administration an Office of Minority Affairs 

13 (referred to in this section as the ‘Office’). 

14 ‘‘(b) DUTIES.—The Office shall be responsible for the 

15 coordination and facilitation of activities of the Food and 

16 Drug Administration to improve minority health and 

17 healthcare and to reduce racial and ethnic disparities in 

18 health and healthcare, which shall include—

19 ‘‘(1) promoting policies in the development and 

20 review of medical products that reduce racial and 

21 ethnic disparities in health and healthcare; 

22 ‘‘(2) encouraging appropriate data collection, 

23 analysis, and dissemination of racial and ethnic dif24 ferences using, at a minimum, the categories de25 scribed in the 1997 Office of Management and 
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•S 1833 IS 

1 Budget standards, in response to different therapies 

2 in both adult and pediatric populations; 

3 ‘‘(3) providing, in coordination with other ap4 propriate government agencies, education, training, 

5 and support to increase participation of minority pa6 tients and physicians in clinical trials; 

7 ‘‘(4) collecting and analyzing data using, at a 

8 minimum, the categories described in the 1997 Of9 fice of Management and Budget standards, on the 

10 number of participants from minority racial and eth11 nic backgrounds in clinical trials used to support 

12 medical product approvals; 

13 ‘‘(5) the identification of methods to reduce lan14 guage and literacy barriers; and 

15 ‘‘(6) publishing an annual report about the ac16 tivities of the Food and Drug Administration per17 taining to minority health. 

18 ‘‘(c) STAFF.—The staff of the Office shall include—

19 ‘‘(1) one or more individuals with expertise in 

20 the design and conduct of clinical trials of drugs, bi21 ological products, and medical devices; and 

22 ‘‘(2) one or more individuals with expertise in 

23 therapeutic classes or disease states for which med24 ical evidence suggests a difference based on race or 

25 ethnicity. 
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•S 1833 IS 

1 ‘‘(d) COORDINATION.—In carrying out its duties 

2 under this section, the Office shall coordinate with—

3 ‘‘(1) the Office of Minority Health in the Office 

4 of the Secretary of Health and Human Services; 

5 ‘‘(2) the National Center for Minority Health 

6 and Health Disparities in the National Institutes of 

7 Health; and 

8 ‘‘(3) the Office of Minority Health in the Cen9 ters for Disease Control and Prevention. 

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

11 purpose of carrying out this section, there are authorized 

12 to be appropriated such sums as may be necessary for 

13 each of the fiscal years 2005 through 2010.’’. 

14 SEC. 608. SAFETY AND EFFECTIVENESS OF DRUGS WITH 

15 RESPECT TO RACIAL AND ETHNIC BACK16 GROUND. 

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

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

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

21 RESPECT TO RACIAL AND ETHNIC BACK22 GROUND. 

23 ‘‘(a) PRE-APPROVAL STUDIES.—If there is evidence 

24 that there may be a disparity on the basis of racial or 
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•S 1833 IS 

1 ethnic background as to the safety or effectiveness of a 

2 drug, then—

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

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

7 of the Public Health Service Act for approval of a 

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

10 the disparity; and 

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

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

14 ‘‘(b) POST-MARKET STUDIES.—

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

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

17 ethnic background as to the safety or effectiveness 

18 of a drug for which there is an approved application 

19 under section 505 or a license under section 351 of 

20 the Public Health Service Act, the Secretary may by 

21 order require the holder of the approved application 

22 or license to conduct, by a date specified by the Sec23 retary, post-marketing studies to investigate the dis24 parity. 
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•S 1833 IS 

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

2 that the post-market studies confirm that there is a 

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

4 the drug shall include appropriate information about 

5 the disparity. 

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

7 specify all aspects of study design, including the 

8 number of studies and study participants, in the 

9 order requiring post-market studies of the drug. 

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

11 Secretary may by order modify any aspect of the 

12 study design as necessary after issuing an order 

13 under paragraph (1). 

14 ‘‘(5) STUDY RESULTS.—The results from stud15 ies required under paragraph (1) shall be submitted 

16 to the Secretary as supplements to the drug applica17 tion or biological license application. 

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

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

20 for adult and pediatric populations as to the safety or ef21 fectiveness of a drug’ includes—

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

23 basis of racial or ethnic background as to safety or 

24 effectiveness of a drug in the same chemical class as 

25 the drug; 
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•S 1833 IS 

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

2 basis of racial or ethnic background in the way the 

3 drug is metabolized; and 

4 ‘‘(3) other evidence as the Secretary may deter5 mine. 

6 ‘‘(d) APPLICATIONS UNDER SECTION 505(b)(2) AND

7 505(j).—

8 ‘‘(1) IN GENERAL.—A drug for which an appli9 cation has been submitted or approved under section 

10 505(j) shall not be considered ineligible for approval 

11 under that section or misbranded under section 502 

12 on the basis that the labeling of the drug omits in13 formation relating to a disparity on the basis of ra14 cial or ethnic background as to the safety or effec15 tiveness of the drug, whether derived from investiga16 tions or studies required under this section or de17 rived from other sources, when the omitted informa18 tion is protected by patent or by exclusivity under 

19 clause (iii) or (iv) of section 505(j)(5)(D). 

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

21 and (iv) of section 505(j)(5)(D), the Secretary may 

22 require that the labeling of a drug approved under 

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

24 disparity on the basis of racial or ethnic background 

25 as to the safety or effectiveness of the drug include 
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•S 1833 IS 

1 a statement of any appropriate contraindications, 

2 warnings, or precautions related to the disparity 

3 that the Secretary considers necessary.’’. 

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

5 Food, Drug, and Cosmetic Act (21 U.S.C. 352) is amend6 ed by adding at the end the following: 

7 ‘‘(w)(1) If it is a drug and the holder of the approved 

8 application under section 505 or license under section 351 

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

10 to complete the investigations or studies, or comply with 

11 any other requirement, of section 505C.’’. 

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

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

14 is amended by adding after ‘‘required’’ the following: ‘‘, 

15 including supplements required under section 505C of the 

16 Act’’. 

17 SEC. 609. UNITED STATES COMMISSION ON CIVIL RIGHTS. 

18 (a) COORDINATION WITHIN DEPARTMENT OF JUS19 TICE OF ACTIVITIES REGARDING HEALTH DISPARI20 TIES.—Section 3 of the Civil Rights Commission Act of 

21 1983 (42 U.S.C. 1975a) is amended—

22 (1) in paragraph (1)(B), by striking ‘‘and’’ at 

23 the end; 
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•S 1833 IS 

1 (2) in paragraph (2), in the matter after and 

2 below subparagraph (D), by striking the period and 

3 inserting ‘‘; and’’; and 

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

5 ‘‘(3) shall, with respect to activities carried out 

6 in healthcare and correctional facilities toward the 

7 goal of eliminating health disparities between the 

8 general population and members of racial or ethnic 

9 minority groups, coordinate such activities of—

10 ‘‘(A) the Office for Civil Rights within the 

11 Department of Justice; 

12 ‘‘(B) the Office of Justice Programs within 

13 the Department of Justice; 

14 ‘‘(C) the Office for Civil Rights within the 

15 Department of Health and Human Services; 

16 and 

17 ‘‘(D) the Office of Minority Health within 

18 the Department of Health and Human Services 

19 (headed by the Deputy Assistant Secretary for 

20 Minority Health).’’. 

21 (b) AUTHORIZATION OF APPROPRIATIONS.—Section 

22 5 of the Civil Rights Commission Act of 1983 (42 U.S.C. 

23 1975c) is amended by striking the first sentence and in24 serting the following: ‘‘For the purpose of carrying out 

25 this Act, there are authorized to be appropriated 
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•S 1833 IS 

1 $30,000,000 for fiscal year 2005, and such sums as may 

2 be necessary for each of the fiscal years 2006 through 

3 2010.’’. 

4 SEC. 610. SENSE OF CONGRESS CONCERNING FULL FUND5 ING OF ACTIVITIES TO ELIMINATE RACIAL 

6 AND ETHNIC HEALTH DISPARITIES. 

7 (a) FINDINGS.—Congress makes the following find8 ings: 

9 (1) The health status of the American populace 

10 is declining and the United States currently ranks 

11 below most industrialized nations in health status 

12 measured by longevity, sickness, and mortality. 

13 (2) Within the spectrum of declining health, ra14 cial and ethnic minority populations tend to be in 

15 the poorest of health and face substantial cultural, 

16 social, and economic barriers to obtaining quality 

17 healthcare. 

18 (3) The problems affecting minority health have 

19 been exacerbated by the fact that adequate resources 

20 (funding, staffing, stewardship, and accountability) 

21 have not been devoted to initiatives designed to ex22 amine and eliminate racial and ethnic disparities in 

23 health. 

24 (b) SENSE OF CONGRESS.—It is the sense of Con25 gress that—
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•S 1833 IS 

1 (1) funding should be doubled by fiscal year 

2 2005 for the National Center for Minority Health 

3 Disparities, the Office of Civil Rights in the Depart4 ment of Health and Human Services, the National 

5 Institute of Nursing Research, and the Office of Mi6 nority Health; 

7 (2) adequate funding by fiscal year 2005, and 

8 subsequent funding increases, should be provided for 

9 health professions training programs, the Racial and 

10 Ethnic Approaches to Community Health (REACH) 

11 at the Center for Disease Control and Prevention, 

12 the Minority HIV/AIDS Initiative, and the Excel13 lence Centers to Eliminate Ethnic/Racial Disparities 

14 (EXCEED) Program at the Agency for Healthcare 

15 Research and Quality; 

16 (3) current and newly-created health disparity 

17 elimination incentives, programs, agencies, and de18 partments under this Act (and the amendments 

19 made by this Act) should receive adequate staffing 

20 and funding by fiscal year 2005; and 

21 (4) stewardship and accountability should be 

22 provided by Congress and the President for health 

23 disparity elimination. 
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•S 1833 IS 

1 TITLE VII—STRENGTHENING 

2 HEALTH INSTITUTIONS THAT 

3 PROVIDE HEALTHCARE TO 

4 MINORITY POPULATIONS 

5 SEC. 701. AMENDMENT TO THE PUBLIC HEALTH SERVICE 

6 ACT. 

7 Title XXIX of the Public Health Service Act, as 

8 amended by section 602, is further amended by adding 

9 at the end the following: 

10 ‘‘Subtitle G—Strengthening Health 

11 Institutions That Provide 

12 Healthcare to Minority Popu13 lations 

14 ‘‘CHAPTER 1—GENERAL PROGRAMS 

15 ‘‘SEC. 2971. GRANT SUPPORT FOR QUALITY IMPROVEMENT 

16 INITIATIVES. 

17 ‘‘(a) IN GENERAL.—The Secretary, in collaboration 

18 with the Administrator of the Health Resources and Serv19 ices Administration, the Director of the Agency for 

20 Healthcare Research and Quality, and the Administrator 

21 of the Centers for Medicare and Medicaid Services, shall 

22 award grants to eligible entities for the conduct of dem23 onstration projects to improve the quality of and access 

24 to healthcare. 
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•S 1833 IS 

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

2 under subsection (a), an entity shall—

3 ‘‘(1) be a health center, hospital, health plan, 

4 health system, community clinic. or other health en5 tity determined appropriate by the Secretary—

6 ‘‘(A) that, by legal mandate or explicitly 

7 adopted mission, provides patients with access 

8 to services regardless of their ability to pay; 

9 ‘‘(B) that provides care or treatment for a 

10 substantial number of patients who are unin11 sured, are receiving assistance under a State 

12 program under title XIX of the Social Security 

13 Act, or are members of vulnerable populations, 

14 as determined by the Secretary; and 

15 ‘‘(C)(i) with respect to which, not less than 

16 50 percent of the entity’s patient population is 

17 made up of racial and ethnic minorities; or 

18 ‘‘(ii) that—

19 ‘‘(I) serves a disproportionate percent20 age of local, minority racial and ethnic pa21 tients, or that has a patient population, at 

22 least 50 percent of which is limited English 

23 proficient; and 

24 ‘‘(II) provides an assurance that 

25 amounts received under the grant will be 
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•S 1833 IS 

1 used only to support quality improvement 

2 activities in the racial and ethnic popu3 lation served; and 

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

5 application at such time, in such manner, and con6 taining such information as the Secretary may re7 quire. 

8 ‘‘(c) PRIORITY.—In awarding grants under sub9 section (a), the Secretary shall give priority to applicants 

10 under subsection (b)(2) that—

11 ‘‘(1) demonstrate an intent to operate as part 

12 of a healthcare partnership, network, collaborative, 

13 coalition, or alliance where each member entity con14 tributes to the design, implementation, and evalua15 tion of the proposed intervention; or 

16 ‘‘(2) intend to use funds to carry out system17 wide changes with respect to healthcare quality im18 provement, including—

19 ‘‘(A) improved systems for data collection 

20 and reporting; 

21 ‘‘(B) innovative collaborative or similar 

22 processes; 

23 ‘‘(C) group programs with behavioral or 

24 self-management interventions; 

25 ‘‘(D) case management services; 
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•S 1833 IS 

1 ‘‘(E) physician or patient reminder sys2 tems; 

3 ‘‘(F) educational interventions; or 

4 ‘‘(G) other activities determined appro5 priate by the Secretary. 

6 ‘‘(d) USE OF FUNDS.—An entity shall use amounts 

7 received under a grant under subsection (a) to support 

8 the implementation and evaluation of healthcare quality 

9 improvement activities or minority health and healthcare 

10 disparity reduction activities that include—

11 ‘‘(1) with respect to healthcare systems, activi12 ties relating to improving—

13 ‘‘(A) patient safety; 

14 ‘‘(B) timeliness of care; 

15 ‘‘(C) effectiveness of care; 

16 ‘‘(D) efficiency of care; and 

17 ‘‘(E) patient centeredness; and 

18 ‘‘(2) with respect to patients, activities relating 

19 to—

20 ‘‘(A) staying healthy; 

21 ‘‘(B) getting well; 

22 ‘‘(C) living with illness or disability; and 

23 ‘‘(D) coping with end of life issues. 

24 ‘‘(e) COMMON DATA SYSTEMS.—The Secretary shall 

25 provide financial and other technical assistance to grant-
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•S 1833 IS 

1 ees under this section for the development of common data 

2 systems. 

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

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

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

6 2005 through 2010. 

7 ‘‘SEC. 2971A. CENTERS OF EXCELLENCE. 

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

9 the Administrator of the Health Resources and Services 

10 Administration, shall designate centers of excellence at 

11 public hospitals, and other health systems serving large 

12 numbers of minority patients, that—

13 ‘‘(1) meet the requirements of section 

14 2971(b)(1); 

15 ‘‘(2) demonstrate excellence in providing care to 

16 minority populations; and 

17 ‘‘(3) demonstrate excellence in reducing dispari18 ties in health and healthcare. 

19 ‘‘(b) REQUIREMENTS.—A hospital or health system 

20 that serves as a Center of Excellence under subsection (a) 

21 shall—

22 ‘‘(1) design, implement, and evaluate programs 

23 and policies relating to the delivery of care in ra24 cially, ethnically, and linguistically diverse popu25 lations; 
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•S 1833 IS 

1 ‘‘(2) provide training and technical assistance 

2 to other hospitals and health systems relating to the 

3 provision of quality healthcare to minority popu4 lations; and 

5 ‘‘(3) develop activities for graduate or con6 tinuing medical education that institutionalize a 

7 focus on cultural competence training for health care 

8 providers. 

9 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 

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

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

12 2005 through 2010. 

13 ‘‘SEC. 2971B. CONSULTATION, CONSTRUCTION AND REN14 OVATION OF AMERICAN INDIAN AND ALASKA 

15 NATIVE FACILITIES; REPORTS. 

16 ‘‘(a) CONSULTATION.—Prior to the expenditure of, or 

17 the making of any firm commitment to expend, any funds 

18 appropriated for the planning, design, construction, or 

19 renovation of facilities pursuant to the Act of November 

20 2, 1921 (25 U.S.C. 13) (commonly known as the Snyder 

21 Act), the Secretary, acting through the Service, shall—

22 ‘‘(1) consult with any Indian tribe that would 

23 be significantly affected by such expenditure for the 

24 purpose of determining and, whenever practicable, 

25 honoring tribal preferences concerning size, location, 
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•S 1833 IS 

1 type, and other characteristics of any facility on 

2 which such expenditure is to be made; and 

3 ‘‘(2) ensure, whenever practicable, that such fa4 cility meets the construction standards of any na5 tionally recognized accrediting body by not later 

6 than 1 year after the date on which the construction 

7 or renovation of such facility is completed. 

8 ‘‘(b) CLOSURE OF FACILITIES.—

9 ‘‘(1) IN GENERAL.—Notwithstanding any provi10 sion of law other than this subsection, no Service 

11 hospital or outpatient healthcare facility or any inpa12 tient service or special care facility operated by the 

13 Service, may be closed if the Secretary has not sub14 mitted to the Congress at least 1 year prior to the 

15 date such proposed closure an evaluation of the im16 pact of such proposed closure which specifies, in ad17 dition to other considerations—

18 ‘‘(A) the accessibility of alternative 

19 healthcare resources for the population served 

20 by such hospital or facility; 

21 ‘‘(B) the cost effectiveness of such closure; 

22 ‘‘(C) the quality of healthcare to be pro23 vided to the population served by such hospital 

24 or facility after such closure; 
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1 ‘‘(D) the availability of contract healthcare 

2 funds to maintain existing levels of service; 

3 ‘‘(E) the views of the Indian tribes served 

4 by such hospital or facility concerning such clo5 sure; 

6 ‘‘(F) the level of utilization of such hos7 pital or facility by all eligible Indians; and 

8 ‘‘(G) the distance between such hospital or 

9 facility and the nearest operating Service hos10 pital. 

11 ‘‘(2) TEMPORARY CLOSURE.—Paragraph (1) 

12 shall not apply to any temporary closure of a facility 

13 or of any portion of a facility if such closure is nec14 essary for medical, environmental, or safety reasons. 

15 ‘‘(c) PRIORITY SYSTEM.—

16 ‘‘(1) ESTABLISHMENT.—The Secretary shall es17 tablish a healthcare facility priority system, that 

18 shall—

19 ‘‘(A) be developed with Indian tribes and 

20 tribal organizations through negotiated rule21 making; 

22 ‘‘(B) give the needs of Indian tribes the 

23 highest priority, with additional priority being 

24 given to those service areas where the health 

25 status of Indians within the area, as measured 
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•S 1833 IS 

1 by life expectancy based upon the most recent 

2 data available, is significantly lower than the 

3 average health status for Indians in all service 

4 areas; and 

5 ‘‘(C) at a minimum, include the lists re6 quired in paragraph (2)(B) and the method7 ology required in paragraph (2)(E); 

8 except that the priority of any project established 

9 under the construction priority system in effect on 

10 the date of this Act shall not be affected by any 

11 change in the construction priority system taking 

12 place thereafter if the project was identified as one 

13 of the top 10 priority inpatient projects or one of the 

14 top 10 outpatient projects in the Indian Health 

15 Service budget justification for fiscal year 2004, or 

16 if the project had completed both Phase I and Phase 

17 II of the construction priority system in effect on 

18 the date of this title. 

19 ‘‘(2) REPORT.—The Secretary shall submit to 

20 the President and Congress a report that includes—

21 ‘‘(A) a description of the healthcare facility 

22 priority system of the Service, as established 

23 under paragraph (1); 

24 ‘‘(B) healthcare facility lists, including— 
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•S 1833 IS 

1 ‘‘(i) the total healthcare facility plan2 ning, design, construction and renovation 

3 needs for Indians; 

4 ‘‘(ii) the 10 top-priority inpatient care 

5 facilities; 

6 ‘‘(iii) the 10 top-priority outpatient 

7 care facilities; 

8 ‘‘(iv) the 10 top-priority specialized 

9 care facilities (such as long-term care and 

10 alcohol and drug abuse treatment); and 

11 ‘‘(v) any staff quarters associated 

12 with such prioritized facilities; 

13 ‘‘(C) the justification for the order of pri14 ority among facilities; 

15 ‘‘(D) the projected cost of the projects in16 volved; and 

17 ‘‘(E) the methodology adopted by the Serv18 ice in establishing priorities under its healthcare 

19 facility priority system. 

20 ‘‘(3) CONSULTATION.—In preparing each report 

21 required under paragraph (2) (other than the initial 

22 report) the Secretary shall annually—

23 ‘‘(A) consult with, and obtain information 

24 on all healthcare facilities needs from, Indian 

25 tribes and tribal organizations including those 
396

•S 1833 IS 

1 tribes or tribal organizations operating health 

2 programs or facilities under any funding agree3 ment entered into with the Service under the 

4 Indian Self-Determination and Education As5 sistance Act; and 

6 ‘‘(B) review the total unmet needs of all 

7 tribes and tribal organizations for healthcare 

8 facilities (including staff quarters), including 

9 needs for renovation and expansion of existing 

10 facilities. 

11 ‘‘(4) CRITERIA.—For purposes of this sub12 section, the Secretary shall, in evaluating the needs 

13 of facilities operated under any funding agreement 

14 entered into with the Service under the Indian Self15 Determination and Education Assistance Act, use 

16 the same criteria that the Secretary uses in evalu17 ating the needs of facilities operated directly by the 

18 Service. 

19 ‘‘(5) EQUITABLE INTEGRATION.—The Secretary 

20 shall ensure that the planning, design, construction, 

21 and renovation needs of Service and non-Service fa22 cilities, operated under funding agreements in ac23 cordance with the Indian Self-Determination and 

24 Education Assistance Act are fully and equitably in25 tegrated into the healthcare facility priority system. 
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•S 1833 IS 

1 ‘‘(d) REVIEW OF NEED FOR FACILITIES.—

2 ‘‘(1) REPORT.—Beginning in 2005, the Sec3 retary shall annually submit to the President and 

4 Congress a report which sets forth the needs of the 

5 Service and all Indian tribes and tribal organiza6 tions, including urban Indian organizations, for in7 patient, outpatient and specialized care facilities, in8 cluding the needs for renovation and expansion of 

9 existing facilities. 

10 ‘‘(2) CONSULTATION.—In preparing each report 

11 required under paragraph (1) (other than the initial 

12 report), the Secretary shall consult with Indian 

13 tribes and tribal organizations including those tribes 

14 or tribal organizations operating health programs or 

15 facilities under any funding agreement entered into 

16 with the Service under the Indian Self-Determina17 tion and Education Assistance Act, and with urban 

18 Indian organizations. 

19 ‘‘(3) CRITERIA.—For purposes of this sub20 section, the Secretary shall, in evaluating the needs 

21 of facilities operated under any funding agreement 

22 entered into with the Service under the Indian Self23 Determination and Education Assistance Act, use 

24 the same criteria that the Secretary uses in evalu-
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•S 1833 IS 

1 ating the needs of facilities operated directly by the 

2 Service. 

3 ‘‘(4) EQUITABLE INTEGRATION.—The Secretary 

4 shall ensure that the planning, design, construction, 

5 and renovation needs of facilities operated under 

6 funding agreements, in accordance with the Indian 

7 Self-Determination and Education Assistance Act, 

8 are fully and equitably integrated into the develop9 ment of the health facility priority system. 

10 ‘‘(5) ANNUAL NOMINATIONS.—Each year the 

11 Secretary shall provide an opportunity for the nomi12 nation of planning, design, and construction projects 

13 by the Service and all Indian tribes and tribal orga14 nizations for consideration under the healthcare fa15 cility priority system. 

16 ‘‘(e) INCLUSION OF CERTAIN PROGRAMS.—All funds 

17 appropriated under the Act of November 2, 1921 (25 

18 U.S.C. 13), for the planning, design, construction, or ren19 ovation of health facilities for the benefit of an Indian 

20 tribe or tribes shall be subject to the provisions of section 

21 102 of the Indian Self-Determination and Education As22 sistance Act. 

23 ‘‘(f) INNOVATIVE APPROACHES.—The Secretary shall 

24 consult and cooperate with Indian tribes, tribal organiza25 tions and urban Indian organizations in developing inno-
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•S 1833 IS 

1 vative approaches to address all or part of the total unmet 

2 need for construction of health facilities, including those 

3 provided for in other sections of this title and other ap4 proaches. 

5 ‘‘(g) LOCATION OF FACILITIES.—

6 ‘‘(1) PRIORITY.—The Bureau of Indian Affairs 

7 and the Service shall, in all matters involving the re8 organization or development of Service facilities, or 

9 in the establishment of related employment projects 

10 to address unemployment conditions in economically 

11 depressed areas, give priority to locating such facili12 ties and projects on Indian lands if requested by the 

13 Indian owner and the Indian tribe with jurisdiction 

14 over such lands or other lands owned or leased by 

15 the Indian tribe or tribal organization so long as pri16 ority is given to Indian land owned by an Indian 

17 tribe or tribes. 

18 ‘‘(2) DEFINITION.—In this subsection, the term 

19 ‘Indian lands’ means— 

20 ‘‘(A) all lands within the exterior bound21 aries of any Indian reservation; 

22 ‘‘(B) any lands title to which is held in 

23 trust by the United States for the benefit of 

24 any Indian tribe or individual Indian, or held by 

25 any Indian tribe or individual Indian subject to 
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•S 1833 IS 

1 restriction by the United States against alien2 ation and over which an Indian tribe exercises 

3 governmental power; and 

4 ‘‘(C) all lands in Alaska owned by any 

5 Alaska Native village, or any village or regional 

6 corporation under the Alaska Native Claims 

7 Settlement Act, or any land allotted to any 

8 Alaska Native. 

9 ‘‘(h) DEFINITIONS.—For purposes of this section, the 

10 definitions contained in section 4 of the Indian Health 

11 Care Improvement Act shall apply. 

12 ‘‘SEC. 2971C. RECONSTRUCTION AND IMPROVEMENT 

13 GRANTS FOR PUBLIC HEALTH CARE FACILI14 TIES SERVING PACIFIC ISLANDERS AND THE 

15 INSULAR AREAS. 

16 ‘‘(a) IN GENERAL.—The Secretary shall provide di17 rect financial assistance to designated healthcare providers 

18 and community health centers in American Samoa, Guam, 

19 the Commonwealth of the Northern Mariana Islands, the 

20 United States Virgin Islands, Puerto Rico, and Hawaii for 

21 the purposes of reconstructing and improving health care 

22 facilities and services. 

23 ‘‘(b) ELIGIBILITY.—To be eligible to receive direct fi24 nancial assistance under subsection (a), an entity shall be 

25 a public health facility or community health center located 
401

•S 1833 IS 

1 in American Samoa, Guam, or the Commonwealth of the 

2 Northern Mariana Islands, the United States Virgin Is3 lands, Puerto Rico, and Hawaii that—

4 ‘‘(1) is owned or operated by—

5 ‘‘(A) the government of American Samoa, 

6 Guam, or the Commonwealth of the Northern 

7 Mariana Islands, the United States Virgin Is8 lands, Puerto Rico, and Hawaii or a unit of 

9 local government; or 

10 ‘‘(B) a nonprofit organization; and 

11 ‘‘(2)(A) provides care or treatment for a sub12 stantial number of patients who are uninsured, re13 ceiving assistance under a State program under a 

14 title XVIII of the Social Security Act, or a State 

15 program under title XIX of such Act, or who are 

16 members of a vulnerable population, as determined 

17 by the Secretary; or 

18 ‘‘(B) serves a disproportionate percentage of 

19 local, minority racial and ethnic patients. 

20 ‘‘(c) REPORT.—Not later than 180 days after the 

21 date of enactment of this title and annually thereafter, the 

22 Secretary shall submit to the Congress and the President 

23 a report that includes an assessment of health resources 

24 and facilities serving populations in American Samoa, 

25 Guam, and the Commonwealth of the Northern Mariana 
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•S 1833 IS 

1 Islands, the United States Virgin Islands, Puerto Rico, 

2 and Hawaii. In preparing such report, the Secretary 

3 shall—

4 ‘‘(1) consult with and obtain information on all 

5 healthcare facilities needs from the entities described 

6 in subsection (b); and 

7 ‘‘(2) include all amounts of Federal assistance 

8 received by each entity in the preceding fiscal year; 

9 ‘‘(3) review the total unmet needs of each juris10 diction for healthcare facilities, including needs for 

11 renovation and expansion of existing facilities; and 

12 ‘‘(4) include a strategic plan for addressing the 

13 needs of each jurisdiction identified in the report. 

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

15 is authorized to be appropriated such sums as necessary 

16 to carry out this section. 

17 ‘‘CHAPTER 2—NATIONAL HEALTH SAFETY 

18 NET INFRASTRUCTURE. 

19 ‘‘Subchapter A—General Provisions 

20 ‘‘SEC. 2972. PAYMENTS TO HEALTHCARE FACILITIES. 

21 ‘‘(a) IN GENERAL.—The Secretary, with the approval 

22 of the Health Safety Net Infrastructure Trust Fund 

23 Board of Trustees described in section 2972C(d) (here24 after in this subtitle referred to as the ‘Trust Fund 

25 Board’), shall make payments, from amounts in the 
403

•S 1833 IS 

1 Health Safety Net Infrastructure Trust Fund established 

2 under section 2972C(a) (hereafter in this subtitle referred 

3 to as the ‘Trust Fund’), for capital financing assistance 

4 to eligible healthcare facilities whose applications for as5 sistance have been approved under this subtitle. 

6 ‘‘(b) GENERAL ELIGIBILITY REQUIREMENTS FOR AS7 SISTANCE.—

8 ‘‘(1) ELIGIBLE HEALTHCARE FACILITIES DE9 SCRIBED.—

10 ‘‘(A) IN GENERAL.—A healthcare facility 

11 shall be generally eligible for capital financing 

12 assistance under this subtitle if the healthcare 

13 facility—

14 ‘‘(i) receives an additional payment 

15 under section 1886(d)(5)(F) of the Social 

16 Security Act and is described in clause 

17 (i)(II) or clause (vii)(I) of such section, or 

18 is deemed a disproportionate share hospital 

19 under a State plan for medical assistance 

20 under title XIX of the Social Security Act 

21 on the basis described in section 

22 1923(b)(1) of such Act; 

23 ‘‘(ii) is a hospital which meets the cri24 teria for designation by the Secretary as 

25 an essential access community hospital 
404

•S 1833 IS 

1 under section 1820(i)(1) of such Act or a 

2 rural primary care hospital under section 

3 1820(i)(2) of such Act (whether or not 

4 such hospital is actually designated under 

5 such section);

6 ‘‘(iii) is a Federally qualified health 

7 center (as defined in section 1905(l)(2)(B) 

8 of such Act); 

9 ‘‘(iv) is a hospital which—

10 ‘‘(I) is a sole community pro11 vider; or 

12 ‘‘(II) has closed within the pre13 ceding 12 months; 

14 ‘‘(v) is a facility which—

15 ‘‘(I) provides service to ill or in16 jured individuals prior to the trans17 portation of such individuals to a hos18 pital or provides inpatient care to in19 dividuals needing such care for a pe20 riod not longer than 96 hours; 

21 ‘‘(II) is located in a county (or 

22 equivalent unit of local government) 

23 with fewer than 6 residents per 

24 square mile or is located more than 
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•S 1833 IS 

1 35 road miles from the nearest hos2 pital; 

3 ‘‘(III) permits a physician assist4 ant or nurse practitioner to admit and 

5 treat patients under the supervision of 

6 a physician not present in such facil7 ity; and 

8 ‘‘(IV) has obtained a waiver from 

9 the Secretary permitting the facility 

10 to participate in the medicare pro11 gram under title XVIII of the Social 

12 Security Act; or 

13 ‘‘(vi) is a hospital that the Secretary 

14 otherwise determines to be an appropriate 

15 recipient of assistance under this subtitle 

16 on the basis of the existence of a patient 

17 care operating deficit, a demonstrated in18 ability to secure or repay financing for a 

19 qualifying project on reasonable terms, or 

20 such other criteria as the Secretary con21 siders appropriate. 

22 ‘‘(B) DEVELOPMENT OF CRITERIA.—For 

23 purposes of subparagraph (A)(vi), with respect 

24 to rural hospitals which are at risk or critical 

25 to healthcare access, the Prospective Payment 
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•S 1833 IS 

1 Review Commission, not later than January 1, 

2 1994, shall develop criteria to assist the Sec3 retary in deciding if such hospitals deserve as4 sistance, after considering, at a minimum, the 

5 following factors: 

6 ‘‘(i) AT-RISK RURAL HOSPITALS.—In 

7 the case of rural hospitals the closure of 

8 which within the next year is imminent or 

9 the continued operation of which over a 2- 

10 to 5-year period is questionable, such fac11 tors as the level of health resources avail12 able in a community as measured by physi13 cian supply, the population base of the 

14 area served by the hospital and utilization 

15 of services by such population as measured 

16 by service area population, and financial 

17 indicators predictive of closure. 

18 ‘‘(ii) RURAL HOSPITALS CRITICAL TO

19 HEALTHCARE ACCESS.—In the case of 

20 rural hospitals which provide access to es21 sential health services within a service area 

22 where no other provider of such essential 

23 services exists, such factors as the market 

24 share of the hospital for an area or popu25 lation, the number of outpatient visits, the 
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•S 1833 IS 

1 proximity of the next closest provider of 

2 such services, and the degree to which the 

3 area population is medically underserved. 

4 ‘‘(2) OWNERSHIP REQUIREMENTS.—In order to 

5 be eligible for assistance under this subtitle, a 

6 healthcare facility (other than a healthcare facility 

7 described in clauses (ii) and (v) of paragraph (1)) 

8 must—

9 ‘‘(A) be owned or operated by a unit of 

10 State or local government; 

11 ‘‘(B) be a quasi-public corporation, defined 

12 as a private, nonprofit corporation or public 

13 benefit corporation which is formally granted 

14 one or more governmental powers by legislative 

15 action through (or is otherwise partially funded 

16 by) the State legislature, city or county council; 

17 ‘‘(C) be a private nonprofit healthcare fa18 cility which has contracted with, or is otherwise 

19 funded by, a governmental agency to provide 

20 healthcare services to low income individuals 

21 not eligible for assistance under title XVIII or 

22 title XIX of the Social Security Act, where rev23 enue from such contracts constitute at least 10 

24 percent of the facility’s operating revenues over 

25 the prior 3 fiscal years; or 
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•S 1833 IS 

1 ‘‘(D) be a nonprofit small rural healthcare 

2 facility (as determined by the Secretary).

3 ‘‘(3) PRIORITY.—In making payments under 

4 this section, the Secretary shall give priority to eligi5 ble healthcare entities that are federally qualified 

6 health centers (as defined in section 1905(l)(2)(B) 

7 of the Social Security Act), or other similar entities 

8 at least 50 percent of the patients of which are mi9 nority or low-income individuals. 

10 ‘‘(c) MEETING ADDITIONAL SPECIFIC CRITERIA.—

11 Healthcare facilities that are generally eligible for assist12 ance under this subtitle under subsection (b) may apply 

13 for the specific programs described in this subtitle and 

14 must meet any additional criteria for participation in such 

15 programs. 

16 ‘‘(d) ASSISTANCE AVAILABLE.—Capital financing as17 sistance available under this subtitle shall include loan 

18 guarantees, interest rate subsidies, matching loans and di19 rect grants. Healthcare facilities determined to be gen20 erally eligible for assistance under this subtitle may apply 

21 for and receive more than one type of assistance under 

22 this subtitle. 
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•S 1833 IS 

1 ‘‘SEC. 2972A. APPLICATION FOR ASSISTANCE. 

2 ‘‘(a) IN GENERAL.—No healthcare facilities may re3 ceive assistance for a qualifying project under this subtitle 

4 unless the healthcare facility—

5 ‘‘(1) has filed with the Secretary, in a form and 

6 manner specified by the Secretary, with the advice 

7 and approval of the Trust Fund Board (as described 

8 in section 2972C(d)), an application for assistance 

9 under this subtitle; 

10 ‘‘(2) establishes in its application (for its most 

11 recent cost reporting period) that it meets the cri12 teria for general eligibility under this subtitle; 

13 ‘‘(3) includes a description of the project, in14 cluding the community in which it is located, and 

15 describes utilization and services characteristics of 

16 the project and the healthcare facility, and the pa17 tient population that is to be served; 

18 ‘‘(4) describes the extent to which the project 

19 will include the financial participation of State and 

20 local governments if assistance is granted under this 

21 subtitle, and all other sources of financing sought 

22 for the project; and 

23 ‘‘(5) establishes, to the satisfaction of the Sec24 retary and the Trust Fund Board, that the project 

25 meets the additional criteria for each type of capital 

26 financing assistance for which it is applying.
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•S 1833 IS 

1 ‘‘(b) CRITERIA FOR APPROVAL.—The Secretary, with 

2 the approval of the Trust Fund Board, shall determine 

3 for each application for assistance under this subtitle—

4 ‘‘(1) whether the healthcare facility meets the 

5 general eligibility criteria under section 2972(b); 

6 ‘‘(2) whether the healthcare facility meets the 

7 specific eligibility criteria of each type of assistance 

8 for which it has applied, including whether the 

9 healthcare facility meets any criteria for priority 

10 consideration for the type of assistance for which it 

11 has applied; 

12 ‘‘(3) whether the capital project for which as13 sistance is being requested is a qualifying project 

14 under this subtitle; and 

15 ‘‘(4) whether funds are available, pursuant to 

16 the limitations of each program, to fully fund the re17 quest for assistance. 

18 ‘‘(c) PRIORITY OF APPLICATIONS.—In addition to 

19 meeting the criteria otherwise described in this subtitle, 

20 at the discretion of the Trust Fund Board, the Secretary 

21 shall give preference to those applications for qualifying 

22 projects that—

23 ‘‘(1)(A) are necessary to bring existing safety 

24 net healthcare facilities into compliance with accredi25 tation standards of fire and life safety, seismic, or 
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•S 1833 IS 

1 other related Federal, State or local regulatory 

2 standards; 

3 ‘‘(B) improve the provision of essential services 

4 such as emergency medical and trauma services, 

5 AIDS and infectious disease, perinatal, burn, pri6 mary care, and other services which the Trust Fund 

7 Board may designate; or 

8 ‘‘(C) provide access to otherwise unavailable es9 sential health services to the indigent and other 

10 needy persons within the healthcare facility’s terri11 torial area; 

12 ‘‘(2) include specific State or local governmental 

13 or other non-Federal assurances of financial support 

14 if assistance for a qualifying project is granted 

15 under this subtitle; and 

16 ‘‘(3) are unlikely to be financed without assist17 ance granted under this subtitle. 

18 ‘‘(d) SUBMISSION OF APPLICATIONS.—Applications 

19 under this subtitle shall be submitted to the Secretary 

20 through the Trust Fund Board. If two or more healthcare 

21 facilities join in the project, the application shall be sub22 mitted by all participating healthcare facilities jointly. 

23 Such applications shall set forth all of the descriptions, 

24 plans, specifications, and assurances as required by this 
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•S 1833 IS 

1 subtitle and contain other such information as the Trust 

2 Fund Board shall require. 

3 ‘‘(e) OPPORTUNITY FOR APPEAL.—The Trust Fund 

4 Board shall afford a healthcare facility applying for a loan 

5 guarantee under this section an opportunity for a hearing 

6 if the guarantee is denied. 

7 ‘‘(f) APPLICATIONS FOR AMENDMENTS.—Amend8 ment of an approved application shall be subject to ap9 proval in the same manner as an original application. 

10 ‘‘SEC. 2972B. PUBLIC SERVICE RESPONSIBILITIES. 

11 ‘‘(a) IN GENERAL.—Any healthcare facility accepting 

12 capital financing assistance under this subtitle shall 

13 agree—

14 ‘‘(1) to make the services of the facility or por15 tion thereof to be constructed, acquired, or modern16 ized available to all persons; and 

17 ‘‘(2) to provide a significant volume of services 

18 to persons unable to pay therefore, consistent with 

19 other provisions of this Act and the amount of as20 sistance received under this subtitle. 

21 ‘‘(b) ENFORCEMENT.—The Director of the Office for 

22 Civil Rights of the Department of Health and Human 

23 Services shall be given the power to enforce the public 

24 service responsibilities described in this section. 
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•S 1833 IS 

1 ‘‘SEC. 2972C. HEALTH SAFETY NET INFRASTRUCTURE 

2 TRUST FUND. 

3 ‘‘(a) CREATION OF TRUST FUND.—There is estab4 lished in the Treasury of the United States a trust fund 

5 to be known as the Health Safety Net Infrastructure 

6 Trust Fund, consisting of such amounts as may be trans7 ferred, appropriated, or credited to such Trust Fund as 

8 provided in this subtitle. 

9 ‘‘(b) AUTHORIZATION OF APPROPRIATIONS TO

10 TRUST FUND.—There are authorized to be appropriated 

11 to the Trust Fund such sums as may be necessary to carry 

12 out the purposes of this subtitle. 

13 ‘‘(c) EXPENDITURES FROM TRUST FUND.—Amounts 

14 in the Trust Fund shall be available, pursuant to appro15 priations Acts, only for making expenditures to carry out 

16 the purposes of this subtitle. 

17 ‘‘(d) BOARD OF TRUSTEES; COMPOSITION; MEET18 INGS; DUTIES.—

19 ‘‘(1) IN GENERAL.—There shall be created a 

20 Health Safety Net Infrastructure Trust Fund Board 

21 of Trustees composed of the Secretary of Health and 

22 Human Services, the Secretary of the Treasury, the 

23 Assistant Secretary for Health, the Director of the 

24 Office of Minority Health, and the Administrator of 

25 the Centers for Medicare and Medicaid Services (all 

26 serving in their ex officio capacities), and 5 public 
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•S 1833 IS 

1 members who shall be appointed for 4 year terms by 

2 the President, from the following categories—

3 ‘‘(A) one chief health officer from a State;

4 ‘‘(B) one chief executive officer of a 

5 healthcare facility that meets the general eligi6 bility criteria of this subtitle; 

7 ‘‘(C) one representative of the financial 

8 community; and 

9 ‘‘(D) two additional public or consumer 

10 representatives.

11 ‘‘(2) DUTIES.—The Board of Trustees shall 

12 meet no less than quarterly and shall have the re13 sponsibility to approve implementing regulations, to 

14 establish criteria, and to recommend and approve ex15 penditures by the Secretary under the programs set 

16 forth in this subtitle. 

17 ‘‘(3) MANAGING TRUSTEE.—The Secretary of 

18 the Treasury shall serve as the Managing Trustee of 

19 the Trust Fund, and shall be responsible for the in20 vestment of funds. The provisions of subsections (b) 

21 through (e) of section 1817 of the Social Security 

22 Act shall apply to the Trust Fund and the Managing 

23 Trustee of the Trust Fund in the same manner as 

24 they apply to the Federal Hospital Insurance Trust 
415

•S 1833 IS 

1 Fund and the Managing Trustee of that Trust 

2 Fund. 

3 ‘‘SEC. 2972D. ADMINISTRATION. 

4 ‘‘(a) IN GENERAL.—The Administrator of the Cen5 ters for Medicare and Medicaid Services shall serve as Sec6 retary of the Board of Trustees and shall administer the 

7 programs under this subtitle. 

8 ‘‘(b) LIMITATION ON ADMINISTRATIVE EXPENSES.—

9 Not more than 5 percent of the funds annually appro10 priated to the Trust Fund may be available for adminis11 tration of the Trust Fund or programs under this subtitle. 

12 ‘‘Subchapter B—Loan Guarantees 

13 ‘‘SEC. 2973. PROVISION OF LOAN GUARANTEES TO SAFETY 

14 NET HEALTHCARE FACILITIES. 

15 ‘‘(a) IN GENERAL.—The Safety Net Infrastructure 

16 Trust Fund will provide a Federal guarantee of loan re17 payment, including guarantees of repayment of refi18 nancing loans, to non-Federal lenders making loans to eli19 gible healthcare facilities for healthcare facility replace20 ment (either by construction or acquisition), moderniza21 tion and renovation projects, and capital equipment acqui22 sition. 

23 ‘‘(b) PURPOSES.—The loan guarantee program shall 

24 be designed by the Trust Fund Board with the goal of 

25 rebuilding and maintaining the essential health services of 
416

•S 1833 IS 

1 healthcare facilities eligible for assistance under this sub2 title. 

3 ‘‘SEC. 2973A. ELIGIBLE LOANS. 

4 ‘‘(a) IN GENERAL.—Loan guarantees under this 

5 chapter are available for loans made to eligible healthcare 

6 facilities for replacement facilities (either newly con7 structed or acquired), modernization and renovation of ex8 isting facilities, and for capital equipment acquisition. 

9 ‘‘(b) LOAN GUARANTEE MUST BE ESSENTIAL TO

10 BOND FINANCING.—Eligible healthcare facilities must 

11 demonstrate that a Federal loan guarantee is essential to 

12 obtaining bond financing from non-Federal lenders at a 

13 reasonably affordable rate of interest. 

14 ‘‘(c) ADDITIONAL ELIGIBILITY CRITERIA FOR LOAN

15 GUARANTEES.—In order to be eligible for assistance 

16 under this chapter, a healthcare facility must demonstrate 

17 that the following criteria are met: 

18 ‘‘(1) The healthcare facility has evidence of an 

19 ability to meet debt service. 

20 ‘‘(2) The assistance, when considered with other 

21 resources available to the project, is necessary and 

22 will restore, improve, or maintain the financial or 

23 physical soundness of the healthcare facility. 

24 ‘‘(3) The applicant agrees to assume the public 

25 service responsibilities described in section 2972B. 
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•S 1833 IS 

1 ‘‘(4) The project is being, or will be, operated 

2 and managed in accordance with a management-im3 provement-and-operating plan which is designed to 

4 reduce the operating costs of the project, which has 

5 been approved by the Trust Fund Board, and which 

6 includes—

7 ‘‘(A) a detailed maintenance schedule; 

8 ‘‘(B) a schedule for correcting past defi9 ciencies in maintenance, repairs, and replace10 ments; 

11 ‘‘(C) a plan to upgrade the project to meet 

12 cost-effective energy efficiency standards pre13 scribed by the Trust Fund Board; 

14 ‘‘(D) a plan to improve financial and man15 agement control systems; 

16 ‘‘(E) a detailed annual operating budget 

17 taking into account such standards for oper18 ating costs in the area as may be determined by 

19 the Trust Fund Board; and 

20 ‘‘(F) such other requirements as the Trust 

21 Fund Board may determine. 

22 ‘‘(5) The application includes stringent provi23 sions for continued State or local support of the pro24 gram, both with respect to operating and financial 

25 capital.
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•S 1833 IS 

1 ‘‘(6) The terms, conditions, maturity, security 

2 (if any), and schedule and amount of repayments 

3 with respect to the loan are sufficient to protect the 

4 financial interests of the United States and are oth5 erwise reasonable and in accord with regulation, in6 cluding a determination that the rate of interest 

7 does not exceed such annual percentage on the prin8 cipal obligation outstanding as the Trust Fund 

9 Board determines to be reasonable, taking into ac10 count the range of interest rates prevailing in the 

11 private market for similar loans and the risks as12 sumed by the United States.

13 ‘‘(7) The healthcare facility must meet such 

14 other additional criteria as the Secretary may im15 pose. 

16 ‘‘(e) STATE OR LOCAL PARTICIPATION.—Projects in 

17 which State or local governmental entities participate in 

18 the form of first guarantees of part or all of the total loan 

19 value shall be given a preference for loan guarantees under 

20 this chapter. 

21 ‘‘SEC. 2973B. GUARANTEE ALLOTMENTS. 

22 ‘‘(a) IN GENERAL.—$150,000,000 shall be annually 

23 allocated within the Trust Fund to the loan guarantee pro24 gram established by this chapter in order to create a cu25 mulative reserve in support of loan guarantees. 
419

•S 1833 IS 

1 ‘‘(b) LOAN GUARANTEES FOR RURAL HEALTHCARE

2 FACILITIES.—At least 20 percent of the dollar value of 

3 loan guarantees made under this program during any 

4 given year shall be allocated for eligible rural healthcare 

5 facilities, to the extent a sufficient number of applications 

6 are made by such healthcare facilities.

7 ‘‘(c) GUARANTEES FOR SMALL LOANS.—At least 

8 $200,000,000 of the annual dollar value of loan guaran9 tees made under the program shall be reserved for loans 

10 of under $50,000,000, if there are a sufficient number of 

11 applicants for loans of that size. 

12 ‘‘(d) SPECIAL RULE FOR REFINANCING LOANS.—

13 Not more than 20 percent of the amount allocated each 

14 year to the loan guarantee program established by this 

15 chapter may be allocated to guarantee refinancing loans 

16 during the year. 

17 ‘‘SEC. 2973C. TERMS AND CONDITIONS OF LOAN GUARAN18 TEES. 

19 ‘‘(a) IN GENERAL.—The principal amount of the 

20 guaranteed loan, when added to any Federal grant assist21 ance made under this subtitle, may not exceed 95 percent 

22 of the total value of the project, including land. 

23 ‘‘(b) GUARANTEES PROVIDED MAY NOT SUPPLANT

24 OTHER FUNDS.—Guarantees provided under this chapter 
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1 may not be used to supplant other forms of State or local 

2 support. 

3 ‘‘(c) RIGHT TO RECOVER FUNDS.—The United 

4 States shall be entitled to recover from any applicant 

5 healthcare facility the amount of payments made pursuant 

6 to any loan guarantee under this chapter, unless the Trust 

7 Fund Board for good cause waives its right of recovery, 

8 and the United States shall, upon making any such pay9 ment pursuant to any such loan guarantee be subrogated 

10 to all of the rights of the recipients of the payments. 

11 ‘‘(d) MODIFICATION OF TERMS.—Loan guarantees 

12 made under this chapter shall be subject to further terms 

13 and conditions as the Trust Fund Board determines to 

14 be necessary to assure that the purposes of this Act will 

15 be achieved, and any such terms and conditions may be 

16 modified by the Trust Fund Board to the extent that it 

17 determines such modifications to be consistent with the 

18 financial interest of the United States. 

19 ‘‘(e) TERMS ARE INCONTESTABLE ABSENT FRAUD

20 OR MISREPRESENTATION.—Any loan guarantee made by 

21 the Trust Fund Board pursuant to this chapter shall be 

22 incontestable in the hands of an applicant on whose behalf 

23 such guarantee is made, and as to any person who makes 

24 or contracts to make a loan to such applicant in reliance 
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1 thereon, except for fraud or misrepresentation on the part 

2 of such applicant or other person. 

3 ‘‘SEC. 2973D. PREMIUMS FOR LOAN GUARANTEES. 

4 ‘‘(a) IN GENERAL.—The Trust Fund Board shall de5 termine a reasonable loan insurance premium which shall 

6 be charged for loan guarantees under this chapter, taking 

7 into account the availability of the reserves created under 

8 section 2973B. Premium charges shall be payable in cash 

9 to the Trust Fund Board, either in full upon issuance, 

10 or annually in advance. In addition to the premium charge 

11 herein provided for, the Trust Fund Board is authorized 

12 to charge and collect such amount as it may deem reason13 able for the appraisal of a property or project offered for 

14 insurance and for the inspection of such property or 

15 project.

16 ‘‘(b) PAYMENT IN ADVANCE.—In the event that the 

17 principal obligation of any loan accepted for insurance 

18 under this chapter is paid in full prior to the maturity 

19 date, the Trust Fund Board is authorized in its discretion 

20 to require the payment by the borrower of an adjusted 

21 premium charge in such amount as the Board determines 

22 to be equitable, but not in excess of the aggregate amount 

23 of the premium charges that the healthcare facility would 

24 otherwise have been required to pay if the loan had contin25 ued to be insured until maturity date. 
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1 ‘‘(c) TRUST FUND BOARD MAY WAIVE PREMIUMS.—

2 The Trust Fund Board may in its discretion partially or 

3 totally waive premiums charged for loan insurance under 

4 this section for financially distressed healthcare facilities 

5 (as described by the Secretary). 

6 ‘‘SEC. 2973E. PROCEDURES IN THE EVENT OF LOAN DE7 FAULT. 

8 ‘‘(a) IN GENERAL.—Failure of the borrower to make 

9 payments due under or provided by the terms of a loan 

10 accepted for insurance under this chapter shall constitute 

11 a default. 

12 ‘‘(b) ASSIGNMENT OF DEFAULTED LOANS.—If a de13 fault continues for 30 days, then, upon the lender’s trans14 fer to the Trust Fund Board of all its rights and interests 

15 arising under the defaulted loan or in connection with the 

16 loan transaction, the lender shall be entitled to debentures 

17 which, together with a certificate of claim, are equal in 

18 value to the amount the lender would have received if, on 

19 the date of transfer, the borrower had repaid the loan in 

20 full, together with the amount of necessary expenses in21 curred by the lender in connection with the default.

22 ‘‘(c) FORECLOSURE BY LENDER.—Subject to the ap23 proval of the Trust Fund Board, or as provided in regula24 tions, the lender may foreclose on the property securing 

25 the defaulted loan. 
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1 ‘‘(d) FORECLOSURE BY TRUST FUND BOARD.—The 

2 Trust Fund Board is authorized to—

3 ‘‘(1) acquire possession of and title to any prop4 erty securing a defaulted loan by voluntary convey5 ance in extinguishment of the indebtedness, or 

6 ‘‘(2) institute proceedings for foreclosure on the 

7 property securing any such defaulted loan and pros8 ecute such proceedings to conclusion. 

9 ‘‘(e) HANDLING AND DISPOSAL OF PROPERTY; SET10 TLEMENT OF CLAIMS.—

11 ‘‘(1) PAYMENT FOR CERTAIN EXPENSES.—Not12 withstanding any other provision of law relating to 

13 the acquisition, handling, or disposal of real and 

14 other property by the United States, the Trust Fund 

15 Board shall also have power, for the protection of 

16 the interests of the Trust Fund, to pay out of the 

17 Trust Fund all expenses or charges in connection 

18 with, and to deal with, complete, reconstruct, rent, 

19 renovate, modernize, insure, make contracts for the 

20 management of, or establish suitable agencies for 

21 the management of, or sell for cash or credit or lease 

22 in its discretion, any property acquired by the Trust 

23 Fund under this section. 

24 ‘‘(2) SETTLEMENT OF CLAIMS.—Notwith25 standing any other provision of law, the Trust Fund 
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1 Board shall also have the power to pursue to final 

2 collection by way of compromise or otherwise all 

3 claims assigned and transferred to the Trust Fund 

4 in connection with the assignment, transfer, and de5 livery provided for in this section, and at any time, 

6 upon default, to foreclose or refrain from foreclosing 

7 on any property secured by any defaulted loan as8 signed and transferred to or held by the Trust 

9 Fund.

10 ‘‘(3) LIMITATIONS ON AUTHORITY.—Sub11 sections (a) and (b) shall not be construed to apply 

12 to any contract for hazard insurance, or to any pur13 chase or contract for services or supplies on account 

14 of such property if the amount thereof does not ex15 ceed $1,000.

16 ‘‘(f) REGULATIONS.—The Trust Fund Board shall 

17 propose and the Secretary shall promulgate regulations 

18 governing procedures in the event of a default on a loan 

19 accepted for insurance under this chapter. 

20 ‘‘Subchapter C—Grants for Urgent Capital 

21 Needs 

22 ‘‘SEC. 2976. PROVISION OF GRANTS. 

23 ‘‘(a) IN GENERAL.—The Trust Fund Board shall 

24 make available $400,000,000 in direct grants annually. 

25 The Secretary, with the approval of the Trust Fund 
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1 Board, shall make direct grants to eligible healthcare fa2 cilities with urgent capital needs. 

3 ‘‘(b) PURPOSES.—Direct grants shall be available to 

4 eligible healthcare facilities for 3 types of projects: 

5 ‘‘(1) Emergency certification and licensure 

6 grants would be available to eligible healthcare facili7 ties that are threatened with closure or loss of ac8 creditation or certification of a facility or of essential 

9 services as a result of life or safety code violations 

10 or similar facility or equipment failures. Such grants 

11 would provide limited funding for repair and renova12 tion where failure to fund would disrupt the provi13 sion of essential public health services such as emer14 gency care. 

15 ‘‘(2) Emergency grants would be available for 

16 capital renovation, expansion, or replacement nec17 essary to the maintenance or expansion of essential 

18 safety and health services such as obstetrics, 

19 perinatal, emergency and trauma, primary care and 

20 preventive health services. 

21 ‘‘(3) Planning grants would be available to eli22 gible healthcare facilities who require pre-approval 

23 assistance to meet regulatory requirements related 

24 to management and finance in order to apply for 
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1 loans, loan guarantees, and interest subsidies under 

2 this subtitle. 

3 ‘‘(c) PRIORITY TO FINANCIALLY DISTRESSED

4 HEALTHCARE FACILITIES.—Priority for direct grants 

5 under this section would be given to financially distressed 

6 healthcare facilities (as described by the Secretary). 

7 ‘‘(d) APPLICATION PROCESS.—The Secretary, with 

8 the approval of the Trust Fund Board, shall create an 

9 expedited application process for direct grants. 

10 ‘‘SEC. 2976B. ELIGIBLE PROJECTS. 

11 ‘‘(a) MATCHING GRANTS.—

12 ‘‘(1) LIMITATION ON AMOUNT.—Grants for cap13 ital expenditures by eligible healthcare facilities will 

14 be limited to $25,000,000. 

15 ‘‘(2) MATCHING REQUIREMENT.—At least half 

16 of the projects funded in a year must receive at least 

17 50 percent of their funding from State or local 

18 sources. The remaining projects funded during the 

19 year could be financed up to 90 percent with a com20 bination of Federal grants and loans. 

21 ‘‘(3) RESERVATION FOR RURAL HEALTHCARE

22 FACILITIES.—No less than 20 percent of the grant 

23 funds in any given year would be reserved for rural 

24 healthcare facilities, provided that a sufficient num25 ber of applications are approved. 
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1 ‘‘(b) PLANNING GRANTS.—Applicants who can dem2 onstrate general qualification for the direct matching loan, 

3 loan guarantee, or interest subsidy programs under this 

4 subtitle or eligibility for mortgage insurance under section 

5 242 of the National Housing Act will be eligible for a 

6 grant of up to $500,000 to assist in implementation of 

7 key budgetary and financial systems as well as manage8 ment and governance restructuring.’’. 

9 TITLE VIII—MISCELLANEOUS 

10 PROVISIONS 

11 SEC. 801. DEFINITIONS. 

12 For purposes of this Act (including the amendments 

13 made by this Act other than the amendments made by 

14 subtitles A through G of title I): 

15 (1) APPROPRIATE HEALTHCARE SERVICES.—

16 The term ‘‘appropriate healthcare services’’ includes 

17 services or treatments to address physical, mental, 

18 and behavioral diseases, conditions, or syndromes. 

19 The definition contained in this paragraph shall not 

20 apply for purposes of sections 206 and 606. 

21 (2) HISPANIC.—The term ‘‘Hispanic’’ means 

22 individuals whose origin is Mexican, Puerto Rican, 

23 Cuban, Central or South American, or any other 

24 Spanish-speaking country. 
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1 (3) INDIAN.—The term ‘‘Indian’’, unless other2 wise designated, means any person who is a member 

3 of an Indian tribe 

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

5 means any Indian tribe, band, nation, or other orga6 nized group or community, including any Alaska Na7 tive village or group or regional or village corpora8 tion as defined in or established pursuant to the 

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

10 (43 U.S.C. 1601 et seq.), which is recognized as eli11 gible for the special programs and services provided 

12 by the United States to Indians because of their sta13 tus as Indians. 

14 (5) LIMITED ENGLISH PROFICIENT.—The term 

15 ‘‘limited English proficient’’ with respect to an indi16 vidual means an individual who cannot speak, read, 

17 write, or understand the English language at a level 

18 that permits them to interact effectively with clinical 

19 or nonclinical staff at a healthcare organization. 

20 (6) MINORITY.—

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

22 and ‘‘minorities’’ refer to individuals from a mi23 nority group. 
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1 (B) POPULATIONS.—The term ‘‘minority’’, 

2 with respect to populations, refers to racial and 

3 ethnic minority groups. 

4 (7) MINORITY GROUP.—The term ‘‘minority 

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

6 ethnic minority group’’. 

7 (8) RACIAL AND ETHNIC MINORITY GROUP.—

8 The term ‘‘racial and ethnic minority group’’ means 

9 American Indians and Alaska Natives, African 

10 Americans (including Blacks), Asian Americans, 

11 Hispanics (including Latinos), and Native Hawai12 ians and other Pacific Islanders. 

13 (9) SECRETARY.—The term ‘‘Secretary’’ means 

14 the Secretary of Health and Human Services. 

15 (10) STATE.—The term ‘‘State’’ means each of 

16 the several states, the District of Columbia, the 

17 Commonwealth of Puerto Rico, the Indian tribes, 

18 the Virgin Islands, Guam, American Samoa, and the 

19 Commonwealth of the Northern Mariana Islands. 

20 (11) TRIBAL ORGANIZATION.—The term ‘‘tribal 

21 organization’’ means the elected governing body of 

22 any Indian tribe or any legally established organiza23 tion of Indians which is controlled by one or more 

24 such bodies or by a board of directors elected or se25 lected by one or more such bodies (or elected by the 
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1 Indian population to be served by such organization) 

2 and which includes the maximum participation of 

3 Indians in all phases of its activities. 

4 (12) UNDERREPRESENTED MINORITY.—The 

5 terms ‘‘underrepresented minority’’ and ‘‘underrep6 resented minorities’’ refer to individuals who are 

7 members of racial or ethnic minority groups that are 

8 underrepresented in the health professions relative 

9 to their numbers in the general population. 

10 (13) UNDERSERVED POPULATIONS.—The term 

11 ‘‘underserved population’’ means the population of 

12 an urban or rural area designated by the Secretary 

13 as an area with a shortage of personal health serv14 ices or a population group designated by the Sec15 retary as having a shortage of such services. 

16 SEC. 802. DAVIS-BACON ACT. 

17 All laborers and mechanics employed by contractors 

18 or subcontractors in the performance of construction work 

19 financed in whole or in part with assistance under this 

20 Act (or an amendment made by this Act), including cap21 ital financing assistance, or grants or loan guarantees 

22 from the Safety Net Infrastructure Trust Fund (estab23 lished under section 2972C of the Public Health Service 

24 Act), shall be paid wages at rates not less than those pre25 vailing on similar work in the locality involved as deter-
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1 mined by the Secretary of Labor in accordance with sub2 chapter IV of chapter 31 of title 40, United States Code 

3 (commonly referred to as the Davis-Bacon Act). The Sec4 retary of Labor shall have, with respect to such labor 

5 standards, the authority and functions set forth in Reor6 ganization Plan Numbered 14 of 1950 (15 F.R. 3176; 64 

7 Stat 1267) and section 3145 of title 40, United States 

8 Code.

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