II 

108TH CONGRESS 

2D SESSION S. 2091

To improve the health of health disparity populations. 

IN THE SENATE OF THE UNITED STATES 

FEBRUARY 12, 2004

Mr. FRIST (for himself, Ms. LANDRIEU, Mr. COCHRAN, Mr. DEWINE, Mr. 

BOND, Mr. WARNER, Mr. TALENT, and Mrs. HUTCHISON) 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 health disparity populations.

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

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

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

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

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

7 this Act is as follows:

Sec. 1. Short title; table of contents. 

Sec. 2. Findings. 

TITLE I—IMPROVED HEALTH CARE QUALITY AND EFFECTIVE 

DATA COLLECTION AND ANALYSIS 

Sec. 101. Standardized measures of quality health care. 

Sec. 102. Data collection. 
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TITLE II—EXPANDED ACCESS TO QUALITY HEALTH CARE 

Sec. 201. Access and awareness grants. 

Sec. 202. Innovative outreach programs. 

TITLE III—STRONG NATIONAL LEADERSHIP, COOPERATION, AND 

COORDINATION 

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

TITLE IV—PROFESSIONAL EDUCATION, AWARENESS, AND 

TRAINING 

Sec. 401. Workforce diversity and training. 

Sec. 402. Higher education technical amendments. 

Sec. 403. Model cultural competency curriculum development. 

Sec. 404. Internet cultural competency clearinghouse. 

TITLE V—ENHANCED RESEARCH 

Sec. 501. Agency for Healthcare Research and Quality. 

Sec. 502. National Institutes of Health. 

TITLE VI—MISCELLANEOUS PROVISIONS 

Sec. 601. Definitions.

1 SEC. 2. FINDINGS. 

2 Congress makes the following findings: 

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

6 have been made in the health and medical sciences. 

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

11 (3) In particular, people of lower socioeconomic 

12 status, racial and ethnic minorities, and medically 

13 underserved populations have experienced poor 
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1 health and challenges in accessing high quality 

2 health care. 

3 (4) Recent studies have raised significant ques4 tions regarding differences in clinical care provided 

5 to racial and ethnic minorities and other health dis6 parity populations. These differences are often 

7 grouped together under the broad heading of ‘‘health 

8 disparities’’. 

9 (5) Studies indicate that a gap exists between 

10 ideal health care and the actual health care that 

11 some Americans receive. 

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

13 race, ethnicity, and primary language across feder14 ally supported health programs are essential for 

15 identifying, understanding the causes of, monitoring, 

16 and eventually eliminating health disparities. 

17 (7) Current health related data collection and 

18 reporting activities largely reflect the efforts of the 

19 Department of Health and Human Services. Despite 

20 considerable efforts by the Department, data collec21 tion efforts governing racial, ethnic, and health dis22 parity populations remain inconsistent and inad23 equate. They often quantify disparities but shed lit24 tle light on their causes. 
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1 (8) Many Americans, and particularly racial 

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

4 care. Similarly, management of chronic illnesses in 

5 these populations presents unique challenges to the 

6 nation’s health care system. 

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

9 the same health care access problems as do members 

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

12 nonmetropolitan, rural areas such as Appalachia, 

13 where the high percentage of countries designated as 

14 health professional shortage areas (47 percent) and 

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

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

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

24 and quality improvement experts begun to address 

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

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

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

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

11 (12) Preventable disparities in access to and 

12 quality of health care are unacceptable. Health care 

13 delivered in the United States should be care that is 

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

15 and equitable as possible. 

16 TITLE I—IMPROVED HEALTH 

17 CARE QUALITY AND EFFEC18 TIVE DATA COLLECTION AND 

19 ANALYSIS 

20 SEC. 101. STANDARDIZED MEASURES OF QUALITY HEALTH 

21 CARE. 

22 (a) IN GENERAL.—

23 (1) COLLABORATION.—The Secretary of Health 

24 and Human Services, the Secretary of Defense, the 

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

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

5 care quality measures across all Federal Government 

6 health programs. Such measures shall be designed to 

7 assess quality improvement efforts with regard to 

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

10 across all federally supported health care delivery 

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

13 (2) DEVELOPMENT OF MEASURES.—Relying on 

14 earlier work by the Secretary of Health and Human 

15 Services or others (including work such as the 

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

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

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

22 measures for—

23 (A) 5 common health conditions by not 

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

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

5 of the quality measures developed under paragraph 

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

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

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

13 programs described in subsection (a). 

14 (c) FULL IMPLEMENTATION.—The Secretaries shall 

15 work collaboratively to prepare for the full implementation 

16 of all standardized sets of quality measures and reporting 

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

18 later than January 1, 2009. 

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

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

22 subsection (a). 

23 (e) COMPARATIVE QUALITY REPORTS.—Beginning 

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

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

4 provide for the pooling and analysis of quality measures 

5 collected under this section. Nothing in this section shall 

6 be construed as modifying the privacy standards under the 

7 Health Insurance Portability and Accountability Act of 

8 1996 (Public Law 104–191). 

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

10 of Health and Human Services shall ensure the ongoing 

11 evaluation of the use of the health care quality measures 

12 established under this section. 

13 (g) EXISTING ACTIVITIES.—Notwithstanding any 

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

16 to the extent practicable and appropriate, any existing 

17 measurement and reporting activities currently utilized by 

18 federally supported health care delivery programs. 

19 (h) EVALUATION.—

20 (1) INSTITUTE OF MEDICINE.—

21 (A) IN GENERAL.—The Secretary of 

22 Health and Human Services shall request the 

23 Institute of Medicine to conduct an evaluation 

24 of the collaborative efforts of the Secretaries to 

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

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

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

5 the date of enactment of this Act, the Institute 

6 of Medicine shall submit a report concerning 

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

9 (2) REGULATIONS.—

10 (A) PROPOSED.—Not later than 18 

11 months after the date on which the report is 

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

15 quality measures and reporting requirements 

16 described in this section. 

17 (B) FINAL REGULATIONS.—Not later than 

18 3 years after the date on which the report is 

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

21 the uniform, standardized health care quality 

22 measures and reporting requirements described 

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

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

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

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

8 race, ethnicity, and primary language and available 

9 for inclusion in the National Health Disparities Re10 port; 

11 (2) enforce State data collection and reporting 

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

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

15 State Children’s Health Insurance Program under 

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

17 and ensure that such data are available for inclusion 

18 in the National Health Disparities Report; 

19 (3) ensure that ongoing and any new program 

20 initiatives—

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

24 (B) address technological difficulties; 

25 (C) ensure privacy and confidentiality of 

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

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

6 primary language to improving health care access 

7 and quality; 

8 (5) raise awareness that these data are critical 

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

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

12 and 

13 (6) support research on existing best practices 

14 for data collection. 

15 (b) GRANTS FOR DATA COLLECTION BY HEALTH

16 PLANS, HEALTH CENTERS, AND HOSPITALS.—

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

18 through the Director of the Agency for Healthcare 

19 Research and Quality, may support or conduct not 

20 to exceed 20 demonstration programs to enhance the 

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

23 (2) ELIGIBILITY.—To be eligible to receive a 

24 grant under this section an entity shall—
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1 (A) be a health plan, federally qualified 

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

4 (B) prepare and submit to the Secretary 

5 an application at such time, in such manner, 

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

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

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

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

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

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

17 an inpatient or outpatient basis; 

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

19 for enrollees; and 

20 (iii) in the case of a federally qualified 

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

23 (B) provide analyses of racial, ethnic and 

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

2 and therapeutic procedures, or outcomes; 

3 (C) improve health data collection and 

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

6 categories if such groups can be aggregated into 

7 the minimum race and ethnicity categories; 

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

10 confidentiality regulations; 

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

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

15 data collection, analysis, and reporting by race, 

16 ethnicity, and preferred language are legal and 

17 essential for eliminating disparities in health 

18 and health care; and 

19 (F) ensure the evaluation of activities con20 ducted under this section. 

21 TITLE II—EXPANDED ACCESS TO 

22 QUALITY HEALTH CARE 

23 SEC. 201. ACCESS AND AWARENESS GRANTS. 

24 (a) DEMONSTRATION PROJECTS.—The Secretary of 

25 Health and Human Services (in this section referred to 
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1 as the ‘‘Secretary’’) may award contracts or competitive 

2 grants to eligible entities to support demonstration 

3 projects designed to improve the health and health care 

4 of health disparity populations through improved access 

5 to health care, health care navigation assistance, and 

6 health literacy education. 

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

8 term ‘‘eligible entity’’ means—

9 (1) a hospital; 

10 (2) an academic institution; 

11 (3) a State health agency; 

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

13 Indian tribal health facility, or urban Indian facility; 

14 (5) a nonprofit organization including a faith15 based organization or consortia, to the extent that a 

16 grant awarded to such an entity is consistent with 

17 the requirements of section 1955 of the Public 

18 Health Service Act (42 U.S.C. 300x–65) relating to 

19 grant award to nongovernmental entities; 

20 (6) a primary care practice-based research net21 work as defined by the Director of the Agency for 

22 Healthcare Research and Quality; 

23 (7) a Federally qualified health center (as de24 fined in section 1905(l)(2)(B) of the Social Security 

25 Act (42 U.S.C. 1396d(l)(2)(B))); or
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1 (8) any other entity determined to be appro2 priate by the Secretary. 

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

4 under this section shall submit an application to the Sec5 retary at such time, in such manner, and containing such 

6 information as the Secretary may require, including assur7 ances that the eligible entity will—

8 (1) target patient populations that are members 

9 of racial and ethnic minority groups or health dis10 parity populations through specific outreach activi11 ties; 

12 (2) coordinate with appropriate community or13 ganizations and include appropriate community par14 ticipation in planning and implementation of activi15 ties; 

16 (3) coordinate culturally competent and appro17 priate care; 

18 (4) include a plan to ensure that the entity will 

19 become self-sustaining when funding under the grant 

20 terminates; and 

21 (5) include quality and outcomes performance 

22 measures to evaluate the effectiveness of activities 

23 funded under this section to ensure that the activi24 ties are meeting their goals, and disseminate find25 ings from such evaluations. 
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1 (d) PRIORITIES.—In awarding contracts and grants 

2 under this section, the Secretary shall give priority to ap3 plicants that intend to use amounts received under this 

4 section to carry out all programs specified under sub5 section (e). 

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

7 amounts received under this section to carry out programs 

8 that involve at least 2 of the following: 

9 (1) Providing resources and guidance to individ10 uals regarding sources of health insurance coverage, 

11 as well as information on how to obtain health cov12 erage in the private insurance market, through Fed13 eral and State programs, and through other avail14 able coverage options. 

15 (2) Providing patient navigator services to help 

16 individuals better utilize their health coverage by 

17 working through the health system to obtain appro18 priate quality care, including programs in which—

19 (A) trained individuals (such as represent20 atives from the community, nurses, social work21 ers, physicians, or patient advocates) are as22 signed to act as contacts—

23 (i) within the community; or 

24 (ii) within the health care system, to 

25 facilitate access to health care services; 
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1 (B) partnerships are created with commu2 nity organizations (which may include hospitals, 

3 federally qualified health centers or health cen4 ter networks, faith-based organizations, primary 

5 care providers, home care, nonprofit organiza6 tions, health plans, or other health providers 

7 determined appropriate by the Secretary) to 

8 help facilitate access or to improve the quality 

9 of care; 

10 (C) activities are conducted to coordinate 

11 care and preventive services and referrals; 

12 (D) services are provided for translation, 

13 interpretation, and other such linguistic services 

14 for patients with limited English proficiency; or 

15 (E) an entity receiving a grant under this 

16 section negotiates on behalf of the patient with 

17 relevant entities, or provides referrals and 

18 guides the patient through the mediation or ar19 bitration process, to resolve issues that impede 

20 access to care. 

21 (3) Promoting broad health awareness and pre22 vention efforts, including patient education and 

23 health literacy programs to help increase a patient’s 

24 knowledge of how to best participate in such pa-
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1 tient’s and such patient’s children’s treatment deci2 sions. 

3 (4) Enhancing preventive services and coordi4 nated, multidisciplinary disease management of 

5 chronic conditions, such as diabetes mellitus, HIV/

6 AIDS, asthma, cancer, cardiovascular disease, and 

7 obesity. 

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

9 an entity receives a grant under this section and annually 

10 thereafter, the entity shall provide to the Secretary a re11 port containing the results of any evaluation conducted 

12 pursuant to subsection (c)(5). 

13 (g) AUTHORIZATION OF APPROPRIATIONS.—There 

14 are authorized to be appropriated to carry out this section 

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

16 2005 through 2009. 

17 SEC. 202. INNOVATIVE OUTREACH PROGRAMS. 

18 (a) GRANTS TO PROMOTE INNOVATIVE OUTREACH

19 AND ENROLLMENT UNDER MEDICAID AND SCHIP.—Sec20 tion 2104(e) of the Social Security Act (42 U.S.C. 

21 1397dd(e)) is amended—

22 (1) by striking ‘‘Amounts allotted’’ and insert23 ing the following: 

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

25 amounts allotted’’; and 
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1 (2) by adding at the end the following: 

2 ‘‘(2) GRANTS TO PROMOTE INNOVATIVE OUT3 REACH AND ENROLLMENT EFFORTS.—

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

5 of each fiscal year, beginning with fiscal year 

6 2004, the Secretary shall reserve from any un7 expended allotments made to States under sub8 section (b) or (c) (including any portion of such 

9 allotments that were redistributed under sub10 section (f) or (g)) for a fiscal year that would 

11 revert to the Treasury on October 1 of the suc12 ceeding fiscal year but for the application of 

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

14 total amount of such unexpended allotments for 

15 purposes of awarding grants under this para16 graph for such succeeding fiscal year to States 

17 or national, local, and community-based public 

18 or nonprofit private organizations to conduct 

19 innovative outreach and enrollment efforts that 

20 are designed to increase the enrollment and 

21 participation of eligible children under this title 

22 and title XIX. 

23 ‘‘(B) PRIORITY FOR GRANTS IN CERTAIN

24 AREAS.—In making grants under subparagraph 

25 (A)(ii), the Secretary shall give priority to grant
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1 applicants that propose to target geographic 

2 areas—

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

4 unenrolled children, including such chil5 dren who reside in rural areas; 

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

7 whom English is not their primary lan8 guage; or 

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

10 ethnic minorities and health disparity pop11 ulations. 

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

13 desires to receive a grant under this paragraph 

14 shall submit an application to the Secretary in 

15 such form and manner, and containing such in16 formation, as the Secretary may decide. Such 

17 application shall include quality and outcomes 

18 performance measures to evaluate the effective19 ness of activities funded by a grant under this 

20 paragraph to ensure that the activities are 

21 meeting their goals, and disseminate findings 

22 from such evaluations.’’. 

23 (b) DEMONSTRATIONS TO REDUCE HEALTH DIS24 PARITIES.—
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1 (1) IN GENERAL.—The Secretary of Health and 

2 Human Services shall, through contracts or grants 

3 to public and private entities, support demonstration 

4 programs for the purpose of conducting interven5 tions among health disparity populations to—

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

7 behavioral risk factors that contribute to health 

8 disparities; 

9 (B) promote translation, interpretation, 

10 and other such linguistic services for patients 

11 with limited English speaking proficiency; 

12 (C) promote preventive services; or 

13 (D) enhance coordinated, multidisciplinary 

14 disease management of chronic conditions, such 

15 as diabetes mellitus, HIV/AIDS, asthma, can16 cer, and obesity. 

17 (2) APPLICATION.—An entity desiring a con18 tract or grant under paragraph (1) shall submit an 

19 application to the Secretary of Health and Human 

20 Services in such form and manner, and containing 

21 such information, as the Secretary may require. 

22 (3) AUTHORIZATION OF APPROPRIATIONS.—

23 There are authorized to be appropriated to carry out 

24 this subsection such sums as may be necessary for 

25 each of fiscal years 2005 through 2009. 
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1 TITLE III—STRONG NATIONAL 

2 LEADERSHIP, COOPERATION, 

3 AND COORDINATION 

4 SEC. 301. OFFICE OF MINORITY HEALTH AND HEALTH DIS5 PARITIES. 

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

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

8 (1) by striking the section heading and insert9 ing the following: 

10 ‘‘OFFICE OF MINORITY HEALTH AND HEALTH

11 DISPARITIES’’; and 

12 (2) in subsection (a)—

13 (A) by striking ‘‘Office of Minority 

14 Health’’ each place that such appears and in15 serting ‘‘Office of Minority Health and Health 

16 Disparities’’; and 

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

18 inserting ‘‘for Minority Health and Health Dis19 parities’’. 

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

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

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

23 (A) by inserting ‘‘and health disparity pop24 ulations’’ after ‘‘groups’’ and 
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1 (B) by striking ‘‘for Minority Health’’ and 

2 inserting ‘‘for Minority Health and Health Dis3 parities’’; 

4 (2) in paragraph (1)—

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

6 follows through ‘‘coordinate’’ and inserting ‘‘Co7 ordinate’’; and 

8 (B) by striking ‘‘such individuals’’ and in9 serting ‘‘health disparities’’; 

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

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

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

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

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

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

16 (4), (5), (6), (8), and (10) as paragraphs (3), (4), 

17 (6), (7), (9), (10), (11), and (12), respectively; 

18 (7) by inserting before paragraph (3) (as so re19 designated) the following: 

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

21 goals and objectives for analyzing the causes of 

22 health disparities and addressing them, with a par23 ticular focus on the areas of health promotion, dis24 ease prevention, chronic care and research. 
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1 ‘‘(2) Work with agencies within the Department 

2 of Health and Human Services and with the Sur3 geon General to establish a strategic plan to analyze 

4 and address the causes of health disparities. The 

5 plan shall include recommendations to improve the 

6 collection, analysis, and reporting of data at the 

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

8 including how to—

9 ‘‘(A) implement data collection while mini10 mizing the cost and administrative burdens of 

11 data collection and reporting; 

12 ‘‘(B) expand awareness of the importance 

13 of such data collection to improving health care 

14 quality; and 

15 ‘‘(C) provide researchers with greater ac16 cess to racial, ethnic, and other health disparity 

17 data.’’; 

18 (8) by inserting after paragraph (4) (as so re19 designated), the following: 

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

21 care among health care providers, health plans, and 

22 the public.’’; 

23 (9) in paragraph (6) (as so redesignated)—
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1 (A) by striking ‘‘Support’’ and inserting 

2 ‘‘In cooperation with the appropriate agencies, 

3 support’’; 

4 (B) by inserting before the period the fol5 lowing: ‘‘for— 

6 ‘‘(A) expanding health care access; 

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

8 ‘‘(C) increasing health care educational op9 portunity.’’; 

10 (10) by inserting after paragraph (7) (as so re11 designated), the following: 

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

13 the Health Care Gap Act of 2004, coordinate the 

14 classification and collection of health care data to 

15 allow for the ongoing analysis of the causes of dis16 parities and monitoring of progress toward the elimi17 nation of disparities.’’; and 

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

19 redesignated, the following: 

20 ‘‘(13) Work with Federal agencies and depart21 ments outside of the Department of Health and 

22 Human Services to maximize program resources 

23 available to understand why disparities exist, and ef24 fective ways to reduce and eliminate disparities. 
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1 ‘‘(14) Support a center for linguistic and cul2 tural competence to carry out the following: 

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

4 proficiency in speaking the English language, 

5 enter into contracts with public and nonprofit 

6 private providers of primary health services for 

7 the purpose of increasing the access of such in8 dividuals to such services by developing and 

9 carrying out programs to provide bilingual or 

10 interpretive services. 

11 ‘‘(B) Carry out programs to improve ac12 cess to health care services for individuals with 

13 limited proficiency in speaking the English lan14 guage. Activities under this subparagraph shall 

15 include developing and evaluating model 

16 projects.’’. 

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

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

19 amended—

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

21 Disparities’’ after ‘‘Minority Health’’; 

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

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

24 (3) in paragraph (4)(B)—
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1 (A) by inserting ‘‘and health disparities’’ 

2 after ‘‘minority health’’; and 

3 (B) by inserting ‘‘and health disparity pop4 ulations’’ after ‘‘minority groups’’. 

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

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

7 amended—

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

9 and inserting ‘‘(b)(14)’’; 

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

11 and inserting ‘‘(b)(13)’’; and 

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

13 the unique cultural or linguistic issues facing such 

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

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

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

17 (1) in paragraph (1)—

18 (A) by striking the subsection heading and 

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

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

21 ‘‘2006’’; 

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

23 Commerce of the House of Representatives, and 

24 to the Committee on Labor and Human Re-
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•S 2091 IS 

1 sources of the Senate’’ and inserting ‘‘appro2 priate committees of Congress’’; and 

3 (D) by inserting ‘‘and health disparity pop4 ulations’’ after ‘‘racial and ethnic minority 

5 groups’’; 

6 (2) in paragraph (2)—

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

8 ‘‘2005’’; and 

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

10 after ‘‘minority health’’; 

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

12 paragraphs (2) and (3), respectively; and 

13 (4) by inserting after the subsection heading, 

14 the following: 

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

16 the date of enactment of the Closing the Health 

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

18 the appropriate committees of Congress, a report on 

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

20 (f) AUTHORIZATION OF APPROPRIATIONS.—Section 

21 1707(h) of the Public Health Service Act (42 U.S.C. 

22 300u–6(h)) is amended—

23 (1) by striking ‘‘FUNDING.—’’ and all that fol24 lows through the paragraph designation in para25 graph (1); and
29

•S 2091 IS 

1 (2) by striking ‘‘$30,000,000’’ and all that fol2 lows through the period and inserting ‘‘$50,000,000 

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

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

5 TITLE IV—PROFESSIONAL EDU6 CATION, AWARENESS, AND 

7 TRAINING 

8 SEC. 401. WORKFORCE DIVERSITY AND TRAINING. 

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

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

11 by inserting before section 736 the following: 

12 ‘‘SEC. 736A. PURPOSE OF PROGRAM. 

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

14 quality and access in medically underserved communities, 

15 to improve the cultural competence of health care pro16 viders by increasing minority representation in the health 

17 professions, and to strengthen the research and education 

18 programs of designated health professions schools that 

19 disproportionately serve health disparity populations.’’. 

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

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

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

23 following: 

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

25 to, and enter into contracts with, public and nonprofit pri-
30

•S 2091 IS 

1 vate health or educational entities, including designated 

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

3 the purpose of assisting the schools in supporting pro4 grams of excellence in health professions education for ra5 cial or ethnic minority or health disparity populations.’’; 

6 (2) in subsection (b)—

7 (A) in paragraph (2), by striking ‘‘under8 represented minority’’ and inserting ‘‘racial or 

9 ethnic minority’’; 

10 (B) in paragraph (3), by striking ‘‘under11 represented minority’’ and inserting ‘‘racial or 

12 ethnic minority’’; 

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

14 health’’ and inserting ‘‘health disparity’’; 

15 (D) in paragraph (5), by striking ‘‘under16 represented minority groups’’ and inserting ‘‘ra17 cial or ethnic minorities and health disparity 

18 populations’’; 

19 (E) in paragraph (6)—

20 (i) in the matter preceding subpara21 graph (A), by striking ‘‘under-represented 

22 minority’’ and inserting ‘‘individuals from 

23 racial or ethnic minorities or health dis24 parity populations’’; and 

25 (ii) by striking ‘‘and’’ at the end; 
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•S 2091 IS 

1 (F) in paragraph (7), by striking the pe2 riod and inserting ‘‘; and’’; and 

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

4 ‘‘(8) to conduct accountability and other report5 ing activities, as required by the Secretary.’’; 

6 (3) in subsection (c)—

7 (A) in paragraph (1)(B)—

8 (i) in clause (i), by striking ‘‘under9 represented minority’’ and inserting ‘‘indi10 viduals from racial or ethnic minorities or 

11 health disparity populations’’; 

12 (ii) in clause (ii), by striking ‘‘under13 represented minority’’ and inserting 

14 ‘‘such’’; 

15 (iii) in clause (iii)—

16 (I) by striking ‘‘under-rep17 resented minority individuals’’ the 

18 first place that such appears and in19 serting ‘‘such students’’; 

20 (II) by striking ‘‘such individ21 uals’’ and inserting ‘‘such students’’; 

22 and 

23 (III) by striking ‘‘under-rep24 resented minority’’ the second place 
32

•S 2091 IS 

1 that such appears and inserting 

2 ‘‘such’’; and 

3 (iv) in clause (iv), by striking ‘‘under4 represented minority individuals’’ and in5 serting ‘‘individuals from racial or ethnic 

6 minorities or health disparity populations’’; 

7 and 

8 (B) in paragraph (2)(B)—

9 (i) in clause (i), by striking ‘‘under10 represented’’ and inserting ‘‘racial or’’; and 

11 (C) in paragraph (5)(B)—

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

13 and inserting ‘‘racial or’’; and 

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

15 population’’ after ‘‘minorities’’; 

16 (4) in subsection (d)(1), by striking ‘‘Under17 Represented Minority Health’’ and inserting ‘‘Minor18 ity Health and Health Disparity’’; 

19 (5) in subsection (h)—

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

21 ‘‘$26,000,000’’ and all that follows and insert22 ing ‘‘$50,000,000 for fiscal year 2005, and 

23 such sums as may be necessary for each of fis24 cal years 2006 through 2009’’; and 

25 (B) in paragraph (2)—
33

•S 2091 IS 

1 (i) in subparagraph (C)—

2 (I) in the matter preceding clause 

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

4 more’’ and inserting ‘‘exceed 

5 $30,000,000 but are less than 

6 $40,000,000’’; and 

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

8 ‘‘any remaining funds’’ and inserting 

9 ‘‘any remaining excess amount’’; and 

10 (ii) by adding at the end the fol11 lowing: 

12 ‘‘(D) FUNDING IN EXCESS OF

13 $40,000,000.—If amounts appropriated under 

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

15 or more, the Secretary shall make available—

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

17 grants under subsection (a) to health pro18 fessions schools that meet the conditions 

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

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

21 grants under subsection (a) to health pro22 fessions schools that meet the conditions 

23 described in paragraph (3) or (4) of sub24 section (c) (including meeting conditions 

25 pursuant to subsection (e));
34

•S 2091 IS 

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

2 grants under subsection (a) to health pro3 fessions schools that meet the conditions 

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

5 ‘‘(iv) after grants are made with 

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

7 remaining funds for grants under sub8 section (a) to health professions schools 

9 that meet the conditions described in para10 graph (2)(A), (3), (4), or (5) of subsection 

11 (c).’’; and 

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

13 ‘‘(i) EVALUATION.—

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

15 the date of enactment of the Closing the Health 

16 Care Gap Act of 2004, the Secretary shall request 

17 that the Institute of Medicine evaluate the effective18 ness of the programs under this section in meeting 

19 the purpose of this part. The Institute of Medicine 

20 shall submit a report on the evaluation to the Sec21 retary. 

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

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

24 convene a working group composed of stakeholders, 

25 including designated health professions schools de-
35

•S 2091 IS 

1 scribed in subsection (c), to define quality perform2 ance measures and reporting requirements of grant 

3 recipients that shall be tied to the purpose of this 

4 part. 

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

6 after the date the Institute of Medicine submits the 

7 report under paragraph (1), the Secretary shall pub8 lish proposed regulations regarding the quality per9 formance measures and reporting requirements de10 scribed in paragraph (2). Not later than 3 years 

11 after the date the Institute of Medicine submits the 

12 report under paragraph (1), the Secretary shall pub13 lish final regulations regarding the quality perform14 ance measures and reporting requirements described 

15 in paragraph (2).’’. 

16 (c) SCHOLARSHIPS FOR DISADVANTAGED STU17 DENTS.—Section 737 of the Public Health Service Act (42 

18 U.S.C. 293a) is amended—

19 (1) in subsection (c), by striking ‘‘under-rep20 resented minority’’ and inserting ‘‘minority and 

21 health disparity’’; and 

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

23 health disparity’’ after ‘‘minority’’. 
36

•S 2091 IS 

1 (d) LOAN REPAYMENTS AND FELLOWSHIPS REGARD2 ING FACULTY POSITIONS.—Section 738(b) of the Public 

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

4 (1) in paragraph (1), by striking ‘‘underrep5 resented’’; 

6 (2) in paragraph (3)(A), by striking ‘‘underrep7 resented minority individuals’’ and inserting ‘‘indi8 viduals from racial or ethnic minorities or health dis9 parity populations’’; and 

10 (3) by striking paragraph (5). 

11 (e) NATIONAL HEALTH SERVICE CORPS.—

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

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

14 amended—

15 (A) in the second sentence—

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

17 and inserting the following: ‘‘shall—

18 ‘‘(A) give preference’’; and 

19 (ii) by striking the period and insert20 ing ‘‘; and’’; and 

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

22 ‘‘(B) give preference to applications from enti23 ties described in subparagraph (A) that serve indi24 viduals a majority of whom are members of a racial 

25 or ethnic minority or other health disparity popu-
37

•S 2091 IS 

1 lation with annual incomes at or below twice those 

2 set forth in the most recent poverty guidelines issued 

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

4 Community Services Block Grant Act.’’. 

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

6 Health Service Act (42 U.S.C. 254f–1(a)) is 

7 amended—

8 (A) by redesignating paragraphs (1) 

9 through (3) as paragraphs (2) through (4), re10 spectively; and 

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

12 so redesignated), the following: 

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

14 in section 333(a)(3);’’. 

15 (e) AUTHORIZATION OF APPROPRIATIONS.—Section 

16 740 of the Public Health Service Act (42 U.S.C. 293d) 

17 is amended—

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

19 inserting ‘‘2009’’; 

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

21 inserting ‘‘2009’’; 

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

23 inserting ‘‘2009’’; and 

24 (4) by striking subsection (d). 
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•S 2091 IS 

1 (f) GRANTS FOR HEALTH PROFESSIONS EDU2 CATION.—Section 741 of the Public Health Service Act 

3 (42 U.S.C. 293e) is amended—

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

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

6 Secretary’’ and inserting ‘‘The Secretary’’; and 

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

8 and all that follows through the period and inserting 

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

10 years 2005 through 2009.’’. 

11 (g) HEALTH CAREERS OPPORTUNITY PROGRAM.—

12 Subpart 2 of part E of title VII of the Public Health Serv13 ice Act (42 U.S.C. 295 et seq.) is amended—

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

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

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

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

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

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

20 and enter into cooperative agreements and contracts with 

21 eligible entities for any of the following purposes: 

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

23 ‘‘(A) are from disadvantaged backgrounds 

24 or health disparity populations; and
39

•S 2091 IS 

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

2 health professions. 

3 ‘‘(2) Providing counseling or other services de4 signed to assist such individuals in entering a health 

5 professions school and successfully completing their 

6 education at such a school. 

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

8 of such individuals into the regular course of edu9 cation of such a school, preliminary education de10 signed to assist the individuals in successfully com11 pleting such regular course of education at such a 

12 school, or referring such individuals to institutions 

13 providing such preliminary education. 

14 ‘‘(b) RECEIPT OF AWARD.—

15 ‘‘(1) ELIGIBLE ENTITIES; REQUIREMENT OF

16 CONSORTIUM.—The Secretary may make an award 

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

18 the following conditions: 

19 ‘‘(A) The eligible entity is a public or pri20 vate entity, and such entity has established a 

21 consortium consisting of private community22 based organizations and health professions 

23 schools. 

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

25 consortium are schools of medicine or osteo-
40

•S 2091 IS 

1 pathic medicine, public health, nursing, den2 tistry, optometry, pharmacy, allied health, or 

3 podiatric medicine, or graduate programs in 

4 mental health practice (including programs in 

5 clinical psychology). 

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

7 the membership of the consortium includes not 

8 less than 1 nonprofit private community-based 

9 organization and not less than 3 health profes10 sions schools. 

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

12 exclusive activity under the award will be car13 rying out 1 or more programs described in sub14 section (a)(5), the membership of the consor15 tium includes not less than 1 nonprofit private 

16 community-based organization and not less 

17 than 1 health professions school. 

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

19 entered into an agreement specifying—

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

21 comply with the conditions upon which the 

22 award is made; and 

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

24 award will be allocated among the mem25 bers. 
41

•S 2091 IS 

1 ‘‘(2) REQUIREMENT OF COMPETITIVE

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

3 made on a competitive basis. 

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

5 award under subsection (a) only if the Secretary deter6 mines that, in the case of activities carried out under the 

7 award that prove to be effective toward achieving the pur8 poses of the activities—

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

10 have or will have the financial capacity to continue 

11 the activities, regardless of whether financial assist12 ance under subsection (a) continues to be available; 

13 and 

14 ‘‘(2) the members of the consortium dem15 onstrate to the satisfaction of the Secretary a com16 mitment to continue such activities, regardless of 

17 whether such assistance continues to be available. 

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

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

20 the Secretary shall establish objectives regarding the ac21 tivities to be carried out under the award, which objectives 

22 are applicable until the next fiscal year for which such 

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

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

25 establish additional objectives for the applicant. 
42

•S 2091 IS 

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

2 purpose of carrying out this section, there are authorized 

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

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

5 SEC. 402. HIGHER EDUCATION TECHNICAL AMENDMENTS. 

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

7 (20 U.S.C. 1063b(c)) is amended—

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

9 semicolon, the following: ‘‘, and for the acquisition 

10 and development of real property that is adjacent to 

11 the campus to improve the academic environment’’; 

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

13 end; 

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

15 inserting a semicolon; and 

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

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

18 and fellowship to enable attainment of advanced de19 grees in their field of instruction; and 

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

21 programs designed to improve academic success.’’. 

22 SEC. 403. MODEL CULTURAL COMPETENCY CURRICULUM 

23 DEVELOPMENT. 

24 (a) CURRICULA DEVELOPMENT AND MODEL CUR25 RICULA.—The Secretary of Health and Human Services 
43

•S 2091 IS 

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

2 grants to eligible entities for curricula development for the 

3 training of health care providers and health professions 

4 students regarding cultural competency, and for dem5 onstration projects to test new innovations for cultural 

6 competence education model curricula for and identify ad7 ditional barriers to culturally appropriate care. 

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

9 grant under subsection (a) 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 (c) AUTHORIZATION OF APPROPRIATIONS.—There 

13 are authorized to be appropriated to carry out this section 

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

15 2005 through 2009. 

16 SEC. 404. INTERNET CULTURAL COMPETENCY CLEARING17 HOUSE. 

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

19 Minority Health and Health Disparities, with assistance 

20 from the Administrator of the Agency for Healthcare Re21 search and Quality, shall develop and maintain an Internet 

22 clearinghouse to improve health care quality for individ23 uals with specific cultural needs or with limited English 

24 proficiency or low functional health literacy and to reduce
44

•S 2091 IS 

1 or eliminate the duplication of effort to translate mate2 rials. 

3 (b) TEMPLATES.—In developing the clearinghouse 

4 under subsection (a), the Director of the Office of Minor5 ity Health and Health Disparities shall develop, test, and 

6 make available templates for standard documents that are 

7 necessary for patients and consumers to access and make 

8 educated decisions about their health care, including—

9 (1) administrative and legal documents; 

10 (2) clinical information such as how to take 

11 medications, how to prevent transmission of a con12 tagious disease, and other prevention and treatment 

13 instructions; and 

14 (3) patient education and outreach materials 

15 such as immunization notices, health warnings, or 

16 screening notices. 

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

18 of the Office of Minority Health and Health Disparities 

19 shall develop a readily accessible online library or database 

20 with searchable clinically relevant cultural information 

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

22 in the direct provision of medical care to individuals from 

23 specific minority, ethnic, or other health disparity groups. 
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•S 2091 IS 

1 TITLE V—ENHANCED RESEARCH 

2 SEC. 501. AGENCY FOR HEALTHCARE RESEARCH AND 

3 QUALITY. 

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

5 (42 U.S.C. 299b) is amended by adding at the end the 

6 following: 

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

8 HEALTH DISPARITIES. 

9 ‘‘(a) ACCELERATING THE ELIMINATION OF DISPARI10 TIES.—

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

12 through the Director, may award grants or contracts 

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

14 short-term research to analyze the causes of dispari15 ties and identify or develop and evaluate effective 

16 strategies in closing the health care gap between mi17 nority and health disparity populations and non18 minority populations or non-health disparity popu19 lations. 

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

21 that research described in paragraph (1) is effective 

22 and is disseminated and applied promptly, the Direc23 tor shall—

24 ‘‘(A) expand practice-based research net25 works (primary care and larger delivery sys-
46

•S 2091 IS 

1 tems) to include networks of delivery sites serv2 ing large numbers of minority and health dis3 parity populations including—

4 ‘‘(i) public hospitals; 

5 ‘‘(ii) health centers; and 

6 ‘‘(iii) other sites as determined appro7 priate by the Director; 

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

9 identify and develop those interventions for mi10 nority and health disparity populations for 

11 which effective implementation strategies are 

12 not clear; and 

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

14 continuous learning among health care pro15 viders (including institutions that did not re16 ceive a grant or contract under paragraph (1)) 

17 so that those participating in research can 

18 share findings and experience throughout the 

19 duration of such research and to facilitate inter20 est in and prompt adoption of such findings 

21 and experience. 

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

23 the Agency for Healthcare Research and Quality 

24 shall provide technical assistance to assist in the im-
47

•S 2091 IS 

1 plementation of strategies of evidence-based prac2 tices that will reduce health care disparities. 

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

4 the term ‘eligible entities’ means institutions with re5 searchers who have experience in conducting re6 search relating to minority health and health dis7 parity populations. 

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

9 the term ‘public hospitals’ means a hospital (as de10 fined in section 1886(d)(1)(B) of the Social Security 

11 Act) that—

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

13 State or local government, is a public or private 

14 non-profit corporation which is formally granted 

15 governmental powers by a unit of State or local 

16 government, or is a private non-profit hospital 

17 that has a contract with a State or local gov18 ernment to provide health care services to low 

19 income individuals who are not entitled to bene20 fits under title XVIII of the Social Security Act 

21 or eligible for assistance under the State plan 

22 under title XIX of the Social Security Act; and 

23 ‘‘(B) for the most recent cost reporting pe24 riod that ended before the calendar quarter in25 volved, had a disproportionate share adjustment 
48

•S 2091 IS 

1 percentage (as determined under section 

2 1886(d)(5)(F) of the Social Security Act) 

3 greater than 11.75 percent or was described in 

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

5 ‘‘(b) REALIZING THE POTENTIAL OF DISEASE MAN6 AGEMENT.—

7 ‘‘(1) PUBLIC-PRIVATE SECTOR PARTNERSHIP

8 TO ASSESS EFFECTIVENESS OF EXISTING DATA MAN9 AGEMENT STRATEGIES.—The Director shall estab10 lish a public-private partnership to assess the effec11 tiveness of disease management strategies and iden12 tify effective interventions and support strategies 

13 with respect to minority and health disparity popu14 lations. 

15 ‘‘(2) EFFECTIVE MANAGEMENT OF PATIENTS

16 WITH MULTIPLE CHRONIC DISEASES.—

17 ‘‘(A) INITIATIVE FOR DISEASE MANAGE18 MENT STRATEGIES.—The Director shall coordi19 nate an initiative to identify those chronic con20 ditions for which disease-specific disease man21 agement strategies pose conflicts in preferred 

22 clinical interventions. 

23 ‘‘(B) RESEARCH.—The Director, with sup24 port from other agencies within the Department 

25 of Health and Human Services shall conduct a
49

•S 2091 IS 

1 program of research based in community and 

2 primary-care settings to test and evaluate the 

3 implications for patient outcomes of alternative 

4 approaches for reconciling conflicts from dis5 ease-specific disease management initiatives. 

6 ‘‘(c) DEVELOPMENT OF EFFECTIVE MEASUREMENT

7 OF DISPARITIES.—

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

9 a demonstration project to—

10 ‘‘(A) assess alternative strategies for iden11 tifying population subgroups at highest risk of 

12 poor quality and poor health; 

13 ‘‘(B) improve data collection for health 

14 care priority populations (as described in sec15 tion 901(c)(1)(B)); 

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

17 causes of disparities; and 

18 ‘‘(D) track progress in reducing health 

19 care disparities with a focus on—

20 ‘‘(i) the minimum data set necessary 

21 to track such progress; and 

22 ‘‘(ii) the identification of measures for 

23 which data currently being collected are in24 sufficient. 
50

•S 2091 IS 

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

2 date the demonstration project described in para3 graph (1) receives funding, the Director shall submit 

4 to the appropriate committees of Congress a report 

5 containing the findings of the demonstration project 

6 together with any policy recommendations. 

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

8 HEALTH DISPARITY DATA.—The Secretary, acting 

9 through the Director of the Agency for Healthcare Re10 search and Quality, and in coordination with the Adminis11 trator of the Centers for Medicare & Medicaid Services 

12 and the Director of the Centers for Disease Control and 

13 Prevention, shall provide technical assistance to agencies 

14 of the Department of Health and Human Services in 

15 meeting Federal standards for race, ethnicity, and other 

16 health disparity data collection and analysis of racial, eth17 nic, and other disparities in health and health care in Fed18 erally-administered programs by—

19 ‘‘(1) identifying appropriate quality assurance 

20 mechanisms to monitor for health disparities; 

21 ‘‘(2) specifying the clinical, diagnostic, or thera22 peutic measures which should be monitored; 

23 ‘‘(3) developing new quality measures relating 

24 to racial, ethnic, or other health disparities; 
51

•S 2091 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 SEC. 502. NATIONAL INSTITUTES OF HEALTH. 

6 The Director of the National Institutes of Health, in 

7 consultation with the Director of the National Center on 

8 Minority Health and Health Disparities, shall expand and 

9 intensify research at the National Institutes of Health re10 lating to the sources of health and health care disparities, 

11 and increase efforts to recruit minority scientists and re12 search professionals into the field of health disparity re13 search. 

14 TITLE VI—MISCELLANEOUS 

15 PROVISIONS 

16 SEC. 601. DEFINITIONS. 

17 (a) IN GENERAL.—In this Act, including the amend18 ments made by this Act: 

19 (1) CULTURALLY COMPETENT.—

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

21 competent’’, with respect to the manner in 

22 which health-related services, education, and 

23 training are provided, means providing the serv24 ices, education, and training in the language 

25 and cultural context that is most appropriate 
52

•S 2091 IS 

1 for the individuals for whom the services, edu2 cation, and training are intended, including as 

3 necessary the provision of bilingual services. 

4 (B) MODIFICATION.—The definition estab5 lished in subparagraph (A) may be modified as 

6 needed at the discretion of the Secretary after 

7 providing a 30-day notice to Congress. 

8 (2) MINORITY HEALTH CONDITIONS.—The term 

9 ‘‘minority health conditions’’, with respect to individ10 uals who are members of minority groups, means all 

11 diseases, disorders, and conditions (including with 

12 respect to mental health and substance abuse)—

13 (A) unique to, more serious, or more prev14 alent in such groups; 

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

16 types of medical intervention may be different 

17 for such groups, or for which it is unknown 

18 whether such factors or types are different for 

19 such individuals; or 

20 (C) with respect to which there has been 

21 insufficient research involving such individual 

22 members of such groups as subjects or insuffi23 cient data on such individuals. 

24 (3) MINORITY HEALTH DISPARITIES RE25 SEARCH.—The term ‘‘minority health disparities re-
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•S 2091 IS 

1 search’’ means basic, clinical, behavioral and health 

2 services research on minority health conditions (as 

3 defined in paragraph (2)), including research to pre4 vent, diagnose, and treat such conditions. 

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

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

7 group. 

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

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

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

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

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

13 including the amendments made by this Act: 

14 (1) HEALTH DISPARITY POPULATION.—The 

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

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

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

18 (2) HEALTH DISPARITIES RESEARCH.—The 

19 term ‘‘health disparities research’’ shall include 

20 basic, clinical, behavioral, and health services re21 search on health disparity populations (including in22 dividual members and communities of such popu23 lations) that relates to health disparities as defined 

24 under paragraph (1), including the causes of such 
54

•S 2091 IS 

1 disparities and methods to prevent, diagnose, and 

2 treat such disparities.